Creating Physician Leaders for 21st Century Healthcare

Creating Physician Leaders for 21st Century Healthcare

12.10.13Patrice Murphy

To get leaders’ attention you need to set them to work on real challenges that come with real struggle, real learning, and real results.

Like us, you may think you know a thing or two about developing leaders. At Schaffer Consulting we have been coaching leaders for fifty-plus years, in every industry, government, and not-for-profit situation. We know a couple of things for sure. First, people care more about being a good leader when they see right away how it increases their ability to impact a real problem or issue they face. Second, the greatest development happens when people are challenged and stretched at the edges of their comfort and capability. To get leaders’ attention you need to set them to work on real challenges that come with real struggle, real learning, and real results. In short, on-the-job development happens when leaders are challenged to work at the edge of their capability on an issue that really matters.

These insights were confirmed, with a few twists, in a recent dialogue between Schaffer Consulting and three executives responsible for physician leadership development at MD Anderson Cancer Center, Stanford Hospital and Clinics, and Providence Health and Services. We asked them about the unique challenges they see in developing physician leaders, and how they are responding.

“There is enormous pressure on clinical productivity – the drive to increase the number of patients seen,” says Janis Apted Yadiny, MLS, Associate VP of Faculty Development and Career Enhancement at University of Texas MD Anderson Cancer Center. “Chairs [in a medical research center] are also expected to do so many other things: meet increasingly acute financial demands, recruit fine people, manage and develop residents and clinical fellows, and maintain a great publication program.”

These competing demands reflect the tumultuous change that is sweeping through health care. The financial model is moving from relatively stable fee-for-service focused on acute care – to shifting, shrinking reimbursements and outcome-based funding of population health management. Medical systems are becoming more complex as medical group practices get pulled into large, integrated health systems which have generally been led by administrators, schooled and developed as broad based leaders.

In this world, we anticipate growing demand for physicians to take on senior executive leadership roles that encompass clinical excellence, financial stewardship, and organizational competence. Craig Wright, MD, SVP of Physician Services with Providence Health and Services agrees: “We absolutely need the clinical voice at the table when we are making operational and strategic decisions.”

The challenge is to transition physicians into being leaders of complex organizations. This calls for an understanding of the competencies developed in the training, acculturation, and career progression of practicing physicians, and how these differ from those relied upon by effective organizational leaders. It also calls for deliberate, tailored strategies to help physicians make the transition from clinician to physician-leader.

Physicians versus Leaders: Different Paths to Different Competencies

Consider this checklist of leadership competencies: Effective leaders are visionary thinkers who see the big picture for their organization. They engage and inspire their people to achieve shared goals, using well developed emotional intelligence. They communicate effectively, are open to change and innovation, and move quickly to mobilize and lead teams to work well together. They are versatile in how they respond to changes in the context in which they operate.

These competencies develop out of a combination of nature plus nurture. Leaders typically develop out of some combination of natural ability, a willingness to learn and develop new skills to help them be more effective as they progress in their careers, and exposure to learning environments in which they can practice and extend their skills.

Physicians are at a clear disadvantage on the nurture side of this equation, since they come from a fundamentally different model of education, training and clinical practice. “Physicians’ training and success is based on individual performance,” says Joe Hopkins, MD, Senior Medical Director for Quality at Stanford Hospital and Clinics. “No one got into medical school based on how their whole chemistry class did. They have very little preparation in how to lead, develop, delegate … or the interpersonal skills [for leadership].”

A ‘call to action’ for physician-leader development published in the Journal of General Internal Medicine noted that physicians are educated in scientific disciplines that emphasize data-driven experimental processes. Their training further emphasizes autonomous decision-making, personal achievement, and individual, rather than organizational, performance. Their orientation tends to be on problem solving, appropriate in a clinical diagnostic setting but less helpful in leadership roles where forward-looking appreciative thinking is valued. And physicians may err in assuming the clinical authority they enjoy with patients and colleagues carries over into leadership roles, expecting others in the organization to defer to their authority.

Closing the Competency Gap: Real Development Through Real Experiences

Given the challenges in developing physicians as leaders, major health systems such as Providence, MD Anderson, and Stanford Hospital are making a significant investment in training across a variety of disciplines. These range from Management 101-type programs, focused on basic managerial skills such as finance and human resource management, to programs addressing the more complex attributes of leadership such as strategic thinking and team leadership. The single most powerful learning approach reported for physicians was when they had the opportunity to integrate – and deepen – nascent leadership skills through immediate application to an actual problem that mattered to them and to their organization.

For example, Stanford Hospital and Clinics developed a physician leadership program with this kind of learning-through-action, based on Schaffer’s Rapid Results Approach. In it, physicians are challenged to address issues ranging from improving clinical quality to pursuing new business development opportunities. Working with cross-functional project teams on 90-day projects, physicians experience a rapid evolution of leadership skills.

The rapid cycle leadership learning projects touched both clinical and research issues. Some sample outcomes include:

  • Standardization of internal medicine consultation for cardiac risk reduction in pre-operative patients
  • A 20-point lift in “very good” response to the Press Ganey measure "wait time to see doctor" (increased from 31st to 51st percentile), achieved by piloting the placement of an MD in the Emergency Department triage area
  • Creation of a tissue bank for biopsy and bronchoscopy specimens from remodeled airway disease patients – including designation of space, rules and protocols, and data base links
  • Implementation of a new workflow to take a medical researcher/investigator step by step from concept through the paperwork/due diligence, enrollment, and completion of a clinical trial – in a timely and stress-free manner
  • Design of a new aquatic amphibian research animal facility

Physician-leaders often started work on these projects with a very singular focus, doing much of the work on their own, before coming to realize the power of the team and taking on a more nuanced leadership role. By project-end they had delivered significant performance improvements and demonstrated a broader leadership skill set that impacted their own team as well as colleagues in other disciplines and departments. They were also challenged to inspire others and be influential across organizational boundaries in the absence of formal authority. Hopkins observes “Physicians gained credibility as leaders, so non-physician leaders saw them as allies and partners, not as someone needing to be managed.”

Schaffer Consulting has helped many clients transform their leadership programs by making challenging real-world projects the primary vehicle for learning. Cases in health care settings like Stanford Hospital show that this approach helps physicians to discover new dimensions of leadership and followership, practice engaging less hierarchical teams, and build their capacity to influence others.

If you would like to learn more about how you can transform your leadership development programs while delivering real performance improvement, please let us know. We would be happy to talk with you about how our approach can help you jumpstart your investment in transforming physicians – and other technically specialized experts – into leaders.

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