Tuesday, April 05, 2011

They have heard. Are they ready?

Cheryl Clark at Health Leaders Media offered this summary from a recent conference of the American College of Healthcare Executives (ACHE).

They have heard, and hopefully understand, how important it now is. They are going to have to change their organizations in major, cataclysmic ways especially if they haven't started to do so already.

Tom Dolan, president and chief executive officer of ACHE, says leadership in general is now "much more knowledgeable" about the steps they have to take. "They know they need to reduce costs. They understand they have to adopt Toyota and Lean manufacturing strategies. They know they have to reduce errors, medication mistakes, reduce readmissions and improve quality measures for specific diseases. "They know they have to dramatically re-engineer the way we provide care and can't tinker the way they have in the past."

Here is what I am not sure of, and I mean this with affection and respect. I am not sure that the current generation of leadership in academic medical centers knows how to do what is summarized above. I actually think that leaders of some community hospitals might be better trained in such matters. Why?

Well, the career path of people chosen to be leaders of academic medical centers tends to be based on success in the things valued in the academic medical environment. As is often the case in universities, people work their way up through the ranks of the faculty based on prowess in research and specialized clinical areas. Sure, as they become division and department chairs, they take some courses in business and management, but their promotions tend to be based more on academic achievement than on managerial and leadership skills. And the continuing education courses often do not include strong training in the kind of process improvement techniques and philosophies mentioned by Mr. Dolan.

There are, of course exceptions. I can think of a handful of people who have made the transition and have demonstrated great leadership in instituting these kinds of approaches in an academic medical center. Gary Kaplan at Virginia Mason in Seattle is the prime example.

But maybe I am wrong. Let's give my readers an invitation to offer the names of others they know in this category. This is your chance to brag! Which people in academic medicine are in the vanguard of the kind of change mentioned by Mr. Dolan?


Barry said...

Paul – I don’t know which other leaders are doing what Gary Kaplan is doing and has done but I’m not sure that’s the most important issue. To bring about the change that will improve healthcare quality and reduce costs at Academic Medical Centers, the following broader changes are needed:

1. More, if not all, of the doctors who practice in the hospital need to become hospital employees paid on a salary and bonus basis. That should make it easier to get buy in with respect to quality improvement initiatives like the use of checklists, more consistent hand washing, standardizing procedures in the OR, using fewer varieties of medical devices, etc. To get hired and stay employed, doctors need to embrace the concept of a collaborative team oriented culture as opposed to the independent, I know best mentality.

2. There needs to be two parallel career paths for physicians – researcher / publisher who also see some patients and doctors who primarily treat patients. Both groups should be paid compensation sufficient to attract and hold high quality people.

3. The payment model needs to move away from fee for service, at least for surgeries, and other procedures where a definitive diagnosis has already been determined.

4. The cost of educating the next generation of doctors needs to be covered by general revenue, not built into the charges for patient care. The research mission also needs to be covered by NIH grants, general revenue and philanthropy instead of charges for care.

5. Interoperable electronic medical records are needed to ensure maximum care coordination.

Numbers 1, 3 and 5 also apply to the community hospitals.

Anonymous said...

I believe the Cleveland Clinic is taking some steps in this direction, but have no direct knowledge.

But your post raises an important point - do we really have the right type of people leading our AMC's at this time of radical change? And if not, what are the implications for training the new generation of physicians at such institutions; how will they ever learn?

The other thing that struck me reading your quote is, gee, if they 'know', then how come there hasn't been more progress? Institutions, even in the community, implementing such change are in a tiny minority.

I wish you had still been there to lead them.


David Joyce MD said...

Essential Seminars 4 Physicians, ES4P.com address this issue. Business knowledge among leaders is not an adequate solution. A change in the culture is needed at all levels. Training the rank and file physican in leadership and process improvement is what is needed, otherwise there will be little buy-in of programs initiated by leadership. Let's face it, medical spending originates at the level of individual physicians, and true reform will start with them as well.

Anonymous said...

With respect to Barry' s post: From everything I've read and heard, the government (not patient care revenues) already provides the majority of funding for resident salaries.- Laura Burke

Anonymous said...

Although I am bias I believe the University of Kansas Hospital has made great strides from where they were 10 years ago, this even in a poor economic climate. The new leadership of Bob Page et al has taken one of the worst hospitals in the Kansas City area to what some believe the best, even in comparison to hospitals part of the St. Luke's Health System. The administration understands the needs to cut costs, readmissions, length of stay, etc so what they rely on is the importance of data. Bob Page is a former numbers guy so it came natural.

Hospitaldoctor said...

Cincinati Childrens, Uma Kotagal, Fred Ryckman, Steve Muething et al.

David Vaughan


Paul Levy said...

Excellent examples, for sure!