Physician Leadership Research Articles

Physician Leadership and Advocacy for Team-Based Care.

Team-based care is a strong focus and narrative in medical and health education and within health care systems. Yet it is essential to consider that there are vast differences in power, education, compensation, and job security among team members in most health professional teams. How should clinicians of status play a role in advocating for lower status members of their health care teams, and why is that role important in improving equity within clinic walls and equity and better patient care for the communities they serve?

Summer 2022 Regulatory Affairs and Quality Measure Update

Quality & Regulatory| September 2022 Summer 2022 Regulatory Affairs and Quality Measure Update Matthew Goldan; Matthew Goldan Search for other works by this author on: This Site PubMed Google Scholar Claire Ostarello; Claire Ostarello Search for other works by this author on: This Site PubMed Google Scholar Matthew T. Popovich, PhD Matthew T. Popovich, PhD Search for other works by this author on: This Site PubMed Google Scholar ASA Monitor September 2022, Vol. 86, 19–20. https://doi.org/10.1097/01.ASM.0000874232.52262.3f Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Cite Icon Cite Get Permissions Search Site Citation Matthew Goldan, Claire Ostarello, Matthew T. Popovich; Summer 2022 Regulatory Affairs and Quality Measure Update. ASA Monitor 2022; 86:19–20 doi: https://doi.org/10.1097/01.ASM.0000874232.52262.3f Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAll PublicationsASA Monitor Search Advanced Search Topics: quality indicators Summertime is an active season for ASA physicians and staff who review and respond to regulatory proposals. The ASA Department of Quality and Regulatory Affairs works with physician committees and leadership to ensure our member priorities are heard among federal regulators. Each year, the Centers for Medicare & Medicaid Services (CMS) releases its Inpatient Prospective Payment System (IPPS) proposed rule that sets forth yearly policy on Medicare Part A and hospital-level initiatives. This year, CMS included a broad range of proposals and requests for information (RFIs) on issues directly affecting ASA members, from the COVID-19 Public Health Emergency (PHE) to maternal health quality measures to climate change. In a letter to CMS, ASA took the opportunity to advocate strongly for physician-led anesthesia care while sharing the anesthesiologist's perspective in key issues in patient care and departmental administration. A significant focus of ASA's letter targeted the Anesthesia Services Physician Supervision Rule... You do not currently have access to this content.

Integrating administrative and clinical datasets to improve patient outcomes.

Integrating electronic health records (EHR) with health administrative data offer opportunities for enhanced decision support, health systems evaluations and research for improved patient care. We describe the process of integrating EHR data from 12 hospitals in Southwestern Ontario, Canada and present a health systems evaluation enabled by this linkage. With support and buy-in from the hospital Chief Executive Officers, a data sharing agreement (DSA) with ICES was executed, outlining the process to approve data transfer requests. Due to the complexity and volume of the EHR, complete data were not immediately transferred to ICES; instead, a project subcommittee comprising of physician leadership, local and regional privacy and risk officers, and ICES staff was assembled to review and approve project-specific data integration requests. An evaluation of the adoption of an electronic medication reconciliation system within the EHR on potentially inappropriate prescribing after hospital discharge was conducted using interrupted time-series analyses. The data integration request process begins with confirmation of data availability and accuracy within the EHR, enabled by a dedicated health information analyst and institutional decision support teams. Once data feasibility is confirmed, project rationale is submitted to the project subcommittee approval. Following approval, the request undergoes privacy and legal assessment as per the DSA and a project-ready dataset is submitted for linkage. An evaluation of the adoption of an electronic medication reconciliation system demonstrated an immediate and dramatic reduction in inappropriate medication prescribing and associated adverse events such as a fall or fracture among elderly patients discharged following acute inpatient stays. Administrative data are valuable at assessing population-based health, but often lack key clinical information present in EHRs. Integrating both data sources offers a more comprehensive picture of patient care and allows for robust analyses. Rigorous investigations generate trusted evidence for decision makers to inform policy and quality improvements within the healthcare system.

Evaluating clinician-led quality improvement initiatives: A system-wide embedded research partnership at Stanford Medicine.

