- Email: [email protected]
Developing Physician Leaders of Patient-Centered Care
Invited Perspective
Developing Physician Leaders of Patient-Centered Care Michael Lupinacci, MD We are in the midst of global and domestic economic instability. The casualties of our recession include high unemployment, multiple home foreclosures, and a dramatic increase in the percentage of uninsured families. Medicine now comprises 17% of the U.S. gross domestic product and is an integral part of the economic engine of America. The inherent weaknesses of our current health care system have been magnified as we attempt to handle the social and medical fallout of these economic stresses on individuals and businesses. The United States spends more money on medical care for an individual than any other developed country in the world, but life expectancy in the United States is lower than any developed country. In addition, the variation in life expectancy as a function of where a person lives or grows up is great [1]. Because of the way our health care system is structured currently, even if the financial sector is stabilized, health care coverage, cost, and access will plague American businesses for a very long time unless there is substantial change [2]. Presently, the biggest drivers of health care costs are attributed to medical progress. There are new drugs, new tests, new devices, new ways of using them, and more problematically, multiple specialists spread across several locations. The nightly news often hypes new high-tech medical breakthroughs and creates expectations for our patients. For example, at a cost of $100,000 a man with metastatic prostate cancer can be treated with an infusion of his own cells and live an average of a few months longer [3]. In pop culture and news, the Red Sox pitcher John Lester returned in less than a season after his lymphoma treatment and pitched a no-hitter in 2008. Physicians must now seize the opportunity to assess our health care delivery system more critically than ever before. At the very essence of the health care reform challenge is that doctors in their 50s are now “in charge.” These more senior physicians learned medicine when there was less volume of flow of information, more art than science, and fewer financial influences [4]. The main challenge now is that this rapid increase of technology and information is happening within a health care system that is often fragmented and with physicians who may not have the skill set to lead into this new health care era.
PRINCIPLES AND MODELS The present-day patient is a consumer with greater expectations than ever before. In this context, whether working in a private practice or a large integrated delivery system, there are 3 principles that one should know to lead in the new model of health care delivery [4]. First, outcomes matter, so the bottom line remains how do our patients fare, and how often do they survive their illnesses and improve or recover from their disabilities. The meeting of their emotional and informational needs is equally important. Second is providing health care with “value”; that is, achieving good outcomes as efficiently as possible. Measuring outcomes allows providers to push for improvement and learn from their competitors. Finally, improvement in performance requires teamwork, which means superior coordination and information sharing across disciplines to improve value and outcomes. The new leaders will need to focus on outcomes and use performance as a motivating tool to organize their colleagues and drive improvement. Currently, there are 3 complementary models of U.S. health care [1]. The first is the classic medical model, in which any and all resources are used by physicians to diagnose and treat on the basis of their clinical training. The second is the public health model that is driven by the elimination of root causes of population behaviors that produce poor health, PM&R 1934-1482/10/$36.00 Printed in U.S.A.
M.L. Physicians of Rehab Industrial and Spine Medicine Prism PC, Mechanicsburg, PA.Address correspondence to M.L.; e-mail: [email protected] Disclosure: 9, AAPM&R president-elect
© 2010 by the American Academy of Physical Medicine and Rehabilitation Vol. 2, 983-986, November 2010 DOI: 10.1016/j.pmrj.2010.10.010
983
984
Lupinacci
DEVELOPING PHYSICIAN LEADERS OF PATIENT-CENTERED CARE
including drug addiction, obesity, alcoholism, and cigarette smoking. The third, and most recent model, is the social determinants of health model. Its premise is that improving the health of a population will require a large range of strategies, including guaranteeing all adults access to meaningful jobs with sufficient income to pursue healthy behaviors; helping children feel safe, healthy, and ready to learn; and empowering women in communities so they may work more effectively to increase the health of the population. There must be a balance between all 3 models to improve patients’ health and the health of a community. Consequently, to shift to a value-oriented, performance-driven health care system, strategies must be defined around the patient-consumer.
