Physicians as Leaders

The ACPE has just published a white paper on the value of physician leadership by Peter Angood and Susan Birk (may-june-white-paper-(small)) . I would encourage leaders from all disciplines in health care to read it. In addition to nicely illustrating the value of physicians participating as leaders, it provides insights as to how physicians  can be better leaders, and suggests the journey that they must go through to get there. For non-physicians to understand the journey could be valuable as well.

Physicians are typically intelligent quick learners who are outcomes-driven and often innovative problem-solvers. However, their training and the skills that often make them great physicians can get in the way of their ability to lead. The white paper shows a table from an October 2012 issue of Trustee magazine. The table compares the nature of medicine to the nature of leadership. For non-physicians to understand where physicians are coming from during those crucial dialogues could help turn those discussions into collaborative learning. Physicians who want to be better leaders ought to study this table as well. It points out that to go from practicing physician to physician executive, one must give up autonomy and isolated problem-solving for collaboration and narrow scope and predictability for broad perspective and ambiguity.


Children’s hospitals are blessed with committed and compassionate physicians (many of whom were also likely to be in the top 10 of their graduating medical school classes). These physicians often have great ideas and are often very engaged. They have a strong desire to help their institution solve problems. These same physicians are also used to dealing with relatively well-defined problems (and if they’re not, making them so before tackling them). They are also used to receiving lots of thanks and praise from others (or at least a sustaining dose of it). As a physician makes the transition to leadership, they will find themselves dealing with messy problems that are ill defined and have no simple easy clear answer. They will meet resistance to change, complaints about all sorts of things and very little thanks.

We need physicians to be leaders at all levels. For some they will struggle to make these shifts, but they’re input and participation is still valuable. For others it will take them time, but their other strengths make the waiting worthwhile. And then for some, the transition will be successful enough to allow them to be great leaders at a time when we need great leaders. The challenge for those physicians will be to stay connected with their clinical past in order to maintain their credibility with those physicians who continue doing the great work of delivering and continuously improving health care.

A few physician leaders will need to be more transformational leaders than transactional leaders.  The best leaders will recognize the value of both approaches and be adept at both.  Yet, they will tend to the transformational.  These leaders will meet more resistance, perhaps to the brink of rejection, and less thanks, even in the face of success.

A leader who has a transformational North Star with a principle-centered approach grounded in the power of relationships and collaboration is what is needed in today’s dynamic and uncertain health care environment.  To persevere s/he will need to embrace humility and servant leadership.

-Thanks for reading, Nate



A Note on Health Care Reform and Children’s Health Care

The affordable care act was designed in part to reduce health care costs.   A principal strategy is to bring the issue of cost per “unit” of care to the table of decision-making in a much more transparent way, while shifting the burden of costs more directly to those receiving the care (the patients) and to those delivering the care (the providers). The presupposition is that if the patients share more of the cost they will utilize fewer health care resources and if the providers share risk they will make health care delivery more efficient and safe, with less overuse and waste.  With price as a more prominent driver of consumer choice, prices will drop in a competitive market place.  Disruptive innovations will be encouraged.

So, what does this mean for us involved in delivering children’s health care?  It means that in addition to improving health increasingly more effectively and on a larger scale, we must also lower the cost per unit of care.   Preventive care, subspecialty care, treatment of acute and chronic illness, procedures, and many of the things we do to help our patients, we must do at a lower cost. Preventable harm and complications, reworks and duplications of care, and inefficient use of people and resources must be minimized.

We have been rewarded on volume (fee-for-service) for a very long time. Our systems, processes, and the way we think are all geared towards producing high volumes.  Many physicians’ compensation is largely dependent on this one measure of work. This has created a way of doing things that will make it difficult for many health care organizations to do well in the new order of health care, whenever that might arrive.

And therein lies the conundrum, when will value based purchasing truly arrive?  Some are thinking it will be years and its best to not change things until it arrives.  What do you think Children’s Hospitals ought to do to position themselves for the future?

I for one think children’s hospitals need to lead the way.