Commentary
POPULATION HEALTH MANAGEMENT Volume 0, Number 0, 2014 ª Mary Ann Liebert, Inc. DOI: 10.1089/pop.2014.0095
Population Health, Physician Leadership, and Quality Byron C. Scott, MD, MBA 1
2-year administrative fellowship while also serving as a junior faculty attending at an emergency medicine residency, which came immediately after residency with a focus on quality improvement and management as a core competency.3 A recent editorial by Dr. David B. Nash gave an overview highlighting some of the work being done by the Association of American Medical Colleges (AAMC) and the Accreditation Council for Graduate Medical Education (ACGME) to make quality and patient safety an important part of graduate medical education.4 I recently saw this in action when I was on a quality webinar and witnessed a firstyear medical resident answer a question about patient safety and use electronic health records while he was doing a quality elective under the supervision of the medical director of clinical quality at Kettering Medical Center in Dayton, Ohio. Other formal degree programs such as masters and doctorate programs in patient safety, health care quality, and medical informatics around the world are also an option for leadership development. Crucial to the success of the AAMC and ACGME will be continued funding and support from both the government and private sector to provide this additional education and training for physicians.
Introduction
H
ealth care leaders read their daily news alerts and monthly journals of choice with the mention of population health during this era of the Affordable Care Act and Accountable Care Organizations (ACOs) in the United States and the drive for quality improvement internationally. Population health strategies vary among health care organizations; however, alignment of physicians with an organization’s strategy is crucial to achieve success. Hospitals and physician groups may want an overall population health approach to improve the overall health of the populations they serve, or want new payment models such as the Medicare Shared Savings Program (MSSP) and bundled payments. Underlying all of this, every organization is inherently concerned about improving health care quality and patient safety. The challenges to improving quality in health care involve not only changing organizational culture but improving our leadership, something that occurs wherever health care occurs in the world.1 We must be mindful that even with the most technologically advanced information technology, electronic health records, and other health analytics tools to help us with population health or quality improvement, organizations will have limited success unless we have physician leaders to manage and drive results.
Leadership Development
During my more than 20-year health care management career as a medical director managing physicians and as a physician executive managing medical directors working for a physician practice management company, I have seen many physician leaders without formal leadership training to help them perform their jobs. Some of them have done well and others have struggled in the absence of formal training. Every hospital and physician group should perform a needs assessment of your current physician leadership hierarchy. This involves the physicians you are recruiting as well as your current physician leadership. Effective leadership involves mentoring, succession planning, and fostering leadership development.5 I am fortunate to have had the pleasure during my career to develop and mentor, including a succession plan for several physician leaders, all of whom have excelled in their current leadership roles. Part of my success as a mentor is directly related to having many great mentors during my career, most of them as my immediate
Graduate Medical Education
To accomplish these goals, one thing is certain—you need data that can be understood to improve patient outcomes. W. Edwards Deming and others have been referenced as saying, ‘‘You can’t manage what you don’t measure’’ to emphasize this point. Physicians influence the majority of revenue, cost, and outcomes in hospitals with admissions, discharges, surgeries, and ordering of diagnostic tests.2 These decisions must be taught and imprinted early with a focus on prevention because they will affect readmissions, mortality, complications, and other quality indicators. If you want to help manage physicians and practice variation, you need leaders to lead them. This leadership needs to begin where physicians are being trained and educated, such as medical school, residencies, and fellowships. Twenty years ago, I was fortunate to have had formal leadership training during my 1
Truven Health Analytics, Chicago, Illinois.