PATIENTS FIRST These principles and models that herald a new era of health care delivery have one theme in common: patients come first and physicians and everyone else come second. Presently, our health care system is based on incomplete metrics. We measure the health care customer experience by use of the retail business model. For example, we assess staff courtesy, ambience, and food quality rather than focusing on metrics that measure true quality of care or patient safety. Health systems’ strategic and financial decisions often are determined by these consumer metrics instead of first identifying whether the metrics really represent the patient’s foremost concerns [2]. Leaders may need to deconstruct their present operational activities to determine whether our health care organizations provide highly reliable and specific solutions to patients’ problems or add value to common processes or the patient’s experience [5]. Managers and clinicians performing bedside activities can be linked by the use of 3 concepts: Do no harm, the use of evidence-based medicine approaches, and providing patientcentered care [2]. Do no harm requires the protection of patients from economic considerations that may drive additional health care services that not only do not benefit, but may pose risks for patients. Leadership and the front line must work together to assure that everyone is engaged in doing work that is highly reliable and consistent for patient care. Well-defined safety engineering principles already exist in high consequence activities such as aviation, fire fighting, nuclear power, and electronic power. Research suggests that we can use these principles to understand error in health care and minimize the chances of human and organizational contributions to error [6]. The second concept is the use of evidence-based medicine, or alternatively, the findings derived from comparative effectiveness research, to improve outcomes. This approach must ultimately assure the implementation of these finding into practice at the point of care. Leaders must be willing to supplement or replace experience with evidence.
The third and most important concept is that of patientcentered care. What are the true metrics for patient-centered care? Patients want their questions answered in understandable terms. They want their fears and uncertainties addressed, and they want to map out a course of preferred action to deal with their health care problems. We also need to let patients know what actions and steps can be taken if their medical progress fails [2]. If patients disagree with our recommendations because their individual preference and lifestyle considerations differ from our own, we must still support them. To operationalize the patient-centered care model, the Cleveland Clinic underwent transformation during the last several years by creating a broad vision of “patients first.” By defining the patients’ needs, Cleveland Clinic used the concept of colocation of care rather than specialty or departmental organization. The various types of physicians who provide most of the care for a specific patient population are in one place, such as for cancer disease or cardiac disease. Cleveland Clinic has substituted traditional departments with institutes defined by the patient’s condition, so the clinic’s cardiologists, cardiac surgeons, and vascular surgeons are in the new Heart and Vascular Institute. This provides a location where everyone uses the same “language” to standardize best practices through the organization [4]. Seattle’s Virginia Mason Medical Center has acted similarly. Virginia Mason Medical Center even sent their leadership to a 2-week immersion course to study the highly consumer-oriented Toyota Production System. They too have evolved to disease specific centers in which all the doctors, nurses, and laboratory technologists come to the patients’ rooms. Even when integrated departments are unrealistic, wellchosen performance measures can facilitate progress by using the “same language to measure the same things in the same way” [4]. An organization of any size or complexity can create patient-centered care by adhering to these concepts. Dismantling cultural barriers is difficult for the more senior physicians because they are accustomed to autonomy. However, doing “the right thing” should always motivate physicians to put the patient first because altruism is an essential core identity of physicians in virtually every field of medicine.
