Physician team management affects goal achievement in the intensive care unit.
OBJECTIVE
There are few investigations evaluating the impact of physician management and leadership skills on patient care. Our objective was to determine whether there were perceived differences in management and leadership performance within a group of intensivists and to correlate these differences with processes of care outcomes.


METHODS
Prospective cohort from January 31 to June 30, 2005.


METHODS
Pediatric intensive care unit in an urban, academic children's hospital.


METHODS
Pediatric intensive care unit staff intensivists were the primary participants.


METHODS
None.


RESULTS
The intensivists' management and leadership performances were assessed by residents and fellows using the Physician Management Index. The primary outcome attributable to the staff was the accomplishment of daily patient goals. A total of 827 resident and fellow assessments of the management and leadership performance of attendings (n = 8) were collected over 2077 patient days (103.4 +/- 39.0 surveys/attending). The mean Physician Management Index was 78.1 +/- 6.2 and differed significantly among the attendings (p < .001). There was excellent agreement by the raters concerning attending performance (intraclass correlation = 0.801). The attendings' Physician Management Indexes were correlated with age (r = 0.594, p < .001) and experience (r = 0.656, p < .001) but not other personal or environmental factors. An average of 3.3 +/- 0.6 goals per patient were written each day, and 86.0% +/- 7.0% were accomplished. Accomplishment of patient goals was correlated with the Physician Management Index (r = 0.306, p < .001) and length of rounds (r = -0.341, p < .001). Other variables, including midnight census, numbers of admissions and discharges, codes, and consultations, did not correlate with the Physician Management Index.


CONCLUSIONS
Management and leadership performance of attending intensivists can be measured and is associated with efficiency of care as assessed by accomplishment of daily patient goals. Attendings differ in their management and leadership performances.
Stockwell
David C
DC
Children's National Medical Center, George Washington University School of Medicine, Washington, DC, USA. dstockwe@cnmc.org
Slonim
Anthony D
AD
Pollack
Murray M
MM
D000046:Academic Medical Centers; D000328:Adult; D002983:Clinical Competence; D004219:District of Columbia; D005260:Female; D006040:Goals; D006776:Hospitals, Pediatric; D006801:Humans; D015278:Intensive Care Units, Pediatric / Q000458:organization & administration*; D007857:Leadership; D008297:Male; D008485:Medical Audit; D008505:Medical Staff, Hospital / Q000592:standards*; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010348:Patient Care Team / Q000458:organization & administration*; D010819:Physician's Role; D011446:Prospective Studies