9 February 2017

Are the Best Hospitals Led by Physicians?

Healthcare’s increasing complexity in this country and the growing emphasis on patient-centered care and efficiency in delivering clinical outcomes are forcing clinicians get better at balancing the competing imperatives of cost versus quality and technology versus humanity. Those challenges are preparing them to take on leadership roles—a good thing, say the authors of a recent op-ed published in the Harvard Business Review, who make a strong case that the best hospitals are led by physicians.

Many of the Top-Ranked Hospitals Are Led by Doctors

James K. Stoller, MD, a pulmonary/critical care physician at the Cleveland Clinic and chairman of the Education Institute; Amanda Goodall, PhD, senior lecturer in management at Cass Business School in London; and Agnes Baker, PhD, assistant professor at the University of Zurich, say there’s a correlation between physician-led hospitals and quality outcomes. Of the U.S. News and World Report (USNWR) 2016-17 Best Hospitals Honor Roll of this country’s top 20 hospitals, the five top-ranked hospitals—Mayo Clinic, Cleveland Clinic, Massachusetts General Hospital, Johns Hopkins Hospital and UCLA Medical Center— have physician CEOs and/or presidents. The authors also said the Mayo Clinic and Cleveland Clinic, ranked No. 1 and No. 2, respectively, have been physician-led since their inception about a century ago.

Dr. Goodall led a study published in 2011 that looked at CEOs of the USNWR’s 100 best hospitals in three key medical specialties: cancer, digestive disorders and cardiovascular care. The analysis found that hospital quality scores are approximately 25 percent higher in hospitals run by medically trained doctors than in hospitals run by professional managers who are not physicians. Research by Nick Bloom, Raffaella Sadun, and John Van Reenen published in 2014 found that hospitals with a higher percentage of clinically trained managers achieve higher quality scores. 

Physician Leaders Have More Credibility With Other Clinicians

When asked why doctors make good hospital managers, Cleveland Clinic CEO Delos "Toby" Cosgrove, MD immediately answered, “peer-to-peer credibility.” Clinicians are more inclined to trust in a leader whose personal experience provides direct knowledge and insight into their challenges, motivations, and desire to put the needs of patients first. The authors assert that physician executives are more likely to have patient-focused strategies, and that if leaders understand based on firsthand experience “what is needed to complete a job to the highest standard, then they may be more likely to create the right work environment, set appropriate goals and accurately evaluate others’ contributions” and to “know what ‘good’ looks like when hiring other physicians.” Dr. Cosgrove also suggest that physician leaders are more likely to allow people to pursue innovative ideas and to tolerate “appropriate failure, which is a natural part of scientific endeavor and progress.”

Training Can Help Physicians Become Even Better Leaders

 The authors argue that physicians traditionally have been trained in “command and control” environments as “heroic lone healers,” who are “collaboratively challenged.” But being an effective leader requires very different skills than those needed to be an effective doctor, including the ability to collaborate and to foster collaboration and teamwork among other clinicians. The op-ed mentions several examples of top-tier hospitals that engage physicians in leadership and management training, such as Yale Medicine and the Cleveland Clinic. Many healthcare institutions have in-house training developed by respected medical societies and business schools.