Drs. Thomas Lee (Chief Medical Officer at Press Gainey) and Toby Cosgrove (a world-renown heart surgeon who served as the President and Chief Executive Officer at the Cleveland Clinic from 2004-2017) have written two articles that I think are important reads for physicians and health care leaders. Both articles were published in NEJM Catalyst. The first, "Six Tests for Physicians and Their Leaders for the Decade Ahead" was written in 2020, but the themes continue to be relevant today. The second ("Health Care Leadership in the AI Era: A Seventh Test for the Decade Ahead") just came out in December, 2024, in which Drs. Lee and Cosgrove added a seventh "test" to the original list.
They start the first article with a rather ominous (but honest) statement: "For physicians and their leaders, the recent past has been difficult, and the decade ahead will be even more challenging." I completely agree with their assessment. I've mentioned in several posts recently that we live in a VUCA/BANI world. Health care as an industry - and medicine as a profession - have certainly been challenged with the COVID-19 pandemic, but it's also important to recognize that we didn't necessarily enter the pandemic on stable footing either. The U.S. health care system continues to cost significantly more compared to our peers, yet we don't compare favorably to these same countries on health-related outcomes. Even before the pandemic, hospital systems were dealing with staff shortages, supply chain issues, and medication shortages. These problems have continued, and in some cases, have worsened since the pandemic. Finally, it's been over two decades since the Institute of Medicine published To Err is Human: Building a Safer Health System and Crossing the Quality Chasm: A New Health System for the 21st Century, we still have significant opportunities to improve both the quality and safety of care (see the report in Health Affairs entitled "Two Decades Since To Err Is Human: An Assessment Of Progress And Emerging Priorities In Patient Safety" for further discussion).
At the same time, there has been significant scientific progress that have made possible a number of advances in therapeutics, technology, and surgical procedures, whereas diseases that used to be fatal are no longer so. As Drs. Lee and Cosgrove call out, the doubling time (the time it takes to double in quantity) of medical knowledge has decreased from 50 years in 1950 to 3.5 years in 2010 to less than 3 months in 2020. It's becoming more difficult for physicians to keep up with this overwhelming body of evidence, which could be one reason that patients receive only half of the care that they should receive, based upon the available evidence (as highlighted in Crossing the Quality Chasm). The overwhelming abundance of information is potentially one of the drivers for the move to artificial intelligence, which is the subject of their second NEJM Catalyst article.
Just as important, the physician workforce has been changing even prior to the COVID-19 pandemic, but the changes have continued to accelerate since the pandemic. As Drs. Lee and Cosgrove mention, older physicians are being replaced (or will soon be replaced) by a newer generation of physicians who are younger, more tech savvy, and increasingly female. This new generation is also more likely to work in teams (a positive trend), and they are more likely to be employed by hospitals or health systems. Gone are the days when physicians owned their practices and were active members of the medical staffs of multiple hospitals.
Drs. Lee and Cosgrove list six tests (in order of ascending difficulty) for physicians and health care leaders that, if successful in meeting, will likely define what is defined as effective health care leadership in the next decade:
1. Really Putting Patients First - The first test is likely not very controversial. Patients have been and should continue to remain the top priority for health care organizations in the coming decade. Research shows that when quality (as defined by the patient) is better, both physician morale and organizational business success improves.
2. Building Super-Teams - Medicine has become a team sport. Chronic, complex medical conditions require a team-based approach in order to achieve the best outcomes. Press Ganey patient satisfaction surveys consistently show that coordination of care between physician teams, between physicians and nurses, and across the continuum of care (inpatient, outpatient, peri-operative) is what patients value most. As Drs. Lee and Cosgrove write, health care needs "to create the medical equivalent of the Navy SEALS; that is, a group of committed, high-performing individuals who understand and value the importance of working as a team to accomplish the mission at hand."
3. Plunging into Competition - Drs. Lee and Cosgrove write, "Physicians should give their complete attention to taking care of their patients, and the best way to ensure that this remains possible is to encourage their organizations to plunge into competition, not deflect it. The reason is that the marketplace must control costs and ensure quality, and if competition cannot accomplish those goals, regulation of some kind will be invoked."
4. Taking on Costs - Health care costs have gotten out of hand. Rather than avoiding it, physicians should embrace cost reduction. As Drs. Lee and Cosgrove mention, "The risks are high that external parties (e.g., government) will take action to cut spending if health care itself is unable to take on this problem."
5. Embracing Innovation - The kind of innovation that is needed to tackle some of health care's most challenging problems will require creativity, courage, and patience.
6. Grasping Leadership - We need physicians to take the lead on solving all of the challenges and problems that exist in health care today. Leadership can be taught, but it takes more than reading articles and books (and blog posts!). Organizations need to invest in leadership development programs for their physicians.
Drs. Lee and Cosgrove added a seventh test in the second article, which appeared more recently. They write, "Artificial Intelligence (AI) is moving quickly into virtually every aspect of health care that involves thinking, reacting, or communicating." While they do not explicitly state the seventh test, they do suggest that "It remains essential that leaders have expertise in operational excellence and strategy, but now they must add management of 'breakthrough innovation' and leadership of the culture change necessary to take full advantage of AI."
I agree with most of the points made in these two articles. These two thought leaders make some excellent points. What do you see as the major challenges for physicians and health care leaders in the coming decade?
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