There's something I've learned as a medical school dean about the selection and training of physicians that I believe is equally true of hospitals and their leaders. Quite simply, the future of health care can be remarkably exciting — to those who embrace a new set of skills.
The old model of succeeding by operating leanly is disappearing as quickly as the small, traditional hospitals that depended on it. Today, the fate of a hospital may just as easily depend on political and economic forces that threaten from outside the hospital.
As a result, the future will demand new, creative partnerships for hospitals. And it will demand of a leadership team creativity, communication, teamwork and emotional intelligence.
Let me describe how I learned this.
Where Business Students Shine
Doctors excel at taking tests. They couldn't have become doctors otherwise. Simply to get into medical school, they outperform their peers. After school, they are tested by clinical puzzles every day of their careers.
But there is one important test where the average MBA student can beat a doctor almost without thinking.
I discovered this anomaly after decades of building a successful obstetrics practice. I wanted to explore the "dark side," the shifts in management and reimbursement that were changing how health care is organized in this country. As a result, I entered the Wharton School of the University of Pennsylvania to study business. It forced me to rethink how doctors are selected, trained and expected to perform.
Here's the test. Teams are placed at tables to take part in a negotiation game. The instructions are simply that you must trade to assemble a finished product, but you cannot cheat by sharing what you have in your hand. If you fail, your career will be destroyed. But it turns out that if you follow the rules, you can't complete the product.
Very quickly, business students figure out if their careers are on the line, the rule against sharing has to be jettisoned. They team up and win. If you give the same test to doctors, they tend not to share. Their projects fail. MBA students will quickly work together; doctors will persist in working alone.
This traditional bias of doctors against collaboration is the result of selection and training — we select people who are good at working alone and who take personal responsibilities for outcomes. Much of this tradition remains good; much of it must change in a world of bundled payments for handling complex chronic illnesses with prevention and behavioral interventions.
In the modern world, teams win.
As medical educators, we must work hard to select and train doctors who can move beyond these traditional biases. We need to create team training. We need to select prospective medical students for emotional intelligence. We must build interprofessional systems.
Now we must do the same for hospitals. I fully realize that hospital chains are in ferocious competition and not about to trade with a competitor. We all see the billboard wars as each hospital system attempts to position itself with the fastest emergency department, the best trauma center, the most successful weight-loss surgery, the only place to go for heart care. As hospital leaders, we have to think beyond the billboard wars. The future lies in creative partnerships.
Partnering with communities. The greatest partnership we can enter into is with our communities. Instead of worrying about political meddling, it is time we all engage in the careful identification of community need — and in assembling resources to meet those needs. Most importantly, we must work with communities to change the lifestyle and behavior as the underpinning of good health.
I helped to launch a national initiative five years ago to address the needs of anyone with a chronic illness — something that would affect their lives every day. What I realized is that our old phrase, "bench to bedside," needed to be adapted. We're not developing science from the lab bench to the hospital bedside — we must develop science for the bedside at home. It is at home, with their families, at their schools, in their neighborhoods, that people struggle with handfuls of pills, insulin pumps, food choices, allergies, wheelchairs, exercise and safety, and make choices that can constrain and shorten lives.
We can forge a new future in which the leaders of health care and the leaders of communities can create partnerships.
Interdisciplinary partnerships. We can forge new partnerships between professions. One of the confounding consequences of the history of medicine and nursing is that medical and nursing students rarely train together. And yet, the single greatest cause of medical errors is the failure of communication between members of the care team. While our schools work to build interprofessional education, it's time our institutions create new teams to help people. Every time we survey students, they get it: Today's care manager may not always be the doctor. It should be the right professional for that patient's mix of issues.
Embracing technology. Leaders in health care must embrace the spirit of entrepreneurship in a fast-shifting economy. The evidence is pouring in that technology can make health care both efficient and effective. Patients may be better served online. Electronic monitoring reinforces better lifestyles. It turns out that we overestimate technology in the short term; we believe it'll suddenly create magic. It doesn't. But we underestimate technology in the long term. The technologies that will support people to be healthier will make dramatic change in our business. Our response to this change should be excitement: An entrepreneurial spirit can make big differences for our patients and for our institutions.
The secret to entrepreneurship is the same secret as the trading game we employ in business school to teach negotiation — creative partnerships. We have to create new partnerships with the entrepreneurial business community. We may need new partnerships with elected officials. And most certainly, we will need to launch new community alliances.
I'll leave you with one last lesson from the education world. What we've found in education is a beautiful paradox: It takes emotional intelligence to design high technology for improved health. As leaders of large systems, we need to seek the same emotional intelligence as we build creative partnerships.
The future for health care can be exciting and optimistic. That's our decision, not fate.
Stephen K. Klasko, M.D., M.B.A., is the president of Thomas Jefferson University and president and CEO of TJUH System in Philadelphia.