THE IMPACT OF AN EXECUTIVE LEADERSHIP DEVELOPMENT PROGRAM

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1 Leadership THE IMPACT OF AN EXECUTIVE LEADERSHIP DEVELOPMENT PROGRAM n Jay S. Grider, DO, PhD, Richard Lofgren, MD and Raph Weicke In this artice A eadership deveopment program at an academic medica center at the University of Kentucky is serving as a training ground for up-and-coming executives. THE ABILITY OF LARGE HEALTH CARE SYSTEMS to respond to the rapidy changing andscape in which they operate is in many ways dependent upon the eadership knowedge and capabiities of those heading up the transformation. Athough the centra direction and core vision for heath system transformation is typicay concentrated in a reativey tight circe of a few individuas, it is the broader acceptance and execution of the transformative steps that determine the success of the initiative. 1 Often, it is ess about having the perfect pan but rather experty executing the pan that has been decided upon that eads to successfu organizationa change and advancement. 1 To address this need, a growing number of heath systems have impemented executive eadership deveopment programs (ELDPs) to identify, equip and utimatey uneash potentia eaders within their organizations to bring about desired transformation. Unti recenty the degree to which these ELDP strategies were being impemented nationay was unknown. Ann McAearny recenty reported the resuts of a nationa survey that examined the number of active ELDPs, their genera structure and outcome measures. 2 It was discovered that most programs have been in existence for five to seven years with an executive-fet, needbased approach and reativey vague outcome measures. Most programs aowed the identified executive to structure the program to their needs/desires in approximatey 40 to 50 contact hours. 2 Additionay the outcomes measures were typicay centered on rate of empoyee advancement, customer and empoyee satisfaction scores and empoyee retention. In this report the difficuty in ceary assessing the impact/outcome of these programs was mentioned as a imiting factor. 2 Purpose-driven executive deveopment has been demonstrated as important across severa areas of business and industry, with ski acquisition and succession panning obvious benefits to the impementing organization. 3 Leadership deveopment is seen as a competitive advantage for those organizations engaged in these activities. 4 This advantage centers on the abiity of the organization to outine and impement objectives efficienty. In heath care, these objectives typicay invove increasing patient satisfaction and safety whie deivering care in an efficient manner. Let s examine the organizationa goa, structure, content and outcomes of a recenty deveoped ELDP in an integrated academic medica center. Additionay, we ook at the strengths and areas for improvement in the current modes. CANDIDATE SELECTION Candidates for the ELDP were nominated and seected by senior eadership within the organization. Criteria for seection incuded personne who had demonstrated eadership potentia or who were in key positions to execute organizationa strategy. The two cohorts of roughy 30 participants each (2009 and 2010) consisted of individuas representing nursing, the physician practice and hospita/coege of medicine administration. The eves of experience were equay varied with some individuas having ess than three years tenure within the institution, whie others had more than 20 years of history with the enterprise. PROGRAM CONTENT The program was centered around two primary components: n Didactic business and eadership curricua. 66 SEPTEMBER/OCTOBER n 2014

2 The executive eadership deveopment program at the University of Kentucky medica center has proven to be an overwheming success, providing both direct and indirect benefits to the cinica enterprise. As a resut of the program, the enterprise now has a growing cadre of highy motivated and engaged managers and potentia senior eaders. n Division of the cohort into teams that were given a project that was an institutiona priority. Both components took pace during two 10-hour sessions per month, totaing more than 200 contact hours. Participants were excused from a work-reated duties to attend the program. For the didactic curricua, modues chosen consisted of personaity trait assessment, appreciative inquiry, negotiation skis, institutiona structure and suppy chain anaysis, LEAN and Six Sigma exposure, budget and finance overview, ethics, eadership techniques, and stye anaysis. Five teams were created centered around projects such as: n Reorganization of a newy acquired ambuatory cinic. n Patient safety and improvement during night hours and weekends. n New empoyee onboarding to institutiona cuture. n Movement coordination of intensive care unit patients into a new bed tower. n Impementation of the Robert Wood Johnson Foundation initiative: Transforming Care at the Bedside. Teams comprised individuas eveny baanced from nursing, physician practice and administration. Each team was given an executive sponsor who is a part of the senior eadership structure and member from a previous ELDP to serve as coaches in competion of project goas. Project goas and objectives were purposefuy ambiguous so that teams coud assess the needs in each area and provide fresh perspectives to the project without preconceived biases. EVALUATION At the end of each ELDP year a status report to senior eadership is given on the progress of each project. Direction and feedback are given, and the project participants continue to impement and shape the dynamics of the project moving forward. Severa measures of participant satisfaction and vaue are obtained throughout the ELDP, and an overa summary of vaue is obtained at the end of the program. RESULTS The ELDP has proven to be an overwheming success providing direct and indirect benefits to the cinica enterprise. The direct benefits have been obvious and papabe. As a resut of the program, the enterprise now has a growing cadre of highy motivated and engaged managers and potentia senior eaders. physicianeaders.org 67

