ARTWORK David Maisel, History’s Shadow GM8, 2010 Archival pigment print, 40" x 30"
Turning Doctors into Leaders
Medicine is in for a radical change as the old guard gives way to performance-driven teams. by Thomas H. Lee
50 Harvard Business Review April 2010
Thomas H. Lee (thlee@ partners.org) is the network president of Partners HealthCare System, in Boston, and a professor of medicine at Harvard Medical School. He is a coauthor, with James J. Mongan, of Chaos and Organization in Health Care (MIT Press, 2009).
April 2010 Harvard Business Review 51
SPOTLIGHT ON FIXING HEALTH CARE
52 Harvard Business Review April 2010
THE PROBLEM with health care is people like me— doctors (mostly men) in our fifties and beyond, who learned medicine when it was more art and less finance. We were taught to go to the hospital before dawn, stay until our patients were stable, focus on the needs of each patient before us, and not worry about costs. We were taught to review every test result with our own eyes—to depend on no one. The only way to ensure quality was to adopt high personal standards for ourselves and then meet them. Now, at many health care institutions and practices, we are in charge. And that’s a problem, because health care today needs a fundamentally different approach—and a new breed of leaders. Most recent discussions of health care have focused on its rising costs, but these financial challenges are really just a symptom. What is the real “disease”? The usual suspects have surprisingly small roles. Greed and incompetence surely exist, but economists agree that they don’t account for doubledigit annual cost increases on their own. The good and the bad news is that the biggest driver of rising costs is medical progress: new drugs, new tests, new devices, and new ways of using them. These tools are frequently marvelous and complex, and their use requires increasing numbers of personnel trained in narrow fields. Patients with complicated conditions end up seeing a variety of physicians who are often spread across several institutions. Of course this progress is welcome, and at times it seems miraculous. The Red Sox pitcher Jon Lester was diagnosed with lymphoma in September 2006, but he reported to spring training in 2007 and pitched a no-hitter in 2008. Steve Jobs is still on the job. Many patients diagnosed with heart failure can now go back to work after receiving a new type of high-tech pacemaker. But this explosion of knowledge is going off within a system too fragmented and disorganized to absorb it. The result is chaos. In my own organization, Partners HealthCare, a poignant example involves the widow of a young man who died of cancer. In the last days of his final six-week stay in the intensive care unit, she demanded that all his doctors have a meeting with the family. The family didn’t really need the meeting, she said—the doctors did. She wanted to be sure that the various physicians were actually talking to one another, because she so often received inconsistent or even contradictory messages from them. The confusion she described
does more than distress families, of course. It leads to redundant care and errors that raise costs and threaten quality.
To effectively attack this chaos we need a new kind of leadership at every level of the health care system, from large integrated delivery systems like Partners to hospitals to physician practices. The specific kinds of work and performance measures may differ from one setting to another, but the key responsibilities of leadership are the same. To understand what they are, leaders must first absorb three painful messages: Performance matters. Most clinicians are hard workers, but the quality of their work should not be measured by how many patients they manage to see or tests and procedures they call for. What matters is their results. This is controversial, because...