What you need as a leader of your accountable care organization

The Michigan Medical Group Managers Association had a conference recently in Mt. Pleasant, MI.  The theme of the conference was “Medical Management: Coaching Your Team to a Winning Season.”

Two speakers—Lloyd Carr, former head football coach of the University of Michigan Wolverines, and Lou Rabaut, partner of law firm Warner Norcross & Judd—both delivered excellent lessons on leadership.  Several of the other speakers focused on the challenges medical group managers will face in the near future.

Coach Carr closed the conference with many lessons on leadership.  One lesson was about responsibility for errors.  Coach Carr related how every Sunday morning after a Wolverine football game he would review the game tapes.  He analyzed the execution errors that the players made during the game.  He said, “I take all of the errors as my responsibility.  If a player committed an error, I believe that it was because of my lapse as a coach.”  He went on to say that he did not, however, take responsibility for personal fouls committed by the player, such as unnecessary roughness.  For these he punished the player who committed one.  I believe he was asking leaders and managers to take responsibility for errors committed by staff who are under their direction.  It is the leader’s responsibility to see that the staff person has been trained and prepared for their work so that it is carried out successfully for the patients and clients.

The second lesson Coach Carr focused upon was team execution and training.  He illustrated this theme by focusing on the ball exchange on each play of the offense between the center and the quarterback.  This exchange must occur flawlessly each play.  If it does not, there can be a fumble or, one of the offense players could start off early if the center fails to deliver the ball to the quarterback on the called snap count, getting the team a penalty of 5 yards for off sides.  To make sure that this critical exchange goes flawlessly it is practiced everyday of team practices; it is practiced over and over.  The point he was making, in my opinion, is that medical staff must work flawlessly together as a team.  Unfortunately, this is something rarely focused upon by medical managers.  Working together well as a team is often critical to the best patient outcomes, though.

Mr. Rabaut focused on the characteristics of leadership and management.  He stated that leaders focus on who and why—who will do it and why we do it.  Leaders create visions and influence others to act on it.  Managers focus on when, where, how and what—what will be done, how it will be done, when it will be done, and where it will be done.  Managers implement the visions of leaders and enable and direct others in reaching the goals of the vision.  Both types are necessary in a successful organization.  In the best cases, individuals in the organization possess both sets of characteristics.

Mr. Rabaut went on to list the key attributes of effective leaders and managers.


  • Emotional intelligence
  • Communication skills
  • Coaching skills
  • Empathy (You hurt, I hurt)
  • An ability to put things in context


  • Skill
  • Technical knowledge
  • Organization
  • Planning
  • Directing
  • Controlling

Mr. Rabaut provided two illustrations to further distinguish leaders and managers.  He stated that a marine sergeant is a good example of a manager in most cases.  He is carrying out the goals of the Marine Corps and effectively directs his soldiers in achieving these goals.  He knows he has succeeded when he hear HUA from the solders—hear, understand, acknowledge.

Mr. Rabaut’s illustration of an effective leader was drawn from his own childhood.  He attended a Catholic elementary school.  There was a nun in the school who directed a young boys choir.  It was harder to become a member of the choir than it was to get onto the athletic teams at this school.  The nun was such an effective leader, a servant leader, that the boys in the school were inspired to be a part of this dynamic group.  Mr. Rabaut was a member of the choir and gladly gave up his lunch period in order to practice in the choir for several years.

As I stated earlier some of the speakers at this conference focused on the challenges medical managers will be faced with in the near future.  Thus, the lessons on leadership, management and teamwork were a good basis to enable the medical managers to face these challenges.  The challenges that were detailed by the other speakers mostly covered accountable care organizations (ACO’s), patient-centered medical homes (PCMH’s) and bundled payments.  At the root of each were primary care physician as the chief organizer and provider of care for the patient and new ways of reimbursing providers.  Organizations which provide high quality outcomes for patients will be the ones who prosper under the new programs.

Looking back over the speakers and discussions with colleagues at the MMGMA conference I am impressed with the fact that there is no denying that significant change in healthcare models of reimbursement and quality care will arrive soon; primary care providers will be significantly impacted.  Navigating these changes will require effective leaders and managers along with expert knowledge.

Donald Tex Bryant is a consultant who helps healthcare providers meet their challenges. He can be reached at Bryant’s Healthcare Solutions.

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