Common Denominators of Success.

There is no mystery to the success stories described in this column. In addition to a lot of hard work, a few basic principles hove been applied to widely differing scenarios. These common denominators provide the philosophies and dynamics that can lead to your breakthroughs in quality health care delivery: (1) Trust--among the physicians and then between them and management and the board of directors; (2) positive physician culture and attitudes; (3) effective physician leadership; (4) patient care focus; (5) strong team orientation; and (6) true accountability by all stakeholders. Your job is to help your physicians feel they are major stakeholders in your health care delivery system and be their voice in clinical and financial decision-making at the highest level.

KEY CONCEPTS

* Physician Executive Success Stories

* Creating Trust

* Positive Physician Culture and Attitudes

* Effective Leadership

* Patient Care Focus

* Strong Team Orientation

* True Accountability by All Stakeholders

Here are some success stories I've heard from physician executives across the country to get the year off to a good start. You'll read these words months later, but they were written on the first day of the new millennium--as an acknowledgment of the positive developments that are beginning to accumulate. The list is growing and the trend is in the right direction.

* Success in a rural environment

A modest-sized rural health system in a tightly knit community is meeting market needs and also making money. Its physicians feel they are engaged in a genuine collaboration effort with system management. As a result, there is real openness for positive developments on the part of the physicians. This true "gem" of a health care system has tremendous potential as a community-based initiative. It's succeeding while many similar-sized hospitals have found it necessary to merge or close.

* Good news in an integrated system

A Midwestern integrated health care delivery system has been so successful that it's difficult to tell where the hospital begins and the clinic ends. Physicians partner with managers and handle profit/loss responsibilities for clinical service centers. All the physicians and clinical services are under the same leadership. Physician governance and system governance have strong mutuality. Things are functioning effectively, in large part due to the character and integrity of the individuals involved, including both physicians and non-physicians. Professionalism is extremely high here.

* A group practice gets it right

Despite many failures by PPMs across the country, one dramatic exception is a group practice that recently came to my attention. When the group's eight internists agreed to be acquired by a large health care delivery system, they entered the relationship solely to gain access to capital--and it worked. A key part of the agreement was that the group maintains its ability to be independent of the larger entity. This, of course, mandates fiscal solvency. One aspect of this sense of being in charge of their destiny is they are acutely attuned to production concerns. At times, the group members have taken the initiative to request a reduction in their compensation when their production has dipped.

* Building systems around physicians

A smaller hospital in a large city has paid attention to building systems around its physicians, and it's paid off in a big way. In an approach maximizing the contributions of care managers, the patient care management team's workers have become the first line of communications with the payers. The care management team members are sought out by the physicians for their facilitation abilities.

Common denominators of success

There is no mystery here. In addition to a lot of hard work, a few basic principles have been directly applied to widely differing scenarios. These are some of the common denominators that, if you introduce them into your health care system, will provide philosophies and dynamics that can lead to your own unique breakthroughs in quality health care delivery:

1. Trust, both among the physicians and then between them and management and the board of directors. With trust, good working relationships develop naturally.

2. Positive physician culture and attitudes. Physicians who feel engaged and participative will aspire to stronger performance and better outcomes. Regardless of what it says on the door--hospital, clinic, or health system--these physicians understand their roles in the organization.

3. Effective leadership. This is when physician executives can really shine, showing their legitimate contributions as physicians to management by blending clinical and financial considerations.

4. Patient care focus permeates the organization. When patient care is the driver, the right decisions are made more frequently.

5. Strong team orientation. A sense of team play can lead to outcomes far beyond what any individual can achieve. In addition, the complexity of contemporary health care means that matrix management structures can genuinely promote better patient care.

6. True accountability by all stakeholders. Physicians are stepping up with strong performance in accountability, a new dynamic in the wake of PPM failures.

Making it happen

Your job, of course, is finding ways to help your physicians feel they are major stakeholders in your health care delivery system. Notice that I didn't say "aligning physicians" or "integrating physicians." When those terms are used, the physicians often do all the aligning and integrating.

Being able to construct genuine partnership models where all participants and stakeholders are truly vested is a far stronger foundation for breakthrough developments. Size and scope of the health care system are less important than values and deeply held beliefs in leading to success.

Become an evangelist for physician accountability and partnership. Let physicians know you are their voice in clinical and financial decision-making at the highest level. When they know how committed you are to making it work, you'll receive their whole-hearted support.

Mary Frances Lyons, MD, is a Senior Consultant at Witt/Kieffer, Ford, Hadelman & Lloyd in St. Louis.