An ‘82 graduate of the University of Washington School of Medicine’s Physician Assistant program, Ed Lopez later completed his formal Internship and residency in General and Specialty surgery at the Albert Einstein College of Medicine and Montefiore affiliated Hospitals in New York City. After 17 years in private Cardiothoracic surgery practice and later as a co-founder of one of the largest private Hospitalist programs in the country, Ed returned to business school completing his studies in professional medical management and healthcare policy at the University of Washington and the Harvard Kennedy School in Cambridge, Mass. Today as an Assistant Medical Director for a large healthcare system in the West, Ed is also a recent graduate of the Physician Leadership Institute’s program in Leadership sponsored by The Center for Transformation and Innovation and the Catholic Health Initiative, Ed has dedicated his efforts to mentoring, teaching and supporting young Physicians to become the leaders of today and tomorrow in making the U.S. healthcare system the finest in the world.
In your practice, how do you define physician leadership?
I’ve done over 30 years in healthcare and over 20 of those years in staffing, managing physician practices, helping hospitals get the right contract surgeons, turning around failing practices and leading lean and process improvement projects in and out of hospitals . Those 30 years has shown me that physicians are primarily technical experts, and frequently were never taught how to understand, empathize and motivate others. College & Medical School was geared to a system of identifying high achieving individuals who by themselves could handle the most intense and arduous of demanding professions. And once the individual excellence was identified, they were often the most singly rewarded.
Most physicians were never formally taught to lead teams or performance groups when they completed their training. Remember, we were training scientists, with the manual skills of DaVinci and the brilliance of Einstein. In fact, most once finishing training went into a practice and hired the talent that did that “organizational and management stuff ” while they dedicated themselves to practicing the “art and the science of medicine.”
But that was yesterday’s model physician.
Today the need for physician leadership has never been more pronounced. As the 21st Century healthcare culture and process of care delivery has changed, it has been wandering in the desert of darkness, looking for true leadership. And as we have seen when there is a void in leadership, there is never a shortage of politicians, policymakers, MBA’s, economists, and well intended do-gooders filling that void. But for healthcare, it is not enough for physicians to be mere participants in the new system. Today the demand and the stakes are so high, that ONLY the well trained and well tuned physician leader can lead us through this healthcare change process successfully.
When did you first realize the need for physician leadership in the workplace?
I’ve been a big fan of Daniel Goleman and his concepts of emotional intelligence from the very beginning – for almost 20 years. But here’s when it struck me in a way that could not be denied. I had gone back to grad school for a policy class – at the Kennedy School at Harvard – where at least one-third of my class was comprised of physicians, lawyers and policy makers from the rest of the world. I noticed that the behavior of the US doctors was unique. We were technocrats, but not people or team leaders. The others were not just physicians in the office or the hospital. Rather, they were spiritual, community leaders as well. They were most often an integral part of the network of their community – not only as “medical healers” but they were also looked upon as social leaders who were involved in every aspect of their cultures. We, as healthcare delivery providers/physicians in the US, pride ourselves as specialists, sub-specialists, and so have compartmentalized our profession that we have little to no say in our society anymore. We are looked upon as mere workers in the vast network of skilled professionals with no voice in the shaping of the future of our new healthcare culture. It was then that I realized that the physicians in this country were in trouble.
What happened? How did you go back to work, and what were you thinking?
When I went back and started talking to my colleagues, they had never thought about it as I did. Most didn’t care, as long as they were getting paid handsomely. The mindset was something like – “I’m responsible for hip surgeries. That’s what I do, I do it well, I have a great referral base so I’m fine thank you very much. Don’t bother me with this touchy-feely political stuff.”
The result of the isolationist-specialist mindset is what you see in healthcare today. In the late 90s we saw fresh-faced MBAs with no medical experience come into our healthcare systems and start dictating how business was to be run. Even then, the standard response was: “as long as they leave me alone to do my job, and I get paid well, I won’t get involved.”
