Tuesday, November 27, 2007

Physician Leadership – A Necessity for the Future

Many people throughout my career have asked me if all health care leaders should eventually be physicians who have moved into administrative roles. My answer to this question has always been, and will likely continue to be, “No.” That doesn’t mean, however, that I don’t believe an increasing number of health care leaders should be physicians or other clinicians. The key, however, is not in their clinical background, but whether they have actually developed the core competencies to become capable leaders.

It is clear that the additional knowledge that clinicians--including physicians--bring to the leadership table because of their health care experiences at the bedside or in the exam room is extremely valuable, particularly in determining what creates the best care management outcomes. However, if this knowledge is not combined with the core competencies of leadership, many of which have been discussed in prior blog posts, this knowledge is often worthless. In fact, with clinical expertise often comes an arrogance which is a barrier to good leadership.

Hence, it is my belief that physicians and clinicians make great leaders if they can develop the necessary competencies, and that more of them who have these competencies are needed.

To be a physician leader, one must be extremely comfortable with the “grey areas” that exist in administration because every decision in health care is not black or white, and the pros and cons must be evaluated in each case to make sure the correct administrative decision is being made. However, physicians have this capability, for we are constantly faced with identifying a list of differential diagnoses for each patient so that we have alternatives to consider if our primary diagnosis proves to be incorrect.

In addition, physicians must be extremely comfortable with change, although for many this is a struggle. However, I believe that most physicians, like myself, have had to learn to utilize new technologies over the years. For example, the open subcostal surgical procedure I did for gallbladder extraction in the past is totally unacceptable today, and if surgeons who trained in my generation could not adapt to this new technology and laproscopic procedure, they actually cannot be practicing in 2007.

And finally, physician leaders must be extremely comfortable with making difficult and tough decisions, particularly if they are in the “grey area” mentioned above. However, once again, I would propose that physicians in their clinical practices are making tough decisions on a quite regular basis.

So, in summary, I do believe that physicians make excellent leaders if they can develop those additional competencies as mentioned, and constantly reflect on the similarities between clinical decision-making and leadership decision-making. It is clear to me that more physician leaders will be sought in the future, because all organizations are putting more emphasis on improving quality of care. Outstanding physicians are well-prepared and best positioned to bring the knowledge of how to accomplish excellent quality to the table.

Second, all organizations like CHRISTUS must eventually go on a journey to excellence similar to the one we have been undertaking for the last eight-and-a-half years. Physician leaders understand the need for a balanced scorecard, which is learned by balancing the patient’s quality of life with his or her quantity of life. Our balanced score card requires us to focus on the simultaneous improvement of four areas: clinical quality, service delivery, business literacy and community value.

Third, excellence must be seen as a necessity, not as a luxury. I believe that physicians understand this, and for the most part, understand each day that they have an awesome responsibility to care for patients’ lives and therefore truly understand what I mean when I say that we have been called to do sacred work.

Fourth, a positive alignment between physicians, hospitals and health systems is key today to overcome the negativity which has been caused by increasing governmental regulations and the polarity of reimbursement between physicians and hospitals. Physicians will listen to many people, but will most intently hear what other physicians are saying, and therefore, physician leaders become critical in this physician alignment process.

Based on the knowledge and understanding garnered from many years as a physician leader, I would reiterate and stress that although non-physicians are key and critical as part of leadership teams, the future of health care will be enhanced if physician leaders can not only increased in number, but can be integrated with present leadership teams to maximize their effectiveness in reaching all the goals which are central to a journey to excellence.

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