High-performance teams and the physician leader: an overview.

The complexity of health care delivery within the United States continues to escalate in an exponential fashion driven by an explosion of medical technology, an ever-expanding research enterprise, and a growing emphasis on evidence-based practices. The delivery of care occurs on a continuum that spans across multiple disciplines, now requiring complex coordination of care through the use of novel clinical teams. The use of teams permeates the health care industry and has done so for many years, but confusion about the structure and role of teams in many organizations contributes to limited effectiveness and suboptimal outcomes. Teams are an essential component of graduate medical education training programs. The health care industry's relative lack of focus regarding the fundamentals of teamwork theory has contributed to ineffective team leadership at the physician level. As a follow-up to our earlier manuscripts on teamwork, this article clarifies a model of teamwork and discusses its application to high-performance teams in health care organizations. Emphasized in this discussion is the role played by the physician leader in ensuring team effectiveness. By educating health care professionals on the fundamentals of high-performance teamwork, we hope to stimulate the development of future physician leaders who use proven teamwork principles to achieve the goals of trainee education and excellent patient care.

High-performance teams for current and future physician leaders: an introduction.

The scope of patient management increasingly crosses the defined lines of multiple medical specialties and services to meet patient needs. Concurrently, many hospitals and health-care systems have adapted new multidisciplinary team structures that provide patient-centric care as opposed to the more traditional discipline-centered delivery of care. As health care continues to evolve, the use of teams becomes even more critical in allowing interdependence between multiple disciplines to provide excellent care delivery and ongoing patient management. The use of teams permeates the health-care industry (and has done so for many years), but confusion about the structure, role, and use of teams contributes to limited effectiveness. The health-care industry's underuse of the fundamentals of corporate teamwork has, in part, created ineffective team leadership at the physician level. As the first in a series of documents on teamwork, this article is intended to introduce the reader to the rudiments of team theory and to present an introduction to a model of teamwork. The role of current and future physician leaders in ensuring team effectiveness is emphasized in this discussion. By educating health-care professionals on the foundations of high-performance teamwork, we hope to accomplish two main goals. The first goal is to help create a common and systematic taxonomy that physician leaders and institutional management can agree on and refer to concerning the development of high-performance health-care teams. The second goal is to stimulate the development of future physician leaders who use proven teamwork principles as a powerful modality to achieve efficient and optimal patient care. Most importantly, we wish to emphasize that health care, both philosophically and practically, is delivered best through high-performance teams. For such teams to perform properly, the organizational environment must support the team concept tangibly. In concert, we believe the best manner in which to cultivate knowledge and performance of the health-care organizational mission and goals is by using such teams.

Anatomy of a malpractice lawsuit.

Given the prevalence of medical malpractice lawsuits, physicians are often thrust into the legal world without the education of a juris doctor. The risk of facing suit varies among specialties, but there is no guarantee any physician will proceed through his or her career without being a defendant in a lawsuit. Every physician stands a significant chance of being sued. Although a lawsuit is an exhausting and intimidating situation in and of itself, the ramifications of a plaintiff's verdict could have chilling effects on the physician's life, both professionally and personally. Therefore, it is imperative that every physician have an understanding of the legal process of which he or she may become involved. This article provides a practical guide for the physician, including the fundamental procedures of a medical malpractice lawsuit, the behavior that will be expected or required of the defendant physician, and the effect of disobeying the required procedures.

Fundamentals of service lines and the necessity of physician leaders.

In the demanding and unpredictable environment of the health care industry, hospitals and health systems continue to search for ways to improve the efficiency and quality of care provision and, thus, thrive. Service line organization in health care, a concept that was popularized in the past, has recently experienced a resurgence, spanning the gamut from small community hospitals to large academic medical centers. The modern service line has transformed into an organizational tool that provides hospitals and health systems with a novel approach to achieve the goals of efficient and effective care. Physician leaders can play an integral role in the management of service lines, using a combination of management skills and clinical expertise to provide the oversight and direction necessary for assuring excellence in clinical care and value in its delivery. This article presents an overview of service line structure, implementation, implications, and the role of the physician-leader.

Gaining hospital administrators' attention: ways to improve physician-hospital management dialogue.

BACKGROUND: Despite marked differences in training and professional interests, physicians and hospital managers face similar problems stemming from the unprecedented rate of change in the health care delivery system: failure of reimbursement to keep pace with rising costs, new therapeutic modalities, increasing government and managed care regulations, heightened consumerism, and an aging patient population. In the face of these mounting challenges, both physicians and hospital managers could benefit significantly from a climate of collaboration and interdependence. METHODS: This article presents a "case report" of a community teaching hospital in which practicing physicians and hospital administrators collaborated to develop an operating plan for the next 3 years to improve the practice environment. RESULTS: The physicians recommended new clinical priorities to enhance service to patients and families, to improve physician-physician communication, to develop clinical protocols, and to build coordinated diagnostic treatment centers, which the administration has implemented. SIGNIFICANCE: Physicians and hospital managers can no longer pass on cost increases at will to patients and third-party payers. Nor can physicians and managers ignore the heightened power of patients and third-party payers. Effective dialogue and collaboration are in all parties' interests to optimize patient care and to develop innovative services. Despite the tensions created by competition and rapid change, transformation from a blaming to a learning environment may be a key strategic advantage in today's health care marketplace.

