Dr. Davidoff on leadership in turbulent times

Health care is undergoing rapid transformation, marked by challenges that test the resilience and adaptability of health care organizations. Health care leaders are being called upon to guide their teams through physician shortages, financial constraints, a surge in more complex conditions, rising workplace violence, and persistent vaccine hesitancy.

During turbulent times, effective leadership is critical for maintaining the integrity and sustainability of health care systems, said Ramin Davidoff, MD, co-CEO of The Permanente Federation, during a wide-ranging on-stage interview at Reuters Events’ recent Total Health USA Conference.

“The way we deal with today’s tumultuous environment as leaders is by being visible, available, accessible, approachable, and by listening,” Dr. Davidoff said. “We especially need to listen to what physician’s challenges are, getting their input, and making sure that we incorporate their input into the delivery system as much as possible.”

Related physician leadership story: Dr. Ansari on health care’s future amid demographic shifts

Encouraging physicians to innovate

“Physicians in general are great innovators,” Dr. Davidoff said. “We do a lot of what’s called ‘small tests of change’ in Kaiser Permanente, enabling physicians to create products that they have ownership of that are focused on patient outcomes and that really helps them get through difficult and tumultuous times.”

Encouraging physicians to take initiative is especially important as their autonomy and control are increasingly limited by regulations and practice management, Dr. Davidoff said. Fortunately, he added, the Permanente Medical Groups have always been physician-led.

“We believe as physician-led entities we can focus on best outcomes for patients in the communities we serve,” he said. “We are technology-enabled, equity-driven, and team-delivered. These are guiding principles that are fantastic for any physician practicing anywhere. But in our system, they really ground us in our mission, our value system, and help us manage the difficult changes underway — with all the directives, the financial burdens people are experiencing, and the burnout and exhaustion that exists throughout health care, especially among physicians.”

Navigating funding reductions: Strategic resource allocation and investment

At a time when financial pressures require health systems to accomplish more with fewer resources, “the message to physicians is, ‘Yes, the practice of medicine is difficult, it’s not getting easier, and we’re going to support you,” Dr. Davidoff said.

Perhaps surprisingly, he said the antidote to resource constraints is strategic investment. That could mean investing in physician practice support, hiring pharmacists to help primary care physicians manage medications for patients with chronic disease, or implementing a team-based approach with nurses, physician assistants, and pharmacists all practicing at the top of their scope.

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 “What we’ve found is that such initial investments actually reduce expenses by reducing ER visits and hospitalizations,” he said. “And when hospitalizations do happen, patients go home earlier and they are managed better on an outpatient basis.”

Another example he mentioned was the rollout in the past two years of ambient listening technology to more than 25,000 Permanente physicians across the United States, a move that has reduced the time spent on documentation, freeing physicians and clinicians to focus on patient care.

Confronting workplace violence: Safety measures and advocacy

Permanente leaders have also invested in improving safety as workplace violence remains a significant threat to the well-being of clinicians and staff.

“There is quite a lot of mistrust, a lot of frustration by the public with health care systems in general and with physicians in particular,” Dr. Davidoff said. “And the violence is not always physical. Sometimes it’s an email or a voicemail that is sent to a physician or clinician. There is quite a bit of abuse directed at all our practitionersand this is an area I believe the health care industry needs to focus on.”

Related physician leadership story: Dr. Davidoff on protecting health care workers from violence

Leaders can play a pivotal role in establishing clear policies, providing training on de-escalation techniques, and advocating for safe working environments. By prioritizing safety and supporting affected individuals, organizations demonstrate their commitment to both employee welfare and patient care.

“In an environment where people work in fear, safety and care quality diminishes,” Dr. Davidoff said. “So, we’reinvesting in systems such as screening some of the email that come through our electronic health record to make sure we properly identify and look into potentially violent patients. There also has to be advocacy at the government level because legislation can help protect our clinicians and all our practitioners. We believe this is tremendously important.”

Overcoming vaccine hesitancy: Evidence-based communication and trust-building

Another key area where Permanente leaders are working to overcome member and patient mistrust is with vaccine hesitancy, which poses a challenge to public health efforts.

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Permanente leaders have responded by encouraging physicians to promote evidence-based practices and foster open dialogue with patients. Effective communication strategies — grounded in empathy, transparency, and scientific rigor — can help address concerns and dispel misinformation, Dr. Davidoff said.

“What’s particularly concerning is that parents are not bringing kids in for vaccinations the way they used to, and the way they should,” he said. “We provide our research, with our clinical expertise and also consider patient values, which come into play with some preventive measures. We still believe vaccination remains one of the safest and most effective ways to protect patients against severe illnesses across all age groups.”