I wanted to become the kind of physician I wanted, but rarely had, as a child. I was born with a disfiguring tumor on my face. Until my parents found a plastic surgeon who removed it, I interacted with a large number of physicians who treated me like an object, subjecting me to terrifying, painful and, as it turned out, ineffective yet dangerous procedures without explaining what they were doing or giving me any control over anything that happened.

Roz D. Lasker, M.D., is founding director of the Center for the Advancement of Collaborative Strategies in Health at The New York Academy of Medicine. The Center's research is focused on ways to improve medical care delivery, public health practice, health policy development, and the effectiveness of community partnerships.

People and organizations need to work together to tackle the complex problems that affect health and well-being. That is why tens of thousands of partnerships have been formed to address issues like substance abuse, health disparities, and medical care. But, far too often, the experience with partnerships generates more frustration than results. Since 1995, Dr. Lasker has studied the dynamics of collaboration, transforming our understanding of how collaboration works and what it takes to make partnerships successful.

Why is a physician in this line of work? For Dr. Lasker, there was little choice. As she puts it, "The goals that have mattered most to me in my career—addressing the root causes of poor health and giving people a meaningful and influential role in addressing problems that affect them—can't be achieved without collaboration." As she quickly found out, however, there is no proven road map for building successful partnerships, even after decades of experience. Consequently, it is very difficult for people to translate the appealing rhetoric and principles of collaboration into practice.

Dr. Lasker established the Center to fill these gaps in knowledge. While her work originally concentrated on health-related collaboration—as described in her book Medicine & Public Health: The Power of Collaboration—the Center soon expanded its focus to explore challenges related to collaborative problem solving, in general.

One of Dr. Lasker's key accomplishments has been to clarify exactly how the process of collaboration strengthens a group's ability to identify, understand, and solve complex problems. The key has been to characterize and measure "partnership synergy," the breakthroughs in thinking and action that are produced when a collaborative process successfully combines the knowledge, skills, and resources of a diverse group of participants. "Synergy," she explains, "is what makes a partnership greater than the sum of its parts."

The rigorous partnership-level research that Dr. Lasker and her colleagues are conducting has important practical applications. The web-based Partnership Self-Assessment Tool (www.partnershiptool.net) shows partnerships how well their collaborative process is working and what they can do to make it work better. Results of large scale research studies are showing how the leaders, managers, and funders of partnerships can successfully involve a diverse array of participants in collaborative problem solving. "These insights and tools can alleviate much of the current frustration with collaboration," Dr. Lasker said. "Our work suggests that many partnerships can be far more successful in their collaborative efforts by changing who is involved, how participants are involved, and the partnership's approach to leadership and management."

After finishing first in her class at the University of Pittsburgh School of Medicine in 1976, Dr. Lasker was a resident in internal medicine at Stanford University Hospital, California; Presbyterian University Hospital, Pittsburgh, Pennsylvania; and Washington University Medical Center, St. Louis, Missouri. She trained in endocrinology at the National Institutes of Health in Bethesda, Maryland. From 1983 to 1985 she was assistant professor of medicine at the University of Vermont College of Medicine, where she was named the Teacher of the Year in 1985.

"Wanting to realize my patient-centered approach to care," she comments, " I practiced endocrinology in Ithaca, New York, but ran into difficulties when my reimbursements were insufficient to subsidize the care of my many uninsured and underinsured patients." To address the problem at its source, she became principal policy analyst for the federal Physician Payment Review Commission from 1987 to 1993, engaging practicing physicians in the development of Medicare policies. She was a member of the Clinton administration's health care reform task force in 1993, and from 1993 to 1995 she served as deputy assistant secretary for health policy development at the U.S. Department of Health and Human Services. In 1995 she received the John W. Gardner Award for excellence and outstanding achievement in public policy, population health, and public service.

In addition to her position at the Academy, Dr. Lasker has been a clinical professor of public health at the Joseph L. Mailman School of Public Health of Columbia University.

What was my biggest obstacle?

Although I was in the vanguard of expanding enrollment for women in the 1970s, and was the first or second woman to hold a variety of positions in my career, gender was not a major obstacle for me. Instead, the biggest barrier seems to have been my patient-centered approach to medicine. To a large extent, medical training is all about physicians—their knowledge, skills, power, services, successes and failures—and patients are viewed in relation to physicians (i.e., doctors care for patients and patients are the objects of doctors' concerns). Because of my early experiences, I never felt comfortable with this approach. Quite the contrary, I always thought about doctors in relation to patients (i.e., I saw physicians as having knowledge and skills that patients could leverage to address their own concerns). This difference in emphasis became an obstacle because it sometimes set me apart from my professional colleagues. When conflicts arose, my primary loyalty was to patients rather than to the medical profession. In practice, I worked with patients as peers to understand and solve problems they cared about. In the course of that work, I recognized that many different kinds of knowledge and skills—going well beyond those of physicians or even the medical sector as a whole—are needed to improve people's health and well-being.

How do I make a difference?

My career has taken me in many directions: medicine, health policy, community health, and collaborative problem solving. If I have made a difference in any of these arenas—never alone, I should point out—it has been by working to give people a meaningful voice and influential role in addressing the issues that affect them. In my medical practice, patients were the key drivers and decision makers. In the federal government, I conducted research and organized consensus processes to engage practicing doctors in the development of physician payment policies. For the last eight years, my Center has been working with partnerships around the country to actively engage residents in identifying, understanding and solving complex community-level problems.

I never took to mentoring very well, probably because most mentors want to recreate mentees in their own image. The only exception was Dr. Philip Lee, chair of the Physician Payment Review Commission and assistant secretary for health in the U.S. Department of Health and Human Services. Dr. Lee helped me clarify what was important to me and chart a course for realizing my aspirations.

How has my career evolved over time?

My career path has not been a traditional one, but it has been extremely stimulating and satisfying because it has enabled me to work with terrific people in many different fields and to go far beyond the boundaries of my medical training. I started out in academic endocrinology. I greatly enjoyed my research experience as a medical student at the University of Pittsburgh and my teaching responsibilities on the faculty of the medical school at the University of Vermont. Wanting to realize my patient-centered approach to care, I joined a multispecialty practice in Ithaca, NY, but ran into difficulties when my reimbursements were insufficient to subsidize the care of my many un- and underinsured patients. To address the policies that affected my ability to deliver care, I moved to the federal government—first as a principal policy analyst for the Physician Payment Review Commission, where I dealt with physician payment under the Medicare program, then as a member of the Clinton Administration's health care reform task force, and finally as deputy assistant secretary for health (policy development) in the U.S. Department of Health and Human Services. Recognizing that it is difficult to develop feasible and effective policies if the people who are directly affected by those policies are not involved in the process, I moved to The New York Academy of Medicine to focus on collaboration. After the multidisciplinary study Medicine & Public Health: The Power of Collaboration was published, I established the Center for the Advancement of Collaborative Strategies in Health at the Academy. Currently, the Center is documenting how the involvement of a broad array of residents and organizations can strengthen the ability of communities to identify, understand and solve complex problems. We are translating our research findings into practical tools—like the Web-based Partnership Self-Assessment Tool—to help communities become successful in running these kinds of collaborations.