Posts Tagged ‘Health care’
Tuesday, July 13, 2010
Health Care Leadership at the Community Level
Sharon Beaty, CEO, Mid-State Health Center, Plymouth, NH
Since health care is becoming a concern for the broader community and no longer strictly the purview of hospitals and doctors, it will become important that the community have members willing to provide leadership ensure the accessibility of quality health care at the community level. These leaders may have to be developed and educated by local medical providers, who may have some discomfort and relinquishing what is perceived as control of their market.
The development of the Patient-Centered Medical Home and Accountable Care Organizations, being piloted at national, state and local levels, encourages the involvement of patients in their care. Patients will, in the longer term, be encouraged to take some responsibility for overall health care costs as national initiatives move forward. Leadership may evolve from what was once “the hospital’s job” to become the domain of a more diverse group that may include town leaders, school officials, and other not formally-defined positions, including members of organizations’ boards, staff members, physicians and even the patients. Indeed, the community health center model that continues to be a model of choice for the national Health Resources and Services Administration actually requires that at least 50% of board members in these primary care organizations be patients of the health center.
The intersection of patient involvement and community needs will require leaders at the local level to participate in decisions that will affect how care may be delivered. To borrow from the State Integration Plan (a guide for the integration of the medical and public health systems when appropriate) being developed by the Citizens Health Initiative in New Hampshire, there are certain qualities that are desirable in local leaders who should be involved in this process.
These “champions” for health care should be passionate about health care and understand the effect that quality of care has on the larger community; indeed, health care is a significant driver of economic development, including local employment as well as the attraction of new businesses and expansion of the tax base. Controlling cost of care at all levels of the care continuum will be a requirement as we implement the new federal legislation being developed.
Other qualities include having vision and an entrepreneurial spirit. To lead health care in the new paradigm, it will be a requirement to be creative and to “think outside the box.” We will not be able to travel the old, comfortable paths–we must break new trails. When new paths become necessary, the leader must have the influence to encourage movement of the parties involved to travel those new roads to success. Having a great idea will be helpful only if the idea can be communicated and accepted. The ability to communicate well will be increasingly important.
In addition to some understanding of the system, or willingness to be educated, the leader must be willing and able to dedicate time and energy. To succeed, the leader should be knowledgeable, personable, encouraging, positive, and supportive, and able to put the needs of the broader community ahead of self interest. The ability to lead occurs only when the followers trust the leader and believe that the interests of the population are paramount.
As always, everything eventually comes down to trust: the community’s trust in the leader to have the interest of the community at heart, trust in the leader from the clinicians and other professionals in the system, and trust by the health care community that the new systems will work. Lastly, the leader must have enough confidence to trust in his/her own abilities and instincts and enough humility to accept input from others when required.
Tuesday, June 29, 2010
Professional Autonomy and Teamwork: Will Health Reform Change the Balance?
This is part of a series of blog entries focused on leadership in the new health system landscape, resulting from the passage of the health reform law. Stakeholders from across the health system have been invited to share their thoughts on the leadership role for their respective industries.
John H. Robinson, MD, CPE
President, New Hampshire Medical Society
Although the Patient Protection and Affordable Care Act (PPACA) enacted in March spent most of its ink on health insurance coverage issues, a moderate nod was given to efforts to transform health care delivery systems in the direction of improved quality and cost-efficiency. Such efforts as Patient Centered Medical Homes (PCMH) and Accountable Care Organizations (ACO) will require major changes in the way physicians practice, particularly primary care providers, putting significant stress on an already troubled profession. Any success in reforming health care delivery will be largely dependent on leadership by clinicians. Conversely, the lack of an engaged clinical leadership elevates the risk of failure such as with previous reform efforts that were largely led by the payer industry at the behest of purchasers.
