The Doctor Crisis: How Physicians Can, and Must, Lead the Way to Better Health Care

by Jack Cochran MD, Charles C. Kenney

Overview

Calming fears, alleviating suffering, enhancing and saving lives — this is what motivates doctors virtually every single day. When the structure and culture in which physicians work are well aligned, being a doctor is a most rewarding job. But something has gone wrong in the physician world, and it is urgent that we fix it.

Fundamental flaws in the US health care system make it more difficult and less rewarding than ever to be a doctor. The convergence of a complex amalgam of forces prevents primary care and specialty physicians from doing what they most want to do: Put their patients first at every step in the care process every time. Barriers include regulation, bureaucracy, the liability burden, reduced reimbursements, and much more. Physicians must accept the responsibility for guiding our nation toward a better health care delivery system, but the pathway forward — amidst jarring changes in our health care system — is not always clear.

In The Doctor Crisis, Dr. Jack Cochran, executive director of The Permanente Federation, and author Charles Kenney show how we can improve health care on a grassroots level, regardless of political policy disputes, by improving conditions for physicians and asking them to take on broader accountability; by calling on physicians to be effective leaders as well as excellent clinicians. The authors clarify the necessary steps required to enable physicians to focus on patient care and offer concrete ideas for establishing systems that place patients' needs above all else. Cochran and Kenney make a compelling case that fixing the doctor crisis is a prerequisite to achieving access to quality and affordable health care throughout the United States.

Product Details

ISBN-13:	9781610394437
Publisher:	PublicAffairs
Publication date:	05/06/2014
Pages:	240
Product dimensions:	8.30(w) x 5.80(h) x 1.00(d)

About the Author

Jack Cochran, MD, FACS, is the executive director of The Permanente Federation. The Permanente Federation represents the national interests of the regional Permanente Medical Groups, which employ more than 17,000 physicians who care for 9.1 million Kaiser Permanente members. Prior to this role, Dr. Cochran served as executive medical director, president, and chairman of the board of the Colorado Permanente Medical Group for Kaiser Permanente. Dr. Cochran serves as a member of the board of directors of the Alliance of Community Health Plans and the UCSF Global Health Group Advisory Board. He is also a past president of the Consortium for Community Centered Comprehensive Child Care (C6). Dr. Cochran earned his medical degree from the University of Colorado and served residencies at Stanford University Medical Center and the University of Wisconsin Hospital. He is board certified in otolaryngology (head and neck surgery) and in plastic and reconstructive surgery.

Charles Kenney is the author of Transforming Health Care: Virginia Mason Medical Center's Pursuit of the Perfect Patient Experience, which received the 2012 Shingo Research and Professional Publication Award. He is the author of two other works: The Best Practice: How the New Quality Movement Is Transforming Medicine, and coauthor, with Maureen Bisognano, of Pursuing the Triple Aim: Seven Innovators Show the Way to Better Care, Better Health, and Lower Cost. He formerly worked as a reporter and editor at the Boston Globe.

Table of Contents

Authors' Note xi

Preface xiii

Part I Miracles, Urgency: A Higher Calling 1

1 A Kind of Miracle: The Beauty of American Medicine 3

2 The Other Side of the Miracle: Failure Is Not an Option 15

3 Healer, Leader, Partner 29

Part II The Colorado Story: Firsthand Lessons for Preserving and Enhancing Physician Careers to Provide Superb Patient Care 45

4 Evolution of a Physician Leader 47

5 Jack's Constants: Preservation and Enhancement of Career 65

6 The Elephant in the Room 87

7 Turnaround 101

Part III Pathway Forward: Solving the Doctor Crisis, Expanding the Learning Coalition 111

8 Solving the Physician Crisis While Expanding the Learning Coalition: The Quadruple Aim 113

9 Learning Coalition: The Pathway Forward 137

10 The Urgent Need to Preserve and Enhance Physician Careers 165

Acknowledgments 187

Notes 191

Index 205

Editorial Reviews

“Jack and Charles have written an inspiring piece that illustrates the personal and professional attributes that physicians and health care workers today must embody in order to improve the quality of patient care and to lead innovation within an all-too-fragmented health care service. Textured with moving vignettes from patients and the clinical community, The Doctor Crisis challenges physicians to stand up and lead, to take action, and to prioritize learning and evidence-based medicine.” —Professor the Lord Ara Darzi, PC, KBE, FRS, Paul Hamlyn Chair of Surgery and Chair of The Institute of Global Health Innovation, Imperial College London

“The vision is compelling and provocative, that physicians and other clinicians should work together to be ‘healers-leaders-partners.' The authors compel us with the new work, and also enable us with a rich array of stories, examples, and tools to guide our own personal journeys of growth.” —Maureen Bisognano, President and CEO, Institute For Healthcare Improvement

“Many doctors are feeling pessimistic about the future of the medical profession. Cochran and Kenny consider part of the remedy is for physicians to play the major part in any ideal health care system that is patient-centered, easily accessed, fair, safe, affordable, efficient, high-quality, and innovative.”—Booklist

