Physician Leadership in a Changing Healthcare Environment
THE TWO ORGANIZATIONS highlighted in this issue's feature articles are engaged in a journey that many hospitals, health systems, and physician organizations are recognizing is key to the task of transforming the US health system. Palomar Health and ProMedica are developing and deploying physician and other clinical leaders in governance, design, operations, and outcomes. Although each feature article describes a different approach, scope, and scale, the organizations are making good investments that will yield positive results. Without engaged physicians leading healthcare redesign, we are doomed to fail. Organizations must build strong programs to engage and develop physician leaders to succeed in the challenging environment ahead. The question remaining for all of us is how to best accomplish this.Texas Health Resources' approach to welcoming, developing, and deploying physician leaders evolved as it moved from three independent systems in 1997 to one combined organization. Our efforts accelerated five years ago when the system sharpened its focus on its mission of improving the health of people in the communities we serve. Texas Health has transitioned from an acute care hospital system to a healthcare system that includes a physician group with more than 500 physicians and more than 200 physician assistants, nurse practitioners, and extenders; it is the largest health system in North Texas. Some of our approaches are similar to, and some are different from, those demonstrated at Palomar Health and ProMedica. We are similar in recognizing that physicians must be involved in decision making and that our organizational cultures must support a shared vision and mutual trust based on experiences gained by working together. Our priorities align, yet we differ in execution. At Texas Health, we are seeing results and a return on our investment in this important area of transformation. Physician leadership is crucial to developing strategy and designing products and processes that standardize care around evidence based quality metrics, enhancing service and patient satisfaction, increasing reliability, and, ultimately, improving outcomes.The American Hospital Association (AHA) and American Medical Association (AMA) issued a historic joint position paper in 2015 titled "Integrated Leadership for Hospitals and Health Systems: Principles for Success." The organizations acknowledge that integrated physicianhospital leadership models provide a pathway for delivering greater value to patients and populations.PHYSICIAN LEADERSHIP AND GOVERNANCEOostra describes ProMedica's governance philosophy of maintaining local boards as organizations join its system. Texas Health shares this practice and has held this philosophy since its creation in 1997. As healthcare has evolved and relationships with physicians have grown closer, we have built leadership models that reflect our underlying philosophy.At ProMedica, physician seats have increased to 16 percent of nearly 500 board seats across the system. Both employed and independent physicians hold seats, with six serving on the parent board. At Texas Health, 35 percent of 264 board seats are held by independent and employed physicians. The benefits of this structure include a focus on safety and outcomes, a clear understanding of physicians' motivating factors, and a focus on the patient experience.Oostra notes that, in addition to and because of increased participation in governance, physician leaders have grown in number and been deployed across a wide continuum of settings and businesses. Texas Health has sought to increase the number of clinically trained leaders across the system. Two thirds of our hospital and physician group leaders are physicians or nurses. Physicians make up one third of our executive leadership committee membership. Sharing governance with physicians and increasing the number of physicians in the ranks of senior leaders have changed Texas Health's perspective regarding strategy development and deployment.
Frontiers of health services management