A Tale of Three Tables: How Physicians and Executives Become Partners

Without effective physician leadership, clinical redesign strategies will fail.

A growing number of physicians are stepping into leadership roles in hospitals and health systems. Many health system CEOs are physicians. There is clearly a strong case for clinicians in the C-suite of the future.

As a career health system executive CEO and executive coach to healthcare leaders, I’ve noted an interesting pattern in how physicians often emerge as leaders. I call it the “Tale of Three Tables.”

Health systems are searching for effective physician leaders to fill a variety of institutional roles: chief medical officer, VP of medical affairs, chief clinical informatics officer, chief of clinical operations… the job titles vary. The clinical quality and patient safety metrics that now directly impact the system’s revenue require real clinical redesign, something non-clinical executives cannot lead. 

In response to this need for physician leaders, executives traditionally looked to their medical staff leaders for help. 

In the past, this made sense. The medical staff was the only forum to affect clinical change. Yet the relationship between physicians and executives were too often characterized by adversity rather than teamwork. Their table manners differed a lot!

Today, the name of the game is population health management, turning the focus to value, teamwork, and coordination of care inside and outside the hospital. Medical staffs alone are ill equipped to manage such care.

One example of a new forum for change is the creation of a hospital employed multi-specialty group practice. Unlike the hospital or the medical staff, this is a new joint-ventured business that is both clinically and financially integrated to manage patient care through better-coordinated clinical practices.  

The result of all of this is the emergence of a new forum — or table — composed of health system executives and physician leaders who bring very different “table manners” from their experience in working with each other through a medical staff structure.

The First Table:  Physician Leadership in a Hospital

Historically, executives managed hospitals, and physicians were granted privileges to practice there. This often created a contentious relationship.  Today’s challenges require a fundamental redesign of the health system. Physician leaders engaged in this work can serve as translators between clinical and non-clinical staff to find better clinical ways to serve patients and generate the financial margins the system needs. Chief Medical Officers become the first line of relationship between management and clinicians to set the agenda for advancing clinical quality and patient safety. It works well for the hospital clinicians, such as hospitalists, nursing, and hospital-based physician services. But the autonomy of the independent physician members of the medical staff can resist the chief medical officer’s efforts to drive change.

The Second Table:  Physician Leadership in a Medical Staff

As hospitals become accountable for the value-outcomes of the care of patients, management usually turns to the medical staff officers for help. They become the target audience for physician leadership training. The premise is that leaders on the medical staff can change the clinical behavior of their peers to benefit the hospital financially.

Eventually, everyone realizes that a medical staff is not well designed to change the clinical and business practices of its members. Its primary purpose is to set and preserve standards of quality for membership on the medical staff. Managing “pedigree” is what gets the attention — proof of education, training, and certification necessary to be privileged to practice in the hospital. Managing performance is limited to monitoring quality and patient safety practices and advocating for compliance with minimally required standards.  

No independent physician would entrust the management of his or her private practice to the medical staff. It isn’t designed to run a business. And yet running a business that assumes the risk for the management of a population’s health is exactly where we are going. A new approach is needed.

The Third Table:  Physician Leadership in a Joint-Ventured Business

What a medical staff is not designed to do is the new work of managing the business performance of its members — keeping referrals in-network, assuring high patient satisfaction, and following agreed-upon clinical protocols based upon best evidence-based practices. This is population health management, and it will require several new business competencies that combine both the institutional resources of the health system and the collaborative leadership capacity of physicians:

  • Automated Care Management: HER, linked from inpatient to ambulatory, with best evidence-based protocols
  • Reduction of Inpatient Readmissions
  • Managing cost and utilization of resources across the continuum of care
  • Improvement of Patient Compliance
  • Managing Clinical Quality Metrics by provider
  • Increasing Patient Engagement
  • Stratification of patients and targeted interventions to the right people
The Indispensable Ingredient for Success is Leadership

Without effective leadership — particularly physician leadership — the best organizational strategies will flounder and fail.

Leaders rarely fail because they don’t know what to do. They fail because of how they do it. “Behavioral competencies” (emotional intelligence and relationship skills) more than “technical competencies” (knowledge of finance, operations, etc.) distinguish the most effective leaders. The behavioral competencies that are essential for healthcare leaders in the 21st Century include:

  • Emotional Intelligence
  • Collaboration
  • Teams Thinking
  • Strategic Perspective
  • Adaptability in Complexity

The training and socialization of physicians and executives cause them to bring different, yet complementary, perspectives to the team. They need to learn how to use them as a cohesive team instead of as rivals. The way adults learn best is through an experiential rather than a didactic process. Executive coaches can lead a team coaching process to make this happen.

The winners in the 21st Century of healthcare will emerge where executive and physician leaders come together as equal partners around Third Tables with the right Table Manners. Effective physician leaders will be essential to their success.

Eric Norwood, FACHE, is President of CenterPoint Insights, a strategic business advisory firm to healthcare leaders based in Phoenix, AZ.  He is also a member of the MEDI Leadership team of executive coaches, the nation’s leading leadership development firms dedicated exclusively to healthcare leaders.

© 2022 CenterPoint Insights. 

Eric Norwood
About the author

Eric Norwood is a trusted, experienced advisor to C-Suite leaders, helping them improve their performance individually and corporately. He is a catalyst for change for his clients.
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