IntroductionMany healthcare delivery systems have developed clinician‐led quality improvement (QI) initiatives but fewer have also developed in‐house evaluation units. Engagement between the two entities creates unique opportunities. Stanford Medicine funded a collaboration between their Improvement Capability Development Program (ICDP), which coordinates and incentivizes clinician‐led QI efforts, and the Evaluation Sciences Unit (ESU), a multidisciplinary group of embedded researchers with expertise in implementation and evaluation sciences.AimTo describe the ICDP‐ESU partnership and report key learnings from the first 2 y of operation September 2019 to August 2021.MethodsDepartment‐level physician and operational QI leaders were offered an ESU consultation to workshop design, methods, and overall scope of their annual QI projects. A steering committee of high‐level stakeholders from operational, clinical, and research perspectives subsequently selected three projects for in‐depth partnered evaluation with the ESU based on evaluability, importance to the health system, and broader relevance. Selected project teams met regularly with the ESU to develop mixed methods evaluations informed by relevant implementation science frameworks, while aligning the evaluation approach with the clinical teams' QI goals.ResultsSixty and 62 ICDP projects were initiated during the 2 cycles, respectively, across 18 departments, of which ESU consulted with 15 (83%). Within each annual cycle, evaluators made actionable, summative findings rapidly available to partners to inform ongoing improvement. Other reported benefits of the partnership included rapid adaptation to COVID‐19 needs, expanded clinician evaluation skills, external knowledge dissemination through scholarship, and health system‐wide knowledge exchange. Ongoing considerations for improving the collaboration included the need for multi‐year support to enable nimble response to dynamic health system needs and timely data access.ConclusionPresence of embedded evaluation partners in the enterprise‐wide QI program supported identification of analogous endeavors (eg, telemedicine adoption) and cross‐cutting lessons across QI efforts, clinician capacity building, and knowledge dissemination through scholarship.

A rapid response for burnout among inpatient physiatrists: A survey of leaders of inpatient rehabilitation facilities.

Symptoms of burnout are highly prevalent among physiatrists, and prior studies have helped identify key contributors to this epidemic of burnout. Little is known about the physician stressors unique to those providing care in inpatient rehabilitation facilities (IRFs) and what strategies such facilities have used to help mitigate burnout among inpatient physiatrists. To identify what IRF leaders perceive as stress points contributing to burnout among inpatient rehabilitation physicians and what, if any, interventions their programs have implemented to help mitigate physician burnout. 10 item cross-sectional survey study of IRF physician and nonphysician leaders in the United States. 104 physicians serving in the roles of IRF medical director, director of rehabilitation, and/or executive leadership and 19 nonphysician IRF leaders. Regulatory demands, late admissions, understaffing, and on-call responsibilities were the major stress points most identified as contributing to physician burnout among both the physician and nonphysician respondents. The use of advanced practice providers and hospitalists were the most common system changes reportedly used to help mitigate physician burnout. Although 57.8% of physician leaders felt late admissions were a major stress point for physicians, only 18.2% of those responding reported having implemented admission cutoff times. There are stressors unique to the practice of inpatient rehabilitation that are likely contributing to physiatrist burnout, including late admissions and on-call responsibilities. Many IRFs have begun to implement system changes to help mitigate burnout among inpatient physiatrists. The use of nonphysiatrist providers is a commonly reported strategy. Future studies are needed to determine the effectiveness of such a strategy on reducing symptoms of burnout among IRF physicians as well as its effect on IRF patient outcomes.

Family physician leadership during the COVID-19 pandemic: roles, functions and key supports

PurposeStrong leadership in primary care is necessary to coordinate an effective pandemic response; however, descriptions of leadership roles for family physicians are absent from previous pandemic plans. This study aims to describe the leadership roles and functions family physicians played during the COVID-19 pandemic in Canada and identify supports and barriers to formalizing these roles in future pandemic plans.Design/methodology/approachThis study conducted semi-structured qualitative interviews with family physicians across four regions in Canada as part of a multiple case study. During the interviews, participants were asked about their roles during each pandemic stage and the facilitators and barriers they experienced. Interviews were transcribed and a thematic analysis approach was used to identify recurring themes.FindingsSixty-eight family physicians completed interviews. Three key functions of family physician leadership during the pandemic were identified: conveying knowledge, developing and adapting protocols for primary care practices and advocacy. Each function involved curating and synthesizing information, tailoring communications based on individual needs and building upon established relationships.Practical implicationsFindings demonstrate the need for future pandemic plans to incorporate formal family physician leadership appointments, as well as supports such as training, communication aides and compensation to allow family physicians to enact these key roles.Originality/valueThe COVID-19 pandemic presents a unique opportunity to examine the leadership roles of family physicians, which have been largely overlooked in past pandemic plans. This study’s findings highlight the importance of these roles toward delivering an effective and coordinated pandemic response with uninterrupted and safe access to primary care.

