Medical director calls for physicians to have more influence

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Dr. Marcel Dvorak is a surgeon, a professor, and a medical administrator who has worked at VCH for over 30 years. He’s been able to look at our health care system from several perspectives and concludes that the physician voice needs to be stronger at decision-making tables.

“We need to do a better job of measuring variables that truly impact health, care, and patient wellbeing,” said the VCH Associate Senior Medical Director, Vancouver Acute, at a recent VPSA Breakfast with Leaders session held at UBC. “We need to focus on health and the quality of our care.”

Dr. Dvorak recalled his work with spinal cord injury patients and how research studies measured outcomes that looked at health: were patients able to move? Were physicians able to restore movement? Were patients cured? Quality health care, he concluded, relies on the provision of interventions to patients that improve their outcomes.

“When medical cures are not possible, such as with dementia patients, care becomes the most important thing we can do because patients do better if they feel cared for,” he added. “Care can be measured by such things as patient satisfaction surveys, but we aren’t doing these.”

Dr. Dvorak sees a disconnect between what we should be measuring and what we are measuring in order to provide quality health care.

“The solution is for physicians to have a greater voice at the administration level,” he said. “Physicians are the only ones who can coherently express a vision for the future that focuses on health, on care, and on the system.”

Dr. Dvorak believes the VPSA as well as our Medical Staff Association have an important role to play in this transformation.

“Physicians have influence and power, but we don’t use it,” he said. “We’re all in silos. There’s a tsunami of need coming at us and we need a different strategy. We need to mobilize patients and be their voice. Groups like VPSA can have influence by bringing us together.”

Dr. Dvorak noted that the most high-functioning health care centres (e.g., Kaiser, Cleveland, Mayo, Intermountain) have two things in common: they have strong physician leadership; and they are organized around patients’ disease categories (rather than around the traditional university-based divisions and departments).

Dyads—that pair physicians with administrators—are tools that can be effective in bringing the physician voice to the table. VPSA is working on creating more of these; they are an important next step in the engagement framework.

Dr. Dvorak’s message resonated with VPSA members attending his session. Survey respondents strongly agreed that he listened and understood their concerns, and all said they were more comfortable now reaching out to him.

“Physicians need to be more involved with hospital administration as they are in a unique position,” wrote one.

“I’m glad we have these opportunities to connect,” said another. “I am very much for having more physician involvement.”

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