Staff docs sometimes make the best QI leaders

Looking for the right physician to head up your latest quality initiative? Keith Moore suggests that you check out the rank-and-file medical staff instead of going automatically to the big title holders.

"Those organizations that have strong informal leaders in the medical staff are fortunate indeed," says Moore, president of McManis Associates, a Denver-based firm specializing in research and management consulting for health care groups. "We see clear differences in their commitment and follow-through on quality issues," he adds.

Organizations with strong informal physician leaders are generally more dedicated to clinical quality, and often, informal physician leadership proves more effective than formal leadership, Moore observes.

He adds that sound strategic planning must, by definition, combine business and clinical outcomes. The latest research on organizational quality commitments points to an emerging dichotomy, says Moore, whose latest book, Beyond Managed Care (Jossey-Bass), is due out this month. "We used to think of health care systems as lined up along a continuum," he notes. On one end were those in which physicians participated in planning toward clinical quality as well as business objectives. On the other were systems totally dominated by business interests.

"Today, we’re seeing more of a divide into two discrete camps," he states. "Those systems that have some physician leadership around quality issues, whether formal or informal, continue to push on them very dramatically and continue to make some progress. Another group of systems is truly going back to the basics and is de-emphasizing quality further."

While a back-to-basics approach might bail an organization out of budget woes in the short term, it’s folly in the long run, observes Moore. With the advent of assertive customers and information systems that tell us more about what’s going on, he continues, "I have to believe we’re going to see more consumer decisions based on quality than we ever have." (For a practicing physician’s tips on how to cultivate your informal medical leadership, see "How to engage doctors in your QI projects," in QI/TQM, February 2000, p. 19.)

(Keith Moore discussed the impact of corporate health benefits buying patterns and consumer choice on health care quality measures in the QI/TQM Quality Talk, March 2000, p. 34.)

Need More Information?

For more on cultivating effective physician leadership within health care systems, contact:

o Keith Moore, McManis Associates, 2000 S. Colorado Boulevard, Suite 2-900, Denver, CO 80222. Telephone: (303) 300-1515. E-mail: