Perspectives in Primary Care: Values-Driven Leadership is Essential in Health Care

Carol P. Herbert

doi:10.1370/afm.1877

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Engaging family physicians in health care change: necessary even though not sufficient
Carol P. Herbert

Published on: 19 February 2016
Transformative Leadership takes Courage
Allan Best

Published on: 19 February 2016

Published on: (19 February 2016)
Page navigation anchor for Engaging family physicians in health care change: necessary even though not sufficient
Engaging family physicians in health care change: necessary even though not sufficient
Carol P. Herbert, Professor Emerita
I thank Best, MacLeod, and Noel for their thoughtful response to my editorial on values-driven leadership. I agree that family physicians who become leaders in health care must be brave and remain true to their principles. However, physicians who understand the advantages of collaborative decision-making for both care of complex patients and management of the health care system are prepared to trade 'power and influenc...
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I thank Best, MacLeod, and Noel for their thoughtful response to my editorial on values-driven leadership. I agree that family physicians who become leaders in health care must be brave and remain true to their principles. However, physicians who understand the advantages of collaborative decision-making for both care of complex patients and management of the health care system are prepared to trade 'power and influence' for better processes, improved outcomes, and a socially responsible health care system.
It is important to distinguish individual physicians from their organizations, particularly those that primarily function as unions to protect physician incomes and influence. It is understandable that some medical organizations have been wary of embracing changes that diminish the autonomy - and potentially the income - of physicians, though generally stating their opposition to change as protecting quality of practice. However, as values-driven physician leaders emerge within medical associations, we have seen a change in the conversation with real attention to how best to utilize skilled health care professionals to provide high quality care cost-effective to individuals and populations, particularly to under-served populations. For example, a former President of the Canadian Medical Association co-authored a report for the Canadian Academy of Health Sciences on "Optimizing Scopes of Practice: New Models of Care for a New Health Care System" (1) (http://www.cahs-acss.ca/) which includes a number of recommendations for collaborative care models. Health professionals across the spectrum agree that maintaining and improving care delivery is central to new models of care.
I also agree that values-driven family physicians are not sufficient to transform an entrenched system, however, I believe that their engagement is necessary as family doctors are the major actors in the primary health care delivery system in Canada and a large component of the primary care work force in the United States. It would be far preferable that needed changes to structures, processes and incentives be negotiated rather than imposed. A collaborative approach will build on experience with new models of care that have been instituted in both countries and minimize disruption to services for patients as new systems are put into place.
1. Nelson S, Turnbull J, Bainbridge L, Caulfield T, Hudon G, Kendel D, Mowat D, Nasmith L, Postl B, Shamian J, Sketris I. Optimizing Scopes of Practice: New Models of Care for a New Health Care System. (2014) Canadian Academy of Health Sciences, Ottawa, Ontario. http://www.cahs-acss.ca/
Competing interests: None declared
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Competing Interests: None declared.
Published on: (19 February 2016)
Page navigation anchor for Transformative Leadership takes Courage
Transformative Leadership takes Courage
Allan Best, Managing Director
Other Contributors:
In a recent editorial, Carol Herbert (2015) describes the need for a transition to more values-driven leadership within our health system, and suggests that primary care physicians are particularly suited to providing this type of leadership.
In support of this transition, Herbert suggests more formal leadership education for medical students to ensure they understand the functions of leadership within complex...
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In a recent editorial, Carol Herbert (2015) describes the need for a transition to more values-driven leadership within our health system, and suggests that primary care physicians are particularly suited to providing this type of leadership.
In support of this transition, Herbert suggests more formal leadership education for medical students to ensure they understand the functions of leadership within complex systems. She also calls on practicing family physicians to adopt and model the values-driven leadership needed for system change, and highlights some of the challenges they will face as they shift to this style of leadership. These include dealing with risk-averse colleagues who will resist change, heavy workloads and rigid accountability systems.
We would like to add that any family physicians taking on this challenge also will require exceptional courage and commitment to their principles as they will be tested continuously.
For example, moving to a more open and collaborative leadership style and embracing inter-professional care will be seen by some physicians as accepting a loss of power and influence. It can also raise questions about the possibility of lost revenue. These concerns are the "elephant in the room," for any values-driven approach to system change, and part of the answer to Herbert's question about why, in spite of all the evidence and reports supporting transformative solutions, "...change has been painfully slow and disappointingly limited".
Rather than aligning culture, skills, knowledge, structure and strategy - the actual requirements for system change - we tend to focus almost exclusively on "structure." Structure is the DNA of our health system. It will faithfully produce the results it has been designed to deliver. The challenge for family physicians is how to contribute as leaders for system change from within such a robust, self-sustaining structure.
Understanding the complexity of our health system is one thing; moving to the sustained action required for change is quite another. Values-driven leadership coupled with a clear action plan and complexity- informed strategy is where it starts.
However, even a strong cohort of family physicians committed to values-driven leadership will likely not be enough to deliver the kind of system transformation we see as needed. For that, fundamental changes to the externalities of health system structures, processes and incentives are required. Current tensions around implementation of the U.S. Affordable Care Act offer a good perspective on those issues.
It is not because things are difficult that we do not dare; it is because we do not dare that they are difficult. ~ Seneca (4 BC-65) Roman philosopher and playwright.
Competing interests: None declared
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Competing Interests: None declared.