Top Cardio Programs Are Physician-Led

HealthLeaders Media Staff, April 23, 2009

I often hear anecdotal evidence that physician leadership can make the difference between an average and a top-performing hospital service, but it isn't often that I come across actual statistical evidence to back up that claim.

While researching this month's magazine article about cardiovascular service lines, I found a study by ECG Management Consultants, Inc., and Thomson Reuters that shows just how much of a difference physician leadership can make.

The study compared a group that had placed in the top quintile of Thomson Reuters' annual ranking of the top 100 heart hospitals, which is based on clinical outcomes, and a "control group" of hospitals that had made the list only once in the last three years—still an admirable accomplishment.

Physician leadership certainly wasn't the only difference between the two groups. The top-performing hospitals tended to spend more on their cardiovascular programs, averaging $25 million over three years, compared to $14 million for the control group.

But consider the numbers when it comes to physician leadership: Roughly one-third of the top hospitals had either physician-directed management or a dyad system—a partnership between a physician and a business administrator—compared to only 8% of the control group.

And that 8% in the control group really only reflects the dyad model, where a non-physician administrator is also involved. None of the control hospitals used a management model that placed a medical director alone at the top of the service line, but 10% of the top-performing hospitals did.

The overwhelming majority of cardiovascular programs are run by a non-clinical service line administrator. And while it makes sense to have a business-savvy manager involved in investment and budgetary decisions, without a physician involved, administrators are missing half the picture, according to Joseph Knapp, MD, who works as the physician half of a dyad model for the heart institute at St. Patrick's Hospital, a 213-bed hospital in Missoula, MT.

I spoke to Knapp for the magazine article, and he told me St. Patrick's recently switched to the dyad management structure in order to better discern both the clinical and business cases for where it makes sense to invest time and energy. "The simple fact of having bean-counter, administrative folks and the doctors sitting down and talking to each other when making decisions is the crux of what we're doing," he says.

As Knapp discussed in recent roundtable discussion about cardiovascular leadership, engaging physicians, particularly those in private practice, is another essential component, particularly when it comes to quality improvement. This is an area where the skills a physician leader brings simply aren't easily transferable to someone with a business or management background.

Although the study was limited to cardiovascular programs, I suspect we would see similar results for other service lines and departments. We might also find similar numbers—only about 30%-40% of programs with physicians at the top.

Why, if physician leadership makes such a difference, don't we see more physician-directed service lines?

Perhaps it's because there isn't exactly an overabundance of physician leaders, and physicians who are interested in those types of positions often need quite a bit of training to learn the required business skills. It takes time to transition, and many hospitals may not have a physician qualified to lead at that high level.

But those that don't should start looking for one, because it obviously makes a difference.

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