CEOs as saviors? Are the CEOs of not-for-profit health care organizations the most likely people to successfully organize physicians? (Rising to the Top).

Discover why one physician executive thinks they are.

Forces transforming health care make it critical that physicians unite. They must unite to:

* Comply with the regulatory environment.

* Tackle the growing complexity and cost of managing the business side of medicine

* Successfully apply the expanding knowledge of clinical medicine

* Achieve some economies of scale

* Simplify processes and create more time

The problem is that physicians have no frame of reference for working together.

We value personal autonomy above everything else. Our collegiality celebrates individuality and differences. Physicians comprise an expert culture where individual success reflects the consequences of individual performance and where power and accomplishment are the primary motivators. Teamwork to physicians implies a golf team.

Individuals within an expert culture make decisions from a personal frame of reference one issue at a time. That is why an encompassing organizational vision must be broad enough to allow each individual to see that it encompasses goals that they personally value. (1)

Speak for yourself

Away from the bedside, the only experience physicians have with acting collectively involves medical staff activities. Anyone who has tried to do business at the medical staff level quickly recognizes how frustrating it can be.

I sometimes believe that the one thing that unites physicians is their mutual commitment to the preservation of individual physician prerogatives. Consider how difficult it is to accomplish peer review and credentialing activities.

Physicians who presume to lead their colleagues do so at their own peril. The response is often something like "So who died and left you boss?" While physicians are quick to express their individual opinions, they are reluctant to speak on behalf of their colleagues. That's because they would resent anyone else presuming to speak for them.

When physicians act collectively, there is an overriding concern to manage for consensus by finding solutions that are the least objectionable to the most people. All groups resist change. (2) When you have a group that seeks to manage for consensus, you magnify that resistance and reject those who would articulate for change.

These cultural dynamics not only create a paucity of leadership, but also an even greater lack of willing followership. The competitiveness that characterizes physicians predisposes them to distrust, and with their emphasis on personal control and autonomy, they reject followership.

Physicians are taught to respect those who are the most clinically competent. That respect is typically given to physicians operating in the environment that stresses individualism.

However, physicians who are most open to change are often those who have not been very successful within the historical model of traditional medical practice. With their lack of traditional success, they win little respect from their mainstream peers who see their potential leadership role as illegitimate. This further limits potential physician leadership.

Differences divide

Also within the medical community, there are a number of conflicting subsets:

* Primary care physicians versus specialists

* Urban versus rural

* Hospital-based specialists versus non-hospital based physicians

* Academicians versus community practitioners

Cutting across these subsets are generational differences in behavior and attitude. These differences make it even more difficult for physicians to unite.

Almost all attempts to aggregate the physician community have failed. Examples of business failures include:

* Medical services organizations 

* Physician hospital organizations

* Physician employment models

* Foundation models

* Acquisition and/or management of physician practices by either for-profit or not-for-profit organizations

Virtually all of these focused solely on structure, governance and economics. Little time was spent defining the "why" and "what" of the enterprise, the metrics that define success or the guiding principles for decision making in pursuit of the primary purpose of the organization.

I am convinced that provider organizations that come together primarily in pursuit of personal economic gain never survive a contracting marketplace. They are merely zero-sum games of economic self-interest that disintegrate into bickering over dollars.

If you agree that physicians need to come together in response to changes in the medical marketplace, who can successfully serve to lead this initiative? It is my belief that the people best positioned to lead this effort are the CEOs of not-for-profit health care organizations.

Economic success is important, but it must be a derivative of the CEOs vision for patient care, not the sole goal of the organization. That is why leadership must come from the not-for-profit sector.

The courage to change

Hospitals cannot succeed without partnering with physicians. And while many physicians can practice medicine independent of the hospital, the need for capital still ties many to the infrastructure that is only affordable within the larger health care enterprise.

After this interdependency is acknowledged, the need to cooperate is obvious.

Leveraging this cooperation, not-for-profit health system/hospital GEOs can promote an encompassing transcendent vision that brings out the best in the physician community, centers on patient care and provides physicians with hope.

This, in turn, lays the groundwork to unite physicians in pursuit of shared values and fuels the positive energy necessary to sustain the organization and achieve economic success.

References

(1.) Atchison, T. and Bujak, S. Leading Transformational Change: The Physician-Executive Partnership. Chicago, Ill., Health Administration Press, 2001.

(2.) O'Toole, J: Leading Change. New York, New York, Ballentine Books, 1995.

Joseph Bujak, MD, FACP, is vice president of medical affairs for Kootenai Medical Center, Coeur d'Alene, Idaho, and an affiliate of the Kaiser Consulting Network. He focuses on the reorganization of the provider community and the redesign of health care delivery. He can be reached by phone at 208/666-2014 or by e-mail at [e-mail].