Search

KEY CONCEPTS * Leading Health Care Organizations * Maximizing Multiple Objectives * Finding Pareto Optimum * A New Philosophy of Management * Creating 'The Optimal Organization' Do physician executives approach managing and leading health care organizations like a CEO of a Fortune 100 company? Or does their training as physicians first give them a unique perspective, leading them to view organizational issues differently? The authors suggest that to be a physician executive is to be the practitioner, teacher, coach, and mentor for a new philosophy of leadership and management called Leading Beyond the Bottom Line. While the financial health of an organization is critical to its survival and its ability to fulfill its purpose, the trap is to focus an maximizing the bottom line. This new philosophy leads an organization to attend in equal measure to the (1) welfare of its patients, (2) its financial health, (3) the well-being of its employees, and (4) the building of its community. 'the Optimal Organization' is one in which these four objectives are seen not only as related, but interconnected, and the goal is to maximize all of them. The legitimate role of the physician executive is t o manage in search of Pareto Optimum, or the maximum benefit for all four organizational objectives. Clearly, this is a tougher job than maximizing profits or lust optimizing profits and patient care., WHAT DOES IT MEAN TO be a physician executive? Are physician executives simply physicians with management training, or does being a physician itself make a distinguishable difference in the leadership [...]

Medical care presents complex problems to physician executives-thoughtful problem definition is a critical management task. Without understanding the context, cultures, bottom line implications, and personal relevance, problem definition is incomplete and problem resolution may be inadequate or inappropriate. If our choices are complex, some of the difficulty may lie in our understanding of the problem. Until we have properly defined the problem, we can't act to resolve it. We need to step back, reframe the issue, ask if it feels right, and understand the whole story, not just the situation at hand. The tests of an organized story are coherence, direction, meaning, and implication. These should be perceptible both as individual attributes and as a whole. The purpose of such a story is not the resolution of the problem, but a coherent understanding of the direction to be taken. When the diagnostic work-up is complete, the next steps can begin. KEY CONCEPTS: Defining the Problem, Complex Problems, The Whole Story, Refraining, Conflict Avoidance, Conflict Resolution., AT HARVARD MEDICAL School in Boston, one gray building bears an inscription, in Latin and in concrete: Ars Longa, Vita Brevis,'1 Roughly that means that the 'art' of medicine takes [...]

If the question were simply put: 'What is it that succeeds or fails to meet patients, needs in managed care?' Dr. John M. Ludden would have a short answer. 'It depends. Success depends on whether you are talking about individuals or about populations of patients. And it depends on whether you are talking about meeting patients, needs or their desires. It depends on whether you're talking about well patients or sick patients, young patients or older patients, new patients or established patients, rich patients or poor patients. And it depends on your ability to balance each of these qualities.' This article explores how to translate high-quality care for a population to high-quality care for individuals., For physicians who work in HMOs concerned with quality, the distinction between caring for individuals--patients one at a time--and populations of patients is central to success. The very evolution of [...]

A friend of mine once said that medical staff/administrative relationships are the Bermuda Triangle of health care management. The Bermuda Triangle, as I recall it, is an area of the Atlantic Ocean into which ships and planes disappear without a trace, for no apparent reason. Sometimes, especially late at night on reruns of 'Twilight Zone,' these planes reappear years later, crew intact and youthful. Sometimes, salt and sharks get the ships, planes, and voyages. In a like manner, problems in medical staff/administrative relations draw consultants into a vortex. Sometimes, the consultants and their reports float to the surface a long afterward. Sometimes, they are digested by the organization and become a part of its mythology. Sometimes, they vanish forever. This is the story of three consultations. All were intended to make recommendations concerning the structural relationship of management to the physicians and their groups in our HMO: How to link the physician organization to the corporate structure. Like any narrative, this story is constructed to provide a context for reflection and is not intended to question the value of the contribution of specific individuals or companies., There are a lot of things to remember about Albert. His German accent and his large gold rings made him instantly memorable. His appearance was slightly imperious, including a three-piece, [...]

The Leading Beyond the Bottom Line article series has received an overwhelming response from ACPE members, mostly in enthusiastic support of this new leadership concept. Some of the important questions [...]