1
2
supervisor. Look for leadership interest in the curriculum vitae or re´sume´ of your potential physician recruits by reviewing publications history; past leadership experience in medical school, residency, or fellowship; and whether they have graduate degrees such as a Master of Business Administration, Master of Health Care Administration, Master of Public Health, or Master of Medical Management. Perform an analysis of the current structure within your physician hierarchy. Most hospitals will have a medical executive leadership including a chief of staff and chief medical officer. Some will even have a chief quality officer, ideally a practicing physician dedicated to achieving patient safety and health care quality goals. Some health care organizations have even begun recruiting for a physician chief of population health with the new focus on the overall health of populations.6 Paramount to survival will be finding a way to invest in physician leadership despite what it costs as medical schools and graduate medical education face funding challenges and decreases. Once you have the structure and people in place, make sure you educate and train your leaders. Develop a list of core competencies your leaders need to learn, including quality, patient safety, health analytics, evidence-based medicine, process of care measures, electronic health records, health law, ethics, patient satisfaction, managing physician performance, and population health. With regard to managing physician performance, be sure your leaders learn and hopefully even earn certification in process improvement techniques such as lean or Six Sigma, along with understanding ways to reduce physician practice variation.7 Managing physician behavior and conflict management is important because impaired physician issues and issues brought to the peer review committee all have a direct impact on patient quality and safety. It is also important for physician leaders to have financial literacy in hospital and physician group finance, given that they will have a key role in hospitals surviving the value- and at-risk-based world of ACOs and MSSP. There are many options to achieve this education, such as sending your physician leaders to boot camps, formal courses, or custom on-site education offered by many health care leadership organizations. Some health care systems such as the Cleveland Clinic have been training physician leaders for years using programs developed internally to address these leadership demands.8 Other programs exist, but the point is that it takes a vision and commitment to create a culture of quality by investing in physician leadership. Conclusion
No longer can medical schools, graduate medical education, hospitals, and physician groups around the world be passive regarding physician leadership development. A very active and detailed leadership development plan is important to create physician engagement and alignment to continue
SCOTT
fostering patient safety and health care quality.9 In reality, it must begin in graduate medical education with the funding and development of more administrative fellowships for physicians to create leaders focused on improving quality and patient safety as we focus more on overall population health. Author Disclosure Statement
Dr. Scott declared no conflicts of interest with respect to the research, authorship, and/or publication of this article. Dr. Scott received no financial support for the research, authorship, and/or publication of this article. References
1. Dixon-Woods M, McNichol S, Martin G. Ten challenges in improving quality healthcare: Lessons from the Health Foundation’s programme evaluations and relevant literature. BMJ Qual Saf. 2012;21:876–884. 2. Emanual E, Steinmetz B. Will physicians lead on controlling health care cost? JAMA. 2013;310:374–375. 3. Scott B. Administrative fellowship in emergency medicine. Physician Exec. 1995;21:35–36. 4. Nash D. Converging on quality and safety. http://jdc.jefferson .edu/hpn/vol27/iss1/2. Accessed March 20, 2014. 5. McMurray A, Henly D, Chaboyer W, Clapton J, Lizzio A, Teml M. Leadership succession management in a university health faculty. Journal of Higher Education Policy and Management. 2012;34:365–376. 6. Punke H. Health system c-suiters, meet the chief of population health officer. http://www.beckershospitalreview.com/ leadership-management/health-system-c-suiters-meet-thechief-population-health-officer.html. Accessed March 25, 2014. 7. Dlugacz Y, Sweetapple C. Tools for quality improvement: Six Sigma. In: Nash D, Clarke J, Skoufalos A, Horowitz M, eds. Health Care Quality: The Clinician’s Primer. Tampa, FL: American College of Physician Executives; 2012:279– 294. 8. Stoller J, Berkowitz E, Bailin P. Physician management and leadership education at the Cleveland Clinic foundation: Program impact and experience over 14 years. J Med Pract Manage. 2007;22:237–242. 9. Taitz J, Lee T, Sequist T. A framework for engaging physicians in quality and safety. BMJ Qual Saf. 2012;21: 722–728.