So healthcare issues have built up over time…
Sure, the history of our profession will show that until very recently, physicians had abdicated their responsibilities. Perhaps not intentionally, but systemically. And in the mid 2000s, not only did physicians lose their say in healthcare, but they were at the mercy of a system that did not put the patient first. The few physicians who were in administrative positions were window dressing. They’d go to meetings and “participate” – not as physicians, but as cogs in the wheel. Physician leadership was non-existent. Unfortunately they were neither physicians, nor leaders but mere participants in the vast healthcare machine . Some of us were thinking: “What have we created?”
That sounds bleak. Are things changing? Are physicians getting back into the game?
Thank God things are changing. Today Physicians are recognizing that there is a dearth of physician leadership at almost every level. The physician leader must understand today how the business works, what the outcomes are, how to lead and inspire teams, and fix problems – all from the perspective of the patient. The government has stepped in as well – forcing the hospital systems to measure outcomes not just costs. This is changing the business dynamic by forcing a sense of accountability for all of us – Doctor, Patient, payor, administration. We ALL now own this thing called the American Healthcare system – You can run but you can’t hide.
To compete, our medical practices must nurture real, authentic physician leaders. Men and women who understand that before we can lead others, we must search our souls and learn to lead ourselves in order to become the leaders we need to be. Leaders must inspire followers through servant leadership – by example and by service. No job is too small or too insignificant when it comes to the patient experience.
Can you give us an example?
There was a rural hospital with 25 beds that was a challenge because it was underperforming at nearly every metric used to measure performance.
The difference was physician leadership. We handpicked the physicians with the right emotional intelligence, with the leadership skills to succeed. Two of the physicians were new grads, another was a veteran, very discouraged and near the end of his career. We asked them if they wanted to make difference. The veteran got behind us when he understood that this is why he had gone to medical school all those years ago. The right people make all the difference, and this case was no different.
Today that hospital is the crown jewel in a 7-hospital system. We are getting results – focusing on outcomes and profitability. Morale is high, and our patients love us.
You ask for a personal commitment from your physicians?
Absolutely yes. My commitment is to do the right thing to help the patients and their families receive the finest experience they can have. No detail is too small. And we teach this to all – from the physician to the janitor. If a patient needs something, we do our best to get it for them. We tell them: “If anything isn’t working for you, please let us know, so we can help.”
There is science behind this. When a patient experiences a feeling of trust and faith, endorphins kick in, and they begin their journey of healing with a positive frame of mind.
Look at what the patient experience is like in a typical hospital. The first thing we do is ask the patient to take off their clothes, wrap them in a piece of cloth and call it a gown with their butts hanging out. Strangers walking in and out of their rooms at all times of the day and night without a sense of privacy. They ultimately feel humiliated, confused, and afraid and yet we expect them to then when asked, to give that hospital a glowing rating when HCAHP scores come a calling. Is that any way to treat the patient?
Patients want and they deserve to receive the best service in town while they are sick and hurting. The experience for the patient must be one they will feel comfortable with. We try to make it as much like a home as possible.
The patient experience is all-important?
It’s everything. At our facility we have built a collaborative care model, with the patient at the center. On daily rounds, physicians visit with all members of the staff who interact with the patients – nurses, therapists, discharge personnel, house-keeping – to ensure that we are all on the same page and understand the needs of the individual patient. No task is beneath anyone. We are butlers, servants, here to serve the patient. Not pamper them, but give them the respect they deserve. Humility is expected from all.
And the end result is patient satisfaction. Our patients ask to come back to us, because they trust us.
This, by the way, is the best way to maximize shareholder value. By focusing on the best outcomes for our patients with results-driven leadership, that’s physician leadership in my book.
I have tried to live by and gain strength from an adage by Lao Tzu: “A leader is best when people barely know he exists, when his work is done, his aim fulfilled, they will say, we did it ourselves.”