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the surgical group has the appearance of solving the problem, but just as one mas-
ters the rules of the game, the environment will change, and instability is destructive
to morale.
Another response to an unstable and dynamic environment is to accept the fact
that health care will never stop changing. There is no generic management solution
to these problems, but the missing ingredient in every health-care organization may
be a lack of effective clinical leadership or inadequate depth of clinical leadership
inside and throughout the organization. Thus, there is a growing need to train and
develop every surgeon to take on a leadership role.^1 Why?
There are at least three reasons why surgeons should be educated and trained to
be leaders:
- There is a new and blossoming science of medicine and management.
- Complex medical organizations such as hospitals should be led by people trained
in the underlying disciplines and applied medical sciences. - There is research evidence that managers with clinical backgrounds can run bet-
ter health-care organizations, and some physician-led multispecialty groups out-
perform organizations run by lay managers.
First, the merging of the biomedical sciences and the management sciences is
occurring through generative emergence. In the same way that biology and chemis-
try became the powerful new medical science of biochemistry during the nineteenth
and twentieth centuries,^2 the new science of medicine and management is emerging.
As researchers blend medicine and management science, they are discovering new
knowledge, such as the physics of patient flow, the measurement of quality and
clinical efficiency, learning from outliers, and the underlying science of improving
patient experiences. Through scientific method and rigorous validation, their aca-
demic findings are beginning to inform patient care throughout the world.
The clinical research and health services research literature are reporting signifi-
cant clinical improvements when clinical medicine applies the science of process
management. At Intermountain Health Care,^3 physicians have led more than100
successful patient-centered clinical improvements that reduced practice variations
[ 32 ]. For example, when they looked at coronary artery bypass grafts (CABG),
there were massive variations in physician practices and twofold variations in cost
(^1) When I refer to leadership, I am not referring to head of state, CEO, or chief but the ability to
mobilize people to want to struggle for some challenging goal in the front stage for patient care and
throughout the organization (see Kouzes and Posner 2016 [ 34 ]).
(^2) According to Afshar and Han [ 2 ], “Advancement of medicine and that of biochemistry are insepa-
rable, and much of modern medicine would not be practiced in the ways, as they are known today,
without our understanding of how genetic, pathogenic and environmental factors affect the human
body at the biochemical level. Thus, the importance of teaching medical students biochemistry is
self-evident” (page 339).
(^3) Intermountain Healthcare is a nonprofit health-care delivery system located in Salt Lake City,
Utah. It is comprised of 22 hospitals that offer a broad range of clinics and services. They employ
approximately 1400 primary care and secondary care physicians.
J.A. Chilingerian