As the practice of medicine continues to become the most tightly regulated industry in this country, physicians are questioning what their role should be and to whom they should answer. Because the U.S. healthcare system has been undergoing a significant transformation in the last decade, it appears that physicians who are primary stakeholders in the medical field will most likely be the best candidates to be agents of change.
The healthcare delivery system depends on the skills and judgment of physicians, who are increasingly dependent on the many organizations in the delivery system to enable them to provide care and meet new demands of value-based performance. But with so many rules to be followed, what happens to the personalized decision-making and historical autonomy of physicians in terms of the individual patient?
These conflicts and the economic pressure of the changing system all factor into the unique skill set required to lead physicians. This article outlines what it means to be an effective physician leader and how to develop those skills that are needed in the changing healthcare environment.
WHO SHOULD LEAD?
The first question is who should lead physicians—physicians, administrators, or bureaucrats? It is critical that the relationship between healthcare executives and physicians be synergistic, with leadership acknowledging doctors as partners rather than adversaries in healthcare delivery. For physicians to invest in significant changes in their practices, they must see an obvious improvement in their delivery of care, the outcomes of their patients, or their own quality of life, or initiatives of change will fail.
Several fundamental issues are crucial in the process of convincing physicians to implement changes. These issues include:
- Trust: In the face of increasing regulations, higher costs, and lower reimbursements, physicians must feel they are part of the initiative to improve healthcare.
- Data: Medical decision-making is data driven. However, data generated from administrative databases can be an inaccurate measurement of physician performance, because individual practices see different types of patients.
- Attitude: Physicians are less willing to accept cultural and behavioral changes in the way they practice medicine than technical advancements in standards of practice.
- Independence: With Accountable Care Organizations and integrated medical centers, the practice of medicine now relies more on team cooperation than independent practices.
- Status quo: Physicians will not be inclined to make dramatic changes in their daily practice unless a failure to do so will compromise their productivity, patient care, or reimbursement.
- Time: Physicians have little time during patient hours for outside meetings. If physicians are to be part of the decision-making process, meetings must be scheduled in advance, keeping typical physician schedules in mind.
- Intelligence: Physicians are trained to be problem-solvers and should be used in nonconventional areas in the organization to provide a different approach to problems.
All these issues can be barriers that keep physicians from accepting the changes required for regulatory agencies, hospital safety initiatives, insurance regulators, and other healthcare reforms. Those wishing to implement changes must take these issues into consideration and provide strong leadership that physicians are willing to follow.
QUALITIES OF A PHYSICIAN LEADER
In the past, hospitals looked for physicians with strong clinical skills, high patient volume, and likability to fulfil the role of chief medical officer. Now the focus is also on obtaining physician leaders with exceptional people skills, capable of communicating effectively and building trust and buy-in across multidisciplinary groups. Management training and knowledge of leadership principles are important ingredients for success. Doctors with recognizable leadership potential or proven skills should be placed in a path of increased responsibility within organizations to help them develop their executive skills.
We need to change our thinking and start teaching physician leadership and organization development in medical schools.
Physician leaders find that they need new skills to engage with the complex questions related to clinical integration, performance metrics, quality, safety, business measures, and population health. In addition to the standard physician core competencies, physicians must develop skills in newer areas such as systems theory and analysis, use of information technology, and enhanced knowledge of the continuum of care. Those who want to be key decision-makers in setting strategy, managing finances, and pursuing quality patient-care outcomes should consider joining and actively participating in professional organizations or pursuing advanced degrees such as an MBA. Acquisition of these physician leadership skills must start in medical school and continue during the physician’s residency program. We need to change our thinking and start teaching physician leadership and organization development in medical schools, because those skills will become crucial in success in private practices as well as for those who become attending physicians in a large bureaucratic medical complex and healthcare system.
Because the specific criteria for this skill set are daunting to say the least, the earlier they are taught as part of a curriculum the better off everyone will be. One key criterion is to learn how to navigate a complex bureaucracy and an intricate matrix of relationships. Organizational leaders today are charged with managing and improving the functions of large systems that play a big role in how a physician’s practice operates.
To be a good physician leader, a physician must first be a good physician. To be a good physician, the physician must have the following core competencies:
- Medical knowledge: Exhibit proficient knowledge of biomedical, clinical, and cognate sciences, and application of patient care.
- Patient care: Provide compassionate, appropriate, effective patient care.
- Practice-based learning and improvement: Continually assess and evaluate patient care practices and assess and assimilate scientific evidence.
- Systems-based practice: Provide cost-conscious, effective medical care. Promote patient safety.
- Professionalism: Demonstrate a commitment to carry out responsibilities. Adhere to ethical principles. Be sensitive to a diverse patient population.
- Interpersonal and communication skills: Demonstrate skills that result in effective communication exchange. Work effectively with other members of the healthcare team.
- Use of informatics: Use informatics to enhance patient care delivery.
However, to be a good physician leader, the following competencies are also important:
- Systems theory and analysis: Identify ways to improve the quality and safety of patient care through greater care coordination and process improvement.
- Use of IT: Effectively use IT to improve the quality and safety of patient care.
