Shared decision-making should be practiced with administrators
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The delivery of high-quality musculoskeletal care is a team approach. Orthopedic surgeons, health care providers, support staff, administrators and business managers should place patients at the center of the care model.
However, the challenges of competition, efficient operations, reimbursement and the complexity of care require synergistic interaction among all aspects of the care model to achieve the desired result of a best-in-class patient experience. Unfortunately, the innate characteristics of the various professionals focused on their individual responsibilities may lead to conflict and contempt throughout an organization. Physician and nonphysician leadership is required to achieve understanding, empathy and collaboration to create a culture that supports the professional and personal aspirations of the entire team.
Board-certified orthopedic surgeons have traveled through a gauntlet of academic, physical, mental and technical challenges to achieve professional competence. The rigor of rapidly expanding musculoskeletal knowledge and surgical care is a unique combination in medicine. Understanding current evidence-based information requires a lifelong commitment to learning and working toward perfecting technical abilities during every surgical procedure. These attributes must be tempered with humility, compassion and an ethical and moral compass that provides the communication patients require to trust their surgeon. No matter what technology or process is developed to improve health care delivery, the one-on-one relationship between surgeon and patient dictates the entire episode of care.
Trusting relationships
In medicine, physicians are privileged to develop trusting relationships with their patients in the delivery of care. With their intellectual and technical efforts augmented by increasingly sophisticated technology, physicians may be viewed as “heroes” in the eyes of patients. Successful outcomes lead to gratitude.
It is important to maintain humility and perspective and not believe we are the only ones who can solve complex problems. This not only applies to patient care, but also extends to professional and personal lives. An out-of-control “hero complex” negatively affects the collaborative culture needed to deliver health care, as well as healthy work-life balance and personal relationships.
Value-based care
Many orthopedic surgeons have had a leadership role during their career. The role may be as simple as leading a single practice or as complex as leading an entire health care system. As a leader of the clinical and surgical aspects of health care, we need to work with administrators to ensure efficient and cost-effective oversight of the business of practicing medicine, including operations, staffing, revenue cycle management, supply chain, compliance and quality improvement.
The education, interests, priorities, culture and personalities of the business team frequently differ from ours. Yet we must strive to find a synergistic, collaborative and integrated model of care if we truly are to focus on achieving the Quadruple Aim of health care: enhanced patient experience; improved quality, including population health; reducing costs of care; and improved work experience of the health care provider.
Today, more than ever, the relationship between orthopedic surgeons and practice administrators is critical to the sustainability and growth of a successful musculoskeletal care delivery system. The powerful internal and external forces shaping health care’s future have rallied behind the concept of value-based care. Unfortunately, the definition and practice of the best value-based care remains elusive. Even in its simplest definition of “quality divided by cost,” we are often inadequately measuring and defining “quality.” As a result, many decisions may be minimally influenced by opinion on quality, defaulting to cost or the ability to create financial margins heavily influenced by opinion combined with the objective components established with healthy business models. As physicians, we should be the patient’s advocate in the discussion. Remind all involved that patient-centered care is the most important goal.
Increased communication
Communication and strengthening bridges between administrators and surgeons should be an active and intentional component of orthopedic practice. Any sense of a “hero complex” among surgeons should be left outside the meeting room as we work with colleagues who have also committed themselves to years of hard work, overcoming challenges, problem-solving and collaboration. Instead of coveting sole ownership of a patient’s gratitude for the care and outcomes, recognize the essential component of teamwork in the highest-quality health care and share these stories with administrative colleagues. Thank them for the environment and support for a place that creates an opportunity for these precious moments to occur. Allow them to share the experience so they know their efforts are a part of the process of achieving high patient satisfaction.
As we focus on efficiency, time and priority management, work-life balance and seemingly unproductive dialogue, we need to remind ourselves that the relationships we have with people in our lives can only be cultivated with time. That time must be prioritized and part of our essential responsibilities. It is appropriate to set agendas to ensure the time is used to discuss current issues and allow for contributions from all involved in the delivery of patient care.
The shared decision-making we practice with patients should also be practiced with administrators. We need to define our roles and the collective vision of the practice, so we can focus on doing our “job” that contributes to the overall result. Feedback should be frequent and ongoing, breaking down the silos often seen in larger practices and health care systems that can lead to miscommunication, lack of transparency and erosion of trust. If we are going to practice patient-centered care with the compass of the Quadruple Aim of health care guiding us, then we need to make an active effort to build trust, respect and effective communication with administrative colleagues, as well as every person who affects the overall patient experience.
- For more information:
- Anthony A. Romeo, MD, is the Chief Medical Editor of Healio | Orthopedics Today. He can be reached at Healio, 6900 Grove Road, Thorofare, NJ 08086; email: orthopedics@healio.com.
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