Change Your Primary Care Mindset--the Physician 2

“Curmudge, when we last talked about the medical home, we left the traditional primary care doc on a treadmill. He’s probably getting pretty tired by now.”

“He certainly is, Jaded Julie. Fortunately the medical home should enable him to get off the treadmill and enjoy practicing medicine again.”

“Sounds great; but as we said in our recent discussion, this requires a change in the physician’s mindset. All through his/her years of training and previous practice, the physician had to think and perform independently and bear personal responsibility for the outcomes of his patients. He communicated little with his colleagues, minimally with his nurse, and often inadequately with his patients. To function in a medical home, he has to practice leadership, communication, and shared responsibility. That’s quite a personal transformation.”

“We’ve talked about leadership, communication, and change management in the past, Julie. Perhaps now we should just touch on a few points as they apply to a physician in a medical home. With respect to changes in the role of the doctor, he or she often has to go so far as to reexamine his/her identity as a physician. ‘This transformation involves a move from physician-centered care to a team approach in which care is shared among other adequately prepared staff. To function in this team-based environment, physicians need facilitative leadership skills instead of the more common authoritarian ones (1).’”

“That sounds pretty profound (probably because it’s a quotation). Where does one go to learn all of this good stuff?”

“Formal in-house instruction, e.g., Affinity Learning Center, almost any bookstore, and for one pushed for time, the Kaizen Curmudgeon postings in April and May 2008. Of course, many physicians already have the requisite leadership skills if their background includes experience in business or the military.”

“As you recommended, Curmudge, I looked up TransforMed’s leadership tips for physicians (2). These look really valuable:

’Exemplary leaders first lead themselves.’ ‘The culture of the practice is always modeled by the leaders for better or for worse.’

‘The basic challenge of leadership is to engage the minds and efforts of the staff to work with enthusiasm toward a specific goal.’

‘An Achilles heel of many physicians is trying to do too much alone. Great leaders get things done through other people. Sharing power has two main advantages: 1) the leader is not overburdened by work that never gets done or gets done poorly, and 2) an empowered staff means leadership at all levels of the practice.’

‘The leader sets the tone for how communication will be disseminated throughout the practice.’ ‘Have meetings of both the leadership and of sub-groups.’

‘It is part of a leader’s job to show appreciation.’ A leader’s two most important words are ‘thank you.’

The leader’s number one success factor is relationships with subordinates. These relationships must motivate staff at all levels of the medical practice.”

“I hope you recall, Julie, that empowerment—noted above—is an important principle of Lean.”

“Of course I do. And intuitively I know what empowerment means, but how do you define it?"

“A leader empowers his or her colleagues by giving them permission to reach their potential (3). I hope you realize how central this concept is to the success of the medical home.”

“I also recognize that empowerment is an essential of servant leadership, and for that matter, the whole medical home list sounds like servant leadership. Back on May 8 and 15 of 2008 we wrote two postings on this. I trust you remember, Curmudge. Servant leadership is too important not to be revisited.”

“We’ll do it, Julie, but you’ll have to remind me. Meanwhile, in our next conversation let’s continue talking about the changing mindset of the folks in the medical home.”

Affinity’s Kaizen Curmudgeon

(1) Initial Lessons From the First National Demonstration Project on Practice Transformation to a Patient-Centered Medical Home (06/09/09)
http://www.medscape.com/viewarticle/703460_print (One must log in--free.)
(2) Johnson, Barbara. Leadership Excellence
http://www.transformed.com/workingPapers/LeadershipTipsPhysicians.pdf
(3) Clark, Keith and Panther, Mike. Leadership, the Art of Empowering. (2009, Monte Alverno Retreat & Spirituality Center)