Design Thinking in Undergraduate Medical Education: Student-Driven Change Applied to Value in Medicine.

To the Editor: There is an overspending problem in U.S. health care. 1 Research has demonstrated that the earlier medical trainees are exposed to cost consciousness, the more lasting it shapes their practices and views. 2 Design thinking in education uses student input to fix what is missing from the learning experience. 3 As Choosing Wisely STARS (Students and Trainees Advocating for Resource Stewardship), participants in a campaign that aims to catalyze grassroots, student-led initiatives to advance health care value in medical education, we leveraged a leadership development program and used design thinking to create extracurricular and curricular interventions that teach evidence-based practices, which prioritize necessary care and avoid medical waste and overuse. Our initiatives as Choosing Wisely STARS have included forming the interest group Healthcare VITALS (Value, Insurance, Transformation, Administration, and Leadership Sciences), which provided an administrative avenue to discuss VITALS’ topics with flexibility and funding. We launched a health care colloquium and invited leaders from within our institution to discuss value from their fields of expertise. We wrote an evidence-based medicine session pairing clinical scenarios with Choosing Wisely recommendations. We included pertinent recommendations in weekly clinical skills guides used by first- and second-year medical students during our clinical immersion program: Medical Student Home (MeSH). We designed ID badges with the principles of high-value care and priming questions for preceptors to generate conversations around these issues for quick reference in the clinical environment. Students, like us, are effective at driving change because we can (1) best identify the unmet need, (2) engage other students by clarifying the why, and (3) force the administration to listen—when students demand change, deans must listen. Becoming student change agents requires creativity to design effective learning experiences, dedication to remain focused through administrative and logistic hurdles, and empowerment to recognize the worth of our contributions. We call on other institutions to create leadership development programs that promote design thinking for curriculum reform. We call on other medical trainees to advance resource-stewardship education so that we can become physician leaders equipped to reduce medical expenditures. Acknowledgments: The authors wish to thank Emily Daigle, James Danahey, Carlos Echeverria, and Kipp Hopper for their partnership. Additionally, the authors wish to thank Drs. Rahul Anand, Ilene Rosenberg, and Andrew Selinger for their mentorship.

Reduction of urea test ordering in the emergency department: multicomponent intervention including education, electronic ordering, and data feedback.

IntroductionIn the emergency department (ED), laboratory testing accounts for a significant portion of the medical assessment. Although excess laboratory test ordering has been proven to be prevalent, different types of interventions have been used to encourage a behavioural change in how physicians order tests. In one western Canadian hospital medicine program, a quality improvement project aimed to reduce the total monthly blood urea nitrogen (BUN) test ordered by physicians was found to be successful. The objective of this project was to evaluate a similar multicomponent intervention aimed at ED physician ordering, with the primary goal of reducing the number of monthly BUN tests ordered per ED visit.MethodsA pre post intervention design was conducted over 12-months. The first intervention component was an educational presentation conducted by physician leaders. Second, a regularly used order panel within the ED electronic order system was modified, removing the BUN test. The third component involved audit and feedback; the total monthly BUN test ordered for the ED department post intervention start was shared with all ED physicians twice (at 5 and 12 months).An interrupted time series analysis was completed to evaluate the multicomponent intervention effect.ResultsThe total monthly ordered BUN test declined from an average of 1905 pre-intervention to 448 post-intervention, and the total monthly BUN test to total ED visit ratio declined from 0.46 to 0.1. These results were a statistically significant reduction in physician BUN test ordering.ConclusionsTargeted education, order panel design and data feedback interventions can impact physician ordering behaviour in the emergent healthcare context, where diagnostic tests are often over used.Supplementary InformationThe online version contains supplementary material available at 10.1007/s43678-022-00333-w.

