Innovation is rarely driven in the C-suite. That’s the crux of a new eBook published by NEJM Catalyst, “The Critical Role of Clinical Leaders: Transforming Care Today and Tomorrow,” which examines the critical role clinical leadership will play in American healthcare’s evolution toward value-based models.
The eBook incorporates clinical leaders’ responses to NEJM Catalyst’s Insights Council survey.
This year, the survey focused on four areas — Leadership, the New Marketplace, Care Redesign and Patient Engagement — and asked clinical leaders for their perspectives on critical issues like preventing provider burnout, improving care quality and efficiency, grasping the growing importance of data analytics, and leveraging patient feedback.
Innovation, the eBook contends, is driven by mid-level leadership in the frontline areas are where patients’ most critical needs are usually first identified: in the emergency room, on the wards, in clinics and in customer service interactions.
It’s therefore up to healthcare leaders below the C-suite level — medical directors, nursing managers, business line supervisors and more — to manage up and show executives how business-level and patient needs are changing. And it’s up to them to suggest new solutions.
Is There a Disconnect Between the C-Suite and Healthcare’s Patient-Facing Outlets?
Yes. It’s not an intentional disconnect, of course; rather, it’s a natural consequence of executives’ roles, according to the report.
CEOs, CFOs, CMOs and other high-level execs oversee large endeavors and issues: capital funding, development, operational expenses, budgeting, service line growth. They typically don’t have time to round.
But physicians, nurses and allied health professionals do. Clinicians interact directly with patients and with each other. They conduct their own research.
In performing their jobs, they gather valuable, real-time evidence — objective and anecdotal alike — about how treatments are evolving, how the patient populations and communities their organizations serve are doing, and how their organization’s business is changing.
When they provide that information back to clinical leadership, those leaders can affect change, according to the NEJM Catalyst authors:
“Clinical leaders are the linchpin of health care organizations, bridging the gap between C-suite executives and frontline clinicians, and bolstering the patient voice…As transformation in the healthcare industry deepens, clinical leaders will be the innovators of design, the assessors of cost efficiencies, and the promotors of more patient-centered care.”
And that works, they wrote, because:
“Clinical leaders focus on patient care and patient engagement, but also share responsibility in their organization’s bottom line and answer to shareholders.”
Mid-level clinical leadership has one foot in the business of healthcare and one foot in the profession of healthcare. And that may be keeping the industry grounded in compassion, despite constant and increasing concerns about costs and profits.
Can Healthcare Continue to Function as Business and Profession?
Many healthcare professionals wonder.
Dr. Joseph Weigel, an internist for three decades and Program Director for Lake Cumberland Regional Hospital’s internal med residency program, worries about the negative effects that corporatization could have on physician morale and, by extension, on quality of care:
“The profession of medicine is fighting for its very soul right now. We’re in a transition period where medicine is devolving from a profession to a business…I’m concerned that younger physicians are being groomed to view this as a job and as shift work.”
Weigel noted that the trend demands that clinical leaders step in to model the professionalism and compassion they expect out of the clinicians who report to them:
“Removing yourself from the bedside makes you less than realistic about what actually goes on.”
Clinical leadership, Weigel suggested, has a strong role to play in rebuilding healthcare’s traditional culture of compassion.
Clinical Leaders Can Serve As Wise Arbiters when Business Conflicts with Care
David Hoffman, a professor of law at Yeshiva University’s Benjamin N. Cardozo School of Law and lecturer in bioethics at Columbia University, made a similar suggestion in a 2014 letter to The New York Times.
“The profit motive is not inherently incompatible with ethical practice is in the provision of health care. The difficulty arises principally from the limited liability afforded to operators of health care businesses…”
When a publicly traded for-profit corporation, particularly one operating on a national scale, attempts to manage profit and loss, simultaneous with promotion of quality of care, conflicts of interest are produced.
There must be buffering mechanisms in place to arbitrate and prevent an organization’s business aims from negatively affecting the quality of care it provides to patients:
Management of the quality of clinical care, as well as efficiency in its delivery, must be undertaken by individuals who are structurally insulated from the influence of quarterly profit expectations.
Clinical leaders fit that criterion. They represent the facilitation point between providers, who must shoulder the burden of care quality, and executives, who must pay attention to the bottom line.
Those competing demands — patients’ need for providers to demonstrate more empathy on the ward, and healthcare organizations’ need for them to meet reporting requirements and protect revenues — contribute heavily to burnout.
It’s up to clinical leaders to ease the tension between.
Clinical Leaders Need to Make Themselves Accessible to Providers and Patients Alike
The keys are to maintain visibility and open communication, according to Susan Robel, executive vice president and chief nursing and patient experience officer at Geisinger Health System in Danville, Pennsylvania:
“Clinical leaders set the tone for culture and expectations of behaviors.”
If a medical director or nursing manager doesn’t make a point to spend time with patients and providers on the ward, she said, he or she won’t know that the organization’s (or its patients’) care expectations are being met.
Tomorrow’s Clinical Leaders Will Need More Business Training
It may help to ease tensions if medical schools were to incorporate more business training into their curricula.
It might also strengthen relationships between healthcare executives and the providers they oversee, said Dr. Diane Harper, chair of the University of Louisville School of Medicine’s Department of Family and Geriatric Medicine:
“We’re doing a poor job of teaching physicians how to think beyond the patient care space.”
Harper noted that providers are already asked to think through patients’ entire care course and ponder questions that physicians and nurses a generation ago never had to consider:
“Who will pay for the medicine? Will the patient have to fail one drug to get into another drug…What will the health system have to do to get paid for the many different team members that are necessary for patient care?”
She told NEJM Catalyst‘s Insights Council that she believes modern medical educators should advise more students to take graduate-level business electives, to make them better resource stewards on the ward.
That, in turn, will help those providers with advancement and build a stronger generation of clinical leaders who have a better appreciation for each side’s goals.