March 2, 2021
COVID-19 Highlights the Need for Physician Leadership in Healthcare Organizations
BY MICHAEL T. HARRIS, MD
Physicians have long helped drive important improvements in the culture of healthcare organizations and the medical care of the communities we have had the privilege to serve. But the need for strong physician leadership in the US health care infrastructure has never been clearer, nor has the need for specific focus on formal operations and finance training of our clinical leaders been more apparent. As in any industry with centuries of history, with few dramatic exceptions change is typically incremental and frequently hard-fought. Healthcare has a number of unique hurdles, not the least of which can be the misalignment of priorities of the business teams and the clinical professionals providing direct care to patients.
Until now.
Over the past year, every aspect of the way that health care is provided around the US has changed. In many COVID hot spots, this has included massive physical plant as well as operational changes. And throughout the country, this has occurred in the setting of unprecedented reliance on the guidance of clinicians including physicians, nurses, and other patient care professionals, who have rapidly demonstrated themselves to be creative problem solvers and transformational leaders.
The mobilization for the care of the expected – and in many areas realized – onslaught of COVID-19 patients has been well documented in the media. Operational challenges and solutions have included the reconfiguration of inpatient and outpatient facilities such as the building of testing centers, the massive rapid expansion of intensive care capacity, and even the construction of entirely new hospitals in record time. Processes have been completely revamped, including the deployment, within days, of telemedicine and other information technology that typically take years to implement. Clinical leaders have embraced decision-making around the rationalization, distribution, and procurement of capital and non-capital resources, the most broadly reported examples of which are ventilators and personal protective equipment. In a time of great uncertainty, the leadership challenge for physicians has also included establishing and maintaining commitment to massive rapid change from both executives and clinicians, and the creation of new lines of communications with patients and their families, hospital colleagues, and other healthcare workers. And in the midst of all this, healthcare teams have had to learn to safely treat patients with a novel deadly disease, and to establish and communicate rapidly evolving standards of care on a local, regional, national, and even global level.
While the main focus has been on COVID-19, the care of patients with virtually every other disease process has also undergone dramatic change, much of which has been largely driven by the partnership of patients and their physicians. There has been a reconsideration of the triage and management of patients requiring services that were previously thought to require immediate availability. Just one example is the types of surgical cases which have traditionally been done on an urgent or emergent basis, such as the removal of the inflamed appendix or gall bladder. New guidance from the American College of Surgeons has led to the treatment of many of these patients with antibiotics alone, with surgery deferred to some future date, if at all. Urgent outpatient office visits have been almost completely replaced by tele-health consultations. Of course, some types of emergencies do not lend themselves to complete revamping of the system, such as trauma, certain surgical emergencies, and true cardiovascular emergencies such as heart attacks and strokes. In addition, clinical leaders are still working on a variety of opportunities to utilize our new processes to best manage patients with a variety of special situations, including chronic disease management. The field is especially focused on the care of people with newly diagnosed cancers and their follow-up and ongoing treatment regimens.
As the acute crisis ebbs, there is the understandable desire of many to return to historic norms. In health system leadership, this is likely to mean a resumption of operational and strategic decision-making that too often excludes or at least marginalizes the input and priorities of clinical professionals in favor of those of business executives. The author is extraordinarily fortunate to have worked with healthcare organizations that recognize the value of clinical leadership at the most senior levels, but that is not necessarily the norm. Traditionally, physician leaders have been selected and promoted for clinical and/or academic excellence, rather than for their business expertise. With rare exception, medical education and training do not include operational literacy, financial numeracy, or executive leadership development, creating a language and knowledge gap between most physician leaders and the executives with whom they serve. This need not be the case. Many truly outstanding healthcare organizations in the US have physicians as their chief executives, such as Mayo Clinic, Cleveland Clinic, and Geisinger, to name but a few. And there are data to suggest that physician led organizations enjoy better patient outcomes, higher patient experience scores, and even superior financial results than similar health systems run by non-clinical executives. A 2016 Harvard Business Review article, “Why the Best Hospitals are Managed by Doctors” discusses why.
A complete return to the status quo in the clinical and operational arenas should not be our goal. The trend over the past several decades has been toward treating people outside of the hospital unless they are very ill and providing as much care as possible in the outpatient setting. This has accelerated with the COVID-19 crisis and skewed even more toward in-home care.
When hospitalization is required, patient separation and some of the newly designed patient flows should be continued. Resource rationalization and flexibility among sites within a system and between systems, elusive before, is now more realistic. True of supplies and equipment, this is even more pronounced with human capital management. The flexible movement of staff, the ability of many to work remotely, and the lowering of interstate barriers has been described as the “future of work” in healthcare and other industries. The future is now.
In the ambulatory setting, the increased convenience and access afforded by new technologies, with telemedicine at the core, has been a huge satisfier to patients, physicians, and staff, even in specialties that have long resisted change. Based on a statistical sample of over 3.5 million patient experience surveys, Press Ganey reports that “patients are overwhelmingly positive about their virtual interactions with their care providers.” It is difficult to imagine a patient wishing to invest in the hours it takes to travel to the doctor’s office, fill out forms, and wait with others in a waiting room for a limited visit with the doctor, the face-to-face component of which may last only a few minutes, rather than conduct the visit in the comfort of one’s own home. There are many reports that the visit itself, rather than losing its personal nature, has become even more satisfying to both patients and their physicians. It is also easier to include family or other loved ones in a meaningful way in the discussion and follow-up planning and care.
“…Many of the changes being proposed and actuated with my physician colleagues at the leadership table have the potential to significantly bend the cost curve downward, both for individuals and the healthcare system as a whole.”
Clinical leaders are open minded and smart enough to keep an eye on the bottom line as well as the patient. An increased focus on the formal training of physicians in operations, finance, and leadership skills is needed to create a deep bench of physician executives that will be even better partners now and for the future of healthcare in the US.
Broad-based physician leadership is required now more than ever. The critical partnership of executive and clinical leaders has never been more of a natural fit. There should be no going back.
Resources
Dr. Harris is the former Chief of Surgical Services, Senior Vice President and Chief Medical Officer of Englewood Health in NJ. Currently, Dr. Harris is a consultant with CaduceusHealth and MTHHealth.com