Treat Your Doctors Like Pilots

As many of you loyal readers know, I spent the early part of this week at HFMA's Annual National Institute in Las Vegas. One of the things I like to do at these shows is talk to vendors and their customers about what's bothering them and what's been successful in their efforts to improve their organizations—mostly hospitals and health systems.

One of the most interesting of those conversations came with Paul Weygandt, MD, who happens to be not only an orthopedic surgeon, but is also a lawyer with an MBA—and is a private pilot. Never mind wondering whether such a person is truly a human being and not a super-cyborg that never needs sleep, Dr. Weygandt has some most interesting theories about what activities and policies will increase patient safety while also putting more cash in the hospital's figurative pocket.

Weygandt is now vice president of physician services with Atlanta-based consulting firm J.A. Thomas & Associates, but he came to that job five years ago following a successful stint as the system executive for medical management at Conemaugh Health System in Johnstown, PA, as well as vice president of medical affairs at the system's Memorial Medical Center.

Weygandt has spent much of his career trying to navigate a healthcare system that as a whole has paid less than optimal attention to patient safety, as numerous statistics show. Perhaps those sobering statistics are why Weygandt has become such a big fan of the healthcare reform legislation, at least from the clinical side, as it makes healthcare providers accountable for quality and cost as the center of the accountable care organization concept that so many are rushing to try to figure out.

You see, Weygandt is on a crusade to try to reconfigure the way doctors and the rest of the care team works together. And his model doesn't require the physician to be the dictatorial head of the patient care team, through whom all decisions, even minor ones, must flow. Instead, he advocates a cultural change similar to what has gone on in the airline industry over the past few decades, which has dramatically reduced the workload of commercial pilots-in-command. In fact, Weygandt contends that this metamorphosis is the number one contributor to increased flight safety over the past 30 years.

Similarly, he advocates reducing the workload of physicians whenever possible, even if the doctor thinks he or she doesn't want that. I'll let him explain:

"The key way to decrease the workload of the physician is not the electronic health record," he says. "The physician can't monitor everything. We need to do away with the notion of the physician being the dictatorial captain of the team members on the ship. The physician is the leader, but the most important thing is not the leader, it's the team."

An example is physician documentation, Weygandt says. Proper documentation not only ensures the hospital is being paid correctly for what is being done to the patient, but also is critical to patient safety and every other variable that determines effective, safe and efficient patient care.

"I want air traffic control for the physician," he explains, using another concept borrowed from aviation. "The pilot has to follow the instructions of the air traffic controller or risk endangering not only his passengers but himself."

Similarly, Weygandt, a surgeon himself, welcomes questions and expertise from team members, from case managers who know how to navigate the continuum of care and ensure patient safety, to clinical documentation specialists who can translate physician language into codable language that ensures both the doc and the hospital get paid what they deserve for services they perform for patients. Even the housekeeping staff should feel comfortable pointing out issues that may interfere with safe patient care.

"These people need to be assertive though," he says. "Even the housekeeping staff can be some of your biggest patient safety advocates."

Not even close to all doctors would share that attitude, clearly, but Weygandt's theories make common sense, and he estimates that if every hospital had such a collaborative team-based approach to patient care, we could shave 20% from the cost of healthcare. Regardless of whether that estimate is ultimately valid, in an industry beset by patient safety issues now and potential revenue problems in the future, it's the only way to fly.