Most physicians miss the connection between results and scorecards.
It was the final event of this year’s three-day American Association for Physician Leadership Spring Summit in Washington, D.C., and board member Lisa Laurent was pressed to catch an early flight out. First, however, she had a point to make – and an issue to challenge.
At a roundtable discussion addressing the Future of Healthcare, Laurent, MD, MBA, MS, CPE, FAAPL, told peers and fellow panelists that “the overwhelming majority of practicing physicians, they’re outstanding men and women – they’re extremely well-trained, and they’re very bright with very high clinical skillsets, but …”
The issue was KRA and KPI scorecards, the very thing that “every single hospital executive lives and dies by,” according to Laurent, president of the medical staff at Advocate Lutheran General Hospital in Park Ridge, Illinois.
But, she adds, “The overwhelming majority of practicing physicians … don’t understand that scorecard or its significance. They can’t connect the dots between the results on that scorecard, the clinical outcomes on that scorecard, and how we get paid.”
And that’s where educating these otherwise extraordinary physicians can make such a difference.
“When we begin to lead teams in this shifting (healthcare) landscape that is thrust upon us,” she says, “everything we do, every project we promote, every initiative we develop, every service line we create, every new idea that we develop – research and innovation must always center around the major tent poles of value-based care.”
Or as another roundtable attendee put it: “Remember that the patient is at the center of all (we do), and quality is the gate through which every innovation must pass. … There’s going to be a lot coming at us, but the basic principles are we want to do the best we can for our patients.”
To that end, Laurent suggests that physicians unfamiliar with the scorecards view their practice through this prism:
“If I do this, how does this improve quality? If I do this, how does this increase safety? If I do this, how does it enhance the patient experience, and if I do this, how does it provide value?” she says. “That way of thinking, although sounding very simplistic, is very foreign to many physicians, if not physician leaders. But if you break it down to those small, digestible quanta of why are you doing what you’re doing, then the KRA or KPI scorecards begin to make sense.”
It’s a fundamental piece of education that should be nurtured, she says. It’s an education that wouldn’t benefit just the physicians or hospitals where they work, but patients, too.
“The big push these days is that every medical school now has an affiliated MBA that you can get in your spare time, and that’s great,” said a roundtable attendee. “But we’re not really focusing on things like the AMA Choosing Wisely Campaign – of how we engage our patients to choose the best value for their healthcare, not just what they see on TV.”
In some cases, it’s not just getting the best value but getting any healthcare at all. Regarding population health initiatives, former AAPL board member Laura Clapper asks: “How do we get involved in regulation and legislation to really help our community be healthier? Taking the broader view, (it’s) not just who comes into the office but who’s not coming in.”
Other “future” issues discussed at the roundtable include:
Delegate: “We should be delegating to others”
How much time do physician leaders spend on triage processing, pre-authorizations or credentialing? All of which distract them from their primary responsibilities. “There’s a lot of stuff that we could delegate,” laments AAPL board member Thomas Higgins, MD, MBA, CPE, FAAPL. “We’ve all seen patients who show up in the emergency room when a phone call to their PCP would’ve been enough. We need a better way of putting people where they can get the care delivered in the most value-added setting,” adding that AI will eventually be the answer. “There’s a lot of administration that we’re doing right now that is, frankly, nonsense pre-authorizations and bookkeeping,” he says. “We shouldn’t be doing that. We should be delegating that to others. We need to know enough about it to supervise the operation, but we, as leaders, shouldn’t be involved in those particular weeds.”
Keeping up with technology: Not an option
“You can always improve yourself to improve your organization,” says AAPL board vice chair Byron Scott, MD, MBA, CPE, FACEP, FAAPL, insisting, for example, that physician leaders must be current and savvy enough about healthcare technology to understand its value when companies peddling their new products come calling. “They’re going to try to sell something to you and, as a leader, you’re going to have to understand data analytics and AI and figure out if it’s something you need,” says Scott. Or else you could end up wasting a lot of money.
Diversity and inclusion: The big picture
“There is a philosophical transition in the traditional way that physicians approach leadership from the autocratic, powerful, in-control model to really understanding how to lead a diverse and inclusive team,” says Laurent. “That requires understanding the organizational culture, not only the department or section that you may lead but of the hospital in which those departments or sections exist – and for most of us how that relates to the larger consortium or enterprise that is the global envelope, if you will.”
Laurent says intergenerational communication poses certain challenges and that “at the risk of making a sweeping generalization, certain demographics like to receive, process, integrate, and deliver information in a certain way. But there must be a reciprocity among the generations so that we all understand how we each have to receive, process, integrate, and deliver information, whether it’s person-to-person or electronically.”
Leading with a heart
Physician leaders must make a concerted effort to be flexible when creating work schedules for the people they lead. “When we understand that there is an amalgam of elements associated with someone’s personal life, social life and world life, and we are receptive to that … and create an environment that nurtures, supports and promotes those individual’s success, the return on investment is exponential,” says Laurent.
Advocacy as a curriculum
“Most of us do not do enough with advocacy at the state and federal level for changes in how healthcare is delivered and funded,” argues Higgins. “We need to be training physicians at all levels, beginning in medical school, to do that advocacy and to be part of a team that argues for what our patients need.” However, he says, at the moment “we’re left behind in the dust, frankly, in some of these things.”
Adds Scott: “As physician leaders, we have to be careful not to be too edgy and pushy, but you need to speak up and make sure you offer your opinion.”
Who’s in charge here?
The question was posed: When we think about who the future of healthcare leadership should be, given the leaps and bounds’ growth of clinical decision support and data analytics, does that person necessarily have to be a physician, or could it be another clinician?
“I still think physicians are captain of the ship,” smiles Scott, “and I will probably die one day still believing that. We, as physicians, have a huge responsibility. We probably have more knowledge than anyone else in the system.” But, he adds, “We need to make sure that we mentor and bring along other young physicians and young physician leaders because that’s how I think we’re going to make sure that we continue to leave an important mark in healthcare.”