IDENTIFYING LEADERS Although the work setting and type of performance measures may differ, the roles and responsibilities of leadership are constants. In addition, to effectively reform health care, there are 3 essential responsibilities of physician leadership [7]. Leaders must establish a clear and compelling direction by articulating a vision and outlining a strategy for attaining that future. Leaders must select the right people and build the right leadership team, which is absolutely imperative to create meaningful change. Leaders must also create the right
PM&R
culture, which is the most difficult and time consuming of all leadership responsibilities. Clearly, a weak culture that is built on empty values is doomed to failure. The most successful cultures are based on cross-organizational commitment to do whatever it takes to provide the best care to patients. Transformational leaders have idealized attributes and instill pride and sense of purpose in others who are associated with them as they go beyond their self interest for the good of the group [8]. They inspire and motivate, and talk optimistically about the future and enthusiastically about what needs to be accomplished. Such leaders provide intellectual stimulation, re-examine critical assumptions to questions, and decide whether to seek different perspectives when problemsolving. Finally, they endorse the individual and spend time in teaching and coaching. Leaders must feel comfortable in not knowing all answers, and their most adaptive traits include the ability to ask the right questions, a tendency to challenge beliefs, and willingness to shift problem solving to the employees [9]. They serve their staff and team and consider the needs of these people rather than rigidly adhering to policy under all circumstances. The successful physician leader needs to be flexible and “make exceptions” more frequently than most people realize [10]. The most effective form of leadership is used by leaders who start with questions, not answers, conduct autopsies without blame when things go wrong in the organization, and treat all colleagues with respect [11]. One of the physician leader’s most important qualities is maintaining integrity in the face of ethical dilemmas [12]. Speaking the truth to those in power when the outcome is unpredictable tests one’s integrity. There are 3 requisite steps for exercising integrity: discerning between right and wrong; acting on what has been discerned, even at personal cost; and stating openly that one’s actions are on the result of a personal understanding of right and wrong [13]. Leaders have a primary responsibility of setting a “culture of candor.” In the medical safety literature, this can be summarized by 3 phrases: “I am concerned,” “I am uncomfortable,” and “I believe that this is a safety issue.”
PM&R: HIGH-PERFORMANCE HEALTH CARE DELIVERY In a very large arena, physical medicine and rehabilitation is at the cutting edge of health care transformation. Take a moment to look at the key words in some of the recent articles that I have referenced concerning the new health care delivery system: performance, outcomes, value, team leadership, patient safety, prevention, social setting, specialty centers, and patient-centered. These words are not just buzz words but clearly components of the core principles, training, and values upon which physical medicine and rehabilitation is based. From managing patients with complex medical problems, to addressing the social consequences of
Vol. 2, Iss. 11, 2010
985
devastating and chronic injury or illness, to maximizing performance and outcomes, and to coordinating multidisciplinary care, physiatry has always defined the essential hallmarks of high-performance teams. Currently, the shifting demographics and professional interests of physiatrists in both inpatient and outpatient settings require deliberate and intense participation (both locally and nationally) in the new model of leadership within our specialty. Physiatrists exercise their leadership every day in a variety of venues, most notably in inpatient or outpatient environments. Although leading a team involves actions and decisions that are not always publicized or highly visible to the staff, the leaders’ attitudes and behaviors have a direct impact on morale, employee retention, and, in the end, customer service and putting the patient first [14]. The physiatric leader sets a tone that defines his practice and how that practice is intertwined into healthcare within the community. Physiatrists should see themselves not just as “providers of care” but also as clinical leaders, whether working at the bedside or in an executive suite, using the principles that have been discussed. Similarly, academic physiatry shares a leadership imperative with “frontline” physiatry. A clear reality of medical practice is that although clinical research can be of immense help in defining what works from an evidence-based perspective, the frontline of health care, otherwise known as the point of care, is often where innovation occurs. This is where academic physiatric leadership and community physiatric leadership will continue to have heightened interface in the future. There must be a dialogue between research-focused and clinically based physiatrists, translating evidence-based information into patient-centered care to catalyze the transformation of the health care delivery system. One of the current most pressing leadership responsibilities is to identify where the field of physiatry will be in the next several years. Medical competencies must be defined and core services identified, and then strategies must be developed as to how these core services will be successfully positioned and integrated into the evolving healthcare system. As policy makers grapple with reform in the U.S. health care system, a common theme is the urgent need to ensure that all Americans receive high-quality patient-centered affordable health care. This represents a great opportunity for physiatry to shine. We have had strong physiatric leaders in the past who have brought the specialty to its present prominence and respect within the U.S. medical system. We need strong current and future leadership to carry on that tradition and place us solidly within the fabric of the evolving healthcare system. Physiatrists should be planning right now how to enhance our role as leaders, collaborate with our colleagues, and work closely with our professional organizations. In the end, only those who provide care can improve that care [15].
