In a time when hospitals are looking for ways to optimize their performance, a recent study suggests an association between physician-led hospitals and high performance ratings.
Among 1,859 hospitals that were analyzed in the specialties of cancer, digestive disorders, and heart surgery, physician-led hospitals scored more than 25% higher than did those with nonphysicians managers, averaging 8-9 points more in their hospital quality ratings, according to Amanda Goodall, Ph.D., a senior research fellow at the Institute for the Study of Labor, Bonn, Germany. She analyzed data from performance ratings for the top 100 hospitals as ranked by U.S. News and World Report in 2009.
Hospital quality points were awarded based on quality measures including mortality rates, nurse staffing, physician decision making, the number of discharges, and availability of necessary technologies.
The fact that the number of physician-led hospitals has declined by 90% (from 35% in 1935 to 4% today) has contributed to the ailing U.S. health care system, according to Dr. Richard Gunderman of Indiana University, Indianapolis, who has written about physicians as hospital leaders (Acad. Med. 2009;84:1348-51). One of the reasons our health care system “is in such sorry shape” is the fact that many of the chief executives of our hospitals and health care corporations see the hospital primarily as a business whose product happens to be health care, Dr. Gunderman said.
He added that the qualities of a good doctor and a good manager are closely linked. “Studying structure and function and using it to improve coordination and performance is second nature to physicians. We need to provide physicians opportunities to better understand the structure and function of hospitals and [other health care organizations], so that they can use that understanding to help hospitals perform better.”
The change, Dr. Gunderman said, needs to come from within the medical school curriculum.
“The organizational dimension of medicine (as opposed to the molecular, cellular, and other dimensions) has been crowded out of the curricula of medical schools and residency programs,” he said.