MD Leader

The Pharmaceutical Research and Manufacturers of America (a pharmacy trade group organization) has recently announced new guidelines addressing conflicts of interest with clinicians.  Member pharmaceutical companies will be barred from distributing office supplies, clothes and other gifts with company logos or product brand names to physicians and clinics. The new guidelines also prohibits the companies from paying for physicians’ meals, including those during medical education events, and requires that all grant money allocated for continuing medical education programs be handled by personnel who are not from sales and marketing departments.  The guideline does not address the common practice of paying clinicians to promote drugs on a speaking circuit or serve as paid consultants.

A number of years ago, Ministry Health Care updated it’s corporate integrity policies banning the receipt of gifts of material value from any vendor and specifically restricting pharmaceutical representative access to our clinicians.  We had a few clinicians who bristled at the policy stating a pharmaceutical representative could not influence their decision-making. Drug companies simply would not waste their money trying to influence clinicians if their tactics did not work. 

Clinicians also related drug samples provided by pharmaceutical reps are given to needy patients. In response, we started a very successful Patient Drug Assistance Program. This program helps our needy patients apply for drug assistance directly from the drug company.

I am proud of the stance Ministry Health Care has taken and fully support it. It is also time for our government to establish similar policies for all government employees including our legislators.  Special interest group sponsored educational junkets are said to provide valuable education for our senators and congressmen; education that undoubtedly leaves them more favorably inclined to vote for legislation supported by their benefactors.

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A government report has announced U.S. life expectancy has now surpassed 78 years.  Good news.  The report suggests the main reason for the rise is less flu deaths and a reduction in the death rate of chronic diseases. If we have the best health care system in the world, why is our rising life expectancy still less than what is experienced in 30 other countries?  Answer: health care only makes a small contribution to life expectancy.  

Experts estimate our health care system only has a direct effect on about 10% of the factors causing death. While our average life expectancy is not world class, your chance of surviving cancer, a heart attack or any catastrophic life threatening event is best in the good old U.S of A.  

Our health care system has developed partly due to economic reality. We have desired high quality acute care and have paid for it preferentially as compared to preventive, wellness, primary or even office based chronic care. In my neck of the woods, health care reimbursement policies have resulted in free standing surgical centers, orthopedic centers, cancer centers and MRI centers while primary care is often thought of as a loss leader feeding providers of highly reimbursed procedures.

The upcoming Presidential election will include a health care debate. My intent behind today’s post is not to provide the answers to the debate, but is to make a few observations which may well lead us to the answers. 

1. Our health care organizations make a lot of money when patients are admitted to the hospital or the various outpatient procedure oriented facilities.
2. Our health care organizations loose money when patients receive care and live a lifestyle allowing them to stay away from hospitals and outpatient procedures.
3. Our communities will spend less money on health care with the same results by increasing or establishing reimbursement for services that keep patients out of the hospital.
4. If we are interested in improving life expectancy, you will get a good bang for buck by concentrating on improving lifestyle behavior that impacts health.

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Physician leaders bring real strengths to the table. They are often the only leaders at the table who have had actual experience caring for patients.  However, by virtue of their training, clinicians have several potential deficiencies needing resolution before they can be truly effective leaders.

One of the main causes of failure to be effective as a leader is a lack of social skills and sensitivity. Improving competence in relationships with others is an important task for many clinician leaders.  As compared to others, clinicians have spent much more of their lives devoted to acquiring knowledge/skills and relatively less time developing social skills.  

Typical “rules of engagement” for clinicians of hard work, command and control leadership, perfectionism (must always know the right answer), competition and self neglect all lead to behaviors not consistent with effective organizational leadership.  

Physicians who are successful leaders become more socially aware and appreciate everyone has their own talents. Teams are constructed bringing balance based on what each individual has to contribute. Vision is widely broadcast but yet each individual is allowed to create their own process to achieve it. Successful leaders invite change and honor individual diversity.  

Most clinicians believe every problem has one correct solution (typically their solution). Perhaps the best indication a clinician has made the transition to being a leader is when there is the recognition that any real problem has at least one more solution, which  has yet to be discovered. Engaging and empowering others is the key to finding hidden solutions and the key ingredient to leadership.

This post was inspired by a presentation to the 2008 Physician Executive MBA Reunion by Ross Ungerleider, MD, MBA and Jamie Dickey, Ph.D., LCSW.

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Physicians are trained to be doers or active managers of health.  Most every clinician is considered to be a leader in their own work unit, providing trusted direction as to how care should be provided.  When clinicians step forward and take leadership positions as department chairmen or temporary officers of a hospital medical staff, their primary mode of operation continues to be as doers.  Even though these roles are often thought of as leadership positions, they are actually operating as managers. The difference is important.

What is the difference between managers and leaders?  The best analogy I have heard to date is as follows: managers make the trains run on time, leaders determine where the tracks will be laid.

Organizations need both managers and leaders. When there is too much management and not enough leadership, the status quo is maintained unless external influences cause a deterioration. When there is too much leadership, day to day management is neglected resulting in chaos.

Most clinicians rise to the level of leaders because of their ability to get things done. However the ability to develop vision and inspire others are traits necessary to be a great leader. The more a leader personally does, the less the organization accomplishes.  As clinicians become leaders, the mind set must change from being a doer to becoming an inspirer of others.  Only by working within an organization to develop vision and long range focus can the leader challenge the various managers to direct their work along the correct path.

Consider the situation of a large logjam.  The manager will know that by removing one log at a time, the logjam will be eventually freed. The leader seeks vision and long range focus by climbing to a vantage point and determines where the key log is likely to be. With much less effort, the key log is removed allowing the logs to flow freely to their destination.

I believe most clinicians are good managers, but only a few clinicians are natural good leaders.  The rest of us can learn to be leaders with proper training, guidance and insight.

I was reminded leadership is all about relationships when I compared notes with a colleague regarding an assignment we both had completed for a management class at the Physician Executive MBA Program, University of Tennessee.  

We had been conducting laddering interviews as part of  a process to determine a customer’s value hierarchy. The intent of the process is to determine and then satisfy a customer’s core values and goals with your services and marketing. The basic drill is to start out asking the customer what attributes or qualities are important when using the product or service.  The attributes most important to the customer are then explored with a series of questions asking why the attribute is important and then what is the importance of the resulting answer. This process continues until one arrives at the core values.

I was interviewing primary care clinicians as part of an electronic health record implementation.  My colleague was interviewing patients as part of medical practice redesign.  Though we were investigating separate services and our customers represented different roles in the medical care system, the value of the provider-patient relationship was a prominent common feature in the all value hierarchies.  

As physicians and leaders, anything we can do to improve the quality of the relationship between doctors and patients will lead to more satisfied providers and more satisfied patients.  More satisfied clinicians and patients should result in better health care outcomes.

Yes, it is all about relationships.