- Cross-disciplinary training and multidisciplinary teams: Understand and respect the skills of other practitioners.
- Expanded knowledge: Develop greater understanding of population health management, palliative and end-of-life care, resource management and medical economics, health policy and regulation.
- Interpersonal and communication skills: Further enhance interpersonal and communication skills to become a true member of the team. Demonstrate empathy and understanding of cultural and economic diversity. Practice excellent customer service. Improve time management. Enhance conflict management skills and provide effective performance feedback. Improve emotional intelligence, self-awareness, and relationship management.
Team dynamics is essential in participative leadership, suggesting that the ideal style is one that takes the input of others into account. This aspect of leadership concentrates on the dynamics of the team and the leader’s interaction with his or her team. Medical teams often are randomly assigned, with the actual make-up of the teams changing frequently. An effective physician leader should draw on the skills of these rapidly changing teams and ensure that they run smoothly. The leader should have vision and communicate it to the team. Because the care plan may change frequently during a single day of caring for a patient, this ensures that the team can continue to function.
A team leader is on the front lines of patient care and can make a difference by influencing and supporting his or her managers and administrators. You and your colleagues can share your experience with those who oversee running and improving these large healthcare systems. Physician leadership roles are more important now as hospital-based physician networks are rapidly forming across the nation, made up of what used to be independent practices.
A good team leader creates an environment that makes team members feel comfortable and enjoy their work.
We can each play a role in helping these larger systems become more functional if we make suggestions for improvement rather than retreating to our exam rooms and complaining. Any effort that you put into developing your own leadership skills pays immediate dividends. Becoming proactive in improving the practice experience for yourself and your staff and the quality of care for yourself and your team will have a positive effect on your patients’ experience.
A good team leader creates an environment that makes team members feel comfortable and enjoy their work. Other team leader roles include supervising team members and resolving any conflicts or problems that arise within the team. Physician leaders should draw on the abilities of and elicit input from their individual team members by creating an environment where team members feel comfortable enough to contribute their thoughts and ideas. This environment should be created while continuing to focus on patient care and accomplish the tasks at hand, even as the patient’s condition or team composition changes. The leader manages the available resources of the team as well. By being organized and efficient, the leader ensures that each team member stays engaged and challenged, and their skills and time are being fully utilized. An important aspect of managing a team is task delegation to ensure that the team’s goals are accomplished. When everyone knows what they are doing and has a role, they feel like they are participating in a useful way.
Although team members believe that the team leader should participate actively within the team, the leader is not simply another member. The leader takes on a managerial role. If managed effectively, the individual team members take ownership, draw from one another, and work together. Then the team, as well as each individual member, works to accomplish the necessary tasks.
When supervising physicians-in-training, attending physicians need to have high expectations, because a demanding attending physician generally results in better performance by inspiring his or her supervisees to live up to expectations. To help a trainee reach his or her potential without feeling mistreated, the underlying goal must be for team members to achieve their potential, so they feel they are getting something in return, such as learning more or being pushed to their limits.
Promoting team members’ participation and engagement is a particularly challenging part of physician leadership, because medical teams typically comprise professionals at different stages of their training. Engaging the team on everyone’s level is important, but it can be difficult. One way to actively engage everybody is to use team members to teach and supervise one another while teaching at a more basic level. Leading a clinical team requires the leader to make sure that patient care and teaching are balanced, while working within time limits. The physician leader also interacts with the team by teaching. With the introduction of resident work-hour limitations, even the most effective leaders may struggle to fit in both roles successfully. To make teaching rounds effective and still allow for time to teach, attending physicians should prepare ahead of time. A good leader in a teaching environment should renew the love for medicine that initially drew students, interns, and residents to the field and bring back their enthusiasm. A large component of creating enthusiasm is role modeling, in which the attending physician shows his or her own satisfaction with his or her job.
“FUTURE PROOF” YOURSELF FOR TOMORROW’S WORKPLACE
Regardless of all the training you have received, you must be open to learning new skills on a regular basis and meeting your new people. The first strategy is to learn on the fly and to be committed to have the capacity to learn and grow professionally. This is an imperative skill that must be developed as a physician as early as possible. With a growth mindset, opportunities to learn will abound and you will find yourself more open to new experiences. Preparing for all the future changes in healthcare allows you to be open to options that you may have rejected in the past or to approaches you find uncomfortable at first. In a word of information overload, you must learn to keep current on the issues most relevant to today’s physicians.
Career growth in the healthcare field demands adaptation. Another trait is seeking genuine feedback. When receiving feedback, it is best to switch to a listening mode and not react to criticism. Instead, try to take a reflective stance, and thank the person giving the criticism. Currently, there are limited resources in the healthcare field, so staff members often are stressed daily. Adjust constantly. When a physician changes to a new role, he or she must develop skills by asking “What do I need?” and “How do I develop new skills for this new position?” The skill set that promoted you to the new position may not necessarily be the skill set you need now.
Insightful healthcare organizations should identify future physician leaders and help in their development. The key is to respect, understand, and begin acquiring physician leadership skills as soon as possible.
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Debra Cascardo, MA, MPA, CFP
Principal, The Cascardo Consulting Group, and Fellow, New York Academy of Medicine