Academic journal article Frontiers of Health Services Management

The Five Questions of Physician Leadership

Academic journal article Frontiers of Health Services Management

The Five Questions of Physician Leadership

Article excerpt

PHYSICIAN LEADERSHIP is widely considered to be essential for success in next-era healthcare systems. This message elicits a variety of responses from healthcare insiders, ranging from antipathy to fear, from resignation to anticipation. Views differ depending on personal experiences and biases, how leadership is defined, and how individuals believe their own career trajectories will be affected by possible shifts in power and influence. All of these reactions to change are normal. The perception seems to be widespread that moving to physician leadership will require major adjustments to relationships between physicians and hospital executives.

Some consumers are bemused: "Haven't doctors always been in charge?" However, we in healthcare see the prospect of medical professionals becoming organization leaders as something new, requiring solid planning and use of change management skills.

In this issue of Frontiers of Health Services Management, the authors of the two feature articles share their thoughts on physician leadership and describe their organizations' efforts in this area. I review their programs from the perspective of the questions that must be addressed to create lasting transformation: why, what, how, who, and when.


We first need to ask ourselves why enhancing physicians' leadership abilities is important. Is it because, as some of my physician colleagues maintain, the majority of tomorrow's CEOs should come from the medical profession because nonmedical executives have not done a good job? Or do healthcare administrators perceive problems with the skills of those who currently hold medical leadership roles (e.g., chief medical officers, chiefs of staff, department directors)? Have these medical leaders failed to deliver on the objectives of their organizations? Or perhaps there is another reason for this recent emphasis on developing physician leaders.

In their feature article, Hemker and Solomon explain that Palomar Healths commitment to engage and integrate physicians is part of a "larger cultural shift... that puts the patients' needs first." Accomplishing this shift requires an alignment of a "diverse medical staff culture with administrative priorities." In his feature article, Oostra states that physician leaders "have a prominent role in leading change, accelerating action, and driving integration." The authors of both feature articles state that hospital executives and medical staff members have operated in silos, resulting in physicians' lack of engagement with healthcare organizations. The articles also suggest that reliance on traditional physician leadership models has not resulted in strong alignment between hospital leaders and medical staffs with the organization's mission and vision. Educating physicians for leadership roles, the authors explain, will result in greater value for patients and communities by improving quality and safety while reducing costs through the alignment of physician and organizational goals.

Hospital historians Margarete Arndt and Barbara Bigelow have studied the multitude of practices and changes that have taken place during the past ioo years. They found that "the problems ascribed to hospitals-in particular of high cost and inefficiency ... have been remarkably consistent over the past nine decades" (Arndt and Bigelow 2000, 339). They argue that most authors "simply assert that hospitals should adopt a practice, be it a product line, management, diversification, restructuring, or reengineering" (344) and that healthcare organizations have made little progress because we tend to accept without question current business trends. Similarly, they argue that healthcare executives tend not to reflect on the "appropriateness of a particular practice for any and all hospitals" (345), which may pose a problem because "not all practices hold promise for all hospitals, and practices claiming transformational change will not achieve it for all functions" (361). …

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