986
Lupinacci
DEVELOPING PHYSICIAN LEADERS OF PATIENT-CENTERED CARE
REFERENCES 1. Brook R. Medical leadership in an increasingly complex world. JAMA 2010;304:465-466. 2. Silbaugh B, Leider H. Physician leadership is key to creating a safer, more reliable health care system. Physician Exec 2009;35:12-16. 3. Bazelle R. New prostate cancer treatment explained. Available at: http:// www.msnbc.msn.com/id/34276015/vp/36871290#36871290. Accessed June 15, 2010. 4. Lee T. Turning doctors into leaders. Spotlight on fixing health care. Harvard Business Rev 2010;Apr:18. 5. Christensen CM, Grossman JH, Hwang J. The Innovator’s Prescription: A Disruptive Solution for Health Care. New York, NY: McGraw Hill; 2009, 79. 6. Kohn LT, Corrigan JM. To Err is Human: Building a Safer Health System. Washington, DC: National Academies Press; 2000. 7. Souba W. The 3 essential responsibilities. A leadership story. Arch Surg 2010;145:540-543.
8. Menaker R, Bahn R. How perceived physician leadership behavior affects physician satisfaction. Mayo Clin Proc 2008;83:983-988. 9. Heifetz RA, Laurie DL. The work of leadership. Harvard Business Rev. 1997;75:124-134. 10. Autry JA. The Servant Leader. New York: Prima Publishing; 2001. 11. Collins J. Good to great. New York, NY: HarperCollins Publishing; 2001, 74-78. 12. Hernandez J. Speak truth to power: The end of bobbleheaded leadership. Physician Exec. 2010;36:40-41. 13. O’Toole J. Speaking Truth to Power: A White Paper. Old Tales and New of Leadership, Organizational Culture, and Ethics. Available at: http:// www.scu.edu/ethics/practicing/focusareas/business/truth-to-power. html. Accessed October 18, 2010. 14. Serio C, Epperly T. Physician leadership: A new model for a new generation. Family Practice Manage 2006;February:51-54. 15. Berwick DM. Eleven worthy aims for clinical leadership of health system reform [abstract]. JAMA 1994;272:797-802.
Developing Physician Leaders of Patient-Centered Care Michael Lupinacci, MD We are in the midst of global and domestic economic instability. The casualties of our recession include high unemployment, multiple home foreclosures, and a dramatic increase in the percentage of uninsured families. Medicine now comprises 17% of the U.S. gross domestic product and is an integral part of the economic engine of America. The inherent weaknesses of our current health care system have been magnified as we attempt to handle the social and medical fallout of these economic stresses on individuals and businesses. The United States spends more money on medical care for an individual than any other developed country in the world, but life expectancy in the United States is lower than any developed country. In addition, the variation in life expectancy as a function of where a person lives or grows up is great [1]. Because of the way our health care system is structured currently, even if the financial sector is stabilized, health care coverage, cost, and access will plague American businesses for a very long time unless there is substantial change [2]. Presently, the biggest drivers of health care costs are attributed to medical progress. There are new drugs, new tests, new devices, new ways of using them, and more problematically, multiple specialists spread across several locations. The nightly news often hypes new high-tech medical breakthroughs and creates expectations for our patients. For example, at a cost of $100,000 a man with metastatic prostate cancer can be treated with an infusion of his own cells and live an average of a few months longer [3]. In pop culture and news, the Red Sox pitcher John Lester returned in less than a season after his lymphoma treatment and pitched a no-hitter in 2008. Physicians must now seize the opportunity to assess our health care delivery system more critically than ever before. At the very essence of the health care reform challenge is that doctors in their 50s are now “in charge.” These more senior physicians learned medicine when there was less volume of flow of information, more art than science, and fewer financial influences [4]. The main challenge now is that this rapid increase of technology and information is happening within a health care system that is often fragmented and with physicians who may not have the skill set to lead into this new health care era.
