Notes from the road: An optimistic view of the future

Physicians are preparing to lead health care change across the country. This is perceived by some entrenched interests to be a threat. To patients and their families, and to physicians’ co-workers, this is a very positive development. I think whoever is closest to patients and consumers will be in the best position to impact change.

Crisscrossing the country over the past few weeks, here’s what I’ve seen and heard to justify my optimism. In Iowa, a large predominately rural health system has launched its Physician Leadership Academy. Each of the thirty-seven physicians were enthusiastic about learning how to improve dysfunctional work processes, develop innovative strategies, and find ways to improve patient outcomes of care. The initial class was nearly 50 percent larger than anticipated, and next year’s new class is equally committed and talented.

In South Carolina, the hospital association and medical association held a joint meeting to discuss what health care reform means for their communities. I talked with several ACPE members during that meeting. I learned that South Carolina has been collaborating with Atul Gawande on the surgical checklist project and with IHI on quality initiatives. The sense of common purpose and respectful disagreement on issues (not people or motives) between the medical society and the hospital association was very impressive. When it comes to interdisciplinary teamwork and measuring health care outcomes, I think South Carolina is a special place.

In Nevada, a large physician group has been managing financial risk for a few years, and doing very well. I listened to a sophisticated conversation at breakfast between two of the attendees about the clinical and financial management of heart failure patients across the continuum. I assumed both were physicians. Wrong. One was the CFO. I believe these kinds of conversations will become commonplace in integrated systems, ACOs, and medical homes if health care change continues in that direction.

In Nebraska, a rural community is beginning an important dialogue with its hospital board, independent and employed medical staff, and hospital staff about how to become a “physician led system, managed by business professionals”. Everyone will have to imagine how their roles will change, and what it means for relationships with large tertiary care centers in nearby cities.

In San Antonio, Texas several dynamic young physician leaders from different branches of the military remind me that some of the best teamwork training and practice occurs in our armed forces. When an individual fails, the whole team fails. They hold both individuals and teams accountable for serious safety events. They correct the problems that lead to the adverse outcomes.

If you see a system around you that frustrates you, or isn’t good for safe and reliable patient care, start now to learn what you can do to change it. Your satisfaction in helping to lead change, and see your role as a physician in a new perspective, will give you exciting new options in your career.