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MEDICINE CRIES FOR LEADERSHIP

 CLEVELAND, Dec. 21 /PRNewswire/ -- Following is an op-ed column provided by C. Cowan Gascoigne, president and founder of The Leadership Co., a consulting firm located in Cleveland, and former marketing director of The Cleveland Clinic Foundation:
 Our health-care system is critically ill. An aging population, expensive technology, Medicare mismanagement, the uninsured, and the easiest target of all, monolithic "money-wasting" hospitals, take most of the blame. I contend that the real issue is a leadership vacuum among U.S. physicians.
 Doctors may hold the patient's hand, but they also hold the purse strings of the health-care economy. The same physicians whose hearts, minds and hands are dedicated to healing the sick have always had it within their power to heal our sick health-care system too. But to do so, they must become leaders, as well as healers, team players as well as superstars.
 To a physician, the ultimate leadership model is the surgeon in the operating room. Individual competence, decisiveness, unquestioned authority and individual (not team) achievement are hallmarks of this model.
 In contrast, excluding operating rooms and other life-and-death situations, the best-led entities are one where leaders:
 -- Admit they don't know it all and actively seek input from others.
 -- Welcome questions and challenges.
 -- Communicate freely.
 -- View mistakes as learning opportunities.
 -- Celebrate successes as team achievements.
 That physicians do not practice this kind of leadership is not surprising. Entrance to medical school demands superior individual, not team, performance. And medical school itself works against teamwork, continually pitting student against student. There are no team projects and no brainstorming sessions.
 The head of one of the nation's best-known medical centers once admitted to me that nothing in his education or training had taught him to value teams. In his mind "committees" hurt quality and slow down progress. He and most physicians don't realize that a properly managed and motivated team can be expected to come up with a better answer (diagnosis?) than any individual, even if the individual is a brilliant physician.
 Yes, teams will take longer to reach decisions, but the decisions will be better ones, and the time required to implement them will be drastically reduced.
 Residency programs reinforce the need to be an all-knowing individual superstar. Prizes go to those with the most right answers. When asked a question during rounds, new residents will never turn to the others and say, "I'm not sure. What do you guys think?" This reluctance to ask for help continues throughout their careers. For Drs. Arrowsmith, Welby, Casey, Kildare and the whole gang at St. Elsewhere, there is only one answer, the right one -- the one they have just voiced. Business leaders know that admitting you don't know it all is a sign of good leadership. Physicians see it as a sign of weakness.
 Similarly, many physicians look upon a request for a second opinion as a betrayal of trust. So not surprisingly, a second opinion is always a "separate" opinion. Instances of doctors working together are more often duels than a meeting of the minds. There are dueling diagnoses, dueling lab reports, dueling X-rays and duels with non-M.D.'S.
 Physicians have a "set-apartness" to them that keeps them independent at best and rebellious at worst when it comes to attempting collaboration.
 The cost of this leadership mismatch has mushroomed as more and more physicians are being thrust into positions of leadership at hospitals, managed-care facilities, medical schools, group practices and even as solo practitioners who make resource allocation decisions on behalf of their patients.
 These costs include greatly increased chances for failed programs, waste, misdiagnoses, mistreatment and lost opportunities for innovation. Physicians who compete rather than collaborate, for instance, are more likely to duplicate diagnostic tests rather than "trust" the results of other physicians. And they are more likely to overlook key data or alternative diagnoses, because they don't solicit others' input. The cost in lives and dollars from innovations that haven't been developed because physicians haven't collaborated is immeasurable.
 The fire for changing the healthcare system can be fueled by patients who begin demanding collaboration among their providers and by payers who can begin to pressure medical schools to change the way physicians are educated. But physicians themselves, more than any other group, have the capability to cure the care industry. They must in words W. Edwards Deming used to counsel American businesses who wished to compete with Japan, "awaken to the challenge, learn their responsibilities, and take on leadership for change."
 The long-range and long-reaching challenge comes in making leadership -- not just technical knowledge -- an integral part of medical education. Imagine, for instance, medical school projects being graded by team rather than individual effort, and also requiring residents to submit team proposals for treatment programs.
 Many physicians are already good leaders, but they are typically the unsung heroes overlooked at promotion time. This cannot continue. The AMA and other medical associations need to showcase physicians who exemplify responsible leadership and to make leadership development a hallmark of their organizations.
 Embracing these concepts will be a challenge for physicians who are more comfortable on a pedestal than in a conference room. But some have already done it. And all can do it. It's merely a matter of desire and practice.
 Physicians have an opportunity and an obligation to lead the way in making American health care not only the best, but the most affordable, accessible and cost-effective in the world. For physicians, leadership is a new dimension of service; for the health-care industry, physician leadership is the road to recovery.
 -0- 12/21/92
 /CONTACT: C. Cowan Gascoigne of the Leadership Company, 216-292-8181, or Crickett Karson of Mills Hall Walborn & Associates, Inc., 216-646-9400, for The Leadership Company/


CO: The Leadership Company ST: Ohio IN: HEA SU:

BM -- CL002 -- 8751 12/21/92 11:47 EST
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Date:Dec 21, 1992
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