PRINCIPLES AND MODELS The present-day patient is a consumer with greater expectations than ever before. In this context, whether working in a private practice or a large integrated delivery system, there are 3 principles that one should know to lead in the new model of health care delivery [4]. First, outcomes matter, so the bottom line remains how do our patients fare, and how often do they survive their illnesses and improve or recover from their disabilities. The meeting of their emotional and informational needs is equally important. Second is providing health care with “value”; that is, achieving good outcomes as efficiently as possible. Measuring outcomes allows providers to push for improvement and learn from their competitors. Finally, improvement in performance requires teamwork, which means superior coordination and information sharing across disciplines to improve value and outcomes. The new leaders will need to focus on outcomes and use performance as a motivating tool to organize their colleagues and drive improvement. Currently, there are 3 complementary models of U.S. health care [1]. The first is the classic medical model, in which any and all resources are used by physicians to diagnose and treat on the basis of their clinical training. The second is the public health model that is driven by the elimination of root causes of population behaviors that produce poor health, PM&R 1934-1482/10/$36.00 Printed in U.S.A.
M.L. Physicians of Rehab Industrial and Spine Medicine Prism PC, Mechanicsburg, PA.Address correspondence to M.L.; e-mail: [email protected] Disclosure: 9, AAPM&R president-elect
© 2010 by the American Academy of Physical Medicine and Rehabilitation Vol. 2, 983-986, November 2010 DOI: 10.1016/j.pmrj.2010.10.010
983
984
Lupinacci
DEVELOPING PHYSICIAN LEADERS OF PATIENT-CENTERED CARE
including drug addiction, obesity, alcoholism, and cigarette smoking. The third, and most recent model, is the social determinants of health model. Its premise is that improving the health of a population will require a large range of strategies, including guaranteeing all adults access to meaningful jobs with sufficient income to pursue healthy behaviors; helping children feel safe, healthy, and ready to learn; and empowering women in communities so they may work more effectively to increase the health of the population. There must be a balance between all 3 models to improve patients’ health and the health of a community. Consequently, to shift to a value-oriented, performance-driven health care system, strategies must be defined around the patient-consumer.
PATIENTS FIRST These principles and models that herald a new era of health care delivery have one theme in common: patients come first and physicians and everyone else come second. Presently, our health care system is based on incomplete metrics. We measure the health care customer experience by use of the retail business model. For example, we assess staff courtesy, ambience, and food quality rather than focusing on metrics that measure true quality of care or patient safety. Health systems’ strategic and financial decisions often are determined by these consumer metrics instead of first identifying whether the metrics really represent the patient’s foremost concerns [2]. Leaders may need to deconstruct their present operational activities to determine whether our health care organizations provide highly reliable and specific solutions to patients’ problems or add value to common processes or the patient’s experience [5]. Managers and clinicians performing bedside activities can be linked by the use of 3 concepts: Do no harm, the use of evidence-based medicine approaches, and providing patientcentered care [2]. Do no harm requires the protection of patients from economic considerations that may drive additional health care services that not only do not benefit, but may pose risks for patients. Leadership and the front line must work together to assure that everyone is engaged in doing work that is highly reliable and consistent for patient care. Well-defined safety engineering principles already exist in high consequence activities such as aviation, fire fighting, nuclear power, and electronic power. Research suggests that we can use these principles to understand error in health care and minimize the chances of human and organizational contributions to error [6]. The second concept is the use of evidence-based medicine, or alternatively, the findings derived from comparative effectiveness research, to improve outcomes. This approach must ultimately assure the implementation of these finding into practice at the point of care. Leaders must be willing to supplement or replace experience with evidence.
