Clinicians and Non-Clinicians…Mutual Trust and Respect

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I listened to an interview this morning titled, “Building Clinicians’ and Non-Clinicians’ Trust and Respect”, by Thomas H. Lee, MD, MSc & Laura L. Forese, MD, MPH. It’s about building teamwork and trust within a healthcare organization, particularly between clinicians and non –clinicians at New York- Presbyterian Hospital. The article discusses the absolute need for high performing teams to have trust and mutual respect amongst all members of the team. Listening to this was not only insightful and right on point, but it helped put things in perspective for me as an Operations Director in a healthcare system that is tasked (and challenged) with a very similar initiative.

Where operations is focused on “boring” things like monitoring and reducing cost and measuring outcomes and optimizing operations, the therapists and doctors I work with are pretty much squarely focused on providing the best possible care they can. Though they understand the need for someone like me in the organization, I believe the cold hard truth of the matter is that they wish people like me would just get out of their way and allow them to work with patients and do their job.
Being a relative new comer to healthcare, I never thought that building trust and respect between clinicians and non- clinicians could be such a challenge. I suppose I should have known this “business” was like no other as I was sitting in Michael Porters Value Based Healthcare Class at Harvard Business School with probably some of the most brilliant physicians and healthcare leaders in the world back in January of 2016. Professor Porter was explaining concepts such of risk sharing and activity based costing (a fancy term for knowing where you spend your money) in very, very basic terms. As I sat there I remember asking myself two things; first, why is he explaining such basic material to people who are 100x smarter than I am and second, why are so many in the room so confused and or so resistant to running their “business” this way (which happened to be the only way I know how to run a business)? It all made perfect sense to me and yet I felt like a fish out of water. I acknowledge that medicine is unlike any business. In fact for those of us who believe we should all be given equal access, it can’t be like every other business. Regardless, I also believe that a healthcare system without 1) aligned goals amongst payers, providers and patients, 2) some level of transparency, 3) open competition, 4) accountability and 5) some form of risk sharing is a system that is simply not sustainable. It took someone with Michael Porter’s stature to make this case, and today I understand why.

Clinicians are trained to spend the majority of their waking hours focused on improving the quality of life for the individuals they are treating. They pour their own blood, sweat and tears in to their work and the work they do is arguably the most important work on the planet. They don’t want to burdened with one ounce more of paperwork than what they are absolutely required to do. They don’t want to spend time making sure that the equipment needed to provide the care is not only “the best” to get the job done but also affordable for the organization. They don’t want to waste precious treatment time encouraging patients to complete outcome surveys. They don’t want to spend extra time in an EHR system documenting data that is not necessarily relevant to quality of care but which is incredibly relevant to payers as they try to measure the value patients are receiving. They don’t want to spend precious resource time arguing with payers over medical necessity in order to squeeze out a few extra days of treatment for a patient in need. They hate this piece, and rightfully so. And many of them don’t believe they should share in any of the risk of whether or not their patients’ outcomes are successful.

Some of this will naturally be remedied as healthcare systems shift away from a fee for service model which rewards providers for volume to a value based model which rewards providers for the value they deliver. Some of it is necessary in order to make this much needed transition. And some will likely always be a part of providing care in a world that demands more and more out of all of us every single day.

In order to be on the right side of making care more affordable, more efficient and more accessible to all, an organization must instill a culture which recognizes the value of all constituents within an organization, both clinical and non- clinical. This is mission critical. With this clinicians can focus on doing what they love and what they do best and the rest of us can support them in providing the best possible care and value for patients and their families.

Tom Lee, the brilliant physician and true social revolutionary, does a great job with this interview. It touches on a lot of really great thought provoking insights and challenges. The first time I met Tom he told me and my colleagues that healthcare is in dire need of more people who truly understand and know how to optimize “operations”. I was with a friend who is a black belt in Lean Six Sigma and Tom was impressed (hard to impress Tom so we were thrilled!). The reality is a high performing team requires that all members are trusted, respected and valued for the work they bring. An organizations’ culture must nurture and promote this philosophy from the top down. There is no other way to succeed in today’s world of healthcare. Those who embrace this reality will survive while those who do not will eventually fade away.