Having explored some of the styles and competencies that enable a physician to be successful in leading a healthcare organization, we are now ready to look at the processes to be engaged by a physician leader in helping to diffuse innovative medical practices. I will turn one last time to the wisdom offered by Mindi McKenna and Perry Pugno (2006), who place great emphasis on the role played by a physician leader in supportive and enabling innovative ideas to be engaged, reviewed, and revised in their organization. We see this emphasis displayed as part of an extensive quote they offer from Daniel Sands, MD, MPH, who at the time was a faculty member at Harvard Medical School, and Chief Medical Office and Vice President of Clinical Strategies at the Aix Corporation. Dr. Sands offers this important insight regarding the role played by the physician leader in the diffusion of innovation (McKenna and Pugno, 2006, p. 106):
“People who aspire to lead should choose the level and field they want to impact. Many people who make medical discoveries are not leaders, or agents of change. It takes a certain type of person to create new innovations, but these skills are different from the skills required to bring about the dissemination and adoption of innovation. For example, I didn’t invent email, nor was I the first to use it in clinical care. I did spread the idea—at policy levels, and through speaking and writing.”
In this final essay in my series on physicians as leaders, I further explore the specific skills and styles needed by leaders to bring about the dissemination and adoption of innovative perspectives and practices.
McKenna and Pugno (2006, p. 106) contribute themselves to this exploration of the dissemination process when presenting an informal description of the stages of dissemination first presented by William Frist, MD (cardiothoracic surgeon and US Senator) and Norman Shumway, a noted medical innovator:
“In the first stage, doubters all around you say ‘It won’t work; it’s never been tried before.’ After several successful experiences with animals, you enter the second stage, and the same doubters say, ‘But it won’t work in man.’ One successful clinical patient later, they tum around, shake their heads, and mumble, ‘Very lucky. But the patient really did not need the operation in the first place. Too bad the tragedy occurred; they’ll probably try it again.’ … After four or five clinical experiences, critics call it ‘highly experimental. Too risky. Probably immoral. Certainly unethical.’ And someone in the back adds in a whisper, ‘I understand that they probably had a number of deaths that they have not reported.’ The fifth stage is characterized by critics saying, after 10 or 15 successful patients, ‘May proceed cautiously in carefully selected cases, but most patients with this defect don’t need the operation anyway.’ In the sixth stage, after a large series of success, some critics, say, ‘I hear that a number of their patients are now dying late deaths,’ while other critics are saying, ‘So-and-so elsewhere cannot get the same results.’ Finally, in the seventh stage, the critics now say, ‘I know this is a very fine contribution. A straightforward solution to a difficult problem. I predicted this. In fact, I had the same idea long before they even started. Of course, we didn’t publish.”
