343per case. However, these CABG patients were not sicker; in fact, 80% of the patients
had similar severity and complexity. By reducing process variations,^4 CABG out-
comes improved and costs were reduced.^5 The new science of medicine and man-
agement advances the medical practice such that the lowest-cost care provides the
best clinical results.^6
Second, consider companies in the computer, software, and internet industry, such
as Google. Who ought to run a technocratic organization like Google? The answer is,
the people trained in the basic underlying science, such as programmers and software
engineers (see [ 24 ]). Perhaps complex biomedical science organizations, such as aca-
demic medical centers, acute general hospitals, or specialty hospitals, should be led by
professionals trained in the underlying disciplines and applied medical sciences, i.e.,
physicians, nurses, and other clinicians trained in the science of medicine.
Third, we have learned from research and from teaching physicians^7 that physi-
cian leaders can make a significant difference in health-care delivery outcomes and
efficiency in hospitals. Moreover, there is growing evidence that the direct involve-
ment of physicians in health-care management improves overall organizational per-
formance ([ 6 ], AJC; [ 18 ] Annals of Internal Medicine; [ 8 , 55 ]).^8 Historically the
most effective health-care organizations are the multispecialty, physician-led groups
[ 56 ].^9 These organizations nurture and integrate physician leaders who are prepared
to bring management science closer to clinical operations and medical decision-
making ([ 16 , 32 ] and [ 37 ]).
There is a counterargument however to the assertion that physicians make the
best health care leaders. Safe, efficient, accountable, high-quality health care in the
twenty-first century demands a broad range of conceptual, technical, analytical, and
leadership skills, a range that is nearly impossible for self-taught physician leaders
to comprehend and manage [ 7 , 19 , 47 , 59 , 60 ].
(^4) The science of process management applied to medicine is only one example of the new science
of medicine and management.
(^5) The new science has been applied to procedures and diagnoses such as prostatectomy, cholecys-
tectomy, pneumonia, and pacemaker implantation [ 32 ].
(^6) When the science of process management is applied to a surgical care program, every care pro-
cess will “always” produce parallel clinical cost and patient experiences.
(^7) In 1995, Brandeis and Tufts partnered to offer medical students a 4-year, dual MD-MBA degree.
Today it is the largest program in the USA. Since 2004, Brandeis offers a 6-day CME leadership
program in Advanced Health Policy and Management, in partnership with the American College
of Surgeons. Finally, Brandeis launched a 16-month executive MBA for physicians. All of these
programs have demonstrated the ability of physicians to take leadership roles and make significant
improvements to clinical and managerial services.
(^8) Research by Bloom, Homkes, Sadun, and Van Reenen in 2010 on 1200 hospitals found that hos-
pitals with more clinically trained managers outperform all the others. They hypothesized that
perhaps clinical managers obtain higher levels of street-level credibility, competence, and authori-
tative clinical expertise difficult to achieve for nonclinical managers. This is what behavioral sci-
entists call “social proof.”
(^9) Staller, Goodall, and Baker [ 56 ] reported that a matched random sample of employees and
employers in the USA and UK found employees reporting to leaders who are experts in the core
business had low intentions to change jobs and higher job satisfaction.
20 Teaching Surgeons How to Lead