• Last Word: Engaging Physicians to Improve Value

    Nov 01, 2011

    An interview with David Maizel, MD 

    Rather than being discouraged by the level of uncertainty and risk in health care today, Maizel is inspired.

    After practicing medicine for 25 years, David Maizel, MD, exchanged his white coat for a suit jacket to become president of Sentara Medical Group, and a few years later, corporate vice president of 10-hospital Sentara Healthcare in Norfolk, Va.


    Although he looks back with pride on his years as a family practice physician, Maizel finds his new role to be tailor made. He believes that many physicians possess a key leadership skill: problem solving. "Physicians can apply what we know about diagnosing and treating patients to the management side of health care."

    This is the foreword to the Fall 2011 Leadership report, Managing Business and Clinical Risks.

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    Mitigating Risks

    "As medical students and practicing physicians, we are trained to be good listeners," says Maizel. "We gather facts by assessing a patient's concerns or complaints and, depending on the situation, order some diagnostics to help narrow down the problem. We then use those facts to come up with a working diagnosis and plan."

    In many ways, providing the best possible clinical care is about managing risks, he says. "When making recommendations to patients, we balance the potential treatment benefits against the possible harm that can result from those treatments."

    This is similar to what Maizel does now in his management role: "We also consider the impact of our recommendations: Is there only going to be a positive impact or are there going to be some unintended consequences we have to manage, mitigate, or minimize?" 

    Training with Intention

    Although not all physicians are inclined to take up leadership roles, many are willing and able to become more involved in efforts to improve healthcare delivery. The first step, says Maizel, is to extend an invitation. "We really need to break down the barriers and the fragmentation that has historically existed in health care, and to really embrace the notion that we are much better off if we all work together."

    The second step is to provide training. Specifically, Maizel has found that physicians often need training in quality and process improvement methods.

    However, timing is key. Maizel suggests involving trainees in a specific improvement initiative where they can use their education to improve whatever that initiative is focusing on. "There's huge power to that."

    Sentara Medical Group used this approach when redesigning primary care practices into patient-centered medical homes (see page 13). About 50 physicians and managers were trained in Lean process improvement methodologies-and then served on teams that reengineered practices to make them more efficient and customer-focused. 

    Influencing the Future

    Rather than being discouraged by the level of uncertainty and risk in health care today, Maizel is inspired. "A lot of people are very concerned about where we are in health care right now. Some are saying, 'Boy, maybe it's time for me to get out,'" he says. "But I think this is one of the most exciting times in the history of our profession and our industry. I think if we take the right approach, we can really influence the way health care is going to be provided in this country for decades to come."

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