Some of the most useful information I get as a medical director does not come from a dashboard or a meeting. It comes from working a clinical shift.
When you are seeing patients alongside the people affected by the processes you help oversee, problems become difficult to ignore. You see where the workflow slows down, where responsibilities are unclear, and where a seemingly simple administrative change creates extra work. That is one reason I believe physician leaders should remain connected to clinical care whenever their roles allow it.
I have spent much of my career working in acute care environments, including emergency medicine and orthopedic urgent care. These are settings where operational problems become visible quickly. When the department is busy, every unnecessary step matters.
A workflow may look perfectly reasonable during a meeting. Then you watch a nurse move between several systems to complete one task. You see staff searching for information that should have been available earlier. You realize a physician is being interrupted repeatedly because ownership of one step was never clearly defined.
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Frontline clinicians usually know where these points of friction are because they encounter them every day. Leaders need to create opportunities for them to say, “This isn’t working,” without making that observation feel like resistance to change.
I also believe strongly in using data to guide improvement. Patient-experience scores, wait times, throughput measures, and safety data can reveal patterns that individual encounters cannot. But a number rarely tells the entire story.
If a patient-experience measure falls, the first question should not always be, “Who is underperforming?” It should also be, “What is happening in the process?”
The data may identify the problem. The people doing the work can often help explain why it is happening.
Leadership has also changed how I practice medicine. I pay more attention now to the parts of a patient’s visit that occur outside my examination room. How long have they been waiting? What were they told? Do they understand what happens next?
When something goes wrong, I also try to ask whether the system made it unnecessarily difficult for someone to succeed. Sometimes the problem is individual performance. But sometimes we are trying to fix a person when we should be fixing a process.
Personal clinical experience should not replace organizational data. One difficult shift or one frustrated patient does not necessarily represent a system-wide problem. The two perspectives need to work together.
If I notice a problem during a shift, I want to know whether the data show the same pattern. If patient feedback identifies a recurring concern, I want to understand what the frontline team is experiencing. And when we make a change, we should measure whether it actually helped.
The bedside keeps leadership grounded. Every policy eventually becomes someone’s workflow, and every metric represents real encounters between patients and health care teams.
Physician leaders have an opportunity to connect those two worlds. The farther we move into leadership, the more important it becomes not to lose sight of either one.
Manoj Sreedharan is a board-certified family medicine physician and the medical director of Injury Express at OrthoIllinois in Rockford, Illinois. He is also an assistant professor at the University of Illinois College of Medicine Rockford and a practicing emergency medicine physician at MercyOne Clinton in Iowa.
His work focuses on health care quality improvement, patient safety, patient experience, clinical operations, and evidence-based medicine. He is actively involved in clinical research, including biologic therapies for rheumatologic conditions, and serves as a peer reviewer for medical journals. He is passionate about advancing health care through physician leadership, medical education, and continuous quality improvement.
His peer-reviewed work includes a study of blood pressure control among U.S. adults with hypertension stratified by glucagon-like peptide-1 (GLP-1) receptor agonist use, drawn from the National Health and Nutrition Examination Survey, 2017 to 2020. He shares updates on LinkedIn.
