Clinicians Leading Change in Health Care

Clinicain leading health care change.

By Ted A. James, MD, MHCM
January 25, 2018

“The Only Thing That Is Constant Is Change”
― Heraclitus

The United States health care system has the dubious distinction of ranking last in outcomes and first in cost compared to most other Western countries. Much of this is due to complex systems, poor coordination, persistent disparities, and care models that incentivize volume rather than quality. This is not a sustainable situation; it threatens the integrity of the entire health care system. Health care needs to change and health care professionals are the ones who need to change it, evolving it into a system capable of achieving our goals of better patient outcomes, healthier communities, and improved health care working conditions.

Real transformation is unlikely to come from government, insurance companies, or hospital administrators. I have a great deal of respect for individuals in these roles, and while I believe that we should partner with them to improve care, clinicians and other health care professionals on the ‘front-lines’ of care delivery need to lead the type of meaningful change that our patients and communities need. “The only realistic hope for substantially improving care delivery is […] a revolution from within.1” We can accomplish this through the design, implementation, and evaluation of innovative care models that improve patient outcomes and set the framework for large-scale health care reform.

There are currently islands of innovation serving as examples of successful transformation in institutions like Geisinger, Mayo Clinic, Virginia Mason, Cleveland Clinic, and Kaiser Permanente.2 The Harvard health care community has also demonstrated ‘bright spots’ of clinical innovation. A recent NEJM Catalyst article describes how one organization is capitalizing on the power of clinicians to redefine health care. Brigham and Women’s Hospital developed the ‘Brigham Care Redesign Incubator and Startup Program (BCRISP)’, a frontline approach to systems redesign engaging clinical staff in the process of generating and implementing small, staged pilots of change in health care delivery. BCRISP invests in promising proposals from clinicians, rapidly tests pilots, scales successful projects, and creates programs that deliver clinical and financial value. Since its inception, the program has engaged over 900 clinicians across all clinical departments, resulting in 36 pilots and over $4.5 million in annual medical cost savings.3

Despite these and other examples of progressive care, we are far from seeing widespread overhauls in the health delivery system. To achieve that aim, we all need to embrace our role as leaders of change in health care; committed to improving quality, access, and affordability. Here are three steps you can take now:

  • Challenge the status-quo – be an advocate for finding better ways of doing things for patient care.
  • Take action – even small steps within your scope of influence can serve as meaningful examples and inspiration for larger change efforts
  • Develop new skills – leadership can be taught. Clinicians can learn the skills to align and motivate others around change.

This type of leadership is not limited to a select few with titles or positions. Everyone who has the privilege of caring for patients also has the responsibility to ensure the system provides the type of care that we know our patients deserve.

This is the first post in a 2018 series that will focus on health care leadership and transformation. Dr. James will offer readers his insights on the last Thursday of each month. Use the Follow link on the right for email notifications of new posts.


  1. Bohmer RM. Fixing health care on the front lines. Harv Bus Rev. 2010 Apr;88(4):62-9
  2. Porter ME, Lee TH. The strategy that will fix health care. Harv Bus Rev. 2013;91:24
  3. Laskowski, KR, Abbett, SK, Dudley, JC. A Grassroots Approach to Care Redesign.  NEJM Catalyst, Feb 2017

Head shot of Dr. Ted James.

Dr. Ted James is the Chief of Breast Surgical Oncology and Vice Chair of Academic Affairs at BIDMC/Harvard Medical School. Dr. James obtained a Master in Health Care Management degree and is involved internationally in leadership development and health care transformation. Follow Dr. James: LinkedIn / Twitter



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