Published 8/1/2008
Marshall K. Steele III, MD

Thoughts on shedding light on the dark side

Progressive hospitals are now developing orthopaedic subspecialty service lines as “destination centers of superior performance.” These subspecialty service lines may focus on total joint replacement, spine, or trauma, and are led by physicians.

In 1995, I became a service line leader (part-time position) in joints, spine, and the operating room. As usual in many hospitals, tensions and issues of trust existed between administration and physicians. Some of my colleagues asked me if I was going to the “dark side.” I found out that the dark side is not so dark. To be sure, there are shadows, but we physicians can shed some light on them.

Hospitals do care about patients. Hospitals do care about physician success and satisfaction. The problem is they often don’t know what it takes to succeed. They are often paralyzed due to politics or resource constraints. This paralysis looks like apathy to physicians; even worse, it may seem like incompetence.

Instead of settling for the status quo, physicians can really make a difference and help hospitals succeed. Here are 10 thoughts from my experience in service line leadership—plus an extra thrown in for the future.

It’s a different job
Being a service line leader is different from the usual jobs that are often associated with medical staff leadership. It’s different than being the chief of orthopaedics or holding a medical staff leadership position. These positions involve representing the department or the physicians and may often be at odds with administration. This new position involves both collaboration and advocacy.

Understand leadership
I had to reconsider my view of leadership. Like most physicians, I considered myself a leader; having staff take my orders made me feel this way. What makes us successful as physicians, however, may put us at a disadvantage when it comes to leadership.

Most of us became successful through individual hard work.

To be successful in the hospital setting, I had to build a team. Today’s business schools teach teamwork and students are rewarded as teams, not just as individuals. I needed to understand this and realize that I was not the owner; I was the quarterback, one of many equals, all of whom are vital to success.

My new position as leader of the service line made me responsible for the success of the entire program, which included helping surgeons I had always competed against become more successful.

Create a vision
As a leader, I must help the service line team develop the right vision, goals, and metrics. In today’s world, it’s easy to forget why we became physicians. Managed care, Stark legislation, and universal health care dominate many discussions. The right vision—with the welfare of the patient squarely in the center—was vital. Focusing on the community good and understanding the needs of all the stakeholders will be essential if we hope to gain public support.

Write it down
Many studies have shown that writing down your goals is essential for long-term success. Most service lines don’t have a written vision or business plan. Writing this vision down (we call it our philosophy), developing a plan, and receiving edits from the team is vital. Otherwise, everyone will have his or her own version and difficulties will quickly arise.

Establish metrics for success
As Peter Drucker, the father of modern management techniques, once said, “If you don’t measure it, you can’t manage it.” Establishing scorecards to share the information is important. If you fail to create a written vision, goals, and metrics you will never reach your full potential. In the heat of discussion, referring back to the vision, values, and metrics you’ve agreed upon often clarifies the best solution for everyone.

Focus on “value” as well as “quality”
Value is really quality divided by cost. While continuing to be a strong advocate for excellence, I needed to understand the real world of full-time equivalents, costs, and budgetary constraints. This doesn’t require an MBA, but it does require a new way of thinking. How to create the most value with the resources available became my newest challenge. My other challenge was to minimize the use of resources that provided little value to the patient.

Run effective meetings
Regular meetings are inevitable and important. We learn and collaborate through multidisciplinary, performance-improvement team meetings. The following four-step process can help facilitate meetings and effective collaboration.

  • Always start by agreeing on the facts and the goals you are trying to accomplish. Nothing will be accomplished without agreement on these two things. For instance, to create more consistency in care, everyone must first agree that this is the goal and that the present system does not support it.
  • Gain understanding and appreciation of everyone’s point of view. Having an appreciation of everyone’s point of view is different from being quick to offer up your own opinion or accept the opinion of the most passionate person or the one with the most authority. Get everyone talking. Call on people for their views. Do not let them be silent. Be patient but be persistent. Without consensus, nothing usually happens.
  • Make decisions that can be implemented and measured. Ask those who will be charged with implementation about the potential hurdles and what the team can do to help overcome them.
  • Have a hospital decision maker present at your meetings. Nothing is more frustrating than agreeing to a decision that will not have hospital support. A recommendation by the entire team will facilitate its adoption and implementation.

Give your program a soul
The culture of every organization is rooted in the soul and passion of its leaders. Will your program be soulful or soulless, passionate or passionless? Programs and companies with a soul and a passion outperform those without one. You, as a leader, set the tone.

Remember the core of what we do: heal the body, the mind, and the soul. Every program needs more than a “to-do list,” more than metrics, more than a push for higher volume and lower costs. Every program needs a soul, which may not necessarily be seen, touched, or heard, but is always felt. Helping your team make this emotional connection with patients is important in ensuring long-term success and enthusiasm.

Don’t let success be your Achilles heel
Your real test as physician leader will be after the launch and after the program succeeds. I have seen countless programs start fast only to slowly fizzle away due to the failure of the physician leader to continue to lead. The main reason for this is a lack of meaningful feedback. Never believe you have found the answers. If you want to avoid complacency you must keep asking the staff, the physicians, and especially the patients for specific feedback on how you can be better. They will tell you; you should listen and act.

Be an excellent physician
Because you are setting the standard, being an excellent physician is essential to ensure the respect of your colleagues. When confronted with difficult issues, I found that focusing on the patient’s needs—rather than the needs of the administration or the physicians—was still best.

Throw your hat in the ring
I’ve added this tip because health care desperately needs physician leaders who can cross the chasm between the organizational aspects of medicine and the bedside care of patients. Restoring trust and collaboration between administration and physicians is important.

The truth is we need each other. Your leadership can help put light on the shadows and build a better healthcare system. With physicians in leadership roles, there should be no dark side. There should be only one side—the patient’s side. As Theodore Roosevelt said, “Far and away, the best prize that life offers is the chance to work hard at work worth doing.” This is work worth doing.

Marshall K. Steele III, MD, is CEO of Marshall Steele & Associates, a healthcare consulting firm. He may be reached at msteele@marshallsteele.com