The importance of medical leadership

The goal of many healthcare providers is a three-pronged goal: better care at lower cost with a focus on a positive patient experience. Providers with these goals need strong medical leaders to help them achieve the goals. More provider organizations are beginning to recognize the importance of medical leadership in order to be successful.

The American Medical Association states in its white paper Integrated Leadership for Hospitals and Health Systems: Principles for Success that healthcare administrators must work with medical leaders to achieve their goals. A relationship based on mutual trust among physicians, clinical staff, and administrators is vital to providing patient-centered care. To quote the article: “Integrated leadership may benefit patients by focusing on developing new channels for patient engagement and delivering care in a way that eliminates overuse, underuse, and misuse of resources by while increasing physician professional satisfaction, builds relationships of trust and financial stability for both physicians and hospitals.”

It is a tenet of lean healthcare and lean manufacturing that the best measurable results occur when the people closest to patients or customers provide insight into the care or manufacturing process. It makes sense, then, that physicians, who along with other clinical staff are closest to patients, can provide meaningful insight into the best processes for delivering care that is effective while avoiding waste and duplication, and thus save costs. The integration of physicians in leadership positions ensures that such knowledge is incorporated into care processes.

I was recently discussing medical leadership with my own primary care physician, Dr. Daniel Harro of Mercy Health Physicians Partners. He said it has been important to him and his medical colleagues that they are represented by Dr. David Blair as president and chief medical officer of Mercy Health Physician Partners. It seems important to them that he still meets with patients on a weekly basis. Dr. Blair has helped this group grow from an independent medical group to a partnership with Trinity Health of Livonia, Michigan. He has also guided primary care physicians to become accredited as Patient Centered Medical Homes with many of the practices achieving Level 3 designation.

In December 2016, the Harvard Business Review in an article titled Why the best hospitals are run by doctors noted that the best quality hospitals are run by physicians. According to US News and World Report, the best hospital is Mayo Clinic. It is led by the highly qualified physician John Noseworthy. The second-ranking hospital, Cleveland Clinic, is run by physician Delos “Toby” Cosgrove. The article further states that of the top 100 hospitals in the US, those that are run by physicians have a 25% higher quality score than those that are not.

The Medical Group Management Association also emphasizes the importance of medical leadership. In a survey of its members, it found that around 60% of those who responded stated that they use a dyad management style on their sites. The leaders are a practice manager and a physician. Because each shares responsibility for the success of the group, it is extremely important that the two integrate effectively to provide leadership and direction to the sites, most of which are ambulatory. MGMA suggests that the two leaders first consider how their leadership styles complement each other and where they might conflict. In doing so, they should strive to present a united front to staff. As Stephen Covey states in The 7 Habits of Highly Effective People The two leaders must think win-win when considering what direction to take the practice staff. MGMA recommends that both leaders focus on several skills to be successful:

· Have a vision and stick with it. As Stephen Covey says, start with the end in mind.

· See changes as an opportunity. Change seems to be accelerating these days and leaders need to be agile in adapting and responding to changes being imposed on practice and also exploring what changes can improve practice outcomes.

· Understand the risks. Leaders must be able to assess the risks facing the practice and must lead the practice to overcome risks and take advantage of risks.

· Unify the staff. Make sure each staff member understands the importance and responsibilities of their roles in practice. Leaders must develop teamwork among staff.

· See the practice as a business. To provide the best care at the lowest cost, leaders must ensure that the practice is run like an efficient business. The healthcare business model is unique and complex.

Physicians as leaders must see the entire structure of the organization that provides care. At an outpatient site, for example, the medical leader must see beyond the physicians who provide direct care to patients. They also need to understand front office processes: receptionist and registration staff, billing and collection staff, administrative leaders, and other personnel who are important to delivering services that support physicians and the organization’s business structure. While understanding and engaging in processes outside of clinical care, the medical leader must also affirm that medical staff can provide effective care to patients without management interference. That is, physicians must feel free to provide clinical care that is patient-centered and consistent with best medical practices using the unique skills of each physician. Medical leaders must build trust among administrative leaders that clinical staff provide patient-centered care.

The pace of change in healthcare delivery is challenging today. In fact, there is great uncertainty about the structure of rebates and the business models that providers must adopt. Because the current risk appears to be high, it is very important that organizations partner effectively with medical leaders to address everyday risks and develop effective models for delivering care to patients. The importance of medical leadership is key to the successful delivery of effective care, to achieve the Triple Goal.