Doctors and hospitals — sometimes at odds in health care's days of old — are being thrust together as the industry aims to forge a new path. Leadership from both sides of the aisle is essential to thriving in a value-based world, but what are the key elements required for both to lead in an integrated hospital system?
Two of the oldest and most well-known professional organizations in health care are answering that question with a report issued this morning. Integrated Leadership for Hospitals and Health Systems: Principles for Success is the result of two years of work between the American Hospital Association and American Medical Association. In 2013, the two groups set out to find the best ways to meld hospital and physician leadership to tackle challenges facing in the field, such as the development of accountable care organizations, employment of physicians by hospitals, and the emergence of new payment models.
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The guide presents six core principles that hospitals and doctors can follow to integrate leadership and rethink their traditional relationships. John Combes, M.D., senior vice president and chief medical officer of the AHA, says that trust between the two sides is foundational to this work.
"Trust is the glue that holds this thing together," Combes says. "There has to be a sense of interdependence and working together toward the mutual, achievable goals of the Triple Aim, and then it's important that physicians and hospital leaders trust each other's good faith and abilities."
Principles the AHA and AMA found to be critical to integrated leadership include:
- Physician and hospital leaders who share values and expectations; aligned incentives; goals across the board with appropriate means of measuring them; responsibility for financial, cost and quality targets; accountable service line teams; strategic planning; and a focus on engaging patients as partners.
- A structure incorporating all disciplines and supporting collaborative decision-making between doctors and hospital executives, with physicians maintaining their clinical autonomy.
- Hospital and clinical leadership is integrated at all levels of the health system, and includes nursing and other caregivers, participating in all key management decisions.
- The partnership between both sides is collaborative, participatory and built on trust, as Combes emphasized. Interdependence and a thrust toward achieving the Triple Aim is "crucial to alignment and engagement," according to the report.
- Transparency of both clinical and business information, across the entire enterprise, is also crucial.
- Finally, integrated leadership requires an IT system that allows clinicians to capture and report quality and performance data of all participants, with leadership holding its workforce accountable for those measurements.
The guide also highlights some of the foundational elements of any successful health care organization, along with common challenges along the way. The latter includes everything from differing mindsets to lack of clarity on values, legal and regulatory issues, and commitment to transforming the hospital business model. Give the guide a read for all of the details, and for more on the topic, be sure to check out our April how-to on developing physician leaders to achieve transformational change.