“With a unique combination of poetic storytelling, technical mastery, and executive savvy, Dr. Jack Cochran and Charles Kenney offer a design and a call for the learning and leadership we urgently need in health care. In a terrain of political debate too often marked by confusion and reductionist claims, this book brings real wisdom and compassion. It is a must-read for those searching for a route to a new care system.” —Donald M. Berwick, MD, President Emeritus and Senior Fellow, Institute for Healthcare Improvement

“The core of this compelling book is the true story of how a dedicated, passionate surgeon took on a leadership role to help turn around a struggling health care organization. Both practical and wise, The Doctor Crisis is a must-read for health care leaders everywhere. Cochran and Kenney have managed to capture the discipline and ordinariness of the many small actions and encounters that together produce dramatic organizational change.” —Amy C. Edmondson, Novartis Professor of Leadership and Management, Harvard Business School, and author of Teaming

“In this time of tumultuous change, physicians have great challenges and wonderful opportunities. Cochran and Kenney effectively make the case for physicians to lead delivery system change, and clearly and persuasively show how physician leadership will be a critical success factor as we build a better health care system for our patients and our communities.” —Gary S. Kaplan, MD, Chairman and CEO, Virginia Mason Health System

“The evidence is overwhelming that the American medical system is broken, yet few people have offered the wisdom, grit, and optimism to see a better future and reach for it. Cochran and Kenney have done just that. With extraordinary humanity and solid data, they remind all of us that status should not be confused with leadership. Each of us must learn from other disciplines, live with purpose and transparency, and make sure the joy in medicine is sustained for the next generation.” —Nancy L. Snyderman, MD, FACS, NBC News Chief Medical Editor, and Associate Clinical Professor, Head and Neck Surgery, University of Pennsylvania

“Jack Cochran uses his personal experiences to draw important lessons for fundamentally transforming the US health care system. Because failure is truly not an option and the issues transcend mere money to encompass human life and well-being, everyone should read and heed Cochran's profound wisdom.” —Jeffrey Pfeffer, Professor of Organizational Behavior, Graduate School of Business, Stanford University

“A compelling portrayal of why physicians must lead and show the way to transformative change in health care. This book should be read by every physician who has lost hope—or is losing hope—in achieving professional fulfillment.” —Dennis S. O'Leary, MD, former President, The Joint Commission

"Rare is the book that defines and successfully presents solutions to a problem as complex as that faced by most practicing physicians today. Cochran and Kenney's ability to present their ideas so clearly and cogently makes this an especially valuable book. Even though it specifically addresses change within the health care industry...it will doubtless serve as a very useful guide for anyone seeking to lead and effect change within their own organization or industry." —Boston Globe

“The executive director of the Permanente Federation argues that physicians are the key to creating a health care system that is patient-centered, safe, equitable, accessible and affordable. With the assistance of former Boston Globe journalist Kenney (Transforming Health Care: Virginia Mason Medical Center's Pursuit of the Perfect Patient Experience, 2010), Cochran draws on his years as president and chairman of the board of the Kaiser Permanente Medical Group in Colorado, where he developed and tested many of the ideas presented here.... Cochran calls on doctors, who have been trained to be healers, to expand their mission and take on a combination role of healer/leader/partner.... the book gives outsiders a peek into the inner workings of a large medical group.”—Kirkus Reviews

From the Publisher

2014-04-10
The executive director of the Permanente Foundation argues that physicians are the key to creating a health care system that is patient-centered, safe, equitable, accessible and affordable.With the assistance of former Boston Globe journalist Kenney (Transforming Health Care: Virginia Mason Medical Center's Pursuit of the Perfect Patient Experience, 2010), Cochran draws on his years as president and chairman of the board of the Kaiser Permanente Medical Group in Colorado, where he developed and tested many of the ideas presented here. When he took over, the morale among physicians was low, and turnover was high; the group was losing members. Working with a team—he had not been a manager before and was learning on the job—Cochran set specific priorities for the group: preserving and enhancing physicians' careers, optimizing the patient care experience and streamlining the care process. In detailing the obstacles and solutions, he makes clear that building a culture of collegiality and teamwork was essential. Nurses and clinical pharmacists were brought into partnerships with physicians, giving them greater responsibilities and career opportunities and freeing physicians to do the kind of work that only they could do. The author is especially proud of the methods he developed to rapidly set up a massive electronic health record system that increased the efficiency of patient care. Cochran calls on doctors, who have been trained to be healers, to expand their mission and take on a combination role of healer/leader/partner, and he insists that health care be a "learning industry." Talented people from all disciplines—clinicians, researchers, the pharmaceutical industry, etc.—must work together and learn from each other to seek out the best practices and apply them to provide the best patient care.While the book gives outsiders a peek into the inner workings of a large medical group, its message is directed primarily at members of the medical profession, more specifically, to those in management positions.

Kirkus Reviews