The American College of Physician Executives recently completed a survey of 1,155 physician-leaders, polling their experiences with patient-safety and quality initiatives at their organizations.
The good news is that physician-leaders are passionate about improving the care that patients receive. Many express heartfelt concerns about the current state of affairs, with statements such as: “Hospitals are still chasing revenue and are not serious about improving quality and efficiency” and “Society does not allocate sufficient payments to hospitals in areas serving the poor to allow implementation of needed improvements—this is a disgrace to the U.S. healthcare system.”
The not-as-good news from the survey also is evident in responses like this: Many physician-executives are finding the implementation of safety and quality initiatives to be tough going.
A majority of the respondents reported they have struggled to find an appropriate balance between what they believe is best for patients and what is best for their healthcare organizations when it comes to implementing these initiatives. Just over one-third of respondents identified a lack of resources as a major barrier to improving patient safety and quality within their institutions; a similar proportion reported that the desire to maintain the status quo was a major obstacle. Just less than one-third reported that physician resistance to the use of evidence-based care is a major obstacle to implementing improvement strategies.
Data transparency, increased accountability and pay-for-performance are here to stay. Given this new world order, life as we know it has drastically changed for physicians and physician-executives.
Personally, when I came to Centra Health in Lynchburg, Va., in 1999, there was only one person in the organization working on quality. By contrast, at the General Electric Co. plant in town, there was a whole team focused on Six Sigma, even though GE had one-third the number of employees compared with the hospital.
It was obvious the hospital hadn’t made a serious investment. Today, the investment in quality improvement for healthcare organizations is much larger, but I venture to say it is still not enough.
As physicians, we can no longer dodge quality and patient-safety activities with the rationalization that healthcare is far too complex for standardized care or use of error-reduction processes borrowed from manufacturing plants. The oft-heard rally against “cookbook medicine” no longer holds weight.
Neither can we as physician-executives hide behind the excuse that lack of physician engagement makes systematic improvement impossible. And, as the ACPE survey results indicate, physician-leaders are committed to the journey ahead but stymied by obstructions in the road. Many are in need of a more clearly defined road map, but where is the map?
The answer, in our opinion, is personal and professional development of physician-leaders. As physician-executives, we must educate ourselves and our clinical colleagues about the methodologies underlying quality measurement, process improvement and patient safety.
We need to learn how to be effective leaders. We need to understand basic business management principles. These are not subjects we were taught in medical school. In fact, key principles in some of these areas run counter to our best intuitive knowledge as doctors.
For example, treating one patient at a time with care that is thoughtful but not necessarily evidence-based has been our modus operandi. Such an individualized approach often blinds us to the big picture, which in turn prevents us from identifying and eliminating inefficiencies.
We need to help our clinicians learn a new way of thinking, a new way of approaching care and a new way of being doctors. To help them, we must have this knowledge ourselves and we must know how to lead.
As physician-leaders we must also become more open-minded about using expertise from other industries to improve healthcare systems. Aeronautics and other high-risk fields can teach us a great deal about finding and reducing errors and inefficiencies.
We also must remember to look to all members of our healthcare team for insight on improving quality and safety. Wise and humble physician-executives understand that their front-line-care providers are wellsprings of important information.
Many smart leaders have introduced safety-walk rounds in their institutions, for example, an exercise that demonstrates the leader’s dedication to safety and quality while bringing together those who influence care and those who provide it.
Physician-leaders also need a cadre of practical skills to effectively perform the roles they’re being increasingly asked to fill. Effective leadership requires an ability to listen, negotiate and partner with others—skills that we can learn.
But education alone is not enough. We also need to recognize that physicians and other healthcare staff need adequate reasons to engage in patient-safety efforts. Whether it’s additional pay for improving safety, or additional benefits such as more time off, physicians, nurses and others need tangible incentives to help them engage in quality initiatives.
Collectively, we need to hold our profession accountable for acquiring the knowledge and skills necessary to effectively lead our medical staff and organizations strongly into the future. We must invest our time, energy and dollars into making this happen. We can get there, but we need to be willing to ask for directions.
