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Bridging the Physician-Management Chasm

Philip Betbeze, for HealthLeaders Media, April 15, 2013
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This article appears in the April 2013 issue of HealthLeaders magazine.

Physicians have always been leaders in their organizations, whether or not they wanted the role. But until recently, that leadership role has b een far from multidimensional. In many cases, especially in thinking about the traditional medical staff hierarchy, that leadership role has been largely ceremonial. But with clinical and financial incentives more closely tied together, physicians are leading the development of clinical protocols and managing their financial repercussions as never before.

Some hospitals seek to place a business-trained physician in a single leadership role. Some have their own leadership institutes in which physicians targeted for management can learn business principles, and many combine physician leaders who have a firm grasp of the clinical and the respect of their colleagues with lay leaders to run departments in a dyad management model. Not only has the move to incorporate the concept of value into healthcare decision-making led to new management structures, but departments themselves also have been restructured based on how they work together to meet patient needs in both the inpatient and outpatient settings.

The upheaval in reimbursement has forced a closer working relationship between the business and clinical sides, but despite the disruptive impetus, many chief executives and other senior leaders are optimistic about the changes they're making. The fact that organizations will be expected to survive on a declining revenue model makes cooperation and holistic decision-making a necessity.

Limiting autonomy
Sheldon Stadnyk, MD, is one of those new leaders who believes that physicians practice medicine with too much autonomy, and that allowing them to continue to do so has a negative impact on quality. He is chief medical officer at North Colorado Medical Center, a 250-staffed-bed hospital in Greeley that is part of Phoenix-based Banner Health, which operates 25 hospitals in seven states. Stadnyk, who also serves as regional medical officer for Banner Health's 10-hospital West Region, is charged not only with improving quality but also with lowering the cost of care.

"I'm in the last trimester of my career," he jokes, adding that physicians his age "were trained that better quality costs more. That's been disproven."

Instead, through training programs developed by cost and quality pioneer organization Intermountain Healthcare, Stadnyk has worked to implement a culture of team agreement on how to treat certain conditions while eliminating a large degree of individual physician autonomy in the trade-off.

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