A marketing-oriented perspective on physician selection.

The process of selecting a physician is an inherently difficult one for patients. Physician selection is often made from limited information, and in many cases, the information used as the basis for physician selection is obtained indirectly through either medical service providers or other consumers or patients. When selecting a physician, patients tend to rely on personal sources of information and place importance on the reputational aspects of the health-care provider, organization, and experience. Patient expectations for the technical aspects of the health-care experience are stringent and must be met or exceeded by physicians and other health-care providers to compete long-term in the health-care market place. Beyond this, health-care providers can favorably influence patient perceptions of the health-care experience by excelling at the functional aspects of service provision (ie, the interpersonal- and process-oriented attributes). This article examines the physician selection process and provides marketing-oriented recommendations for addressing some of the challenges patients encounter when selecting a physician.

Enhancing the clinical skills of surgical residents through structured cancer education.

OBJECTIVE: To assess the short and long-term educational value of a highly structured, interactive Breast Cancer Structured Clinical Instruction Module (BCSCIM). SUMMARY BACKGROUND DATA: Cancer education for surgical residents is generally unstructured, particularly when compared with surgical curricula like the Advanced Trauma Life Support (ATLS) course. METHODS: Forty-eight surgical residents were randomly assigned to 1 of 4 groups. Two of the groups received the BCSCIM and 2 served as controls. One of the BCSCIM groups and 1 of the control groups were administered an 11-problem Objective Structured Clinical Examination (OSCE) immediately after the workshop; the other 2 groups were tested with the same OSCE 8 months later. The course was an intensive multidisciplinary, multistation workshop where residents rotated in pairs from station to station interacting with expert faculty members and breast cancer patients. RESULTS: Residents who took the BCSCIM outperformed the residents in the control groups for each of the 7 performance measures at both the immediate and 8-month test times (P < 0.01). Although the residents who took the BCSCIM had higher competence ratings than the residents in the control groups, there was a decline in the faculty ratings of resident competence from the immediate test to the 8-month test (P < 0.004). CONCLUSIONS: This interactive patient-based workshop was associated with objective evidence of educational benefit as determined by a unique method of outcome assessment.

A broader view of marketing: implications for surgeons.

The health care sector of the economy is changing. There is unprecedented growth in the health care sector, and competitive forces have a more prominent role. In addition, consumers have become more informed and as a result, more empowered. Patients in the health care sector are no exception to this trend. As patients become more informed, it is imperative that health care providers become more effective at marketing their services. In general, physicians typically have received little training in the field of marketing, which results in potentially limited understanding of the key marketing issues being faced in today's health care environment. We identify and examine several key marketing issues critical to the success of health care providers in today's environment. Further, we offer some managerial recommendations designed to address each of these issues.

The next stage in the health care economy: aligning the interests of patients, providers, and third-party payers through consumer-driven health care plans.

This article reviews employers' attempts over the past 25 years to address the cost and accessibility of health care services for their employees and the effect these efforts have had on U.S. health care delivery. The difficulties in aligning the interests of all parties in a third-party health beneficiary contract are examined. Many employers are considering consumer-driven health care plans as an alternative to managed care plans to both control health care costs and improve employee satisfaction. Such plans differ from fee-for-service and managed care models in terms of the economic alignment of the parties. Consumer-driven plans align the employer's economic interest with the employee/patient, and reduce health benefit costs by providing information, tools, and direct economic incentives to employees for self-management of health care dollars. Because these incentives are designed to reduce the consumption of services, providers are the party left out of economic alignment under the consumer-driven model.

Centralized oversight for clinical performance improvement: a pilot initiative at the Lexington VAMC.

BACKGROUND: In July 2000 the Lexington Veterans Affairs Medical Center (Lexington, Ky) centralized oversight of clinical performance improvement (CPI) activities by creating an office of clinical operations (OCO) to improve patient care and operational efficiency. The OCO was designed to eliminate redundancy of effort, correct resource underuse and overuse, and improve the communication of change initiatives and successes. Before 2000 no formal process existed for creating interdisciplinary CPI teams. Lack of organizational oversight for CPI activities had also led to duplication of effort, mixed accountability, and difficulty in remaining focused on organizational goals. CREATING THE OCO: OCO staff have led and facilitated numerous projects, all of which involved interdisciplinary teams consisting of physician and nurse leaders, users, and support staff. The OCO has also developed a utilization management plan for the entire medical center. The OCO formally interfaces with three major arenas of medical center operation: clinical processes, patient safety, and cost-efficiency. CHALLENGES AND LESSONS LEARNED: A major effort of OCO staff has been to learn about data availability and access and to determine how data can be used in a meaningful way to benefit CPI project teams. The creation of the OCO precipitated the typical cultural integration problems that are often encountered with the introduction of new organizational entities that lack existing turf.