3 There is now a rich suppy of taent avaiabe to assume new responsibiities and tasks to drive the constant improvement in performance in terms of quaity, safety, efficiency, service and finance. LEADERSHIP DEVELOPMENT IS SEEN AS A COMPETITIVE ADVANTAGE. In addition the graduates of the ELDP are better prepared and more effective eaders and managers in their current positions and scope of responsibiities. And finay the ELDP projects have consistenty deivered great ideas and recommendations. These projects have provided the enterprise with a fresh and innovative approach to important and often vexing probems. The benefit of the knowedge gained through the ELDP program has been evident as the proposed soutions and ideas have aso been very practica and doabe. However, the indirect benefits of the ELDP program have been equay as vauabe. The graduates now share a common anguage and a common set of toos and approaches that dramaticay improve the communication and impementation of new ideas and initiatives. Many of the graduates were introduced to peope from other units and discipines at the medica center for the first time. They quicky came to appreciate the fu breadth and compexity of an academic medica center as we as the critica interdependencies. As such the program greaty enhanced the intraorganizationa network of critica connections between the various units. These forma and informa connections are essentia to drive change that is accepted, adopted and sustained. The participants aso gained a much greater understanding and appreciation of the corporate goas, vaues and strategies. The resuting excitement, enthusiasm and commitment of these graduates to hep the organization succeed has provided vita energy and acceerated the impementation of new programs and initiatives. Finay the ELDP program has been a very effective mechanism to convey to the young taent that the enterprise cares deepy about their persona goas, aspirations and success. DISCUSSION Leadership deveopment programs in the heath care setting are growing in number. 2,5 Despite the obvious growing popuarity of these programs and the impied intrinsic vaue inherent in such concepts, the structure and evauation methods used vary widey across institutions. McAearney reported that haf of a heath systems responding to a recent survey (n-104) reported having some form of an ELDP in pace or under deveopment. 2 These programs consist of 40 to 50 contact hours with direction and content taiored to the needs/desires of the trainee. The specific content of the ELDPs was not addressed in the study but in genera content was typicay seected based on participant ideas and/or participant feedback suggesting that the content was trainee driven. 2 Likewise the facuty for the ELDP was typicay seected from within the heath care organization. 2 The arger the heath system the more ikey they were to use interna resources. In contrast, University of Kentucky HeathCare senior eadership and the University of Kentucky Gatton Coege of Business facuty mutuay agreed upon the program content in our institution with a strategic eye toward high-yied topics germane to institutiona heath care. With regard to evauation of ELDPs nationay, empoyee job satisfaction was noted to be the primary evauation endpoint with succession panning and patient satisfaction isted as other measures. Interestingy most programs did not evauate their programs on a return on investment (ROI) basis. Those programs evauating ROI used vasty different outcome measures to determine vaue, thus making ROI comparison between programs difficut. In the McAearney study, most respondents suggested that the payoff for participation met or exceeded their expectations. 2 The most popuar aspects of ELDPs nationay appear to be the deveopment of eadership skis and access to coaching. 2 Quaity improvement ski acquisition and sef-assessment toos aso were frequenty reported as being of vaue. Interestingy the more forma business curricua such as finance and suppy chain management were not mentioned as being of vaue by respondents in the McAearney study. 2 It is uncear whether this because these components were absent from most programs or were merey seen as of esser vaue. Our resuts suggest that whie persona ski deveopment was seen as foundationa to most participants, the information on institutiona organization and structure, as we as suppy chain anaysis and negotiating techniques, were aso seen as highy vauabe. It is possibe that presentation of these topics by facuty reguary invoved in the master in business administration coursework improved satisfaction in these areas versus the nationa benchmarks in the McAearney study. 2 Each business topic presented was an abbreviated overview, specificay seected for heath care appication, thus exempting the program participants from the more intricate detais of any singe business discipine. Common reasons cited for impementation of an ELDP incude: 1. Desire to foster empoyee deveopment. 2. Becoming/remaining the empoyer of choice in the region. 3. An institutiona emphasis on education and deveopment. 2 Athough these are aso goas of our institution, the primary desire of senior eadership for this program, in addition 68 SEPTEMBER/OCTOBER n 2014

