by Dr. Kenneth H. Cohn

Just before Thanksgiving, I spoke at a gathering of 180 physicians about how physicians can overcome their frustration -- not just their frustration over losses in reimbursement, but also in authority and autonomy.

Part of the reason for these losses is that we lack training in such process skills as communication, negotiation, and conflict resolution that facilitate leadership and the implementation of sustainable solutions.

In general, our leadership skills are skewed too much toward command and control to actually contribute to high-performing teams. In fact, our teamwork and communication practices resemble those of the airlines in the 1970's.

But I do remain hopeful. The reason? I've worked with physicians who have overcome frustration and skepticism to establish themselves as leaders who make their time count. Three examples follow:

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1) By focusing on time savings, one New England surgeon conceived of a way to make protocols more discussable. The success of an inpatient anticoagulation protocol led to the adoption of a successful PACU weaning protocol that decreased overnight patient stays by more than 30 percent and the subsequent successful implementation of computerized physician order entry, which improved patient safety and ended pages regarding illegible orders.

2) During a clinical priority setting process, a West-coast orthopedic surgeon reviewed the literature and convinced his colleagues that no significant outcome differences existed among different companies' hip and knee implants.

Aided by the knowledge that vendors were earning more in commissions than surgeons' fees, the orthopedists consolidated their vendors from eight to two, which dropped the average implant cost to approximately $4,000 and saved the hospital $4.2 million over three years.

The hospital used these savings to purchase a new fracture table and imaging system for joint replacement surgery. The hospital, orthopedic surgeons, and the community all benefited from this surgeon's leadership [Cohn KH, Allyn TR. Making hospital-physician collaboration work, HFM. 2005. 59(10):102-108)].

3) A Midwestern neurologist was elected the first female medical staff president in a turbulent year, in which the CEO and CMO were fired and more than one-third of board members resigned. She sought coaching because she felt that she was unprepared and did not want to fail.

The most important exercise that she learned was "going to the balcony," i.e. pretending that she was looking down at an intense situation rather than being caught up in the middle of it. Her poise and leadership made her the leading internal CMO candidate, and when she did not get the job, she moved to a nearby hospital to build a new Neuroscience Institute that has brought coordinated care to her community.

The characteristics that these physicians shared included their outstanding clinical skills, which earned their colleagues' respect; desire to leverage their knowledge and experience beyond individual doctor-patient encounters; and their desire to leave a lasting legacy.

What do you think?

Have you witnessed situations in which physicians demonstrated leadership that transcended victimhood and improved patient care? What triggered their responses? How has your community benefited from physicians' leadership?

I welcome your thoughts and comments.

Ken Cohn is a practicing general surgeon/MBA who divides his time between providing general surgical coverage and speaking, writing, teaching, and consulting on physician-hospital relations.