Leadership in an era of rapid change

In an exclusive interview with ArabMedicare, held on the sidelines of Arab Health 2024 (Total Radiology Conference) in Dubai, UAE from 29 January - 1 February 2024, Dr. Giles Boland talks about his experience and expertise on the key drivers in leadership and how leaders need to respond to change and the future of medicine.

Dr. Boland serves in a number of roles at Mass General Brigham in the United States. He is the President of Brigham and Women’s Hospital, the Brigham and Women's Physicians Organization, a faculty practice plan of more than 2000 physicians, and Executive Vice President at Mass General Brigham.

As Executive Vice President at Mass General Brigham, he plays an active leadership role setting and guiding strategy, priorities, and performance within the Mass General Brigham system. He also serves as the executive leader of Global Patient Services, the new systemwide initiative designed to support international patients and their families as they navigate care and logistics at Mass General Brigham.

Dr. Boland, is a radiologist by training and is the Philip H. Cook Distinguished Professor of Radiology at Harvard Medical School. He has been a member of the Mass General Brigham community for more than 30 years.

Boland: It is important for all leaders, independent of their specialties, to understand the key drivers in healthcare.

Leaders must understand the drivers and directions of healthcare, develop a vision for their organization and then deliver results to advance that vision. In the realm of healthcare, everything should begin and revolve around the patient. It is imperative that the development of all initiatives, algorithms and workflows stem from this focal point. While it may pose challenges and be disruptive, which might include physician autonomy, anchoring all efforts around the patient is imperative.

A patient-centered approach can be multi-faceted. Firstly, it entails developing cohesive systems and fostering collaboration within a healthcare organization. By aligning efforts across multiple hospitals and sites of care, there is an opportunity to drive performance with enhanced efficiency and productivity, all while elevating the standards of quality and safety.

Secondly, the ultimate aim is to improve the value of the care we deliver, which means not only continuously improving quality, but also delivering care at a lower cost. Given the expenses associated with healthcare and the disparities in reimbursement rates, achieving outstanding outcomes at a lower cost necessitates a unified approach within a system. Without this cohesion, there can be variation in the quality of care, the implementation of best practices and duplication of efforts, which contribute to higher costs.

Lastly, there's a need to truly seize opportunities presented by a system-based approach, ultimately ensuring that patients receive the best possible care. This involves delivering care in a coordinated, streamlined manner, and providing a singular delivery product or experience as opposed to fragmented services. 

Boland: Healthcare is becoming more like a system. In the United States, healthcare is perceived as becoming more corporatized with less control by traditional providers. This puts stress on healthcare workers and their autonomy.

It has also become hard for healthcare leaders and administrators to support their workforce while the pace of transformation and change within the industry has accelerated. If you were to ask doctors and nurses what some of their biggest challenges are, they would include a loss of agency and loss of voice in helping to steer their organizations forward to success. As an industry, we have not historically had to innovate or change as rapidly as we have had to move in the post-pandemic era in order to ensure our organization can continue to deliver on our mission well into the future.

Leaders are also under a lot of stress to keep their organization financially healthy. There is sometimes a disconnect between leadership, providers, and the caregivers. Healthcare has changed over the decades, and we now have significantly more data to focus our improvement efforts around systems to drive efficiency, productivity and streamlining our work, as well as insisting on common protocols to ensure we are consistently delivering safe, high-quality care. 

Leaders must understand our future, what makes us great, what our key products and values are, and understand our workforce by delivering a vision that is inclusive.

At the end of day, it all starts with the patient. What is the outcome? What is the best clinical pathway? What is the best system? What is the best delivery model for the patient and work backwards from there. We must create a workflow and organization that is continuously benefiting the patient. Everything we do and think about is towards benefiting the patient while being mindful of our clinical teams.

ArabMedicare: Why is medicine at a crossroad?

Boland: Change is always happening. Medicine is moving from a fragmented system to a consolidated one. Individual hospitals are transitioning to a consolidated systems approach whereby in the past organizations operated in silos or selected areas. Individual hospitals and organizations that operate in a fragmented system often lead to clinical variations. By moving to a consolidated systems approach this can improve efficiency and quality and reduce clinical variations thereby leading to better outcomes and care for the patient.

ArabMedicare: How do leaders manage physician burnout?

Boland: Physicians are working harder than ever and partly because information technology (IT) tools such as electronic medical records (EMRs) and direct message (DM) that now facilitate the ability for patients to communicate directly with their doctors at any time, day or night.

Many physicians worldwide are now struggling with the technology and direction of healthcare because they are busier, and they have less autonomy, which contributes to physician burnout. We often see that they also have less time for academic work.

It’s reported that burnout affects about 50% of physicians in the United States. However, the current changes in healthcare are irreversible and physicians need to adapt. We must work in a different way and we are being asked to work in a different way. Hospital leaders must work in partnership with their clinical leaders to forge meaningful solutions for patients, providers and the overall health of the organization. Top-down management will only lead to physician alienation, so it is critically important that we continue to make the case for change, provide context and understanding to our clinical teams and practice inclusive leaders. How we achieve the change we desire is best accomplished when we involve all key stakeholders, including our physicians, advance practice providers and all members of the care team, in the future.

ArabMedicare: How has Mass General Brigham managed change?

Boland: Until just a few years ago, Mass General Brigham was a fragmented organization. Every hospital built its own management, algorithms and delivery systems, and we competed against each other. Over the past few years, Mass General Brigham has more intentionally come together like never before. We have begun to integrate and align best practices, harmonize clinical activities and reduce costs. We are now focused on integrating our academic departments and clinical programs.

Patients are beginning to be able to navigate anywhere within our system and experience the same standards of care, and we are committed to continuing this work. We are unifying the organization to become an integrated academic healthcare system with patients at its center.

ArabMedicare: Any concluding thoughts?

Boland: Leadership is key to all business and no less in medicine. Leaders must make and shape the future versus responding to it.

Leadership is about the people, be inclusive, and listen.... but make decisions and follow through.

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