Physician leadership has a long history in the US, and its success could have implications for the NHS to learn from when putting power into the hands of clinicians.
A key theme of the government’s reforms to the NHS is clinical leadership: GPs, consultants and nurses are to become more involved in the running of the health service, and it is hoped they will help drive more patient centred and integrated care. Physician leadership has a long history in the USA and offers some instructive lessons on how to make clinicians effective leaders.
Partners Healthcare in Massachusetts is one of America’s highest performing health systems and it has a pioneering approach to training physicians as leaders. The first step is for physicians to develop an overarching goal for the organisation. In the case of Partners all physicians are committed to the aim of “improvement of value as defined by outcomes that matter to patients, and cost”. Now that accurate data on costs and outcomes is becoming more widely available, measuring and benchmarking value – and increasingly it – is within the reach of high performing systems.
A “value dashboard” for physicians has been developed at Partners of key criteria in measuring quality, such as length of recovery and waiting times, as well as costs.
As well as engaging physicians with the objective of achieving better care, data – about value and variations in clinical performance – have been used with dramatic effect to improve the performance of the system. Physicians have financial incentives, in the forms of a bonuses and penalties, to improve, but the overarching objective to deliver value to patients has created a culture where peer pressure among doctors drives better patient care. These are the kinds of learnings that are eminently transferrable to the NHS, where data transparency could have a radical impact.
In addition, particular focus is now being given to training physicians up from lone healers to be team leaders. Value for patients is achieved through continuous delivery of care not any single intervention, demanding a team based approach. Recreating the role of doctors as convenors of care also means empowering nurses and other clinicians with greater responsibility.
The practice of physicians taking on greater responsibility in management of healthcare has been a traditional feature of American healthcare. In recent years, the NHS has started to embrace the idea. But with power comes responsibility: the lessons from the most successful health systems, in America and around the world, is that clinicians must be accountable to patients for the cost and quality of the care they deliver.