The third and most important concept is that of patientcentered care. What are the true metrics for patient-centered care? Patients want their questions answered in understandable terms. They want their fears and uncertainties addressed, and they want to map out a course of preferred action to deal with their health care problems. We also need to let patients know what actions and steps can be taken if their medical progress fails [2]. If patients disagree with our recommendations because their individual preference and lifestyle considerations differ from our own, we must still support them. To operationalize the patient-centered care model, the Cleveland Clinic underwent transformation during the last several years by creating a broad vision of “patients first.” By defining the patients’ needs, Cleveland Clinic used the concept of colocation of care rather than specialty or departmental organization. The various types of physicians who provide most of the care for a specific patient population are in one place, such as for cancer disease or cardiac disease. Cleveland Clinic has substituted traditional departments with institutes defined by the patient’s condition, so the clinic’s cardiologists, cardiac surgeons, and vascular surgeons are in the new Heart and Vascular Institute. This provides a location where everyone uses the same “language” to standardize best practices through the organization [4]. Seattle’s Virginia Mason Medical Center has acted similarly. Virginia Mason Medical Center even sent their leadership to a 2-week immersion course to study the highly consumer-oriented Toyota Production System. They too have evolved to disease specific centers in which all the doctors, nurses, and laboratory technologists come to the patients’ rooms. Even when integrated departments are unrealistic, wellchosen performance measures can facilitate progress by using the “same language to measure the same things in the same way” [4]. An organization of any size or complexity can create patient-centered care by adhering to these concepts. Dismantling cultural barriers is difficult for the more senior physicians because they are accustomed to autonomy. However, doing “the right thing” should always motivate physicians to put the patient first because altruism is an essential core identity of physicians in virtually every field of medicine.
IDENTIFYING LEADERS Although the work setting and type of performance measures may differ, the roles and responsibilities of leadership are constants. In addition, to effectively reform health care, there are 3 essential responsibilities of physician leadership [7]. Leaders must establish a clear and compelling direction by articulating a vision and outlining a strategy for attaining that future. Leaders must select the right people and build the right leadership team, which is absolutely imperative to create meaningful change. Leaders must also create the right
PM&R
culture, which is the most difficult and time consuming of all leadership responsibilities. Clearly, a weak culture that is built on empty values is doomed to failure. The most successful cultures are based on cross-organizational commitment to do whatever it takes to provide the best care to patients. Transformational leaders have idealized attributes and instill pride and sense of purpose in others who are associated with them as they go beyond their self interest for the good of the group [8]. They inspire and motivate, and talk optimistically about the future and enthusiastically about what needs to be accomplished. Such leaders provide intellectual stimulation, re-examine critical assumptions to questions, and decide whether to seek different perspectives when problemsolving. Finally, they endorse the individual and spend time in teaching and coaching. Leaders must feel comfortable in not knowing all answers, and their most adaptive traits include the ability to ask the right questions, a tendency to challenge beliefs, and willingness to shift problem solving to the employees [9]. They serve their staff and team and consider the needs of these people rather than rigidly adhering to policy under all circumstances. The successful physician leader needs to be flexible and “make exceptions” more frequently than most people realize [10]. The most effective form of leadership is used by leaders who start with questions, not answers, conduct autopsies without blame when things go wrong in the organization, and treat all colleagues with respect [11]. One of the physician leader’s most important qualities is maintaining integrity in the face of ethical dilemmas [12]. Speaking the truth to those in power when the outcome is unpredictable tests one’s integrity. There are 3 requisite steps for exercising integrity: discerning between right and wrong; acting on what has been discerned, even at personal cost; and stating openly that one’s actions are on the result of a personal understanding of right and wrong [13]. Leaders have a primary responsibility of setting a “culture of candor.” In the medical safety literature, this can be summarized by 3 phrases: “I am concerned,” “I am uncomfortable,” and “I believe that this is a safety issue.”