Address correspondence to: Byron C. Scott, MD, MBA Truven Health Analytics 1 North Dearborn Suite 1400 Chicago, Illinois, 60602 E-mail: [email protected]
POPULATION HEALTH MANAGEMENT Volume 0, Number 0, 2014 ª Mary Ann Liebert, Inc. DOI: 10.1089/pop.2014.0095
Population Health, Physician Leadership, and Quality Byron C. Scott, MD, MBA 1
2-year administrative fellowship while also serving as a junior faculty attending at an emergency medicine residency, which came immediately after residency with a focus on quality improvement and management as a core competency.3 A recent editorial by Dr. David B. Nash gave an overview highlighting some of the work being done by the Association of American Medical Colleges (AAMC) and the Accreditation Council for Graduate Medical Education (ACGME) to make quality and patient safety an important part of graduate medical education.4 I recently saw this in action when I was on a quality webinar and witnessed a firstyear medical resident answer a question about patient safety and use electronic health records while he was doing a quality elective under the supervision of the medical director of clinical quality at Kettering Medical Center in Dayton, Ohio. Other formal degree programs such as masters and doctorate programs in patient safety, health care quality, and medical informatics around the world are also an option for leadership development. Crucial to the success of the AAMC and ACGME will be continued funding and support from both the government and private sector to provide this additional education and training for physicians.
Introduction
H
ealth care leaders read their daily news alerts and monthly journals of choice with the mention of population health during this era of the Affordable Care Act and Accountable Care Organizations (ACOs) in the United States and the drive for quality improvement internationally. Population health strategies vary among health care organizations; however, alignment of physicians with an organization’s strategy is crucial to achieve success. Hospitals and physician groups may want an overall population health approach to improve the overall health of the populations they serve, or want new payment models such as the Medicare Shared Savings Program (MSSP) and bundled payments. Underlying all of this, every organization is inherently concerned about improving health care quality and patient safety. The challenges to improving quality in health care involve not only changing organizational culture but improving our leadership, something that occurs wherever health care occurs in the world.1 We must be mindful that even with the most technologically advanced information technology, electronic health records, and other health analytics tools to help us with population health or quality improvement, organizations will have limited success unless we have physician leaders to manage and drive results.
Leadership Development
During my more than 20-year health care management career as a medical director managing physicians and as a physician executive managing medical directors working for a physician practice management company, I have seen many physician leaders without formal leadership training to help them perform their jobs. Some of them have done well and others have struggled in the absence of formal training. Every hospital and physician group should perform a needs assessment of your current physician leadership hierarchy. This involves the physicians you are recruiting as well as your current physician leadership. Effective leadership involves mentoring, succession planning, and fostering leadership development.5 I am fortunate to have had the pleasure during my career to develop and mentor, including a succession plan for several physician leaders, all of whom have excelled in their current leadership roles. Part of my success as a mentor is directly related to having many great mentors during my career, most of them as my immediate
Graduate Medical Education
To accomplish these goals, one thing is certain—you need data that can be understood to improve patient outcomes. W. Edwards Deming and others have been referenced as saying, ‘‘You can’t manage what you don’t measure’’ to emphasize this point. Physicians influence the majority of revenue, cost, and outcomes in hospitals with admissions, discharges, surgeries, and ordering of diagnostic tests.2 These decisions must be taught and imprinted early with a focus on prevention because they will affect readmissions, mortality, complications, and other quality indicators. If you want to help manage physicians and practice variation, you need leaders to lead them. This leadership needs to begin where physicians are being trained and educated, such as medical school, residencies, and fellowships. Twenty years ago, I was fortunate to have had formal leadership training during my 1
Truven Health Analytics, Chicago, Illinois.