Redesign of the structure of reimbursement systems for health care providers is necessary to provide adequate incentives to reorganize the delivery system, but it is not sufficient for true reform. True reform will require exhaustive assessment of the flaws in the system and seizing on the identified opportunities to make it work better for our patients. Reform will require compilation and review of data about current patterns of care but also about the drivers of optimal patient experiences and about frequently non-productive communications between and among all the clinicians and support staff involved in the care of a patient. Acting on this information will require major behavior changes for clinicians. Those adjustments, in turn, require change leadership, which will likely be effective only if it includes clinicians who fully understand the nuances of individualized patient circumstances and the administrative burdens of operating a practice.
Physicians will need to transform the culture of their interactions with all other clinicians and with non-clinical service providers. Historically physicians have placed a significant premium on professional autonomy. Starting with the competitive nature of medical school admissions processes and continuing through highly selective post-graduate training programs and on toward traditionally small practice arrangements which have an entrepreneurial flavor, physicians are acculturated toward individuality and personal accountability. This professional ethic has decided benefits; it generates well-earned self-confidence which, in and of itself, can be therapeutic to a patient faced with confusing and frightening medical problems for which he or she needs experienced and reliable professional guidance.
But such a premium on professional autonomy comes with costs. The premium on autonomy in the medical profession has, I think, impeded the development of collaboration and teamwork directed at improving the overall efficiency of a system of health care. This is beginning to change as seen with the specialty of anesthesiology, which has adopted a systems approach to safety in the operating room the way airlines have for safe travel. But the change will be difficult for some and impossible for others. Physicians who are more disposed toward an ethic of true teamwork will have an easier time in the transitions ahead.
Coordination of health care and collaboration with other service providers requires more than just membership in a group either informally (we’re both on the same hospital staff) or formally (we both signed the same provider network contract). The goal of improved quality and efficiency of health care requires membership in a fully functioning team. Webster’s defines teamwork as “work done by several associates with each doing a part but all subordinating personal prominence to the efficiency of the whole”. Characteristics that differentiate a group from a team include interdependence, common goals and understandings, creative contribution of ideas, trust and openness, good conflict resolution, participative decision making, commitment and clear leadership. As Casey Stengel said, “Getting’ good players is easy. Getting’ ‘em to play together is the hard part”.
Cultivation of an ethic of teamwork for health care requires good clinical leadership. Clinical leadership, in turn, is not just a question of possessing excellent diagnostic and therapeutic acumen. It involves the development of a clear vision and compelling message, excellent two-way communications skills, good negotiation and conflict resolution skills, and dedication to the task at hand — all grounded in a solid foundation of clinical knowledge and respect for patient values. Not all of these are characteristics are particularly nurtured in the traditional medical professional ethic, although they may be possessed in nascent form by many physicians.
In the end it will be the clinicians who feel compelled to step outside of their daily practice routine to take a leadership role that will determine the success or failure of the grand experiment of health care reform at hand. And it is my fervent belief that leadership must come from the clinical community if failure is to be avoided.
Tuesday, March 16, 2010
Is This the End of the Beginning?
By Ned Helms
It appears that sometime this week Congress will make a decision. Either they will pass health reform and end a process that has taken almost 50 years, or we will once again fail to do, as a country, what every other industrialized country on the face of the planet has done. I hope this really is the end of the beginning, and that we can move beyond the polemical excess of debate and get on with the real work of reforming a system that is out of control, and providing tens of millions of our fellow citizens with the assurance of coverage, without the specter of personal bankruptcy. It will be challenging, but all worthy efforts are challenging. Reforming our system of health and health care is worth our very best effort.
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Wednesday, March 10, 2010
Centralizing the “Centered” Models in New Hampshire
By Laura Davie, Project Director, NH Institute for Health Policy and Practice
In my role as project director in the Institute for Health Policy and Practice, I work on multiple projects. Although these projects have different components (including populations segments being focused on, issue being addressed, partners engaged at the table), it is impossible to ignore how these project are (or, at least, should be) connected across the health systems that they span. In my work of late, I notice the word “centered” is used a lot as an important descriptor of projects being implemented across health systems. These projects include the patient-centered medical home within the health care delivery system and person-centered planning in the long-term care system. I believe that, while these two “centered” models serve different functions within their respective systems, New Hampshire will be best served when these “centered” models overlap (and the sooner, the better.)
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