I attended the Michigan Medical Group Managers Association spring conference in Mt. Pleasant March 23-25. Two speakers, Lloyd Carr, former head football coach for the University of Michigan Wolverines, and Lou Rabaut, partner at the law firm Warner Norcross & Judd, provided excellent lessons on leadership. Several of the other speakers focused on the challenges medical group managers will face in the near future.
Coach Carr, now Dr. Lloyd Carr, closed the conference with many lessons on leadership. It seemed to me that he was addressing his soccer team. I remember two of the lessons vividly. The first lesson was about responsibility for mistakes. Coach Carr recounted how every Sunday morning after a Wolverine football game, he would review the tapes of the game. He analyzed the execution errors that the players made during the game. He said: “I take all mistakes as my responsibility. If a player made a mistake, I think it was because of my slip as a manager.” He went on to say that, however, he does not take responsibility for personal fouls committed by the player, such as unnecessary roughness. For these he punished the player that he committed one. I think he was asking leaders and managers to take responsibility for mistakes made by people under his direction. It is the leader’s responsibility to ensure that the staff member has been trained and prepared for his or her job so that it is carried out successfully for patients and clients.
The second lesson Coach Carr focused on was team execution and training. He illustrated this theme by focusing on the ball exchange on every offensive play between the center and the quarterback. This exchange must occur perfectly every play. If you don’t, there may be a fumble, which would be a disaster if the ball was recovered by the other team. Or, one of the offensive players could start early if the center doesn’t turn the ball over to the quarterback on the called snap count, earning the team a 5-yard offsides penalty. To make sure this critical trade goes off without a hitch, it is practiced every day of team practices; it is practiced over and over again. What he was saying, in my opinion, is that medical personnel have to work perfectly as a team. Unfortunately, this is something medical managers rarely focus on. However, working well together as a team is often critical to getting the best results for patients.
Mr. Rabaut focused on the characteristics of leadership and management. He stated that leaders focus on WHO and because-Who will do it and why we do it. Leaders create visions and influence others to act on them. Managers focus on when, where, as and that-What will be done, how it will be done, when it will be done and where it will be done. Managers implement the visions of leaders and enable and direct others to achieve the goals of the vision. Both types are necessary in a successful organization. At best, individuals in the organization possess both sets of characteristics.
Mr. Rabaut went on to list the key attributes of effective leaders and managers.
Leaders:
emotional intelligence
· Communication skills
skills training
Empathy (It hurts you, it hurts me)
Ability to put things in context.
Managers:
Skills
Technical knowledge
Organization
· Planning
· Management
Controller
Mr. Rabaut provided two illustrations to further distinguish leaders and managers. He stated that a marine sergeant is a good example of a manager in most cases. He is carrying out the objectives of the Marine Corps and effectively directs his soldiers to achieve these objectives. He does it through a chain of command that is clearly defined and obeyed. However, in some situations, such as battle, the sergeant himself can be an effective leader by inspiring his soldiers to overcome impossible obstacles.
Mr. Rabaut’s illustration of an effective leader was drawn from his own childhood. He attended a Catholic elementary school. There was a nun at the school who led a small children’s choir. It was harder to become a choir member than it was to make the sports teams at this school. The nun was such an effective leader, a servant leader, that the children at the school were inspired to be a part of this dynamic group. Mr. Rabaut was a member of the choir and gladly gave up his lunch period to practice in the choir for several years.
As I said earlier, some of the speakers at this conference focused on the challenges facing medical managers in the near future. Therefore, the lessons on leadership, management, and teamwork were a good foundation for medical managers to face these challenges. The challenges detailed by the other speakers primarily covered Accountable Care Organizations (ACOs), Patient-Centered Medical Homes (PCMHs), and blended payments. At the root of each were the primary care physician as the primary organizer and provider of patient care and new ways to reimburse providers. Organizations that provide high-quality outcomes for patients will be the ones that thrive with the new programs.
Each of the speakers who focused on these new organizational structures highlighted the high probability that CMS will adopt these models in the near future. This is evidenced by the fact that CMS has already begun to reimburse for quality results, particularly the PQRI program and meaningful use of EHRs. Initial rules for ACOs will be issued shortly by CMS and there are pilot studies in eight states led by CMS of the PCMH. More evidence of the direction CMS is taking can be found in its document Roadmap for Implementing Value Driven Healthcare in the Traditional Medicare Fee-For-Service Program. As CMS moves toward reimbursing providers through these programs, private insurers are likely to follow suit. In fact, here in Michigan, the two largest private insurers in the state are already supporting PCMHs with monetary rewards.
Looking back at the speakers and discussions with colleagues at the MMGMA conference, I am impressed with the fact that there is no denying that significant change in quality care and reimbursement healthcare models is coming soon; primary care providers will be significantly affected. Navigating these changes will require effective leaders and managers along with expert knowledge.
