Physicians Lead the Way in Transforming Healthcare

Abstract

AN ERA OF AWAKENING began in 1999 with the publication of the Institute of Medicine's report To Err Is Human. The report turned the nation's attention to the urgent need to reduce harm in healthcare institutions. Although the report was met initially with disbelief and distrust of the data-which signaled an alarming level of harm-16 years later, healthcare generally believe that preventable harm continues to occur at unacceptable levels. For this reason, some have committed to achieving zero harm by improving their organization's safety culture, as well as by using improvement science and change management to generate sustainable gains.Across the thousands of US hospitals accredited by The Joint Commission, one observation is consistent: Effective physician leadership is a vital characteristic of high-performing healthcare organizations. Exhibit 1 shows physician engagement along the quality and safety continuum. In high-performing healthcare organizations, physicians lead, collaborate on interdisciplinary teams, and take ownership of improvement activities and outcomes. Conversely, organizations that struggle in their improvement efforts typically lack engaged physicians and effective physician leaders. In these organizations, the physicians-and at times even the physician leaders-are unable to articulate their organization's quality-improvement activities and goals (Nelson et al. 2014; Taitz, Lee, and Sequist 2012).EFFECTIVE LEADERSHIP IMPROVES QUALITY AND SAFETYEffective physician leadership is essential for transforming an organization from one that accepts harm as inevitable and makes only modest improvements each year to one that aims for zero harm and is on a path to becoming a high-reliability organization (HRO). HROs rarely, if ever, have significant accidents. These organizations manage safety hazards well, despite facing dynamic tasks, time constraints, and complex environments. In the pursuit of excellence, they constantly look for lessons in errors and close calls to reduce the risk of harm. A key to becoming an HRO is to learn from the organization's mistakes (Reason 1997; Weick and Sutcliffe 2007).The Joint Commission sets high standards for leaders. For example, according to standard LD.03.01.01 of the Comprehensive Accreditation Manual for Hospitals, leaders create and maintain a culture of safety and quality throughout the hospital (Joint Commission 2015). Standard LD 03.05.01 directs to implement changes in existing processes to improve the performance of the (Joint Commission 2015). The Joint Commission also encourages hospitals and health systems to become learning organizations, which requires a special type of leadership-one that encourages all staff to discuss safety issues openly and provides opportunities for all to participate in safety and quality initiatives. These are just a few of The Joint Commission's expectations of who intend to transform their organization into one that is highly reliable.Although improving quality and patient safety is of critical importance, it is only one of many areas in which effective physician leadership is vital. The increasing integration and growth of health systems, population health management, new payment systems, and competitive market trends are other forces that contribute to the unprecedented demand for physician leadership and physician engagement. Unfortunately, the need far exceeds the nation's supply of physician who have the critical skills required to face today's challenges.Palomar Health in Escondido, California, and ProMedica in Toledo, Ohio, are two excellent examples of healthcare organizations that are responding to this gap. These organizations represent a national movement in which healthcare organizations are taking on the responsibility of developing physician leadership programs or virtual leadership academies. Each recognized the need to improve and transform, developed a customized approach to its curriculum, and aligned physicians with the organization's goals. …