Press Ganey CMO on 'The Pitt': Doctor Report Cards Are Really About Systems

In the pilot episode of HBO's new medical drama The Pitt, a dedicated ER doctor is reprimanded for his low Press Ganey patient satisfaction scores. The interaction—cold and superficial—angers the main character, Noah Wylie's Dr. Michael "Robby" Robinavitch. His defense is that the numbers don't matter; all that counts is his ability to save his patients' lives. As a longtime practicing physician, I can tell you that this fictional doctor's frustration resonates deeply with real health care providers across America. When they are taking care of patients, deeply ill or otherwise, all that should matter is the patient in front of them. Everything else is a distraction, including data that supposedly describes the quality, safety and efficiency of their care. But as an experienced health care manager (and the chief medical officer of Press Ganey), I can tell you that individual physicians rarely save or lose patients' lives on their own. And they don't earn or lose patients' trust on their own, either. Health care is a team sport, and data describes the performance of those teams over time. Physicians are often like the fictional character on The Pitt—inclined to dismiss data that they know does not really capture their personal work or impact. In fact, as someone deeply interested in data, I would say that it is more difficult to measure the impact of physicians than quarterbacks on football teams.

What we can measure is how well the teams perform. However, we tend to organize analyses of patient data around their physicians because medical claims are submitted in those physicians' names. The resulting report cards look like they are about the doctors, while they are really about the teams working with them. Physicians have a lot to do with how their teams perform, but I don't think they should view themselves as "players" akin to quarterbacks. In my new book, Social Capital in Healthcare, I argue that they should see themselves more like chief financial officers (CFOs) for social capital for the web of relationships among their colleagues, their patients and their patients' families. Social capital is not a term used often in health care, but it is as essential to health care excellence as financial capital is for building new buildings. Human capital means the people with the training that enable organizations to open those buildings or staff new programs. Social capital is how those people interact—with each other and with their infrastructure, enabling the organization to deliver care that is reliably safe and excellent. To be "CFO for social capital" means physicians assuming leadership and ensuring that their teams function like real teams. On real teams, everyone knows each other. Everyone speaks up when something might be going wrong. Everyone feels like they belong. And everyone would cringe at the thought of disappointing their colleagues.

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Social capital isn't just theoretical, and it doesn't fall from the sky—it's a practical asset that delivers measurable results, and it has to be earned and built over time. I actually believe that it is more important than financial capital, because money can be borrowed or gifted from the outside; no one can give an organization trust and teamwork and high reliability. So, my take is that the physician in this television show shouldn't just shrug off his Press Ganey data, but he shouldn't take it as a personal affront, either. He should see it as performance information for his group and know that they have work to do. That work to build social capital means rounding and huddling regularly, discussing cases proactively or even starting a weekly cross-team lunch ritual. It may mean social events together to strengthen their relationships. All that can and must wait until the patient needing immediate attention, whether in an hourlong drama or in real life, is stabilized. But the key point is that the path forward isn't just about individual excellence or better metrics—it's about rebuilding the social fabric that enables true health care success on both ends of the stethoscope. Now the Chief Medical Officer at Press Ganey, Dr. Thomas Lee has more than three decades of experience in healthcare performance improvement as a practicing physician, a leader in provider organizations, a researcher, and a health policy expert. He recently published the book Social Capital in Healthcare, where he describes a new and powerful framework for improving healthcare, arguing that managers should approach the work of building trust, teamwork, and high reliability with the same intensity and discipline as CFOs use when managing the finances of their organizations.