Physician leaders who work in a variety of health care settings all around the world face similar challenges — from managing staff members to improving financial performance — in order to lead their organizations to success. They also require a deep understanding of the science of quality improvement, which is a framework used to improve care processes in a systematic way to achieve better outcomes.
If you’re a physician who holds a leadership or management role, there are critical business skills essential to success on the job that you may not have learned in medical school. This includes knowing how to develop and communicate your vision, understand and apply data, and drive value within your organization.
All of these elements are closely related to success, no matter what part of the world you work in or how many resources you have to support your efforts. They are also part of a larger improvement strategy that must be rooted in evidence to achieve meaningful results, according to Cindy Hupke, BSN, MBA, a former director of the Institute for Healthcare Improvement and current co-director of the Harvard T.H. Chan School of Public Health’s International Leadership Development Program for Physicians. This program, co-presented with Ariadne Labs, is geared to physician leaders from around the world, provides in-depth training and development of skills and tools required for success on the job, including a strong grasp on the science of improvement.
She points out that when clinician leaders from a variety of settings around the world build their skills in this area, they will be able to apply the quality improvement framework to everything they are involved in — from a small staff meeting to a large organization-wide initiative — to get the desired outcomes.
Preparing Physicians to Lead Health Care Organizations
“Many physician leaders I’ve worked with over the years have been engaged in quality improvement in their health care organizations. Yet they often don’t understand how to lead these efforts on a deeper level to achieve the transformation they desire,” explains Laurie S. Pascal, MBA, MPH, Senior Lecturer in the Department of Health Policy and Management at the Harvard Chan School and co-director of the International Leadership Development Program for Physicians. Pascal says that physicians who purposefully develop their understanding of the science of improvement — and know how to properly apply it — can increase their effectiveness as change leaders.
Exploring the Science of Improvement in Health Care
The concept of the science of improvement can be traced back to W. Edwards Deming, who completed his studies at Yale University in 1928. Deming received a doctorate in mathematical physics before going on to lecture and write about mathematics, physics, and statistics.
“Deming worked with Walter Shewhart to develop a generalized approach to understanding variation in all systems and processes. Their focus was on reducing variation at the source. This is very different from relying on quality control inspections to check a finished product,” says Gerald Langley, MS, who himself was mentored by Deming and is faculty on the International Leadership Development Program for Physicians. Langley is also a senior fellow with the Institute for Healthcare Improvement, as well as a statistician and consultant with Associates in Process Improvement.
Applying Deming’s Theory to Health Care
“Deming’s theory is that instead of focusing on the end of the work and how it turns out, you should focus on the whole system and understand how it works to reduce variation in the process. If it all runs well, you don’t need quality control inspections,” Langley says. He adds that Deming is credited with taking the Japanese economy to new heights after World War II, and for turning around many companies, including the Ford Motor Company, General Motors, and Hewlett Packard. “In the 90s, other industries — including health care — started hearing about Deming’s success viewing quality through a new lens,” he points out. In fact, Langley was instrumental in helping to extend Deming’s work to the health care field.
“A key point that Deming stressed was consistency of purpose. For health care leaders, this means letting everyone know the purpose of the efforts in every discussion,” Langley says.
“It’s also important to understand the health care organization as a system in order to improve it and to identify where the variation is, along with having a plan to reduce that variation.”
“One of the things leaders need to recognize is that every system is perfectly designed to produce the results it produces. Therefore, health care leaders, regardless of in what part of the world they work, need to look at their systems and ask if they are satisfied with the results. If not, they need to determine how to go about making change,” Langley says.
He adds that all too often, when leaders make a change, it fails and someone gets blamed. But the fundamental way to make changes effectively is to develop, test, and implement changes on a small scale first to gauge the effectiveness before scaling up to the larger system.
“By the time you get an idea to implementation, you have tested it under a variety of conditions and you have the knowledge to predict the results,” Langley stresses.
Questions to Guide Physician Leaders’ Health Care Improvement Efforts
Health care leaders must also take a broader view of their efforts and answer some key questions to be sure they are set up to bring about the desired change in their health care organizations. Pascal shares the type of questions that physician leaders can ask to check their quality improvement efforts and make sure they are positioned well and have all of the right people — and needed buy-in — at the table:
- Who will support the idea and why? This can include other clinicians, administrators, patients and family, and the community.
- Who has a vested interest?
- Who will it impact? It may not the same group of people who have a vested interest.
- Who do you have to bring on as allies or supporters?
- What type of negotiation needs to take place to move the idea forward?
- How do you navigate conflict?
- How do you engage a group of people?
The Value of Quality Improvement in Health Care across the Globe
“Physicians from around the world have many similarities, despite differences in their systems and cultures. They have different resources but still face pressure to hold down costs no matter what the system is, and pressure to improve quality and to increase patient satisfaction. They also need to be able to work effectively with teams, no matter who they are or what they are working on,” Pascal says.
By gaining a real understanding of quality improvement methods, clinician leaders from around the world can use these skills to improve their health care organizations’ systems. This is essential to ensure they will be successful in all their endeavors.
The Harvard T.H. Chan School of Public Health offers the International Leadership Development Program for Physicians, which provides training in leadership and management, focused on the clinical and operational challenges senior physicians face as executives.