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The Collaborative Organization: Leadership Lessons from Mayo Clinic
By Leonard L. Berry, PhD
Organizational Dynamics 33(3): 228-242, 2004
Recently, I was given a group of articles as “pre-reads” for a conference focused on leadership. Dr. Berry's article about collaborative culture impressed me. Medicine is changing rapidly. Many new tools and medicines are transforming our world. Even more dramatic is the changing milieu in which we practice. A new cultural paradigm within our institutions is gaining foothold. This culture is one that speaks to teams and systems and collaboration. Leonard Berry (a marketing professor at Texas A&M) studied the service culture and systems at the Mayo Clinic's Rochester, MN, and Scottsdale, AZ, campuses. He gives a very compelling assessment of a culture that has many lessons to teach. I highly recommend it.
Niccolò Machiavelli, The Prince Carl Sandburg, Abraham Lincoln: The Prairie Years and The War Years
I have made a practice of giving each of my medical chief residents of copy of these two books. I used them to make the point that leadership is about making choices. Machiavelli presented his book of advice to Lorenzo de'Medici on his ascension to the reigns of power in the Florentine republic, when he had no other gift. Sandburg describes Lincoln as a historical figure, but more importantly, describes how he operated in a tense and difficult political environment, and how he maneuvered the strong and combative personalities around him during the Civil War, and how he made choices and mobilized his forces into a successful organization. Most people read these books as histories; leaders or potential leaders should read these books instead of treatises on management.
The Unintended Consequences of Publicly Reporting Quality Information
By Rachel M. Werner and David A. Asch.
Journal of the American Medical Association, 293 (10), 1239–44, 2005
Werner and Asch concisely summarize many concerns about the public reporting of process and outcome quality data. They note as intuitive that public reporting facilitates openness and accountability. However, they dispute the assumption that public reporting will automatically improve the quality of health care. Their argument is based on three key points: preliminary analysis of regions where public reporting of quality is widespread does not support the routine use of these data to make health care choices by either patients or insurers; measures of quality are often flawed; and patterns of practice may be adversely affected. The latter concern is potentially most disconcerting. It is easy to foresee that physicians will decline the care of patients deemed to be at high risk for a bad outcome or feel forced to order unnecessary testing such as cancer screening for patients unlikely to benefit from early diagnosis. Werner and Asch further note that unless public reporting is mandatory, poorer performing practitioners and institutions will choose not to report. This could lead to a false assumption that health care quality is improving, since only the best programs will submit data for public scrutiny.
Piecework: Medicine's Money Problem
By Atul Gawande
The New Yorker, April 4, 2005
Dr. Gawande weaves together a number of seemingly disparate themes and ideas into a concise, coherent summary of some of the issues and challenges facing physicians and health care today. The article correctly points out the immense difficulty in correctly reimbursing for cognitive services. While not directly mentioning cancer care, the problems oncology encounters are a result of the controversy over the original Hsiao study. Dr. Gawande's article shows that although change is constant, everything really stays the same. This article is definitely worth reading.