Defining existing practices to support the sleep of hospitalized patients: A mixed-methods study of top-ranked hospitals.

The objective of this study was to understand the existing practices and attitudes regarding inpatient sleep at the 2020 US News and World Report (USNWR) Honor Roll pediatric (n = 10) and adult (n = 20) hospitals. Section chiefs of Hospital Medicine from these institutions were surveyed and interviewed between June and August 2021. Among 23 of 30 surveyed physician leaders (response rate = 77%), 96% (n = 22) rated patient sleep as important, but only 43% (n = 10) were satisfied with their institutions' efforts. A total of 96% (n = 22) of institutions lack sleep equity practices. Fewer than half (48%) of top hospitals have sleep‐friendly practices, with the most common practices including reducing overnight vital sign monitoring (43%), decreasing ambient light in the wards (43%), adjusting lab and medication schedules (35%), and implementing quiet hours (30%). Major themes from qualitative interviews included: importance of universal sleep‐friendly cultures, environmental changes, and external incentives to improve patient sleep.

Perspectives on physician leadership: The role of character-based leadership in medicine.

Physician leadership is multifaceted, but leadership training in medicine often is not. Leadership education and training for physicians are rarely grounded in conceptual leadership frameworks and suffer from a primary focus on cognitive leadership domains. Character-based leadership is a conceptual leadership framework that moves beyond cognitive competencies and articulates dimensions of character that promote effective leadership. The purpose of this study was to explore the relevance of character-based leadership in the medical context. This qualitative descriptive study used semi-structured interviews to explore health care professionals' perceptions of character in relation to effective leadership in medicine. All interviews were audiorecorded and transcribed. Consistent with descriptive qualitative inquiry, a qualitative latent content analysis was used. Simultaneous data collection and analysis incorporating character-based leadership as a theoretical framework was used to help organise the analysis of the data. The researchers met regularly to clarify coding structures and categorise codes until sufficiency was reached. Twenty-six individuals (12 doctors, 5 nurses, 2 social workers, 2 directors and a pharmacist, dietician, coordinator, administrator and unit clerk) participated. Character-based leadership resonated with participants; they deemed character essential for effective physician leadership. Participants reflected on different character dimensions they attributed to an effective physician leader, in particular, collaboration, humility and humanity. They shared examples of working in interdisciplinary health care teams to illustrate these in practice. Moreover, participants believed that effective physician leaders need not be in a positional leadership role and asserted that physicians who demonstrate character stand out as leaders regardless of their career stage. Our findings suggest a role for a character-based leadership framework in medical education. Participants recognised the execution of character in everyday practice, associated character with effective leadership and understood leadership in dispositional rather than positional terms. These findings provide important insights for expanding and enhancing existing leadership training interventions.

Simple Thoughts on Complex Issues in Complicated Times

As physician leaders, we are best suited to provide the optimal (not the only) insights on evolving the industry to improve care for people by using more cost-effective, safer, higher-quality, and efficient strategies. But the healthcare industry playing field makes it complicated, and as physician leaders, we must keep an eye on its shifting sets of issues and influences.

Advancing Physician Leadership Through Research

As physician leadership matures from a discipline to a profession, it requires a body of knowledge that is evidence-based and supported by research. Research is a systematic approach that creates new knowledge and uses data to find answers to complex problems. A systematic approach relies on clear and reproducible methods and outcomes that are clearly defined, measurable, and relevant.

Outcomes of Mayo Clinic reBoot camps for postimplementation training in the electronic health record.