4 to future eadership identification and nurturing, was and continues to be the creation of an institutiona cuture. Our institution continues to be in transition from academic heath center mode to a regiona heath care destination. Part of the transition is changing the perception of the institution from that of a arge inefficient compartmentaized care-mode into a fuy integrated patient-centered enterprise. This transformation requires that a current and emerging eaders ceary understand the vision and goas of the senior eadership team. Post-program evauations suggest a significant escaation in participant awareness of and buy-in for the overa stated enterprise transformative goa. Data from our ongoing programs suggest that, in contrast to nationa outcomes that focus on empoyee satisfaction and deveopment, ELDPs may be used to bring about cuture change, a typicay monumenta task. If indeed this emerging trend hods true, then the potentia ROI of ELPDS for institutions requiring rapid response to changing environments may be invauabe. Perhaps the most nove and potentiay important aspect of the current program is the combination of didactic knowedge acquisition with rea-word probem soving of the assigned project. The projects are institutiona imperatives seected by senior eadership. Participants are working on high-vaue issues. The coaching aspect of the design and the project management ski acquisition are fet to be important aspects of the overa training. Each participant, by nature of their seection, has pressing administrative and cinica demands. The ELDP project is in addition to their current work oad, simuating the consistent demand that the heath care eaders jugge severa disparate projects simutaneousy. The evauation of how participants grow in their abiity to hande these stressors is aso a key component of the deveopment process. During the process a sma number of participants in our ELDP identified that, despite coaching and ski deveopment that was avaiabe to them, they were personay i-suited to the demands of heath care administration. This is important sef-discovery, before promotion eads to the uncomfortabe pace of a person being hired into a position for which they are utimatey i-suited. Despite the perceived success of the current ELDP structure, there are severa areas for improvement. For exampe, though projects are seected based on institutiona priorities, there was often significant overap with other teams in terms of scope within the institution. As is often the case in compex organizations, project management was occasionay disjointed and ELDP participants reported that they woud encounter frustration from organizationa units. The genesis of these frustrations was the appearance that more than one group was working on the same project, confusing ines of authority and communication. A potentia shift of participants onto aready functioning teams may eiminate this frustration whie enhancing the benefit of the ELDP participant. Conversey, the idea of a fresh ook at an od probem woud be ost. Ceary the baance of these two competing issues must be found. Another potentia area for growth centers on the coaching process. Previousy senior eaders were seected as team coaches, however groups occasionay found that due to the demands of their positions within the enterprise these individuas had itte spare time for the coaching process. Additionay, not every senior eader has the intrinsic quaities that make an exceent coach. An improvement made for subsequent cohorts invoves pairing exceent coaches with busy senior eaders so that participants get exposure to the mindset of their eadership whie receiving exceent mentoring. If both objectives can be accompished with the senior eader then that is idea, but recognizing that coaching is not a universa strength, we fee that a combination that ensures the presence of a premier coach wi improve the experience. n Jay S. Grider DO, PhD, MBA, is an associate professor at the University of Kentucky Coege of Medicine in Lexington, KY. Richard Lofgren, MD, is president and CEO of UCHeath at the University of Cincinnati in Cincinnati, OH. Raph Weicke is president of the Corporation for Positive Change in Lexington, KY. REFERENCES 1. Baird I, Briscoe J, Tuden L and Rosansky L. Word Cass Executive Deveopment Human Resource Panning, 1994, 17(1): McAearney AS. Executive Leadership Deveopment in U.S. Heath Systems. Journa of Heathcare Management, 2010, 55;(3): Coins D, and Hoton E. The Effectiveness of Manageria Leadership and Studies from Human Resources Deveopment Quartery, 2004, 15(2): Day DV. Leadership Deveopment: A Review in Context. Leadership Quartery, 2000, 11(4): Porter J. Doctors Seek Aid From Business Schoos; Universities, Hospitas Create Programs to Assist Medica Professionas In Need of Some Management Know-How. Wa Street Journa, December 17, physicianeaders.org 69

5 SYLLABUS FOR ELDP PROGRAM n DISC work behavior profie. Have individuas understand their own natura work behaviors and strengths. Use their strengths and natura work behaviors in an adaptive manner to become more effective eaders. Understand the work behaviors of peers and empoyees. n Team deveopment. Understand the team deveopment process and quaities/ characteristics of high-performing cross-functiona teams. Demonstrate effective team communication and decisionmaking for a team focused on creative outcomes. Understand the chaenges of teamwork and ways to overcome or mitigate these chaenges (i.e. decision-making, participation, confict, identification and cohesion). n Project management. Learn to scope projects propery through defining the probem, determining critica-to-quaity outcomes and engaging stakehoders. Learn to manage projects through the study of processes. Gain