Physicians are not cogs: How we can be great in healthcare

by Francine Gaillour, MD

A piercing and entertaining article  in Harvard Business Review online, “People Are Not Cogs,” by Nilofer Merchant, author of The New How, offers keen insights worth considering by healthcare executives and physician leaders.

Merchant makes some incisive points about how industry has traditionally measured productivity and hence factored in the value of  the individuals on the production line:

In spite of a forest’s worth of academic papers and rafts of best  practices published by the likes of HBR on the importance  of the “soft”  stuff, most companies continue to treat people as inputs  in a production line.

… most organizations still operate much as they did in the industrial  age. We manage the measurable, rather than the things that create  meaning that fuels creativity, that enables innovative thinking and that  helps any company to outpace the market.

In healthcare one could argue that in addition to productivity we also measure quality and patient satisfaction and therefore we’ve covered all the bases.  However, extrapolating from Merchant’s thinking, an important set of metrics is still missing—metrics that reflect our capacity for greatness.

Merchant’s commentary articulates what I observe in our real world of doctoring. Physicians want to create meaning, to be engaged and connected with their patients and with each other.  Yet the real pressure to see more patients, to cut the time between waiting room and exam room, to be more efficient, makes doctors feel like cogs rather than healers.  We used to be physicians, now we’re providers.  Our patients are now consumers.  Yes, we’re lean, but we we’re not great.

A great physician-patient relationship transcends the metric of minutes shaved off the visit in the name of efficiency. A great relationship and opportunity for healing is crafted over a period of multiple visits, phone calls, reflection over the case, collaboration among physician, consultant and nurse, and the heart-to-heart talks with the patient’s family.

Merchant argues that greatness can be decoded—it’s not a mystery:

It includes all of us having confidence that we’re making a difference.  It’s asking questions that let us reimagine what could be. It’s feeling  motivated. It’s about being challenged within our capabilities. It’s all  of us having a rich, intense sense of joy at  work. It’s trusting  ourselves, and our ability to learn. It’s about being trusted by others.  It’s when we can say to each other: I believe in you.

How do we in healthcare introduce this capacity for imagination and trust—-really, for collegiality—among physicians and clinicians?  From my experience as  a coach and facilitator for physician groups, it requires a deliberate approach to:

  1. Learning communication skills and establishing agreements that enhance our relating to each another and our staff
  2. Integrating into established forums, such as weekly and monthly staff meetings, structures for enriching the experience; making those times we commit to coming together a joyful experience
  3. Learning together around topics such as personal leadership, emotional intelligence, team building, innovation

Let’s start talking about how we  build this capacity for greatness as physicians and leaders.  I have no doubt the by-product of engaged physicians will be a healthy bottom line.

Francine Gaillour is an internal medicine physician and the executive director of the Physician Coaching Institute.  She blogs at

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