Survey Snapshot: “Culture Is What You Do, Process Is How You Do It”

Insights Report · August 18, 2016

We talked to executives, clinical leaders, and clinician members of the NEJM Catalyst Insights Council for a closer look at the leadership skills needed for next generation health care.


Leadership Skills Needed in Evolving Health Care Landscape

Leadership Insights Report. Click To Enlarge.

The ability to build organizational culture will be the most necessary leadership skill as health care evolves, according to Mark Warnken, MD, a pediatric neurologist practicing in suburban St. Paul, Minnesota, who is part of HealthPartners, an integrated health care organization.

Warnken’s response aligns with 47% of Insights Council members who contributed to the recent NEJM Catalyst report, Leadership Survey: Physicians Come First in Achieving Change. Building organizational culture, he says, is essential for the move to team-based and value-based care. Leaders will have to satisfy patient, payer, government, and employer demands, with “each component having different views as to what’s primary and what’s secondary,” he says.

Culture ranks higher than process management (22%) for Warnken because “culture is what you do and process is how you do it.” Organizations must know their intent before they figure out how to carry it out, he says.

How Leadership Skills Are Changing

Mathew Mathew, MD, FACP, Medical Director at Mercy Accountable Care, LLC, an affiliate of Mercy Health System in southeastern Pennsylvania, says, “physicians are clinging to the past, when they were the captain of the ship.” To change that culture, he says leaders will have to educate current physicians on team-based approaches and drastically change the training provided to new physicians.

Leveraging data, named by 19% of respondents, lags behind other leadership skills because it is not as useful in a fee-for-service environment, according to Mathew. But as value-based care takes hold, he says, the need to apply data will rise.

Chrissy Daniels, MS, Director of Strategic Initiatives at University of Utah Health Care, a Salt Lake City–based academic health system with four hospitals and more than 1,100 board-certified physicians, believes the top three skill sets in the NEJM Catalyst survey — building culture, communication, and building teams — must be bundled for effective next-generation health care leadership.

“In the past, we could be more deliberate and prioritize efforts and build consensus around change, but the pace and complexity and level of adaptability necessary today is dramatically different,” she says. Whereas change used to come about from inside, today “external forces are driving change.”

Daniels looks to the works of leaders such as retired Army General Stanley McChrystal, author of Team of Teams: New Rules for Engagement for a Complex World, for guidance on how to prepare leaders for the evolving health care landscape.

What she found is that leaders should offer context for change, and that this message needs to be communicated to those closest to the front lines. “That’s a more difficult and ambiguous challenge,” she says. “We’re dealing with highly trained professionals who are time-starved.”

However, if the need for change isn’t conveyed, frontline employees will find new initiatives harder to deal with and might even consider them unnecessary. “You go to the place where work is being done and give the people there context so they can start solving problems,” Daniels says, adding that this approach is how she develops leadership training models. “The only way this works is if you’re focused on the patient — it’s what brings the team together.”

For Daniels, leveraging data takes a backseat to culture when it comes to leadership skills. “Data on its own is not helpful. Defining the problem is helpful,” she says.

Communication is indeed key to avoiding mixed messages, according to Randal F. Hundley, MD, FACC, Medical Director for Arkansas Blue Cross and Blue Shield. Too often executives themselves are unclear how to execute culture change as they move between fee-for-service and value-based care. Providers feel a real pressure to add new profitable services, even when there is an ostensible commitment to reducing overall health care costs, he says.

Communication skills also will help administrators address fundamental concerns that physicians have, such as the impact of increased access on their personal time and how to move to team-based care delivery. “We have a number of smaller practices that aren’t even interested in getting an EMR system,” he says. “You need communication the whole way downstream to help physicians understand they are part of something that’s good and that’s bigger than themselves.”

Readiness for the Future

Extent to Which Drivers of Change Are Being Addressed

Leadership Insights Report. Click To Enlarge.

Hundley says he was “disappointed” that only 49% of respondents to the NEJM Catalyst survey feel their organizations are appropriately addressing the drivers of change. But he understands the result. “You have a lot of solo doctors and huge systems, and to get them all synthesized and coordinated requires a certain amount of resources and interest,” he says. “Some see opportunity in that and others see threat.”

Mathew is among those who say their organizations are appropriately addressing the drivers of change. But even so, he says health care can’t become fully patient-oriented until the payment system changes. Today, “there is no competitiveness to drive the consumer to the top,” he says.

To Daniels, who is tasked with strategic initiatives for her organization, the survey question on the extent to which leaders are addressing drivers of change poses a challenge. “The people who are working really hard on this think they aren’t doing enough. We’re trying, but we don’t always think we’re winning,” she says.

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