PM&R: HIGH-PERFORMANCE HEALTH CARE DELIVERY In a very large arena, physical medicine and rehabilitation is at the cutting edge of health care transformation. Take a moment to look at the key words in some of the recent articles that I have referenced concerning the new health care delivery system: performance, outcomes, value, team leadership, patient safety, prevention, social setting, specialty centers, and patient-centered. These words are not just buzz words but clearly components of the core principles, training, and values upon which physical medicine and rehabilitation is based. From managing patients with complex medical problems, to addressing the social consequences of
Vol. 2, Iss. 11, 2010
985
devastating and chronic injury or illness, to maximizing performance and outcomes, and to coordinating multidisciplinary care, physiatry has always defined the essential hallmarks of high-performance teams. Currently, the shifting demographics and professional interests of physiatrists in both inpatient and outpatient settings require deliberate and intense participation (both locally and nationally) in the new model of leadership within our specialty. Physiatrists exercise their leadership every day in a variety of venues, most notably in inpatient or outpatient environments. Although leading a team involves actions and decisions that are not always publicized or highly visible to the staff, the leaders’ attitudes and behaviors have a direct impact on morale, employee retention, and, in the end, customer service and putting the patient first [14]. The physiatric leader sets a tone that defines his practice and how that practice is intertwined into healthcare within the community. Physiatrists should see themselves not just as “providers of care” but also as clinical leaders, whether working at the bedside or in an executive suite, using the principles that have been discussed. Similarly, academic physiatry shares a leadership imperative with “frontline” physiatry. A clear reality of medical practice is that although clinical research can be of immense help in defining what works from an evidence-based perspective, the frontline of health care, otherwise known as the point of care, is often where innovation occurs. This is where academic physiatric leadership and community physiatric leadership will continue to have heightened interface in the future. There must be a dialogue between research-focused and clinically based physiatrists, translating evidence-based information into patient-centered care to catalyze the transformation of the health care delivery system. One of the current most pressing leadership responsibilities is to identify where the field of physiatry will be in the next several years. Medical competencies must be defined and core services identified, and then strategies must be developed as to how these core services will be successfully positioned and integrated into the evolving healthcare system. As policy makers grapple with reform in the U.S. health care system, a common theme is the urgent need to ensure that all Americans receive high-quality patient-centered affordable health care. This represents a great opportunity for physiatry to shine. We have had strong physiatric leaders in the past who have brought the specialty to its present prominence and respect within the U.S. medical system. We need strong current and future leadership to carry on that tradition and place us solidly within the fabric of the evolving healthcare system. Physiatrists should be planning right now how to enhance our role as leaders, collaborate with our colleagues, and work closely with our professional organizations. In the end, only those who provide care can improve that care [15].
986
Lupinacci
DEVELOPING PHYSICIAN LEADERS OF PATIENT-CENTERED CARE
REFERENCES 1. Brook R. Medical leadership in an increasingly complex world. JAMA 2010;304:465-466. 2. Silbaugh B, Leider H. Physician leadership is key to creating a safer, more reliable health care system. Physician Exec 2009;35:12-16. 3. Bazelle R. New prostate cancer treatment explained. Available at: http:// www.msnbc.msn.com/id/34276015/vp/36871290#36871290. Accessed June 15, 2010. 4. Lee T. Turning doctors into leaders. Spotlight on fixing health care. Harvard Business Rev 2010;Apr:18. 5. Christensen CM, Grossman JH, Hwang J. The Innovator’s Prescription: A Disruptive Solution for Health Care. New York, NY: McGraw Hill; 2009, 79. 6. Kohn LT, Corrigan JM. To Err is Human: Building a Safer Health System. Washington, DC: National Academies Press; 2000. 7. Souba W. The 3 essential responsibilities. A leadership story. Arch Surg 2010;145:540-543.
8. Menaker R, Bahn R. How perceived physician leadership behavior affects physician satisfaction. Mayo Clin Proc 2008;83:983-988. 9. Heifetz RA, Laurie DL. The work of leadership. Harvard Business Rev. 1997;75:124-134. 10. Autry JA. The Servant Leader. New York: Prima Publishing; 2001. 11. Collins J. Good to great. New York, NY: HarperCollins Publishing; 2001, 74-78. 12. Hernandez J. Speak truth to power: The end of bobbleheaded leadership. Physician Exec. 2010;36:40-41. 13. O’Toole J. Speaking Truth to Power: A White Paper. Old Tales and New of Leadership, Organizational Culture, and Ethics. Available at: http:// www.scu.edu/ethics/practicing/focusareas/business/truth-to-power. html. Accessed October 18, 2010. 14. Serio C, Epperly T. Physician leadership: A new model for a new generation. Family Practice Manage 2006;February:51-54. 15. Berwick DM. Eleven worthy aims for clinical leadership of health system reform [abstract]. JAMA 1994;272:797-802.