The delivery of healthcare in the US is terrible right now. Nurses and physicians have been the backbone of healthcare since before the civil war. Physicians (and probably nurses) are perfectly placed to be the leaders, not only in the clinical side but also in the delivery and management of healthcare. Read on to find out why.
This is the third of a three part series looking at why physicians should be CEOs in healthcare.
Here are links to the other posts:
Why We Need More Physicians as CEOs in Healthcare- Part 1: Defining the CEO
Why We Need More Physicians as CEOs in Healthcare- Part 2: Defining Physicians
OK. Wasn’t sure how to finish this. If you read Part 1 you learned about missions and visions. You learned about CEOs supporting these with strategy. You learned about CEOs being in charge of just three things: culture, people and numbers. Part 2 looked at physicians. What kind of people become physicians. What makes a good physician and what are physicians bad at. Finally what traits did surgeons have that stood out.
Now we get to combine Parts 1 and 2.
This is where it gets interesting. Healthcare is not about selling burgers or cars. The balance sheet is but part of the equation. Healthcare is something that affects everyone. It’s personal. It’s emotional. It’s visceral. The experience of being a patient is something we all go through. We can get new cars or buy a different burger from a different chain but how we deal with the frailties of the human physical condition whose management may have lifelong implications. Mental and physical health issues can have extreme impacts on our overall wellbeing.
Our Achilles Heel is how this care is delivered.
As I said in Part 2 American healthcare is high quality and low value.
Most consumers will say their family physician is a good person and they trust them. Navigating getting medical testing or a procedure, however, is a nightmare. The coalface employees, be they nurses, APPs, physicians, techs or even cleaning staff face hurdles related to staffing, workload, supplies and demands that may not happen in other industries. Healthcare is not selling burgers.
What Makes a Physician CEO Different
In part 1 we talked about what a CEO does: culture, people and numbers. Most physicians are ethical and lead by example. Many go over and above. Physicians have the ability to manage people. Physicians have the ability to foster corporate culture. With respect to numbers, many physicians acquire business skills through graduate degrees (MBA/MHA). Physicians have the essential ingredients for executive leadership. Many physicians, in addition to having mastered these three skill sets, also uniquely have worked at most levels of the a healthcare organization and worked with many of the frontline non-physician workers who are the essential backbone that delivers healthcare.
Healthcare is about people.
When we talk about the CEO of Tesla or Starbucks the terms altruism, compassion and empathy are not the first things that spring to mind but in healthcare because the products are delivered at such a personal level this attributes are important for executives to have. Corporate Social Responsibility (CSR) is about as close as most companies get to these attributes, but for many, it’s marketing stunt to satisfy part of their customer base.
What About The Numbers
Balance sheets, cash flow, expense reports and so on are all part of running a company or an organization. Appreciation of this is often listed as the missing piece in physician leadership skill sets. Business acumen comes in many ways. Many physicians learn skills with human resources, organizational behavior, accounting and strategy through running practices or medical departments. Many also obtain masters level business degrees to complement their clinical training. At the end of the day most organizations have CFOs, CTOs etc etc who have the gritty knowledge that allows the CEO to make the big decisions. CEOs don’t get into the weeds as much as look to the horizon.
Times Of Leadership
Take a look at the infographic below. There are various styles of leadership in organizations.
In healthcare not all of these work. I would argue that servant leaders are the most suited to healthcare with elements of visionary and democratic leadership.
Narcissistic leadership is the worst. Why? Read this blog. Most physicians have empathy, compassion and altruism as their strengths and servant leadership comes naturally.
The Mayo Clinic Model
Let’s take a look at the Mayo Clinic model. Mayo Clinic is ranked as the number #1 medical center/hospital in the US, if not in the world. Think about. The #1 ranked hospital. It is recognized for its clinical excellence, groundbreaking research and through its use of advanced technology that integrates patient care.
Surely to become number one, the Mayo Clinic has discovered the secret sauce? That sauce covers patient care, culture, its people, its staff, its balance sheet? Well let’s look at one thing that Mayo Clinic does that stands out, it’s governance.
Mayo Clinic governance leans heavily on its physician leadership.
Mayo Clinic has 3 locations, one in Minnesota, one in Arizona and one in Florida:
- The CEO and President of Mayo Clinic in Rochester, Minnesota is Gianrico Farrugia, MD who is a gastroenterologist.
- The CEO of the Mayo Clinic, Scottsdale, Arizona is Richard Gray, MD, who is a surgical oncologist.
- The CEO of the Mayo Clinic, Jacksonville, Florida is Kent Thielen, MD, who is a radiologist.
What do these three leaders have in common? All three are physicians and CEOs. All have worked worked at the coalface in patient care. All three now are the executive leaders of the number one rated hospital campus in the country. Mind blowing.
Let’s look at Mayo Clinic’s mission statement and vision:
“Inspiring hope and promoting health through integrated clinical practice, education and research”.
Altruism, empathy and compassion echo through this.
The Mayo Clinic Model shows that executive physician leadership is integral to success in whatever way you want to measure it. Mayo has shown clinically, reputation-wise and financially they are successful by whatever KPI you use.
Mayo Clinic is a model of physician-led leadership:
Senior physician leadership is groomed into administrative leadership. From an article published in 2018, Jeffrey Bolton, the chief administrative officer at that time, talks about John Noseworthy, MD who was CEO at that time:
“Another feature that distinguishes the Mayo Clinic is that it’s a physician-led organization, which is fairly rare. Yet this model leads to better quality of care that routinely lands the clinic atop the lists of best hospitals… … Mayo Clinic uses a “leadership dyad” model in which a physician leader is paired with an administrative partner. Bolton himself is the administrative partner to president and CEO John Noseworthy, a neurologist and multiple sclerosis specialist”
Bolton further states:
“Putting doctors in charge of the organization is one way that the Mayo Clinic ensures that it provides the best care for patients. This approach is taken by the entire clinic, including its research and educational branches. “We are really very conscious about having our physicians and scientists co-lead”
Mayo Clinic exemplifies what can happen when physicians assume executive roles in a healthcare organization.
I had the privilege of completing a fellowship at the Mayo Clinic in Rochester, Minnesota. Their ability to provide healthcare, their patient focus and the culture that was fostered for staff 20 years later is the best I have seen.
HealthCare is People
There are many stakeholders in healthcare:
At the end of the day it’s a people business. The bulk of these people are patients and consumers, clinicians and healthcare workers. It is for this reason empathy, compassion and altruism should not be sacrificed in the administration of healthcare. This is what we, uniquely as physicians, bring to the table.
American Healthcare = High Quality/Low Value.
I stated at the outset that the delivery of American healthcare is not in a good place. High quality. Low value. As physicians we were so busy looking after patients, we gave the other duties away. Over 70% of U.S. physicians are now employed. Healthcare is not tech. It’s not food sales. It’s about people. Empathy, compassion and altruism are not wasted skills in the boardroom. Senior physicians have worked at the coalface in many hospital systems and have touched almost every asset. Physicians are acquiring business skills to make up for any perceived deficiencies. They are getting MHAs and MBAs.
We need more physician CEOs in healthcare.
Mayo Clinic has led the way. Nurses and doctors need to take control again. Physicians have the drive, intellect, ability to adapt and experience to be leaders in the operating room and the board room. Let’s do it!
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