HJBR Sep/Oct 2022

HEALTHCARE JOURNAL OF BATON ROUGE I  SEP / OCT 2022 13 it is responsible for maintaining, improving, and for passing on to the next generation, 2) putting others’ interest ahead of its own, and 3) self-regulation, where financial return is not the accepted measure of success. Considering the woeful performance of the U.S. healthcare system compared to other economically devel- oped countries, I think a good argument can be made that our profession needs to acknowl- edge these failures and lead the way forward to a better future. Doing so will require physi- cians to reconceptualize the notion popular- ized in traditional culture as “doctor knows best.” Abundant evidence from the manage- ment literature illuminates the shortcomings of autocratic leadership, while highlighting the benefits of many other forms of leadership, such as humble leadership, relational leader- ship, or empowerment leadership. While we will always rely on physicians to apply hard- earned tacit knowledge in solving complex unstructured problems or to apply technical skill in performing life-saving surgeries and procedures, the knowledge and skills needed to manage chronic conditions and many of the other problems plaguing healthcare are vastly different. And chronic conditions are where the majority of avoidable costs in healthcare can be found. Better managing of those con- ditions requires flattened hierarchies, humble leadership, relational coordination, and team- work. Physicians must ask the question, “What can I do to help make these people better,” referring to both their patients and the care teams they will lead. And care teams will be comprised of both a healthcare and social care team that will work and learn together with the object of cultivating collaborative practice around providing truly patient-centered care. It is through this interprofessional education where it all gets tied together and where physi- cians will both lead and learn at the same time. General Martin Dempsey, former chairman of the Joint Chiefs of Staff, saw the need for precisely this kind of mindset shift in what was historically the most autocratic and hierarchi- cal of places, the U.S. Army. Dempsey, in his book Radical Inclusion: What the Post 9/11 World Should Have Taught Us About Leader- ship , articulated a vision of leadership focused on empowering others to unleash their full po- tential for achievement. Touting the need for radical inclusivity from a diverse array of partici- pants to accomplish a purpose-driven mission, Dempsey declared that inclusion is about con- centrating the what — the goal or higher pur- pose to be achieved — while simultaneously distributing the how, which involves co-creating the plan and then loosening control to allow the diverse talents of the team to develop strat- egies to achieve the desired outcome. That vi- sion is the essence of team-based care for man- agement of chronic conditions characterized by impaired social determinants of health and unhealthy behaviors. Likewise, General Stanley McChrystal, in his book Team of Teams: New Rules of Engagement for a Complex World , ad- vocated for decentralized managerial authority, which he called empowered execution. The re- sultant shift in military focus changed from rigid control, autocratic command, and operational efficiency, to adaptability, collaboration, and continuous learning and improvement. If the U.S. Army can overcome entrenched hierarchy and autocracy to achieve a higher purpose, then surely my own profession and the world of healthcare can do the same. The higher pur- pose of delivering health is our mission. And to succeed in that mission, we need to recall the true drivers of health outcomes: physical envi- ronment like the water we drink and the air we breathe (10%), clinical care (20%), health behav- iors (30%), and socioeconomic factors (40%). THE FIVE T’S One of my physician colleagues, a dear friend and mentor, speaks about the three “T’s” as they relate to changing how healthcare should be delivered: talent, technology, and team . I agree completely with him that all three will occupy a prominent place toward improving experience of care and reconfiguring how to improve delivery of optimal health outcomes but will add two more of my own that become a byproduct of the first three: time and trust . Aligning the right skill and knowledge level of every provider and caregiver to each prob- lem to be solved in healthcare will translate into optimizing not only the use of talent but its development as well. Talent is a complex enough topic that it could warrant an entire article of its own, but suffice it to say that once we change the fundamental economic model of healthcare, the need for diverse types of tal- ent increases exponentially. For example, do- main knowledge and its application to specific problem-solving, becomes increasingly impor- tant. While the clinical knowledge and skill pos- sessed by every physician remains extremely important, never again would I ever want to practice medicine without a licensed clinical social worker or behavioral therapist tightly in- tegrated into my care team. While I may under- stand mechanisms of disease and pathophysi- ology that they don’t, their own expertise about motivational interviewing vastly exceeds that of almost all physicians and is an essential tool for influencing human behavior. In addition, these therapists know how to expertly assess self- efficacy, perform cognitive behavioral therapy, “Systems that deliver health — as opposed to traditional health systems — differentiate themselves by measuring their surgical outcomes and incorporating feedback from those outcomes to become recognized centers of excellence, not based on brand or reputation, but rather on how selective they are with regard to operating only on patients likely to benefit, how few post-operative complications develop, and on how well the patients do post-operatively.”