Signs of continuous change in health care
For me, a recent partnership serves as a classic example of how much health care has changed and what the demands on leadership will be in the future.
The example is the partnership between the New England Journal of Medicine (NEJM) and the Harvard Business Review (HBJ) to create an information portal on the web entitled “Leading Healthcare Innovation.” The editors describe this as “an eight-week online forum devoted to helping leaders, managers, and others in health care increase value by improving patient outcomes and reducing costs.”
One of the lead articles is by Thomas Lee and Michael Porter. Having recently left the position of CEO of Partners Community Healthcare, Inc., Dr. Lee is the CMO for Press Ganey. Michael Porter is a professor at the Harvard Business School. Their article, “The Strategy that will Fix Healthcare,” is a business proposition to restructure health care to deliver value, which is defined as outcomes and experience divided by cost. The core of their proposal is to organize medical care around specific medical conditions rather than service lines, departments, or specialties.
In another article, “Coaching Physicians to Become Leaders,” the author gives advice about prioritization, the leadership style of “ask more than tell,” and the importance of building complementary teams.
A very interesting analysis of the performance of ACO’s is “Pioneer ACO’s: Lessons from Year One.” The author reviews the successes in bending the cost curve, along with the ominous withdrawal of nine systems from the program. The author points out that the ACO concept has two objectives, payment reform and health system reform.
The idea is that the first, payment reform, will “kick start” the second, health system reform. The two are, in fact, extremely different. True health system reform requires providers to work collaboratively in new ways. In their work they design care to manage chronic illness and health prevention, services that the current health care system not only does not reward but does not do well. Our system is designed for the results it achieves: excellent acute care, poor coordination, poor support for mental health and substance abuse, outstanding technical results, and less outstanding primary care outcomes. Those results are what we currently pay for.
So why do I find this particular collaboration so interesting? It’s because readers of the NEJM are not used to picking up the HBR and reading it just as carefully.
As a physician leader, it’s absolutely clear that unless we immerse ourselves in understanding the business problems and solutions in health care, we will fail in leading our colleagues. Physician leadership is no longer a matter of “understanding the doctors,” or worse, “representing the doctors.”
Physician leadership requires understanding the business challenges of the particular system we work in and bringing the delivery system reform ideas and execution from the physician perspective to the table. Physician leadership requires understanding how to prioritize and build effective teams. Physician leadership requires making difficult decisions in the application of limited resources to unlimited demands. I believe that our perspective in understanding the privilege embodied in the relationship between a provider and patient is critical to staying grounded in our values.
In order to create the value equation in health care, which I equate to the IHI’s triple aim (outstanding patient experience, best possible outcomes, lowest possible cost), we must have skills in much more: Business analytics, creating effective teams, executing plans, to name a few; these are skill sets that physicians in leadership positions have to bring to the table. And for us, the teamwork of respecting those skills in others and learning from them is equally important.
I complement HBR and NEJM for this critical, symbolic step in bringing the disciplines of excellent practice of medicine and strategic business practice together. And I recommend my physician colleagues take a look.
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