ObjectiveAfter a new electronic health record (EHR) was implemented at Mayo Clinic, a training program called reBoot Camp was created to enhance ongoing education in response to needs identified by physician leaders.Materials and MethodsA reBoot camp focused on EHR topics pertinent to ambulatory care was offered from April 2018 through June 2020. There were 37 2-day sessions and 43 1-day sessions, with 673 unique participants. To evaluate outcomes of the reBoot camp, we used survey data to study baseline, immediate, and long-term perceptions of program satisfaction and self-assessed skills with the EHR. The study was conducted among practitioners at a large ambulatory practice network based in several states. Data were collected from April 2018 through January 2021. We analyzed automatically collected metadata and scores that evaluated the amount of personalization and proficiency of use.ResultsConfidence in skills increased by 13.5 points for general EHR use and was significant in 5 subdomains of use (13–18 point improvement). This degree of user confidence was maintained at the 6-month reassessment. The outcomes of configuration and proficiency scores also improved significantly.DiscussionOngoing education regarding EHR tools is necessary to support continued use of technology. This study was novel because of the amount and breadth of data collected, diversity of user participation, and validation that improvements were maintained over time.ConclusionsParticipating in a reBoot camp significantly improved user confidence in each domain of the EHR and demonstrated use of best-practice tools. Users maintained gains at the 6-month evaluation phase.

Engaging Physicians in Leadership: Motivations, Challenges, and Identity-Based Considerations.

Physician leadership has been associated with improved patient outcomes, increased provider satisfaction, and decreased physician burnout as well as more profitable, higher-quality healthcare delivery. However, physicians frequently struggle when assuming leadership positions, given the dissonance between their administrative and clinical roles. Informed by social identity theory, we aimed to identify why physicians lead, how they experience leadership roles, and the challenges they face during the transition into those roles. We conducted 27 semistructured interviews with primary care physician leaders between January and April 2020. Interviews were transcribed and analyzed using the constant comparative method. Four themes were developed from the analysis, including (1) desire for change, (2) desire for growth, (3) challenges experienced during the transition to a leadership role, and (4) changes to professional identity. The results of this study identified aspects of leadership perceived by physicians as attractive and motivating. The study also revealed challenges that occur during the transition into leadership as well as shifts in professional identity experienced by physicians. The results can be used by healthcare managers and executives to empower more physicians to take on leadership roles and implement changes that alleviate stresses associated with physicians transitioning into leadership roles.

Reduction of Laboratory Identified Clostridioides difficile Infections Standardized Infection Ratio

Background A large, complex metropolitan hospital system identified an increase in the standardized infection ratio (SIR) for laboratory identified Clostridioides difficile infections (CDI). Clostridioides difficile infections are serious, often hospital acquired, and increase length of stay, risk of reinfection and death. Methods A multidisciplinary team that included infection prevention, nursing, physicians, laboratory, and antibiotic stewardship was formed. Nursing received education on signs and symptoms of CDI. Physician leadership and infection prevention worked together with the informatics team to leverage the electronic health record to ensure symptomatic patients were tested. Laboratory leadership educated lab technicians, physicians, and nursing on the correct sample to send and rejected inappropriate samples. Results This multifactorial approach proved successful. The annual SIR for fiscal year 2018 was 0.904. The interventions occurred in 2019 and the SIR decreased 13% to 0.786. With persistent education and sharing weekly Clostridioides difficile infections, the SIR decreased another 20% to 0.640 in 2020 during the pandemic. Conclusions This method of education and leveraging the electronic health record proves that healthcare acquired infections can be reduced with simple, persistent interventions. We continue to reinforce education and send a weekly report letting frontline staff know about laboratory identified CDI. Next steps include working closely with the antibiotic stewardship committee and physicians on antibiotic use in the outpatient setting to prevent recurrent Clostridioides difficile infections. A large, complex metropolitan hospital system identified an increase in the standardized infection ratio (SIR) for laboratory identified Clostridioides difficile infections (CDI). Clostridioides difficile infections are serious, often hospital acquired, and increase length of stay, risk of reinfection and death. A multidisciplinary team that included infection prevention, nursing, physicians, laboratory, and antibiotic stewardship was formed. Nursing received education on signs and symptoms of CDI. Physician leadership and infection prevention worked together with the informatics team to leverage the electronic health record to ensure symptomatic patients were tested. Laboratory leadership educated lab technicians, physicians, and nursing on the correct sample to send and rejected inappropriate samples. This multifactorial approach proved successful. The annual SIR for fiscal year 2018 was 0.904. The interventions occurred in 2019 and the SIR decreased 13% to 0.786. With persistent education and sharing weekly Clostridioides difficile infections, the SIR decreased another 20% to 0.640 in 2020 during the pandemic. This method of education and leveraging the electronic health record proves that healthcare acquired infections can be reduced with simple, persistent interventions. We continue to reinforce education and send a weekly report letting frontline staff know about laboratory identified CDI. Next steps include working closely with the antibiotic stewardship committee and physicians on antibiotic use in the outpatient setting to prevent recurrent Clostridioides difficile infections.

