Medical staffs need leadership and management

Dear Medical Staff Leader:

"I would be ecstatic if [physicians] would use data to manage their department and improve consistency. It would actually make their jobs so much easier; data tends to eliminate hesitancy and subjectivity."

When I asked what a hospital chief meant by this statement, his reply was remarkably insightful "For example, we need the medical director of our busy [emergency department (ED)] to take charge and actually manage this service, not just establish the schedule, but to manage she needs to use data," he responded. "How many patients, by shift, by day, by physician? How many admissions, x-rays, consult requests, labs by shift, by day and by physician? How satisfied are the patients by shift, and day?"

He continued, "How many pneumonia patients were placed on antibiotics within four hours of hitting the ED? We have this information but find that the director is reluctant to use it to change behavior and manage the department more effectively. The director claims she can't tell physicians "how to practice."

If the medical director can't tell them, who can? That is exactly what hospitals expect from their physician leaders. They wish for positive change and change will not happen easily without the active involvement of physician managers.

Data does allow for more effective management, which is why we use bank statements, accountant reports, profit and loss ledgers, etc. in our personal lives. Without data, most management is either nonexistent or haphazard and subjective. But once a medical staff manager (like the ED director) understands the power of knowing that (for example) a particular physician has lower patient satisfaction, a higher percentage of admissions, more calls to "on call docs", more x-rays, and lower adherence to established protocols, the leader's management activities can be more effective.

What can medical staff leaders do to encourage colleagues to manage more effectively? Assist them by working with hospital management to ensure that relevant data is constantly available to all medical staff leaders. In addition, arrange for a series of in-house education programs to teach physicians how to use aggregate sets of data to change practice and improve performance.

Rick Sheff MD, chair and executive director of The Greeley Company, is fond of saying "If physicians know what is expected of them, and know that they will receive regular reports reflecting their own performance, they will try to deliver in spades."

That's all for this week.

All the best,

Hugh Greeley