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Why it is important to support physician executives

Michele PelletierHead of emergency, member of a Council of Physicians, Dentists, and Pharmacists (CPDP), director of professional services (DPS), management consultant, director of the organization of services and medical affairs at AQESSS (the now defunct Association québécoise d'établissements de santé et de services sociaux): the management career of Dr. Michèle Pelletier is impressive. Today, the treasurer of the Board of Directors of the Québec Medical Association is still passionate about this essential activity within the health care system that is too often disliked by physicians. She is a member of the executive committee for the Physician Executives Group. This group, created in 2015, guides the QMA’s support and networking decisions and actions for physician executives.

QMA: Why is it important for you to be involved with assisting physician executives?

Dr. Pelletier: Physicians become managers because of personal interest or because they are natural leaders, but they are often not trained for this. So, they find themselves directly in a management situation without any experience and without ever having had a role as a “middle manager” as is generally the case in other departments. Physicians therefore have little to no preparation and are poorly supported, if at all. But when they accept a management position, they have an opportunity to make an impact when it comes to access, quality, appropriateness and performance.

QMA: For the Physician Executives Group, if the health care system wants to improve its performance, it has to rely on co-management between the medical establishment and the organization of institutions. Can you tell us more about this?

Dr. Pelletier: If we want institutions to be more efficient, physicians must be managers in a way that synchronizes with the organization of the institutions. Otherwise, tension will build in the field. When physicians perform management duties, it is often to manage their department, but they rarely do this with a global vision of what that means for the institution. Consequently, they can launch projects that they think improve quality or appropriateness, but the institution does not always follow along. As for the institutions, they can take measures to improve access, but if the physician executives are not involved, it will not lead to anything. To reach the greatest possible efficiency, the organization of the institution and that of the medical world need to synchronize their efforts. The future depends on it.

QMA: After the health care system reform, where do co-management and medical leadership stand?  

Dr. Pelletier: During the structural reform of 2015, the new organization plans for the institutions, which were largely imposed by the MSSS, set up structures by traditional sectors of activity, whereas in the institutions at the time, AQESSS was testing co-management models involving clientele programs. So for instance, there were co-managers for elder care which allowed them to cover the entire continuum of care, whether it was in the emergency department, hospital, rehabilitation, accommodations, etc. And this co-management model can also be applied to smaller management units. During the last three years, there have been so many changes that managers really had no other choice but to adapt to the reform, the new institutions and their size, the new environment and new structures. Today, with the Executive Committee of the Physician Executives Group, there is a consensus that we have to go back to what we wanted to introduce before, and so we have to train teams to be co-managers. So we are working on training modules that, beyond the basics of management and health legislation, will be common to physician executives and institution managers. 

QMA: More generally, what type of management should we set up for the future of the system?

Dr. Pelletier: A much more decentralized management is needed, but with clear, realistic, measurable performance objectives – in short, the basics of good management. We should therefore develop transparent outcome indicators, that are known to all and adopted by all, and publicly follow their degree of achievement. It is also necessary to train physician executives and institution managers to understand each other, because most of the time they don’t speak the same language. With the proper training, physicians become more competent and strategic, which enables them to get more involved in the institution’s organization. And this is important, because if the physicians don’t have the impression that they are able to change things, they will not get involved.

QMA: Who must develop the outcome indicators?

Dr. Pelletier: The Ministère de la Santé et des Services sociaux must certainly play its role in this area. The indicators developed so far are based more on volumes related to electoral expectations than on the real benefits for the health of the population. In partnership with the Health and Welfare Commissioner and organizations such as INESSS and the QMA, the ministry should acquire the means to develop performance indicators founded on evidence-based criteria. Once they are made public, they would enable institutions to compare themselves with their peers and that would create some competition or at least some emulation that would encourage the institutions to aim for excellence and help each other to achieve it.

QMA: Why is it important for the QMA to continue to invest in the training of physician executives?

Dr. Pelletier: Considering the QMA’s mission and actions regarding medical leadership training, medical professionalism, clinical governance and overdiagnosis, it seems natural for the QMA to develop services designed for physician executives. Furthermore, the QMA is the only group and only organization with the necessary impartiality and neutrality to consider training for the purpose of co-management. Of course, physicians need to be properly equipped in terms of tactical and political sense, but institution managers must also learn how to share the power. Both groups must understand each other’s constraints and see what they can do together, hence the importance of supporting and training them together, at all levels, whether it is for a position as a senior manager or as a director of an FMG.

QMA: What is a good manager in 2018?

Dr. Pelletier: For me, the most important thing is that managers understand that they cannot do much alone. First off, they must always listen to their clientele and the needs of the population. Then, of course, their role is to have a global vision, provide guidance and communicate clearly to be understood. It is important to carefully choose collaborators and employees, trust them and give them ongoing feedback. They are the ones who can give meaning to the actions being taken and it is important that the people they are working with know where they are going. Finally, they can’t forget to celebrate success.