Posts Tagged ‘leadership’
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, October 20, 2009
It’s time to rationalize our health care system in New Hampshire!
Paul Spiess
Co-Chair, Citizens Health Initiative
During my three year tenure at the Citizens Health Initiative, I have had an opportunity to immerse myself in the minutiae of health care cost and finance. As a retired banker and former legislator, I bring a somewhat distanced and dispassionate view to the issue of health reform. I must also confess to a fair amount of compassion for financial pain that businesses and individuals have endured over the past ten years as they have struggled to keep up with costs that are growing at a rate that is well above the increase in gross state product (GSP) or personal income.
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