The Leaders We Need, And What Makes Us Follow by Michael MacCoby

Author:Michael MacCoby [MacCoby, Michael]
Language: eng
Format: epub
ISBN: 9781422163603
Publisher: Harvard Business Review Press
Published: 2007-10-03T16:00:00+00:00

IHC, headquartered in Salt Lake City, has been repeatedly rated number one in the nation by independent rating agencies.24 IHC was formed in 1974–1975, when the Mormon Church decided to divest itself of its 14 hospitals. After buying 10 more hospitals and a number of physician practices, IHC comprised 24 hospitals, 26 health centers or neighborhood clinics, and 150 service sites throughout Utah, southern Idaho, and eastern Nevada. When we visited IHC, the system included 400 employed physicians and 1,500 who were directly affiliated. The majority of Utah physicians were impaneled by the IHC health plan. IHC had a 45–50 percent market share of its catchment area, of which 25 percent was paid directly to its system; the rest was contracted out to payers. IHC operated 50 percent of the hospital beds in Utah. The health plan covered 475,000 lives, with only a 6 percent rate of disenrollment after the first year.

IHC’s purpose is to improve the health of the population it serves. It spends millions in direct charity care of over a hundred thousand patients. Intermountain Community Care Foundation supports clinics for homeless and low-income populations with a clinic serving over three thousand children in seven schools. IHC’s policy is to keep premiums low to make quality care as affordable as possible.

IHC leadership can be viewed as a model for any organization of professionals trying to transform itself from a bureaucracy to a learning organization. IHC is moving from a traditional hospital-based bureaucratic system, with physicians essentially operating in a craft mode of production, to a knowledge mode that makes good use of information technology and quality tools to develop evidence-based health care. It’s moving from specialty silos to clinical programs, from treating specific illnesses to solutions that sustain health. To do this, it’s had an exceptional leadership partnership and a leadership system. At the top of the organization, Bill Nelson, the visionary CEO, has a background in finance, and Dr. Charles Sorenson, the emotionally intelligent and interactive chief medical officer, heads operations with the physicians.

At the program level, operational leaders—physicians working with nurses and administrators—work to persuade their colleagues to practice according to protocols (processes or pathways) that reduce variation, lower costs, and improve outcomes. These “doctor” (in the sense defined in chapter 6) leaders are helped in developing protocols and mapping processes by Drs. Brent James and David Burton, who provide the tools of quality management and informatics.

Our team interviewed seventeen leaders of the IHC system, culminating in a two-hour feedback session and discussion of the findings with Nelson and Sorenson. The people we interviewed all believe that IHC is moving in the right direction, up a learning curve. They appreciate Nelson’s leadership and his focus on quality and Sorenson’s interactive style of listening and responding to physician concerns.

A good example of an effective leadership partnership on the operational level of a clinical program comes from Dr. Don Lappé and Susan Goldberg, RN, who run the cardiovascular clinical program. Lappé has a weekly clinical conference at which data is presented on reasons to use a process or therapy.

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