How do you quantify the qualitative?
That is one of the questions Jessica Sweeney-Platt, Executive Director of Physician Performance Research at athenahealth, has to grapple with on a daily basis.
Her work involves, um, researching physician performance (descriptive job titles are fantastic, aren’t they?). That means looking at hard numbers driving the bottom line, as well as more qualitative metrics like “leadership.”
When asked how one can “measure” leadership and quantify its impact on physician practices and the healthcare system as a whole, Jessica said,
When athenahealth started using its data assets to do research into the performance of physician organizations we very quickly realized that we can see a lot of things in our data. But there are a lot of attributes of performance that you can’t see in a rev cycle program or an EHR. And so leadership turns out to be one of those things […] effective leadership shows up again and again and again in the qualitative interviews that we do with high performing organizations. It shows up as highly correlative with things like engagement and self-perceived capability when we survey physicians […] One of the things that always correlates with those very positive outcomes is their perception of the quality of the leadership in their in their organization. So it’s one of these things that you sort of know intuitively matters. But we’re also seeing it in a lot of the data that we report on.
With that research, athenahealth is now able to “make a quantitative case for the value of leadership.” It comes down to the idea that an organization with good leadership will function more effectively and therefore find greater financial success while providing better care and outcomes to patients.
Jessica notes that actually “quantitatively measuring leadership” isn’t really possible right now, but measuring perception of leadership is. And a lot of the connection between leadership and measurable performance indicators is based on perception.
[I]f physicians say that those leading their organization are the best ones to be those leaders across the next five to 10 years, so they are best positioned to lead the organization successfully, you see higher levels of financial performance and you see higher levels of performance on certain clinical quality indicators.
It’s a little weird that we have to have a whole conversation about the value of leadership, much less dedicate significant resources to researching it’s value. Good leadership is obviously, intuitively good, isn’t it?
Yes. It is. Everyone knows that; it is intuitive. But not every organization is investing in hiring or developing the best leaders. So where’s the gap?
Jessica suggests that the gap comes naturally because so much in the world of health is quantitative.
I think one of the things that we wrestle with in healthcare is that because so much of what we do is measurable — there are process metrics and, increasingly, outcomes metrics — that we tend to look at those things as the be-all-end-all definition of performance. […] Leadership, because it is harder to measure, seems like it’s the ‘nice to have’ that comes after you’ve taken care of all of those ‘need to have things.’ And I can totally understand that, it’s totally rational, but it is why I think we tend to see leadership consistently ranking as one of the things that health care organizations struggle with.
The good news is that leadership training has been a big part of healthcare for a while now; Jessica points to people doing “leadership development for healthcare executives and physicians.”
In addition, there’s a strong push during medical training to get the next generation of physicians up to speed on the business side of healthcare. As a result, medical school is starting to produce MDs who can translate between the clinical and business worlds. That includes the language used by each group, as well as helping non-medical executives understand what it looks like on the ground in a clinical setting.
Over time, we can hope this will lead to a more integrated, collaborative system where a clinician’s work towards a patient’s best interest aligns with the business realities of running a medical practice or health system.
It is the ability to understand what it’s like to be in a clinic day in and day out, treating patients, dealing with the bureaucracy, handling all of the minutia that running your own practice or managing your own panel of patients entails. And then to be able to take those insights and apply them at scale across a large organization.
One of the things that is going to be most important for healthcare delivery organizations to master […] is the ability to see the patient experience from the perspective of the patient.
We need to start thinking about their journey through the healthcare system, not just their experience with one office visit or one hospitalization but their journey across the entire ecosystem and think about what would make that work for them. And once we can start to deal with that at a system level, then we will be getting somewhere.