The challenges impacting the functioning of a health care system are immense. Quality, humanity, technology, costs and other complex issues need to be monitored, solved, and reconciled. This requires exceptional managers.
According to the US News and World Report 2019, the Mayo Clinic, Rochester, is once again the best hospital in the United States this year. It is followed by the Massachusetts General Hospital, Boston, the Johns Hopkins Hospital, Baltimore, and the Cleveland Clinic.1 These leading hospitals have one thing in common: their CEOs are all highly qualified physicians. Clinics such as the Mayo Clinic and the Cleveland Clinic have been run by physicians since they were founded about a century ago.
In an exciting article in the Harvard Business Review, Dr. James K. Stoller, pulmonologist, intensive care physician and chairman of the Cleveland Clinic's Education Institute, examines the question of whether there is a wider message behind these results.2
A cross-sectional study examined the CEOs of the top 100 best clinics in three disciplines: oncology, gastrointestinal and cardiovascular diseases.3 The quality scores of the clinics managed by physicians were approximately 25% higher. Other studies also found this link. The relationship between clinic performance and management skills was also illustrated by a study of a large database of clinics in nine different countries.4 It was the proportion of managers with a medical degree that had the greatest positive effect.
It is also known from other industries that managers who are or were "at home" in the respective areas of expertise (as in the case of former top athletes who are later linked to a higher success rate of the teams they lead or coach) are characterized by better organizational performance. Having a boss who is an expert in the core business of an organization goes hand in hand with a high level of employee satisfaction and lower turnover.5
What makes physicians in executive positions perform better than pure business economists? The Mayo Clinic website states that it is run by a physician to ensure that patients' needs come first.
Dr. Toby Cosgrove, a former CEO of Cleveland Clinic, says it's because of the “eye-level” effect and credibility of someone who has worked through the same positions and activities. Such a physician can understand the needs of their colleagues in the profession, despite how high their position in the organization is. When a manager understands from their own experience what it takes to perform a particular task at the highest level, they are more likely to create the right working conditions, set realistic goals, and adequately assess or appreciate someone's performance.
Dr. Cosgrove also argues that decision-makers are often more open to innovative ideas or proposals that may seem “crazy” at first glance. One such idea was the first coronary bypass at Cleveland Clinic in the late sixties. He says a good boss gives people with extraordinary ideas a safe space, and tolerates, within an acceptable framework, failures that are a natural part of scientific pursuit and progress.
However, good management cannot do without social competence. We still tend to be educated as lone warriors during our studies, although health care is one of the few areas where a lack of teamwork can cost lives. It is also difficult for many to take on the role of a leader after years of study and residency when it is often required that you follow, classify and repeat the established structures and procedures. This can be a handicap that has to be overcome by physicians who often do not have formal leadership training.
If physicians would receive systematic training on how to manage with good leadership, whether only contextually or in a permanent leadership position, the performance of the clinics would certainly be even better. For years, the Cleveland Clinic and the American Association of Physician Leadership have been training US physicians with high clinical management skills potential, paying particular attention to emotional and psychological intelligence, team building, leadership and conflict resolution.
References:
1. 2019-20 Best Hospitals Honor Roll and Medical Specialties Rankings. US News & World Report Available at: https://health.usnews.com/health-care/best-hospitals/articles/best-hospitals-honor-roll-and-overview. (Accessed: 25th August 2019)
2. Stoller, J. K., Goodall, A. & Baker, A. Why The Best Hospitals Are Managed by Doctors. Harvard Business Review (2016). Available at: https://hbr.org/2016/12/why-the-best-hospitals-are-managed-by-doctors. (Accessed: 25th August 2019)
3. Goodall, A. H. Physician-leaders and hospital performance: is there an association? Soc Sci Med 73, 535–539 (2011).
4. Bloom, N., Sadun, R., Lemos, R. & Van Reenen, J. Healthy Business? Managerial Education and Management in Healthcare. (2017). Available at: https://papers.ssrn.com/abstract=3039454. (Accessed: 25th August 2019)
5. Artz, B. M., Goodall, A. H. & Oswald, A. J. Boss Competence and Worker Well-Being. ILR Review 70, 419–450 (2017).