Six tests for physician leadership

By Megan Headly

Over the years, physicians have been frequently accused of resisting change. In the face of tremendous new pressures—ranging from explosive levels of new technology and data to changing regulatory burdens and expectations—it is understandable that care providers may struggle to keep up. Now, Thomas H. Lee, MD, chief medical officer for Press Ganey and a physician at Brigham and Women’s Hospital in Boston, finds that this reluctance to change may itself be changing.

In recent years, Lee says, there’s been a promising “changing of the guard” that he believes may better support the new demands of leadership in healthcare’s future. “They’re different,” Lee says of the physicians coming out of medical school today. “They’re wired more to be part of teams as opposed to individuals raging about change.”

That’s a necessary evolution, as Lee sees the demands facing future leaders steadily increasing. The trends against which physicians have pushed back are not, as he puts it in a June article for NEJM Catalyst, “trends that can be ignored or reversed … physicians need leadership guidance to help them plunge into these trends.”

The changing of the guard

Lee’s article, “Six Tests for Physicians and Their Leaders for the Decade Ahead,” written with Toby Cosgrove, MD, executive advisor and former president and CEO of the Cleveland Clinic, highlights the traits needed of tomorrow’s physician leaders. However, it also notes a change in how this leadership is organized. Citing the AMA’s 2019 Physician Practice Benchmark Survey, the pair point out that 2018 was the first year in the survey’s history that there were fewer physician practice owners (45.9%) than employees (47.4%). Only 26% of physicians under age 40 had an ownership stake in their practice in 2018, hinting at the greater shift to come as physicians consolidate beneath the umbrellas of large practices or health systems.

This consolidation is a trend that supports the need for greater economies of scale, effectively meeting new consumer expectations and preventing physician burnout. As Lee and Cosgrove write, “Problems are emerging that can only be addressed through scale. For example, small groups and hospitals are simply unable to take on emerging cybersecurity challenges.”

The consolidation trend will demand strong leadership from physicians at the helm of these evolving models—as well as physician employees who want to drive their practice toward best practices for navigating future challenges.

As Lee and Cosgrove put it, there’s no retreating from challenges, which include:

• An explosion in knowledge due to research advances—and increasing complexity that threatens to overwhelm physicians
• Greater pressures to improve in order to meet regulatory burdens of the Affordable Care Act
• A loss of autonomy for physicians, who are increasingly driven to work in groups
• The need to improve interactions between physicians and their electronic medical records

Lee and Cosgrove have identified a set of six “tests” for physicians and their leaders that they predict will define effective healthcare leadership in the future.

Emphasizing transparency in all aspects of care

According to the NEJM article, “The idea that good care is good business seems obvious, but the notion that meeting patients’ needs should be the focus for every decision remains disruptive.”

Patient care may be the mission, but Lee finds that “distractions” keep physicians from focusing foremost on patient care. Reprioritizing patients is the first test for leaders, and this may mean rethinking payment and compensation.

By organizing around the fee-for-service system, the authors suggest, physicians prioritize performing procedures, tests, and operations rather than taking care of patients. “The organizational structure and the fee for service incentives behind it don’t incentivize bad care, but they don’t directly reward us for being at our best,” they write. The practice of coupling compensation with volume of services also gets in the way of excellent care.

Transparency, Lee suggests, can help drive these needed shifts. It’s already underway for some practices with online reviews. “Transparency tends to have its most dramatic effects on the parties who are being measured, even more than on the patients/consumers who might seem the targets for the information,” the authors write in the NEJM article. “Physicians want what is said about them on the Internet to be consistent with how they see themselves. And the most reliable way to make that happen is to be their best selves consistently.”

This shift toward prioritizing patients will continue with greater transparency around cost, a critical, if often overlooked, piece of the patient experience. As Lee and Cosgrove point out, many health systems are beginning to take steps in this direction. While groups such as Mayo Clinic, Cleveland Clinic, and Geisinger Health System see most of their revenue flow through fee-for-service contracts, they pay their physicians straight salary, without financial incentives for performing more services.

“The trend is in this direction, but we need to accelerate it,” Lee elaborates. He suggests that the groups that provide greater transparency and are more reliable in meeting these patient needs will prosper.

Embracing collaboration and competition

Physicians are becoming more collaborative, both with their peers in these growing practices as well as with colleagues across other areas of care. But Lee and Cosgrove encourage the creation of super-teams, with members who remain focused on the goal of excellent patient care above all else.

“The team members don’t worry about job descriptions; they do what it takes to help the team achieve its goal, and they know they can count on their colleagues to do the same. They are resilient individually and collectively, which enables them to deal with unexpected crises with effective aplomb.”

It’s a tricky demand at a time when physician burnout remains on the rise, but this push toward super-teams can actually help physicians work more efficiently. Super-teams proactively address complaints from both patients and physicians. They are made up of high-performing partners across care delivery: administrators, schedulers, scribes, and others who work to simplify the burdens that distract from patient care.

“Scheduling turns out to be one of the biggest causes of dissatisfaction,” Lee says by way of example. “So, in a really good team, the scheduler is sitting right there with the clinicians to make things work.”

With a focus on collaboration, it may seem counterintuitive to also focus on competition, but Lee and Cosgrove say actively thinking about—and ultimately embracing—competition is another critical test of leadership.

“Most physicians don’t think positively about the effects of competition in the health care marketplace,” the pair write. Physicians are often glad when their organization deflects competition through mergers with potential competitors. But this may not be the best strategy for improving patient care. Healthy competition can drive the lower prices, better care, and increased transparency that patients truly desire.

One such step, Lee says, is checking your online ratings and embracing the competition with other practices. You may already be the best, but it’s critical to ensure consumers see this. “Knowing that every patient can comment on my work, and anyone can see the comments, makes me want to be wonderful. That’s the way I want to be seen,” Lee says. “Creating an environment where people are trying to be at their best all the time is kind of stressful, but it’s necessary for plunging into competition.”

Driving change and innovation

As Lee mentions, change is coming more easily to many physicians, but the next step is to embrace innovation—pushing to introduce something new.

“The desire to be perfect creates a culture that has a way of smothering innovation,” Lee and Cosgrove write. “Physicians are afraid of failing. They and their colleagues get paralyzed by exceptions. They say something shouldn’t be tried unless there is evidence that it will make things better—and, as a result, it never gets tried.”

A strong first step toward embracing innovation, Lee suggests, is to start looking beyond the healthcare industry. “Healthcare is a decade or two behind other businesses,” he points out. “The idea of using balanced scorecards and having a clear strategy that helps you focus on what it is you’re trying to do so that you can be reliable about doing those things, that is 1990s insights for the rest of the business world, but it’s relatively new to healthcare.”

This is becoming somewhat easier as other industries begin to move into healthcare, particularly the technology industry. As new names offer entirely new service delivery concepts that compete with traditional models, innovation will become increasingly necessary for physician practices to survive.

And, with technology tackling diagnostics and other challenges, Lee says soft skills may become a more critical edge for leaders in the years ahead. Leadership training will need to support this and other shifts. Training more managers in the needs for physician leadership will encourage the collaborative, innovative processes that will help drive organizational success.

“When Toby and I started having this conversation, we could see that the decade ahead we were going to have to change. But we didn’t know how the new physician workforce would respond,” Lee says. Now? “We’re optimistic.”

Megan Headley is a freelance writer and owner of ClearStory Publications. She has covered healthcare safety and operations for numerous publications. Headley can be reached at megan@clearstorypublications.com.