PHYSICIAN MANAGERS OF THE FUTURE

“To Change or Not To Change? That is Not the Question”:

  • Link up with allies
  • Look for win-win situations with health plans and insurers, regulators and agencies and other areas of potential conflict in your professional life
  • Prepare for even more change
  • Innovate
  • Petition government, such as for battle for a real patients’ bill of rights
  • Vote

According to the article by D. Ted Lewers, M.D., “To Change or Not To Change? That is Not the Question,” American Medical News (May 7, 2000), Tom Peters of In Search of Excellence, quotes the founder of Visa International, Dee Hock as saying, “The problem is never how to get new innovative thoughts into your mind, but how to get the old ones out.”

Lewer’s shares his to do list with fellow physicians, including: Link up with allies; look for win-win situations with health plans and insurers, regulators and agencies and other areas of potential conflict in your professional life; prepare for even more change; innovate; petition government, such as for the battle for a real patients’ bill of rights; and vote.

Lewers claims sweeping changes are coming, not just to the medical profession and the health sector in particular but to society as a whole. That a new, universal symbol of change is the Internet and he encourages physicians to be leaders. He recommends for physicians to use the AMA’s Grassroots Action Center resources available on the AMA Internet site at http://www.ama-assn.org.

Lewers quotes, Alfred North Whitehead, philosopher and mathematician who wrote, “The art of progress is to preserve order amid change and to preserve change amid order.”

For the AMA good stewardship is in asking again and again, “Is it good medicine?”

According to David Nash’s book, physician managers of the future will also be charged with fostering the creation of a vision for the future for managed care organizations and encouraging clinician “Buy-in” to this vision.

As the health market becomes more competitive some say it will become more important for many physicians to get administrative skills and they may go back to school to get MBA’s.

Some physicians might join a health care corporation for reasons such as salary. As corporate employees, physicians may have to answer to regional mangers and accounting departments and play corporate politics. Such physicians may lose autonomy over how they practice medicine. Physician managers of the future will look proactively towards the future and see the big picture issues.

Using a decade of research on hospital strategic decision making, an article by Donde P. Ashmos, Dennis Duchon and Reuben R. McDaniel, “Physicians and Decisions: A Simple Rule for Increasing Connections in Hospitals,” Health Care Management Review (Winter, 2000) reinforces the simple decision rule of “let doctors help decide” for strategic issues.

This article is written by a Professor and an Associate Professor of Management at The University of Texas at San Antonio and a Regent Chair in Health Care Management and Professor in Department of Management Science & Information Systems at The University of Texas at Austin, Texas. This article gives managerial guidelines for implementing this rule:

  1. Encourage self-organizing: let patterns of relationships emerge rather than try to preordain them. For example, do away with dividing the hospital into clinical and non-clinical matters, thus predetermining that clinical issues will be resolved by clinicians and non-clinical issues will be resolved by administrators. Allow appropriate patterns of relationships among important players to emerge as a function of information sharing and meaning generation.
  2. Create structures that allow for different goals, maximum participation in strategic decision making, and different strategic activities: Managers need to be flexible enough to shape their organizations to fit the moment. Mechanized processes may be pseudo-efficient but are in fact inefficient because they are insensitive.
  3. In order to develop strategies that are sufficiently complex for environmental conditions, allow for maximum physician participation in the design of those strategies: Physicians as part of decision-making process offer rich interpretations of what is happening and better to articulate strategic activities.
  4. Look beyond the MBAs to the MDs for input in strategic decisions that affect bottom line: “market medicine”, though important, should not be at the expense of the perspective of the clinical professional.
  5. Pay attention to the hospital’s predisposition: predisposition or “dominant logic” is a sort of cognitive filter that determines what data the organization views as important and what data it ignores.
  6. If you want to change the hospital’s predisposition, alter who’s involved in making strategic decisions.
  7. Pay attention to what is being decided; involve physicians in decisions where they are likely to make the biggest impact.
  8. Check out your perceptions about how much physicians think they have say in strategic decisions: Physicians almost always think they participate less in strategic decisions than executive think they do. “Plunging in” to a decision process, without checking out the perceptions of important stakeholder groups about the process, leads to poor strategic choices and mistakes.

This article states that Hospitals are “incredibly fragmented places” in which four worlds exist: the trustees, the physicians, the managers and the nurses. Mostly these four worlds talk past each other, attempt to solve problems in isolation from each other, even if the problems are systemic problems that is problems that spread across multiple worlds.

Hospitals can be viewed like flight operations on aircraft carriers as smart systems that have developed a “collective mind”, consisting of interrelating agents working alone and the system is constructed of interdependent know-how, teams of people who think on their feet and do the “right thing” in novel situations, and the consequences of any lapse of attention are swift and disabling.

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