The End of Us vs. Them
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Redefining physicians' leadership role
A few hospitals and health systems have historically been led by physicians, but more often, doctors have had less than ideal representation on the leadership team. Organizations where physicians have been in charge and that employ all their physicians have often been held up as exemplars of the type of coordinated, safe, and high-quality care that others should emulate. But many hospitals and health systems still have a long way to go in incorporating doctors into their senior leadership team.
In fact, in the most recent HealthLeaders Media Industry Survey, 36% of hospital and health system CEOs reported that they have zero physicians on their senior leadership team, which includes titles from senior vice president and up. Meanwhile, 45% did report that between 1% and 20% of their senior leadership team is made up of physicians. Many experts were not surprised at the high number of organizations where physicians are not in senior leadership, but were quick to add that the statistic is changing very rapidly.
Senior physician leadership "is a piece of our success," says Murphy. "Our clinical integrated network strategy has been developed by our Unified Clinical Organization, which is led by P. Terrence O'Rourke [MD], who is our chief clinical officer at the home office."
Within Trinity are several other physician leaders, including Paul Harkaway, MD, vice president for clinical integration and accountable care, who is working in tandem with Murphy and O'Rourke in launching the system's ACO strategy and its clinical integrated network strategy.
The three work to set the agenda for the organization's physician councils in different markets, not only to engage physicians who are leaders in the employed network, but also those independents who belong to physician-hospital organizations and independent physician associations with Trinity.
These small work groups "collaborate and share knowledge on how to move to value-based purchasing," he says. "We needed to engage with the primary care community, and you can't do that one-on-one. We do it through the IPAs and the PHOs."
Smaller hospitals have a tougher time integrating physicians into senior leadership, but that doesn't mean they don't create opportunities, says Mark Adams, chief executive officer at Ogden (UT) Regional Medical Center, a 160-staffed-bed hospital owned by Nashville-based HCA Healthcare.
The low level of physician leadership reported in the HealthLeaders Media Industry Survey "doesn't surprise me," he says. "But it's changing fairly quickly. We don't have full-time physician executive leadership at this hospital—we're fairly small—but we are engaging physicians in part-time formal relationships, such as part-time medical director."
Ogden also has physicians in part-time liaison roles for executive relationships and in a position for director of quality and process improvement. In service lines, such as cardiovascular, Ogden has deployed an employment-alignment model with shared governance where physicians who practice there participate in operational decision-making for their service line. Other physician service line leaders have been appointed for the hospitalist program, the ED, surgical, and the neonatal ICU.
"Those leaders meet regularly with other service line leaders in our network to discuss how we can work together as a healthcare system," Adams says.
Some healthcare organizations have worked to increase the influence of the chief medical officer on the executive leadership team. Count Trinity among those.
"In most of our organizations, we have transitioned to having that CMO role more broadly defined," Murphy says. "They're far more focused on developing the value-based model of the future and how physicians will be integrated into that strategy."
The AAMC's Kirch is optimistic about the future of physicians in senior leadership. "Today's physicians are actively involved in redesign of clinical systems and clinical safety," he says, adding that there's a growing pool of more recently trained physicians who are eager to take on these tasks.
"You might continue to see a relative deficit of MDs occupying the CEO or COO position, but I'm very impressed by the strength of the cadre who are occupying the chief innovation, quality, or medical officer chairs at hospitals and health systems. A number of those will evolve into the higher leadership positions."
But Kirch adds that, generally, physicians are ultimately concerned with delivering excellent patient care, and, "in many ways, the CMO or CQO is able to have a much greater direct impact on patient care than the CEO."
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