1
2
supervisor. Look for leadership interest in the curriculum vitae or re´sume´ of your potential physician recruits by reviewing publications history; past leadership experience in medical school, residency, or fellowship; and whether they have graduate degrees such as a Master of Business Administration, Master of Health Care Administration, Master of Public Health, or Master of Medical Management. Perform an analysis of the current structure within your physician hierarchy. Most hospitals will have a medical executive leadership including a chief of staff and chief medical officer. Some will even have a chief quality officer, ideally a practicing physician dedicated to achieving patient safety and health care quality goals. Some health care organizations have even begun recruiting for a physician chief of population health with the new focus on the overall health of populations.6 Paramount to survival will be finding a way to invest in physician leadership despite what it costs as medical schools and graduate medical education face funding challenges and decreases. Once you have the structure and people in place, make sure you educate and train your leaders. Develop a list of core competencies your leaders need to learn, including quality, patient safety, health analytics, evidence-based medicine, process of care measures, electronic health records, health law, ethics, patient satisfaction, managing physician performance, and population health. With regard to managing physician performance, be sure your leaders learn and hopefully even earn certification in process improvement techniques such as lean or Six Sigma, along with understanding ways to reduce physician practice variation.7 Managing physician behavior and conflict management is important because impaired physician issues and issues brought to the peer review committee all have a direct impact on patient quality and safety. It is also important for physician leaders to have financial literacy in hospital and physician group finance, given that they will have a key role in hospitals surviving the value- and at-risk-based world of ACOs and MSSP. There are many options to achieve this education, such as sending your physician leaders to boot camps, formal courses, or custom on-site education offered by many health care leadership organizations. Some health care systems such as the Cleveland Clinic have been training physician leaders for years using programs developed internally to address these leadership demands.8 Other programs exist, but the point is that it takes a vision and commitment to create a culture of quality by investing in physician leadership. Conclusion
No longer can medical schools, graduate medical education, hospitals, and physician groups around the world be passive regarding physician leadership development. A very active and detailed leadership development plan is important to create physician engagement and alignment to continue
SCOTT
fostering patient safety and health care quality.9 In reality, it must begin in graduate medical education with the funding and development of more administrative fellowships for physicians to create leaders focused on improving quality and patient safety as we focus more on overall population health. Author Disclosure Statement
Dr. Scott declared no conflicts of interest with respect to the research, authorship, and/or publication of this article. Dr. Scott received no financial support for the research, authorship, and/or publication of this article. References
1. Dixon-Woods M, McNichol S, Martin G. Ten challenges in improving quality healthcare: Lessons from the Health Foundation’s programme evaluations and relevant literature. BMJ Qual Saf. 2012;21:876–884. 2. Emanual E, Steinmetz B. Will physicians lead on controlling health care cost? JAMA. 2013;310:374–375. 3. Scott B. Administrative fellowship in emergency medicine. Physician Exec. 1995;21:35–36. 4. Nash D. Converging on quality and safety. http://jdc.jefferson .edu/hpn/vol27/iss1/2. Accessed March 20, 2014. 5. McMurray A, Henly D, Chaboyer W, Clapton J, Lizzio A, Teml M. Leadership succession management in a university health faculty. Journal of Higher Education Policy and Management. 2012;34:365–376. 6. Punke H. Health system c-suiters, meet the chief of population health officer. http://www.beckershospitalreview.com/ leadership-management/health-system-c-suiters-meet-thechief-population-health-officer.html. Accessed March 25, 2014. 7. Dlugacz Y, Sweetapple C. Tools for quality improvement: Six Sigma. In: Nash D, Clarke J, Skoufalos A, Horowitz M, eds. Health Care Quality: The Clinician’s Primer. Tampa, FL: American College of Physician Executives; 2012:279– 294. 8. Stoller J, Berkowitz E, Bailin P. Physician management and leadership education at the Cleveland Clinic foundation: Program impact and experience over 14 years. J Med Pract Manage. 2007;22:237–242. 9. Taitz J, Lee T, Sequist T. A framework for engaging physicians in quality and safety. BMJ Qual Saf. 2012;21: 722–728.
Address correspondence to: Byron C. Scott, MD, MBA Truven Health Analytics 1 North Dearborn Suite 1400 Chicago, Illinois, 60602 E-mail: [email protected]
