In an era of unsurpassed innovation and business disruption, the stakes are greater than ever for physician leadership. The next 20 years likely won’t be any different.
Medicine always has revolved around remarkable advances in knowledge and technology. However, in an era of unsurpassed innovation and business disruption, the stakes are greater than ever.
Physicians increasingly struggle to stay current with fast-changing medical knowledge. They must adapt to a steady stream of new and different technologies. And they face enormous time and performance pressures, which frequently lead to burnout and other problems.
“Science and technology have made so many things possible that weren’t in anyone’s consciousness only a few years ago,” observes Thomas Lee, MD, MSc, chief medical officer for consulting firm Press Ganey Associates and a professor of medicine at Harvard T.H. Chan School of Public Health. “But the side effect of all the progress is increased complexity. This environment produces gaps and challenges that require a different approach to leadership.”
The task won’t become any easier in the years ahead. New treatment and business models will force physician leaders to examine and re-examine their strategies, approaches and methods like never before. Success will hinge on understanding people, process and technology at a deeper and more-integrated level.
“We are at an inflection point where roles and responsibilities are changing,” says Steven Strongwater, MD, president and CEO at Atrius Health, a not-for-profit, physician-led health care organization based in Newton, Massachusetts.
Change is a constant in business, and health care is no exception. We asked industry experts to take a forward-thinking look at some of the key factors likely to affect medicine — and leadership — in the next 20 years.
Technology Changes Everything
Changes driven by technology top the list of leadership challenges in medicine. Providers increasingly struggle to put technology to work effectively — and balance it with the human element essential to effective health care. Understanding how technology affects doctors, nurses, technicians and patients is crucial for remapping care and building a better delivery system.
Ultimately, it’s important to find the sweet spot between automation and hands-on care.
“Leaders must think about how to create greater meaning for clinicians, and how to make care more coordinated and seamless for patients — which both involve respecting people’s time and getting rid of the things that waste their time,” says Adrienne Boissy, MD, MA, chief experience officer and a staff physician at Cleveland Clinic.
An emerging wave of connected systems — including home-monitoring equipment and consumer devices — are changing and even disrupting traditional interaction points. More advanced telehealth systems, which rely on internet connectivity, potentially will alter the dynamics of care in significant ways.
Today, connected devices track everything from blood sugar and heart health to compliance. In the future, it’s likely they will monitor virtually all vital signs and gauge activity and exercise in a comprehensive and holistic manner. Connected systems with microsensors also will monitor and control the release of medicines into the body. All of this could aid doctors in doing what matters most: improving patient health.
Virtual visits — using videoconferencing or even virtual reality — likely will become more common. VR also will play a key role in training physicians, including surgeons. And other technologies, including robotics, natural language processing, artificial intelligence and augmented reality, will create new opportunities along with obstacles.
“There is a lot of sparkly technology out there,” Boissy says. The key to driving adoption is to determine how and where it has value. “Did it decrease burnout, enhance relationships and drive better outcomes?” she asks.
As data science, analytics and evidence-based medicine take hold, there also will be a need to rethink patient treatment. In many cases, the conventional way of diagnosing, advising and prescribing will change. Data will provide deep and accurate insights that are only beginning to become visible today.
“There is an opportunity to take enormous loads off of doctors, pharmacists and others through the use of data and AI,” Strongwater says. “One of the reasons there is so much burnout today is the demand placed on physicians using electronic medical records.”
Better interfaces and automation enabled by AI could change the equation. “The goal must be to free up time for more strategic tasks,” he says.
One highly disruptive trend involves unconventional players, including the likes of Amazon, Berkshire Hathaway and JPMorgan Chase, entering the health care marketplace. Although it’s not clear what path these companies ultimately will take and how they will influence medicine, it is apparent that health care will change — mostly likely in dramatic fashion.
High costs and uneven quality of care magnify the issues, says Stephen Swensen, MD, MMM, professor emeritus at Mayo Clinic and a senior fellow at the Institute for Healthcare Improvement. “Many organizations in other industries have been flattened by disruption. Health care needs to be disrupted, and leaders must pay attention to trends,” he says.
Lloyd B. Minor, MD, dean of the Stanford University School of Medicine and an otolaryngologist at Stanford Health Care, says leaders must knit together diverse technologies and requirements.
“From improved interoperability between electronic health record systems, to more widespread use of application program interfaces, to intelligent algorithms that are helping clinicians wade through vast amounts of patient data, I see signs that we are on the cusp of an industry transformation,” he says. “These developments are moving us toward a future in which data will democratize the practice of health care and shift the focus toward disease prediction and prevention.”
People Still Will Matter
Although technology is a key driver for change in health care, it is not the end game. At some point, the equation always comes back to people. Boissy says different thinking and management approaches are required for this framework. She describes it as “liquid leadership,” built on agility, flexibility, transparency and a willingness to simplify things for everyone in the ecosystem. It also focuses on greater empathy for all. This might mean using remote diagnostics and video chats to replace office appointments.
“If a multiple sclerosis patient needs an appointment in the dead of winter, why should this person have to drive 30 minutes each way and trek through an icy parking lot?” she asks.
Identifying value points is the key to pinpointing the right technologies and processes. “You have to be able to pivot quickly and think creatively,” she argues.
Dealing with human issues requires more than simply adding layers of technology on top of existing technology. At some point, the accumulation of tools, applications and systems — combined with the need to move faster — creates an almost unbearable situation. With about half of U.S. physicians exhibiting symptoms of burnout, it’s vital to understand how to improve interfaces and reduce administrative burdens.
