Issue link: https://beckershealthcare.uberflip.com/i/568709
78 THOUGHT LEADERSHIP The Responsibility Matrix: A Strategy for Stronger Physician-Administrator Partnerships By James Merlino, MD, President & Chief Medical Officer of the Strategic Consulting Division at Press Ganey I want to help peo- ple." In medical school inter- views and later at matriculation, that was how I, like many aspiring physicians, articulated my reason for wanting to be a doctor. e desire to help people through healing was the "why" of my career choice. But even in speaking those words, I had only a vague sense of what they really meant. I struggled to bring real meaning to what was a nebulous definition. e true meaning would come later, through the countless snapshots of patient in- teractions that define every physi- cian's career. One especially vivid picture in my own "photo album" occurred early in my career when I was the trauma surgeon on-call and a young man was brought into the ED with a gunshot wound to the chest. e patient, who was initially awake, alert and sitting up on the gurney, suddenly lost consciousness before our eyes. We sprang into action. An emergency trauma ultrasound showed blood accumulating around his heart, indicating the bullet had penetrat- ed the chest, struck the heart and triggered a life-threatening peri- cardial effusion. We rushed him to the operating room, opened his chest and stopped the bleeding. Six days later, he walked out of the hospital. On my way back to the call room, my adrenaline was pumping and it felt awesome! I was in awe of the fact I had just helped to save a life. at experience of being part of an incredibly gied team of professionals who came together like a well-practiced symphony validated my career choice. e experience — one among many — provided me with clarity on the "why" I went into medicine. Col- lectively, such stories sustain our passion for the work that we do and help us keep our sights set on our overarching goal to improve the care that we deliver to pa- tients, something my colleague Dr. omas Lee refers to as our shared "higher purpose." In the words of Charles Sorenson, MD, president and CEO of Salt Lake City-based Intermountain Healthcare: "ere is no greater 'why' in what we do." Remaining mindful of that higher purpose — that greater 'why' — can be challenging as we grapple with the complexities of our ever-changing healthcare system. is is as true for hospital administrators as it is for physi- cians. On the physician side, the increasing complexity of medical decision-making and the growing difficulty surrounding the business of medicine parallel record-high levels of physician burnout. Phy- sician personalities and cultural expectations also play a role. In an article published earlier this year, Steven Adelman, MD, director of Massachusetts Physician Health Services, described physicians as "rugged individualists" with a "problem-solver orientation" who generally feel they can figure things out for themselves. is mindset, he said, requires them to tackle their own problems, as well as others, while maintaining their environment and controlling their destiny. Such clinical autonomy is a cultural barrier to change, be- cause it is at odds with the tenets of value-based healthcare, which requires collaboration, teamwork, transparency and accountability. Physicians who are reluctant or uncomfortable with change feel burdened by the new rules, as the "why" of their career choice be- comes buried in more paperwork and bureaucracy. At the same time, hospital administrators are also struggling as they try to wade through an increasingly complex environ- ment for physicians and for the hospitals they serve. e goals and objectives of the two groups may not always mesh, which can strain working relationships and cause distrust, poor collegiality and, in some cases, outright anger. Bridging this "us" vs. "them" divide is one of the critical strat- egies for meeting the complex "