• David C Stockwell, Anthony D Slonim, and Murray M Pollack.
• Children's National Medical Center, George Washington University School of Medicine, Washington, DC, USA. dstockwe@cnmc.org
• Pediatr Crit Care Me. 2007 Nov 1; 8 (6): 540-5.

ObjectiveThere 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.DesignProspective cohort from January 31 to June 30, 2005.SettingPediatric intensive care unit in an urban, academic children's hospital.ParticipantsPediatric intensive care unit staff intensivists were the primary participants.InterventionsNone.Measurements And Main ResultsThe 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.ConclusionsManagement 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.

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