Linking autonomy with accountability reaps rewards

ATLANTA—Accountability and autonomy can go hand in hand. Citing a lesson learned from his military service, Christopher White, MD, showed that cardiologists at Ochsner earned autonomy through a program that made them accountable for resource use.

Speaking June 10 at the MedAxiom Cardiovascular Service Line Symposium in Atlanta, White described strategies for engaging cardiologists and aligning them to meet mutual goals. White, an interventional cardiologist, chief of medical services and medical director at the John Ochsner Heart & Vascular Institute in New Orleans, emphasized the importance of using data to convince physicians to change and measuring results to track the outcomes.

The challenge for systems such as Ochsner is aligning its disparate physician groups to meet goals. While all of Ochsner’s physicians at the medical center are employed, only about 20 percent in community hospitals are; about 60 percent there are aligned or independent. That’s where his training in the Army proves useful.

“If you are going to be a good leader in the Army you have to be a good follower,” he said. That credo creates cooperation and collaboration, he added. Those who achieve their goals earn autonomy.

Ochsner uses employed and community cardiologists in its seven catheterization labs. As part of a supply chain management initiative, they polled cardiologists about their drug-eluting stent preferences, which proved “all over the map.” Leadership proposed that if the cardiologists used one vendor for half of their cases—a cost-saving move that wouldn’t impact quality—they could have their preferred stents for the other half.

When cath labs fell below the 50 percent threshold, he would raise the issue with the manager. Systemwide, they achieved a 53 percent utilization rate and met their target with $300,000 in savings.

“The doctors are not unhappy about this,” he said. “They thought they had the power and accountability that earned them autonomy.”

They since have extended the strategy to defibrillators and pacemakers.  

“We need to manage our message,” White advised. “Negative accountability isn’t a good way to manage. What we really want is positive accountability to help people achieve their goals.”