Wisdom On Closing Health Care Case Study

SPOTLIGHT ON FIXING HEALTH CARE

Spotlight

ARTWORK David Maisel, History’s Shadow GM8, 2010 Archival pigment print, 40" x 30"

Turning Doctors into Leaders
Medicine is in for a radical change as the old guard gives way to performance-driven teams. by Thomas H. Lee

50 Harvard Business Review April 2010

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Thomas H. Lee (thlee@ partners.org) is the network president of Partners HealthCare System, in Boston, and a professor of medicine at Harvard Medical School. He is a coauthor, with James J. Mongan, of Chaos and Organization in Health Care (MIT Press, 2009).

April 2010 Harvard Business Review 51

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SPOTLIGHT ON FIXING HEALTH CARE
52 Harvard Business Review April 2010

THE PROBLEM with health care is people like
In many cases, the first step is colocation— putting the various types of physicians who provide most of the care for a patient population in one place. Sometimes an opportunity for colocation is created by the construction of a new facility dedicated to patients with specific conditions, such as cardiac disease or cancer. More often, institutional leaders must move groups around in an elaborate multiyear effort to bring physicians from different disciplines but the same patient population closer to one another. But colocation alone can’t guarantee a wellcoordinated effort to improve patient outcomes. That’s why Delos Cosgrove abolished the Cleveland Clinic’s traditional departments and replaced them with “institutes” defined by patients’ conditions. He realized that as a cardiac surgeon, he needed to collaborate more with cardiologists than with surgeons who operated on other parts of the body. So he brought together the clinic’s cardiologists, cardiac surgeons, and vascular surgeons in the new Heart and Vascular Institute, and started capturing and publishshpatients ing information on how its pa ients have fared. pat ents
They figure out which patients need to see which physicians and when. The more subtle ingredient in this model’s success—the secret sauce, as it were—is a culture in which care coordinators can actually coordinate care. It requires that physicians be both team leaders and team players. Not long ago, in the strict hierarchy of medicine, nurses were largely regarded as technicians whose job was to follow orders. No decision was made without a physician’s knowledge and consent. The notion of a nurse as a critical contributor and independent decision maker on a clinical team would have seemed absurd. That’s changing, because providers that deliver care in the traditional way simply can’t match the performance of Geisinger and other organizations where physicians work in teams with care coordinators. In these organizations the coordinator’s role is something like that of a point guard in basketball, with the physician acting as a combined general manager and player-coach. Leading these teams requires physicians to hand off considerable responsibility to nurses. The payoff is improved performance on the metrics that matter most to them and their patients. Team building is a critical competency for leaders of physician groups, particularly the increasingly common groups of 25 or more that include doctors from a range of specialties. Most of