As we have stressed in previous posts, a missing element to balancing medical care (making patient well-being the priority) seems to be the autonomous doctor. Autonomous doctors have a different perspective from non-clinicians and doctors employed by hospitals/ insurance companies. Not just concerned with governance of their own affairs, truly autonomous doctors assume responsibility for the standard of care in the community. Unlike employed doctors whose leadership opportunities are usually limited, autonomous doctors often become master leaders, thinking like CEOs—physician CEOs. Previously we noted how doctors nowadays function more as managers being led, not as leaders driving change. Transitioning doctors from managers to leaders, then, is the first step toward balancing medical care. That transition starts by changing focus from performing tasks to setting purpose. Purpose becomes the driver—the “why” leaders do what they do. For physician CEOs, purpose, as we previously established, means taking ownership— ownership of the medical care provided in the community. Ownership becomes their vision.
The next step is the establishment of culture. Obviously genuine leaders believe in their visions. They sell it to others on the team. When successful, the team buys into the leader’s vision, generating a set of common beliefs that form relationships. Those relationships subsequently constitute team culture (shared beliefs around a common purpose/vision). This is how all cultures form. Like the “why” for purpose, culture becomes the “how”—how teams interact and ultimately perform. Implicit in the process of culture formation is communication (as shown in the Figure above). How can a vision be shared without communication? Likewise, how can common beliefs be formulated without team members talking about them? In fact, how can any relationship be established and sustained without communication?
In our book, Unbalanced—The Evolving Medical Care Crisis, we emphasized that medicine is challenged by poor communication. Emphasis on communication has seemingly failed to keep pace with our medical advances. When we think about it, medicine is perhaps the only complex social/ industrial system in America that does not have a separate communication infrastructure supporting its operations. Communication is an afterthought. It is a duty added to someone’s other job. Nurses, for instance, are not only expected to administer medicines for dozens of sick patients but also to be immediately available for families who arrive to visit relatives in the hospital. Doctors, scheduled back-to-back with patients and surgeries, are also expected to be the primary means of communication for their patients. Again, when we think about it, this illogical approach is like asking the airline pilot to manage the customer service desk while flying the airplane. A customer service arm to support medical care has never materialized.
That said, medicine is different. Not every airline passenger wants to speak with their pilot. Patients, on the other hand, feel they have a right to communicate with the chief clinicians on their medical case. And those feelings are justified. But why do those clinicians always need to be the professionals performing the direct care? What if we developed teams of professionals whose sole responsibility is to communicate with patients and families—an ancillary cadre of clinical communicators to support clinical operations? Messages emanating from an electronic medical record are not a substitute for the comfort of a knowledgeable treating doctor or nurse. Which brings us back to culture. How can a healthy culture happen in a medical care environment devoid of communication? The answer is simple. It cannot. Perhaps the greatest opportunity for the physician CEO, then, is the development of a system of communication.
Which takes us to the third step: performance. Performance is the “what” that happens from leadership. If we assume that doctors lead, not perform tasks, how then do we ensure that tasks of medical care (like communications, teaching, research and office business management) are being adequately performed? The answer is delegation. Delegation is a master skill of effective and efficient leaders. Master leaders develop teams with extraordinary expertise. The leader then delegates tasks to the appropriate experts. This is the essence of leadership. Leaders lead people, not processes. Therefore, they must delegate. In fact, master leaders are master delegators—making sure that all team members are operating at the top of their skill level/ ability. Clearly there are times when the doctor is the most competent (only competent) person to perform the task (e.g., critical portions of a surgical operation, assessment of complex heart murmurs or abdominal masses, etc.). When this is the case, the doctor performs the task. This assures the highest quality. But when others on the clinical team can perform the task with equal or better proficiency than the doctor (e.g., well-patient visits, opening and closing operative cases, populating the electronic medical record, etc.), the task is delegated. This enhances productivity without compromising quality. Thus, delegation maximizes productivity, maintains quality and yields the highest performance.
In summary, if physician CEOs are master leaders and guardians of patient well-being, doctors must strive for autonomy—transitioning from managers performing tasks to leaders leading leaders of tasks. This can be a daunting challenge. Doctors are so programed to think like taskmasters that strategic reasoning (purpose, culture and performance) seems foreign.
But if we are to balance medical care, this is a challenge we must accept—and overcome.
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