Physician cure thyself.
After 30 years of participation in multiple medical staffs, including small regional hospitals and large academic settings, there is one constant that continually undermines how content physicians are with their medical practice and the health care system. Many challenges in patient care seem insurmountable. From declining reimbursements to intensified quagmire of bureaucracy, the practicing physician, whether employed or not is berated by administrative authorities with no experience in practical patient care. The employed physician has further abdicated her autonomy as a health care expert by capitulating to rules and regulations hospitals impose as they funnel and process health care through the lens of an economic bottom line. The single location where diverse physicians could coalesce, collectively bargain for non-economic benefits, and demand health care delivery appropriate for their patients is at the medical staff level.
Natural selection placed independent practitioners proximate to their colleagues and challenged these providers to develop rules and regulations governing participation and credentialing within a hospital system. Each provider, of course, agrees to rules and regulations set forth by his predecessor when joining a medical staff, but then is provided a voice to answer the call of self-governance and to develop collective agreements on how best to serve their community within the rules and regulations defined by health care law.
Too often at these staff meetings the positional demands of authority direct conversation away from improved health care and concentrate on interpersonal battles and power demands of a few administrators or practitioners. Serving as department of surgery chairman, medical staff office president, and elected representative to the hospital boards, I can attest that the majority of meetings and time are spent addressing the many problems and ills between administration and providers, and/or between competitive providers. These fights drown out and slow a potential efficient process of flexibility and adaptability critical to successful business organizations in this rapidly changing national economy.
The medical staff collective demands strong leadership and would benefit from the social psychology organizational tools recommended in the late 1990s through the first decade of the century. Coined as appreciative inquiry (AI), the concept is best described: “As a philosophy, AI emphasizes collaboration and participation of all voices in the organization and approaches change as a journey rather than an event. It has a systems orientation that focuses on changing the organization rather than the people.”
AI is a conceptual reframing in the way we view a person, an organization, and the world and approaches effective and positive change by acknowledging difficulties between individuals and within the system. AI assumes that focusing on even the smallest successes in determining methodology that resulted in past success, even in an environment where similar situations resulted in contempt and failure, demonstrates that there is a pathway for success and concentrates on nurturing and maturing that methodology.
In essence, “Let’s look at the best that there is. Let’s define and study that, and then use the data to build on what is working.” AI is a change process and new approach to existing organizational development interventions such as strategic planning, business process redesign, team-building, organization restructuring and individual and project evaluation (valuation).
AI is different than problem solving which focuses on a negative event, or problem, and seeks to proactively identify potential issues when there’s a deviation from the AI developed system methodology. To further differentiate, the typical steps in problem solving are as follows:
- Identify the problem.
- Conduct an analysis of the cause.
- Analyze possible solutions.
- Plan some action or treatment.
In contrast, AI focused on:
- Appreciate and value the best of what is.
- Envision what might be.
- Dialogue about what should be.
- Innovate and create what will be.
The effect on a receptive medical staff would concentrate on the skill sets inherent in most providers, that of service. Instead of recalcitrant positional demands, the collective medical staff body would organically drive the highest quality of health care by recognizing the interests and needs of their colleagues and incorporate those healthy requirements for fulfilling practice into the collaborative representation of a health care provider group whose strengths demand appropriate and excellent medical practice delivery.
For once, the often quoted “what’s best for the patient” actually is a mantra that this collective organization can demand of administration, insurance company authorities, and regional and national regulatory bodies. First, let us raise a collaborative voice with a single chorus that requires physician-driven health care decisions and not medicine by economic coercion.
John H. Schneider is a neurosurgeon.