CIO Era Magazines

Tom Jackiewicz

I’ve worked with physicians from the very beginning of my 30-year career in healthcare. From overseeing financial reporting for clinical practices at the University of Pennsylvania Health System to directing business operations for the departments of medicine at Oregon Health Sciences University and Stanford University School of Medicine, and then moving into CEO roles at University of California, San Diego Health System and Keck Medicine of USC, physicians have not been people who work for me. They have been colleagues, mentors, collaborators, and most importantly, fellow leaders of transformational change.

That’s not to say that healthcare isn’t a team sport, especially when it comes to driving change. As you may know from other articles I’ve written, I’m a big fan of football metaphors. So here I’ll add one from the University of Michigan. Michigan coach Bo Schembechler is famous for many things, like his 1983 speech that inspired the popular phrase “The team, the team, the team!” Schembechler said, “No man is more important than the team, no coach is more important than the team. If we think that way – all of us – everything you do, take into consideration what effect does it have on my team.” Bo’s wisdom applies equally to athletes and everyone who works for hospitals and health systems.

But when we’re talking about transformational change in healthcare, such as restructuring to better care for patients and taking shared accountability for lowering the cost of care, too often, physicians have been left out of the process or relegated to figurehead roles. As we’re strive to collaborate and achieve shared accountability across specialties and among administration, physicians must be given meaningful, actionable opportunities to participate and lead. 

When I joined Keck Medicine of USC almost a decade ago, it was an academic medical center start-up in every way. USC purchased two hospitals from Tenet to create the second academic health system in Los Angeles. It was a gratifying journey from the acquisitions in 2009 to achieving top 20 designation 10 years later, but it was not an easy one. The Tenet model had not embraced physicians as central players. Instead, physicians had to be entrepreneurial and build their programs with other community hospitals. Essentially, Keck physicians were operating like a big private practice, with undertones of an “us” versus “them” mentality and decisions made in silos. When I joined Keck as CEO, it was clear we needed to coalesce and become true partners in transforming the organization into a unified enterprise. 

Some of the best advice I ever received was from a close physician colleague at Stanford. As we were struggling to identify key stakeholders to solve an operational problem, he turned to me and said, “You know physicians may be 50% of the problem, but they are 100% of the solution.” I never forgot this advice, and it is now one of my core beliefs.

About 80% of the challenges Keck needed to overcome required significant physician buy-in. Failing to communicate with and convince physicians that the current path wasn’t sustainable, meant, bluntly, we would be in a world of hurt going forward. Knowing that creating a wave of physician support and engagement was key to our future, we started by trying to get the culture right. When physician apathy or aversion to change has taken root, barriers will not be overcome without trust. At Keck, that meant promoting a culture of rigorous dialogue and discussion, accommodating different approaches to problem solving, and including physician leaders with strong opinions.

Our chairs had vigorous discussions, but those discussions soon became productive as we learned to be honest with each other and leave the room as friends and colleagues. A common commitment that we’re all in this together and that we agree on what’s important was eventually forged. That process also forced us to be better communicators.

Trust began to emerge among physician leaders, executive leaders, operations leaders, and academic leaders. That trust was the foundation for growth, care delivery redesign to improve quality and reduce length of stay, achievement of Magnet status, and many other initiatives that propelled Keck forward.

Organizational challenges and crises can break health systems or galvanize them. As leaders of these enterprises, we need to redouble our efforts to support physicians and their departments, elevate physician leaders, and sustain momentum for major initiatives by keeping physicians at the forefront. When we do, the transformation we are seeking for our organizations has an exponentially greater chance of succeeding.