In this special Speaker Series, Becker's Healthcare caught up with Giovanni Piedimonte, MD, Chief of Global Pediatric Research Operations at Cleveland Clinic Foundation.
Dr. Piedimonte will speak on a panel at Becker's Hospital Review 7th Annual CEO + CFO Roundtable titled "Telehealth and Leadership" at 1:30 p.m. on Tuesday, Nov. 13. Learn more about the event and register to attend in Chicago.
Question: What keeps you excited and motivated to come to work each day?
Dr. Giovanni Piedimonte: Developing new therapies, taking care of sick children and teaching new generations of doctors how to do the same is my calling. These have been the highlights of my professional life and help me keep my sanity because I have incredible fun doing something that gives me pleasure every day.
However, there isn't a day that I don't interact with colleagues that are emotionally exhausted, often showing obvious signs of depression or uncontrolled anxiety. Burnout in healthcare is a huge and pervasive problem that is already affecting more than half of our workforce and keeps spreading like metastatic cancer. In the same way we treat cancer, we as a society need to address burnout systemically and prioritize this as the most serious threat to our aspiration of providing high-quality and safe medical care to every patient coming through the doors of our hospitals and clinics.
I am convinced the hidden root of the ongoing epidemic of caregiver burnout in our country is the frustration of working without joy and without having the satisfaction of making a difference in the life of your patients. All of this, while drowning in bureaucracy, inefficiency and politics. The older I get, the more I understand that only when you do something that makes your heart beat a little faster, you will do it better than anyone else, you will make a difference and it will not feel like you are working.
Q: What is one of the most interesting healthcare industry changes you've observed in recent years?
GP: I would choose precision medicine, intended as the emerging approach to disease treatment and prevention that takes into account differences in individuals' lifestyle, environment and biological makeup to create targeted prevention and treatment interventions. We have been building our knowledge for decades on double-blind, placebo-controlled clinical trials. These arrive at an average for what will work for the general population. But there is no such thing as an "average individual" because each one of us is unique. Precision medicine says, "I will find the therapy that is right for you as an individual."
Indeed, the idea that genetic factors underlie individual variability in humans is not new and has actually been around for more than a century. What we now call precision medicine has evolved from the discovery of the double-helical structure of DNA in 1953 and the 13-year NIH's Human Genome Project completed in 2001. However, the term "precision medicine" was coined only in 2011, and only three years ago President Barack Obama launched the Precision Medicine Initiative. Finally, the NIH "All of Us" Research Program officially opened for enrollment just weeks ago on May 6, aiming to enroll 1 million Americans in order to advance the promise of precision medicine and transform healthcare.
Thus, I feel the "tipping point" has just been reached and this approach is now growing exponentially, leaping beyond genome sequencing into a wide array of solutions, services and technologies — including advanced therapies, mobile health, eHealth, patient engagement, big data and analytics. The ultimate goal is achieving personalized diagnosis, treatment, and — eventually — the earlier detection and prevention of human diseases based on an individual's risk. There is no doubt that many complex challenges must be tackled before precision medicine becomes mainstream, but its potential to affect human health and healthcare economics is so extraordinary to warrant top priority and substantial investments by both federal and corporate entities.
Q: What do you see as the most vulnerable part of a hospital's business?
GP: I think we all agree that, as the field of healthcare faces unprecedented transition and disruption, there is an increased need for strong physician leaders. Yet, different from other industries like computing and biotechnology, I see in healthcare a dearth of truly transformational leaders able to communicate a clear shared vision, motivate followers to passionately pursue the organizational mandate, and ultimately improve care for our patients. I am convinced that historically disruptive leaders like Steve Jobs would have a low chance of becoming the CEO of a healthcare system or would fail miserably in such position because they would be seen as a vital threat to the status quo. This is also one of the reasons leading non-medical corporations like Amazon, Apple, Google and the like to rapidly develop new healthcare products and technologies that better reflect their culture and the digital age we live in.
Whereas transformational leadership focuses on motivating the team to pursue a distant, shared vision while navigating uncertain waters, the dominant mode in today's healthcare industry is transactional leadership that focuses on motivating the team to maintain the status quo and avoid loss of productivity even at the cost of limited or no progress. This is one of the causes of the rapid turnover of healthcare executives we have been witnessing recently. I feel strongly that new generations of executives should engage in self-reflection of their own personality traits. By understanding their natural tendencies and preferences, physician leaders would be served to have a better grasp of how to capitalize on their strengths to address potential challenges in their efforts to become a transformational leader.
Q: How can hospital executives and physicians ensure they're aligned around the same strategic goals?
GP: In order to create a culture of open and goal-congruent communication, it is important that the tenants of psychological safety be present. In other words, the hospital/health system leadership and caregiver community should be able to communicate openly without retribution. This impacts a number of key performance metrics that are closely monitored by the C-suite, including quality, safety, readmission rates and patient satisfaction scores. Although the system should be focused on being "patient centric," which makes logical sense, equal focus should be placed on the employees/team members of the organization.
If there is freedom to communicate errors, problems, frustrations we are able to engage in prevention rather than reactive behavior, which is disruptive and more costly. For example, if a physician working in the clinic observes a safety issue and feels that it is encouraged to bring this issue to his/her leadership the issue can be addressed. Conversely, using the same scenario, if the same individual does not report the issue because of fear, this could lead to an adverse event for a patient exposing the patient and the clinic/hospital to unnecessary risk, adverse outcomes and escalated costs. Similar scenarios can occur every day in any C-suite when complex management issues are discussed and many of the players prefer to bite their tongues to avoid later repercussions on their careers.
Unfortunately, innate hurdles to psychological safety and unconscious bias are hardwired in the neurobiology of human behavior, whose primary task is self-protection. Therefore, it is essential to systematically develop specific logical skills in the next generations of healthcare executives as a priority to build working environments that are psychologically safe to benefit the wellbeing and productivity of both patients and caregivers.