Minor says a recent study conducted by Stanford and The Harris Poll found that, on average, doctors now spend more than half of their time interacting with their electronic health records system. Stanford Medicine’s approach was to become the first academic medical center to create a position of chief wellness officer in 2017. “It’s going to take strong leadership if we’re to address it effectively,” he says.
Evidence-based medicine and technology-driven change also require different thinking and behavior. “If you go back 25 years, physician leadership meant protecting doctors, because the preservation of autonomy was considered synonymous with quality medicine,” Lee says. “Physician leaders have to become managers that can organize colleagues and help them become more efficient and collaborative.”
Along the way, physicians will have to learn new roles and understand that data will often drive clinical and practical decision-making. Adds Minor: “Physician leaders will need to be increasingly comfortable with soliciting feedback and taking their time when it comes to decision-making.”
Training requirements will change, too. Doctors must become lifelong learners, especially those who wish to pursue a leadership career track. They also will have to possess at least some knowledge of data science and have at least a basic literacy in genomics, Minor says.
Mayo Clinic’s Swensen likens the evolving role of a physician leader to that of an orchestra conductor. He believes greater diversity is required to address the needs of a more diverse society. This includes doctors, nurses and others who can lead an organization in a more organic and collaborative way. “The best leaders are practitioners who continue to practice because they truly understand the framework of health care and medicine,” Swensen says. This also helps them interact with others who approach things from a business-centric perspective.
Swensen and others predict women will change leadership in health care significantly, and, in the next two decades, could be a dominant presence. Today, more than half of medical school graduates are women, and the sensibilities they bring to leadership roles — and the workplace itself — are different than that of the male-dominated status quo. A growing body of literature provides evidence that women deliver a level of empathy and cooperation that helps groups flourish in a collaborative, technology-centric world.
“Having women and more diversity in leadership roles is nothing but good. We need different thinking and different perspectives,” Strongwater says.
Processes Must Change
Radically different organizational structures and work models will require a different type of leader. In the years ahead, observers say, there will be a need to drive greater transparency into processes and pricing, facilitate communication, open up decision-making, and help teams and individuals develop the skills necessary to build a better health care organization. This, in turn, will lead to better processes and workflows. Yet, amid all the disruption, delivering value must be the primary focus. “The patient must come first, and that determines everything else,” Lee explains.
When organizations put patient needs first, all else — technology, skills, policies and workflows — reveals itself through data, discussion and analysis, Lee notes. Within an open and collaborative model, an organization can identify the paths and processes required for change.
Boissy says leaders must rethink and sometimes replace many existing metrics and measures. For example, measuring clicks and downloads for patient materials or a video isn’t particularly important. “Looking for and delivering real behavioral change will drive better health,” she says.
At the same time, “patients’ and clinicians’ expectations regarding health care will continue to evolve,” Boissy adds. The Amazons and Ubers of the world have changed the way people use voice technology, camera phones and geolocation technology. In the business world, this is known as a consumer-centered approach, and it’s rippling into medicine as well.
Apple’s Health App, for example, allows consumers to connect their fitness data and health record in one place. The missing element is deep, real-time integration with medical systems and doctors — currently, there’s no analysis of the data that signals when a doctor should act or react. Adding these capabilities, for now, simply adds to their burden. In the next two decades, health care leaders will have to understand how to use AI and other tools to balance automation and the human element.
“We are at an inflection point where the technology is driving changes in the delivery system, rather than the other way around,” Strongwater says. As a result, physician leaders will have to understand opportunities and medical interventions in an entirely different context in 20 years.
For instance, if a wrist device or other home monitoring system detects a problem, waiting for the patient to contact the doctor might result in a bad outcome — a patient might put off a visit to the doctor and possibly die. Ideally, AI would prioritize the patient, schedule a meeting or consultation, and set up additional tests — perhaps with no human interaction. It also might interact with the patient through a chat or voice interface.
“We’re beginning to see this convergence, but it will accelerate in the coming years,” Strongwater says. To navigate through the next couple of decades, though, it will be necessary for physician leaders to not only practice medicine but also understand the fundamentals of information technology and people at a much deeper level. “The magic is to unburden the doctor, unburden the patient and make it easier for everyone to interact using technologies and processes that have already delivered results in business settings,” he says.
The Future Unfolds
Although no one has a crystal ball that can predict the exact direction medicine will go during the next two decades, it’s clear health care will face enormous structural changes. Simply adding digital technologies to existing, and sometimes inefficient, systems and processes might deliver incremental benefits, such as a few dollars saved or a few minutes gained, but they won’t unleash the level of innovation required to solve problems such as physician burnout and increasingly demanding patients. It also won’t bring about true organizational transformation.
Ultimately, a new generation of leadership will be required.
“There must be a deeper awareness of how everything — technology, data, processes and people — fit together,” Lee says.
Strongwater believes that physician leaders must fundamentally rethink and redesign care by leaving no stone unturned — even embracing concepts from a century or two ago and combining them with digital technology.
“We will need to shift care from the hospital to the home,” he says. “Ultimately, the goal must be to use both data and human expertise to take medicine to a smarter, better and more efficient level.”
Samuel Greengard is an Oregon-based journalist covering business and technology. He is the author of The Internet of Things (MIT Press, 2015), which explores the benefits and risks of the connected world.
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