Physician Engagement is Good, but Physician Leadership is Better

I frequently hear the phrase, “We need more physician engagement!” It is a common refrain whenever the healthcare system is facing a particularly sticky wicket, whether that be a complex clinical care issue that needs to be resolved, a sub-performing regulatory metric that lags behind expected standards, or  limited participation by physicians in any number of activities.

It is a well-meaning statement and I agree that health systems have a strong and compelling need to improve. In order to improve, I think that what we need is not just physician engagement. We need physician leadership. Engagement is good. Leadership is better.

Let’s define our terms. Being engaged means to be involved or greatly interested in something. But someone who leads guides the way, provides direction, especially by going in advance. As you can see, there is a distinct different between the two. One is a participant follower, the other sets the direction; one is greatly interested, the other is greatly invested.

One of my all time favorite quotes comes from a White Paper, written for the Institute for Healthcare Improvement (IHI) by James L. Reinertsen and others. The quote summarizes for me the difference between engagement and leadership and a critical mind shift which the highest performing health systems in the country have found to be essential to their success:

“The first element of the framework requires a mind shift on the part of hospital administrators. It suggests that the question we have been asking—“How can we engage physicians in the hospital’s quality agenda?”—could also be rephrased as “How can the hospital engage in the physicians’ quality agenda?”[1]

I hope you see the shift from engagement to leadership. Physicians go from being interested followers of an agenda set by the hospital administration (engaged), to being the ones who set the agenda (leaders). It is the hospital that needs to be engaged, and the physicians that need to lead.

When organizations make this mind shift, and then back that up with sincere and real opportunities and support, the clinical quality and safety of the care that is delivered in their system skyrockets. In fact, I believe that physician leadership is essential for traversing the future of healthcare and leading organizations into the stratosphere of exceptional patient care. Without physician leadership, an organization can only aspire to mediocrity. With strong physician leadership, patients are the ultimate winners.

Dr. Jennifer Brown, Dan McElligott and I are committed to this mind shift. We recognize that without it we will not achieve the goals of exceptional care; goals that all of us are committed to. We’re not alone in this realization. In an appeal to his physician colleagues, Dr. Don Berwick, a Pediatrician, Former President of IHI and head of CMS stated:

“We can do this – we who give care – and nobody else can.”[2]

 Because leadership into the arena of exceptional care requires physician leaders, Jennifer, Dan and I have worked tirelessly over the past 24 months to cultivate an environment that will develop physician leaders for our organization. This need for physician leadership does not diminish the need for other leaders. It does not minimize the critical nature of all other disciplines on the leadership team. Rather, it enhances our leadership corps, and positions all of us to achieve the common goals to which we aspire. We all have equal value. We each have different roles. 

Physician Leadership Institute Participants:

Dr. Michael McGahan

Dr. Shane Burr

Dr. Craig Vincent

Dr. Scott Frankforter

Dr. Travis Hageman

To be honest, most physicians have not been formally trained in leadership. Most come to it by happenstance. In fact, the training received in medical school and residency is often anathema to successful leadership behaviors and skills. Therefore, formal education and development opportunities need to be supported and created.

We have done just that. Beginning this year, five of our active medical staff have committed to an 8 month program provided by CHI and The Physician Leadership Institute.[3] This education is as a broad-based, structured leadership development program that will formally introduce and train leadership skills and behaviors. In addition, we are providing additional training for more physicians – Dr. Molly Johnson, Dr. Traci Rauch, Dr. Salam Salman – via a CHI-sponsored session in August provided by the Advisory Group.

Over the past year, we have had more that 10% of our active medical staff attend or plan to attend formal leadership training. There is little doubt that this cadre of physicians will lead the transformation of healthcare in our community, for our patients, and for our organization. It is a rich and rewarding time at Saint Francis Medical Center, and part of this is because of physician engagement and leadership. 

[1] Reinertsen JL, Gosfield AG, Rupp W, Whittington JW. Engaging Physicians in a Shared Quality Agenda. IHI Innovation Series white paper. Cambridge, MA: Institute for Healthcare Improvement; 2007. (Available on pg

[2] Berwick, DM, The Moral Test. IHI National Forum. Orlando, Florida, December 7, 2011.

The Centrality of the Patient

I had the opportunity to interview a young man from India today. He has been at St. Francis Medical Center for many months, serving as an intern for our performance improvement team. As the interview came to a close, we began to talk about his experience here. He had many nice things to say about how welcoming our organization was to him, how impressed he was about our desire to do better, and he was thankful for the opportunity to be with us.

This is a bright young man. He is working on his Master’s degree in engineering. He plans to go on to get an MBA. He would like to move into healthcare administration.

As we finished off the interview, he reflected on what was the most important lesson he learned while he was here. Without hesitation he stated, “The passion for the best patient care is inspiring.” When I came here, he said, he was interested in experiencing health care. As a result of his exposure to our work, our passion for the best patient care, he now wants to invest his life and career in health care. We converted him.

The interview reminded me of a central truth; a truth that unites us – nursing, physicians, administrators, clinicians, technologists, ancillary staff – all of us. This truth is our passion to provide the best care to patients. Each of our professions and disciplines brings a valuable and necessary skill set that is leveraged for the benefit of the patient. Everyone has value, everyone has a different role, and all of us have the same goal.

If we remember this, much misunderstanding, cynicism, and conflict will fall to the wayside, and we don’t need spend a great deal of time or energy questioning other people’s motives. When we face problems, trying to improve our care, we don’t need to make our analysis about people, we can focus on processes.

As we move into new models of healthcare delivery, the role and responsibility of the physician will expand. We’ve always needed to be clinically astute, but the future will demand clinical acumen and systems thinking. We need to work with our patients to prevent and help them recover from illness and be able to diagnose and treat sick systems of care which may harm or deter recovery from our clinical interventions. The exceptional physician of the future will fully recognize the value of all those involved in the care delivered to patients and contribute towards developing, sustaining, and fixing processes that support their clinical actions.

Our common passion for the best patient care serves to bridge disciplines and silos. This passion for patient care is where we find our motivation, our shared vision, and our hope for continuous improvement.

Sometimes reminders about this central truth come at us from interesting directions. In this case, a twenty-something, non-clinician.