A Hospital's Roadmap for Improving Nursing Excellence Using AACN's Healthy Work Environment Standards.

A Hospital's Roadmap for Improving Nursing Excellence Using AACN's Healthy Work Environment Standards.

Evaluation of the Processes and Outcomes of a Physician Leadership Program: The Continuous Feedback Loop Design.

Physicians assume leadership roles in their health care organizations and practices often without support or training. The Physicians Leadership Academy provides integrated leadership seminars, mindfulness training, and executive coaching in a 10-month curriculum to physicians across area organizations. Program evaluators responded to stakeholders' need for continuous program improvement by developing a continuous feedback loop evaluation design incorporating a program monitoring system and a theory-driven program evaluation. Given the size of the 2019 to 20 cohort ( n = 19), a one-group pretest/posttest design was used to assess the mechanisms of the program (mindfulness and wellbeing) along with knowledge development, emotional intelligence, and personal and professional growth. The assessments used a combination of published and administrator-developed assessments to address the unique aspects of the program. Doing such ensured continuous improvement and sustainability for the program. The cohort of physicians demonstrated significant engagement and learning across the curriculum, improved mindfulness, and improved capacity of the providers to affect their health care system and communities. The utility of the program was demonstrated through quantitative and qualitative analyses. Implications of the methodology for future evaluations of program developments are discussed.

Industry Relationships With Medical Oncologists: Who Are the High-Payment Physicians?

Many oncologists have relationships with industry. Previous work has shown that these payments are usually modest; however, there exist a subset of medical oncologists who receive more than $100,000 US dollars (USD) annually. Here, we describe the characteristics of these physicians. This retrospective cohort study used the Open Payments data set to identify all US-based medical oncologists/hematologists who received $100,000+ USD in general payments linked to cancer medications in 2018. Open Payments and a web-based search were used to identify physician characteristics, demographics, research profile, and leadership positions. One hundred thirty-nine medical oncologists received > $100,000 USD in general payments. The median payment was $154,613 USD, and the total payment was $24.2 million USD. These high-payment physicians represent 1% of all US medical oncologists (N = 10,620) yet account for 37% of all industry payments in 2018. Sixty percent (84 of 139) and 21% (29 of 139) of these high-payment physicians hold hospital and specialty association leadership roles, respectively. One quarter (24%, 33 of 139) serve on journal editorial boards, and 10% (14 of 139) have authored clinical practice guidelines; 72% (100 of 139) hold faculty appointments. A small number of medical oncologists receive very high payments from the pharmaceutical industry. These physicians hold major leadership roles within oncology. Further work is needed to understand the extent to which these conflicts of interest may shape clinical practice and policy.

ADVICE: Optimizing meetings, a critical post-pandemic task for physician leaders

Meetings and committees occupy a significant amount of the working time of physician leaders and their teams. The amount of time spent in meetings has grown over decades and that growth has rapidly accelerated over the COVID-19 pandemic. The return to in-person work offers physician leaders the opportunity to optimize their meetings by thinking about the entire suite of meetings they and their teams are involved in. Creating a meeting inventory and evaluating it can reveal patterns, inefficiencies, and redundancies that can become targets for optimization. Effective meetings can create a competitive advantage for leaders, teams, and organizations and can support productivity and job satisfaction. Meeting optimization should be a high priority for physician leaders.

Model to improve charting performance for physicians

Timely, accessible, and comprehensive charting of medical care is a complex issue that has clinical, legal, regulatory, and financial implications. Documentation, along with the rise in other administrative tasks, is a factor contributing to physician burnout. We posit that difficulties with charting are multifactorial and can stem from physician, patient, and environmental factors. Physician leaders have a responsibility to enforce charting standards and deadlines and are best positioned to lead charting-related solutions. To assist physician leaders, we propose a charting performance model as a tool to assess charting difficulties within their organizations.