Physician leaders are in a unique position to observe, assess and manage enterprise risk and the points where strategy converges with patient care and clinical care models.
Given the pressures on health care organizations to perform in turbulent markets, leaders will be encouraged to push strategy to productivity performance limits and beyond. This is a concern. Strategy pushed beyond reasonable performance limits implicates enterprise risk. This enterprise risk is the portfolio of exposures affected by strategy; risk to:
- Organizational reputation.
- Financial stability.
- Operational effectiveness.
- Quality and safety.
- Professional liability.
- Life safety.
- Derivatives (risk derived of strategic business relationships).
- Directors and officers.
The interactions of multiple operating tactics often exacerbate risk potential; one example is the clinical collaboration of independent and employed physicians operating under a system-branded, clinical service line strategy extending across multiple sites and several affiliated and networked care providers.
Physician leaders are in a unique position to observe, assess and manage enterprise risk and the points where strategy converges with patient care and clinical care models. Examples can include implied brand promises of organizational strategies, whether it’s access, evidence-based clinical best practices, team-based approaches to care, superior patient experiences effective cost management or improvements in quality and safety.
Strategy impacts patient care. It always does. It is the responsibility of physician leaders to uncover, understand and manage the intersection of strategy and care. As organizations push strategy for increasing productivity and performance, the roles of physician leaders become increasingly important.
Where Do Physician Leaders Begin?
Breakthrough brand messaging campaigns are being launched by health systems nationally.
Messaging strategies emphasize implied brand representations, known as brand promises, such as:
- Breakthrough research.
- Exemplary care.
- Redefining the science of medicine.
- Revolutionary solutions to the challenges of managing health.
- A broad and deep network of providers working together for your health.
- World-class specialty care.
- Mission-focused/patient-centered care.
- Compassionate and personalized care over a lifetime.
- Innovators in care delivery.
- Cost effective.
- Evidence-based, clinical best practices.
- High-reliability quality and safety.
- Ready access to world-class care.
With these promises made, the questions for physician leaders are:
- What are we trying to achieve?
- Can we deliver?
- Where are the gaps?
- What risks do we run?
- How do we manage those risks?
A good place to start risk assessment is with the organization’s brand campaign, with a focus on the brand promises being made. Physician leaders should ask brand managers to respond to these questions:
“If the patients (markets) we wish to reach believe our brand promises, how will they expect our health system to perform? And, how do our brand promises translate to how patients expect us to deliver on their needs?”
Discussions should not be at high levels. These are ground-level discussions regarding the system’s real abilities to deliver on expectations of access; primary care and first referral appointments; communicating with patients; roles of primary care physicians; how team care works; basic clinical protocols; evidence-based clinical best practices and managing episodes of care as well as chronic conditions.
Physician leaders are faced with a fundamental issue: How do they best assure that the systems of care they lead can deliver on the brand promises made?
This question is especially important as health systems respond to market pressures with the assembly of clinically integrated networks of providers operating from multiple clinical care and business models. Often, these are designed with idiosyncratic missions, strategies, operating incentives, capital structures and models and methods for patient care.
Mapping Deliverability on Brand Promise
The importance of answers to related questions goes beyond whether the organization can deliver on patients’ expectations for a satisfying experience. Brand promise failures can have serious consequences for patients, consequences that expose organizations to significant reputational and financial risk.
Physician leaders can do an initial mapping of the brand promises to assess the organization’s ability to deliver. An initial assessment may be cursory, but it can be powerful nonetheless.
The messages inherent in the brand campaign can be reduced to functional promises. Is the organization able to deliver on the brand promise? Physician leaders can establish the straw man for discussion, starting with the C-suite.
An example of this initial mapping is available from brand messaging samples that derive from an actual brand campaign of a large academic medical center. Assume a patient who is dissatisfied or was harmed by system performance is standing before the C-suite staff, or his or her legal representative is there prepared to plead a case. Here, the physician leader stands in for the hypothetical patient to make the case:
Our promise: A broad and deep network of providers working together for our patients’ health, providing compassionate and personalized care over a lifetime.
Brand promise failures can have serious consequences for patients, consequences that expose organizations to significant reputational and financial risk.
Facts: Our network of providers consists of hundreds of clinicians affiliated by multiple legal arrangements, including employment. Affiliated independent practitioners are not on our electronic health record. Each office operates from a business model designed to serve its own interests, practice style preferences and financial goals. There are no standardized expectations for access and many of our affiliates are also affiliated with more than one health system network. A referral physician may or may not know a referring physician.
Our promise: Exemplary care.
Facts: We don’t have a unified and standardized approach to qualifying or evaluating the care provided by all the physicians we employ, much less affiliated independent practitioners, unless the evaluation is after a suspicious or untoward event. Although we may be well-intended in the selection of affiliated providers, we don’t know if their care is, in fact, exemplary.
Our promise: Cost-effective care.
Facts: The third parties that pay us for the care we provide know more about our costs than we do, especially our total costs of care (aggregate costs for defined episodes of care or annualized costs for managing patients with chronic conditions).
Patients treated by independent practitioners in our network are subject to idiosyncratic care models, as well as the cost implications of varying independent business models.
Our promise: High-reliability, quality and safety.
Facts: We don’t know if we are the safest place to receive health care.
The term high-reliability, including related models, methods and analytic applications, likely means something different to our patients. “My bad outcome may fall within your definition of acceptable statistical confidence limits, but as far as I’m concerned, your failure rate with me is 100 percent.”
Our promise: Evidence-based, clinical best practices.
Facts: Even among our employed primary care physicians, we lack consensus on the evidence for a standardized annual physical exam for males older than 50. And while ongoing conversation may be useful and productive, the evidence demonstrates considerable variation across our providers and provider teams.
Some of our primary care providers operate from interprofessional team models. There is variation in design and operation and, for many, there is considerable overlap in the work performed by physicians and advance-practice clinicians.
Examples provided here represent a good start for physician leaders in their roles as those uniquely qualified to assist an organization in understanding its abilities to deliver on promoted brand promises.
No Health System Is Perfect
Imperfect? True, but when bold claims are made in brand campaigns, existing and future customers may interpret brand claims as brand promises.
David Melloh, partner and chair of the health law group for Lindquist & Vennum LLP in Minnesota, advises on risks associated with hospital and health system advertising campaigns:
Hospitals and health systems are liable for the statements made in their brand campaigns. False statements and deceptive trade practice statutes apply. A deceptive trade practice is generally defined as representations that goods or services have characteristics or benefits they do not have, including representations that goods or services are of a particular standard, quality or grade, if they are not. False statements in advertising deceive or mislead the public with the intent to sell goods or services.
Hospitals and health systems are liable for physicians’ acts if they are employees and hospitals, and health systems cannot rely upon physicians being independent to off-load responsibility.
Daniel K. Zismer, Ph.D, is a founder and managing director of Castling Partners, a consultancy focused on strategy performance and integrative risk management for health care organizations. He has a 30-year career in the leadership of health care organizations and executive education. His area of specialization is strategy and the performance of strategy. He is the Wegmiller Professor Emeritus, School of Public Health, University of Minnesota Programs in Health Care Administration.