As a career unfolds there are many influences over the direction one can take and choose. The patience of family and colleagues has certainly been appreciated during the time taken to write this book. From the University of Louisville College of Business administration I would like to thank Associate Dean, Audrey Kline, PhD, and Vernon Foster for their encouragement and support provided during my research and writing of this book. Next and most importantly are the management and leadership team of BayCare Health System where I received my start in health care. Opportunities were provided to broaden and deepen my understanding of the interworking mechanisms, processes, and cultural dynamics that physicians and other clinical leaders engage in daily to provide leadership to the front-line staff who work tirelessly to provide the utmost excellence in health care services. Without this experience I would not have been prepared to co-author and collaborate with Dr. Grace Terrell on the writing and development of Physician Leadership for the Information Age.
J.M. Bohn, MBA
Foreword
By Barry Silbaugh, MD, MS, FACPE
The greatest of all heroes are those who don’t consider themselves such. Despite accolades and honor from the world, they view their accomplishments as just doing their job. They believe that every other man or woman, when faced with similar circumstances, would behave the same way. In short, they see others as having the same potential to be heroes in the eyes of the world. This attitude is at the heart of remarkable leaders, across all cultures, governments, and industries.
As a young man convinced that a career in medicine would confer upon me the hero status of my role models — the doctors in my community — I willingly entered the competitive undergraduate world of pre-medical education to pursue my goal. I was proud to be accepted into the physician culture of self-sacrifice to serve others. My academic mentors taught the essential ingredients of the traditional hero’s journey: trust only yourself, be decisive, act independently, and know that you are special because you are one of us.
That perspective caused more trouble than satisfaction.
Grace Terrell and J.M. Bohn have written an insightful, timely, well-researched and referenced book about important issues of our time: Where can we find physician leaders? How do they think and act differently? How can physicians develop the needed skills, attitudes, and behaviors necessary to lead our nation’s health system to better performance for of us — consumers, patients, and health care professionals?
This book provides both historical and deep personal perspective from a physician who’s traveled the common path from endlessly curious student to clinician. Dr. Terrell has also traveled the uncommon path: from clinician to health system leader. Her passion and talent for writing, coupled with her practical experience as a clinician and leader, makes the reader see not only how conflicts arise in health care, but what must change for improvement to occur. Whether you’re a physician, someone who lives or works with physicians, a policy maker, or someone who seeks to understand how our health system became so complicated and confusing (and how to improve it), this book provides both historical and deep personal perspective in answering those questions.
During my tenure as CEO of the American College of Physician Executives, I have been fortunate to know Dr. Terrell as a Board member with uncommon ability to frame critical issues with appropriate questions, research, and relevant personal stories. She and J.M. Bohn use those same effective techniques in Physician Leadership in the Information Age.
No one illustrates the hero to leader attitude and transition better than Jeff Skiles, co-pilot on USAir Flight 1549 that landed in the Hudson River in the winter of 2009. Listening to Jeff describe his work on that fateful day in some presentations we’ve done together with physicians and health system leaders, he says he was just doing his job as part of a well-trained team. He describes the flight attendants’ actions that day with awe and respect. He points out that he and Captain Sullenberger, air traffic controllers, ferry boat operators, and others all knew when teamwork was required, and when they needed to act autonomously. Paradoxically, when leaders approach their roles as members of a team, no better or worse than others, and not as heroes, heroic accomplishments occur.
Table of Contents
Part I: Where We Stand 1
Chapter 1 — State of Affairs 3
The Beginning 3
The Impact of a Generation 5
The Medical Profession in America 6
The Individual Physician 9
Paradigm-Shifting Elements 11
Setting the Stage 15
Chapter 2 — Power Shift 21
Physician and Patient: A Shift in Position 23
Information Technology and Autonomy 24
Physicians in the Boardroom 26
Health Economics of the Shift 27
Reflection Points 29
Chapter 3 — Leadership: The Challenge and Future 33
Leadership Basics 35
Emerging from the Chaos: Governance 40
A New Model for Leadership 42
Measuring Progress 44
Reflection Points 46
Chapter 4 — Barriers to Advancement 51
Structural Barriers. 52
The Psychosocial Challenges 55
Other Impediments to Progress 57
Reflection Points 64
Chapter 5 — Starting the Hero’s Journey 67
Systemic Challenges 68
New Frontier for Learning 71
The Disruptive Hero 74
The Heroic Model of Contemporary Training 78
The Academic Journey 79
Spectrum of Motivations 81
Reflection Points 83
Part II: Our Future 89
Chapter 6 — The Pace of Change Accelerates 91
Strengthening Communications 93
Improving Quality and Safety 98
Reflection Points 103
Chapter 7 — Professionalism: Patients and Industry 107
Competing Clusters and the Physician Leader 111
Professional Existentialism 116
Professionalism in Industry Relations 117
Reflection Points 121
Chapter 8 — The Next Generation 127
Innovation Today 128
Complexity of the Journey 131
Path of the Physician Leader 132
Conclusion 134
Bibliography 137
Index 143
Part I: Where We Stand
The State of the Physician Community in America
Chapter 1
State of Affairs
The dogmas of the quiet past are inadequate to the stormy present. The occasion is piled high with difficulty. As our case is new, so we must think anew and act anew. We must disenthrall ourselves, and then we shall save our country.1
President Abraham Lincoln
1862 Address to Congress
The Beginning
The