Intenionality was not a considera1on but because of the role as leaders has lead to a legacy and gold standard

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2 Intenionality was not a considera1on but because of the role as leaders has lead to a legacy and gold standard physicians involved in cross- func1onal decision- making, inputs beyond medicine- based issues (but of course linked to it) In 1863, William Worrall Mayo ( ) came to Rochester, Minnesota as part of his appointment as an examining surgeon for the military drah board during the Civil War. The city would be to his liking, and his wife and children would join him in early W.W. Mayo opened his medical prac1ce aher the war, and would also serve in several leadership roles in the community. Both of W.W. Mayo's sons, William James Mayo ( ) and Charles Horace Mayo ( ) would grow up in Rochester, and when old enough both asended medical school. William (Will) graduated in 1883 and joined his father's prac1ce, with Charles (Charlie) joining aher he completed his training in (wikipedia) 2

3 Today fewer than 4% (i.e., only 235) of our nearly 6,500 U.S. hospitals are headed by physicians (personal communica1on, Sara Beazley, American Hospital Associa1on, March 15, 2008). By contrast, in 1935 physicians were in charge of 35% of hospitals. 2 hsp://journals.lww.com/academicmedicine/fulltext/2009/10000/ Perspec1ve Educa1ng_Physicians_to_Lead.16.aspx#P41; MacEachern MT. Hospital Organiza1on and Management. Chicago, Ill: Physicians Record Co;

4 assn.org/amednews/2011/08/22/bise0824.htm 4

5 Fred Hosler, M.D., M.P.H., M.B.A. - catalyst to crea1ng inten1onal leadership selec1on, instruc1on, permission for physicians to lead with greater confidence and effec6veness. 5

6 Research to provide a forum for permission 2 hours in ER shadowing physician ER doc as part of MOMS internship He spent 15 minutes with pa1ents ER was completely full, he was one of 2 doctors on call, spent bulk of 1me chasing records, informa1on and reading computer screens Nursing team was unorganized, duplica1ve in commuinca1on and nearly half had 1me to sit in the cetner communica1ons area during this busy 1me, also reading computers and answering phones 6

7 Just ONE area of clinical care. Physiican must navigate physicial space, technological, human/emo1onal; reac1ve, educa1on, focus on clinical skills complexity in decision- making in healthcare segng - either create the visual or find one that illustrates physicians with pa1ents, with admission, with nursing teams, with academic teams, back to physicians. 7

8 Bangalore India only people in 2 room office (minus the bathroom) was doctor and pharmacist (also was cashier) Reason went into medicine to heal and diagnose 8

9 Trained and talented to ACT on an en1ty within formulas and diagnosis. Surgery and running a hospital is more than this. Must gain founda1on as a player in the system. There are important parallels between caring for pa1ents and running a hospital. To ensure effec1ve collabora1on, both physicians and hospital CEOs need to func1on like symphony conductors. 9

10 Tradi1onal command and control in medicine science the diagnosis, rela1onships with nursing teams, real 1me, where seeking an understanding is part of the interac1on regarding a pa1ent, process or strategic decision 10

11 Accidental leadership whoever volunteers to take his/her turn, rota1on, tenure; naturally evolving in a complex world but to a great extent unpredictable and unsustainable 11

12 Gallup building in Omaha - libera1ng structure of allowing partners to innovate, create new budget and build new products such as physician- specific learning, development and MBA built by physicians and leaders in prac1cal applied behavior- based leadership science. 12

13 OPEN BOOK Libera1ng structure of Gallup ongoing coaching linking individual physician talent to physician demands/projects/ challenges; includes rela1onships, thought process/mindset, mo1va1on, approach to working/style, business strategy 13

14 confidence in use of and applica1on of talent- based science - insight into others' behavior, rela1onship building, understanding, team management including team engagement 14

15 StrengthsFinder & Leadership Talent Assessment illustra1ng an applica1on of a science into how a physician will lead vs. can physician lead; the "can" the physician lead should be applied before they are appointed or placed in the posiaon but development begins with creaang an understanding of self and as those physicians and the teams they interact with are informed and evolved in applying the language of talent, this intenaonal selecaon of "can" is possible for future appointments LiberaAng structures for physician leadership: strengthsfinder themes, leadership educa3on, coaching, problem project w/sponsorship, appointment by inten3on [consider: could accidental leadership have been considered an organizing answer to complexity? likely not due to the lack of merit that went beyond physician groups so defining inten3onal as at the administra3ve table vs. just a box check] 15

16 Long standing partnership degree gran1ng 16

17 Mary Uhl- Bien UNL faculty, introduced complexity. The physicians were great about it because they were "poised" to learn about and understand complexity. So I had a "friendly" and interested audience. They were eager to learn, and that was the group I was able to go farthest and deepest with. It was a breath of fresh air, but also unusual. In my teaching (and some speaking) experiences with complexity I typically get a breakdown of half the group loving it and half ha1ng it. For those who embrace it the challenge is the level of understanding. Many don't fully understand so you have to spend 1me gegng the basics out to them. If you have a group that gets it then you can push thinking about what it means and how to apply it. It shihs the way we see and think about leadership/management, so when I get an audience like that I engage conversa1on around what the shih involves and have them talk with one another about how to do it. Quite ohen you have people who are doing it, and then you can engage them in talking about how they do it and answering ques1ons for the others who are struggling with it. I do that in combina1on with my own insights and understandings of what needs to be done. It is quite fun and really gets people thinking! My sense is that many people (depending on audience, most people) recognize we have a problem in leadership. So they are open to new thinking and intrigued by complexity. As a field, our biggest challenge is gegng people to understand complexity. Only when that happens can we engage the higher level conversa1ons that can more fully unleash its poten1al. 17

18 Physician cohort in bangkok experience Stephanie Sharma, Co- creator, Physician- based MBA program Dr. Anne Harbison, Leadership Faculty and coach 18

19 Physician gradua1on with mba s Permission to lead in business applica1on of development star1ng with fellow class- mates, then family and then in a peer segng of physicians, nurses, poten1ally pa1ents; full integra1on includes administra1on and nursing teams 19

20 Why should we care quality of rela1onship lacking, quality of communica1on lacking, quality of pa1ent care/quality lacking, quality of strategic alignment lacking. not sure what this could look like - maybe mul1ple indicators on one slide "Summary of HCAHPS Survey Results. Hcahpsonline.org/HCAHPS_Execu1ve_Insight. [Public Repor1ng Period}. Centers for Medicare & Medicaid Services, Bal1more, MD. 20

21 How do we change and evolve to this permission based culture/environment fully integrated healthcare leadership team inclusive of communica1on, strategy and team engagement lead by and with physicians, administrators, nursing teams and pa1ents Bureacracy and barriers created by administra1on and nursing that limit this evolving leadership by physicians (hierarchy/structural, nurse silos are deeply entrenched - survivalist, technology, administrator mindsets) Consul1ng model created by Terry Chappell, designer. Gallup Consul1ng 21