I admit I have an addiction. It's a passion for data that's so strong it lured me from my comfortable, secure practice as a primary-care physician to a challenging, volatile position as an executive at Meridia Health System, a large Cleveland-based healthcare organization.
By effectively using data, my medical management department has been able to quantify and improve performance in regard to length-of-stay, cost-of-care, complication and mortality rates for Meridia's four-hospital, 1,368-physician network. Achieving these improvements, however, has been an uphill, often grueling task fraught with physician skepticism.
It all started several years ago when managed care in the Cleveland market began dramatically altering the physician-hospital-payer relationship by putting significant pressure on the cost of delivering services. In response, Meridia's top executives, led by its chief executive officer, Charles Miner, felt it was imperative that its medical staff members and service line managers address specific DRGs so they could improve overall performance. This involved conducting a more complete study of what drives DRG performance and using clinical re-engineering to improve outcomes.
They needed someone to handle the job for them, and they thought of me. I had been medical director for a Cleveland-area HMO and was responsible for utilization management and quality improvement. It had been difficult to make the decision to take the Meridia position because I worried about giving up the perceived safety of my medical practice for the uncertainty of administrative work.
The data were what drew me to the administrative side. I had become fascinated with translating information into improvements in medical care. For example, at the HMO, we had increased the annual mammography screening rate to 49% from 17% (of women enrollees age 50 or older) in just two years. We achieved this by providing our physicians with statistical reports, gaining their consensus and rewarding them for following protocols.
When Miner heard I was leaving the HMO, he tried to convince me to join Meridia. I laughed because I believed the organization really was looking for a physician liaison for peace-keeping and social functions between the administrative and medical staffs.
I explained that I wanted to be able to work autonomously and creatively. To do this, I needed a department, a budget, authority and a free hand to do things that might be unpopular but necessary. Miner and I came to a handshake agreement within an hour, and in May 1996 I became senior vice president of medical management, with authority over quality management and ancillary departments.
I quickly realized that to be effective it's important to learn to do the right thing without worrying about other people's perceptions of me. In sports parlance, I wanted to be the team coach who tries to see the game objectively without taking losses personally or getting upset when some of the players don't follow the game plan exactly.
My focus was to be able to help our medical staff members survive the onslaught of managed care. I knew managed-care organizations had identified a number of our physicians, and if I did not do what was necessary, there would be considerable fallout and pain. I wanted to help our team be managed-care-ready and reduce the number of casualties I anticipated.
While I am committed to my fellow physicians, they don't all feel so positive. I used to work side by side with them, and now I am pestering them to make changes. Even though these changes are in their best interest, they often balk at them.
To enjoy the best possible relationships with my peers, I've learned that I need to maintain a candid, personal rapport with them. I also have developed skills to deal with adversaries. Specifically, when dealing with recalcitrant physicians, I take the time to fully discuss their specific concerns and leave them convinced that I understand the situation. And then I work to solve their problems.
As an administrator, it's important to repeat the above steps over and over. If physicians observe you repeatedly working to understand and solve their problems, they eventually will come to trust you.
Unfortunately, a number of people in leadership positions believe in the power of intimidation and control. I believe the opposite: You should work to understand -- and craft a way to meet -- others' needs. Since this is something we're not taught in medical school, it requires a lot of reading outside the field, as well as experience in interpersonal relationships.
I constantly try to prove myself by:
At Meridia, we've enjoyed a number of successes in the past year or so. They include:
There are many keys to our success, including our ongoing efforts to educate physicians and staff about the realities associated with Medicare, Medicaid and managed care. We also have a budget for sophisticated computer programs that allow relentless data reporting, including the publication of physician profiles, to our medical staffs.
Even more crucial is that our CEO and board of trustees have given me a great deal of freedom to make changes. This allows me to hire and retain talented people who act on initiatives even without majority support and who identify and publicize best practices.
Along the way, I've discovered that to create change, you don't have to gain support from the majority. Rather, you can be successful if a small portion of the group believes in you and your mantra. Then you must repeat the mantra to the point of nausea. Persistence pays.
My role is to bridge the gap between medical staff, community and business interests and help our physicians focus on succeeding as a unit. In the future, this role will become increasingly important to ensure the success of doctors and their associated healthcare organizations.
Kious, a familiy practitioner, is senior vice president of medical management at Meridia Health system, which is affiliated with the Cleveland Clinic Health System.