ski in the appication of methods and toos for effective, on-time projects. n Managing muti-unit organizations. Understand the chaenges (and benefits) associated with organizing and managing diverse, muti-unit organizations. Activey discover and engage in (through simuation) the processes invoved with the aignment and integration of organization units. Learn to baance the organization s overarching need for strategic and structura coherence with departmenta-, unit- and/or person-eve differences in operationa processes, expectations/attitudes and cuture. n Matrix management. Learn the meaning, structure and benefits of a matrix organization. Understand the operating opportunities for managers and empoyees in a matrix organization. Learn to navigate the chaenges of a matrix structure. n Appreciative inquiry. Learn the appreciative inquiry mode and process. Appy the appreciative inquiry process to daiy operations. Understand the vaue of appreciative inquiry in empoyee engagement. n Compeing communication. Learn to appy their communication preferences to compeing communications. Learn and appy the toos to have compeing communication that can address difficut topics. Understand the emotiona aspect of compeing communication. n Leadership modes. Learn how to baance the competing demands paced on organizationa eaders. Harness the power of vaues-centered eadership. See more ceary, think more broady and fee more deepy so as to act more effectivey. n Emotiona inteigence. Deveop insight into the foundations of your own emotiona states. Gain power to proactivey direct your emotions so that you become an appropriatey empowered agent for positive change. Expore ways to understand and work with the emotions of others. n Confict management. Be abe to define confict and manage it appropriatey. Diagnose different types of confict. Identify the causes of organizationa confict. Recognizes that there are functiona and dysfunctiona aspects of confict. n Customer service in a gracious space. Appying service outcomes to heath care service deivery. Consider the impications of the experience economy for heath care. Identify the characteristics of service-focused organizations. n Presentation skis. Learn how to organize a presentation that hods isteners attention and gets resuts. Appy toos to make presentations more visua. Practice presenting addressing fow and deivery. n Performance management. Defining the roe of performance management systems in deveoping empoyees and driving performance. Identify the types of performance interventions and metrics. Learn toos for engaging empoyees in the performance management process. 70 SEPTEMBER/OCTOBER n 2014

6 n Appreciative coaching. Learn a mode and process for coaching within an appreciative framework. Identify guideines for a coaching interaction. Experience having appreciative coaching conversations. n Heath care finance. Understand the macro view of heath care finance. Review the key financia drivers in heath care finance. Learn how the unique aspects of heath care finance impact daiy operations. n Lean process mapping. Standard work what it is, what it is not, why it is an important first step for getting quaity resuts. Measurement Students wi be abe to create a pyramid of pain measurement system to directy connect outcomes with process measures. Process fow Students wi earn how to create and read a basic process fow diagram. n Negotiation skis. Diagnosing different types of negotiation. Articuates differences between distributive (win-ose) negotiating and integrative (win-win) negotiating. Can engage in muti-issue negotiating, incuding recognizing differences in preferences and Raiffa s forma negotiating techniques. Can engage in muti-party negotiating, incuding recognizing the importance of understanding both positions and interests. n Service industry, Lean and suppy chain. Gain exposure to the key concepts of suppy chain management (SCM) and Lean thinking. Expore the appication of SCM and Lean principes to heath care. Learn to map the suppy chain and vaue streams associated with heath care service deivery. Experience the chaenges of matching suppy and demand, yieding soutions for heightened service whie containing resources. n Information management. Define the appication of information management as a management too. Discuss the roe of data in management decision-making. Learning to appy information in driving operationa performance. n Budgeting. Learn the fundamentas of budgeting. Identify key drivers of their individua budget and financia performance. Learn how to use the budget as a management too to drive operations. n Quaity and safety. Understand the definition, scope and characteristics of quaity improvement and safety in heath care and how they are distinct. Approach quaity, safety and high reiabiity from a systems perspective. Learn about the roe of compeing communication in quaity, safety and high reiabiity. n Ethics. Increase our sensitivity to the presence of ethica issues. Assess our persona ethica deveopment as eaders. Improve our abiity to anayze and resove ethica diemmas. n Strategy. Deveop an understanding of current ideas, concepts and best practices associated with managing the tota organization from the perspective of top management. Gain new perspective about the vita roe of organizationa innovation in fostering organizationa growth and advantaged positioning vis-à-vis competitors Activey engage in (through simuation) strategic panning and the deveopment/impementation of a mutifunctiona strategy. n Strategic marketing. Understand the buiding bocks of marketing (segmentation and positioning) and the reationship they have with organizationa brand and identity. Examine the roe of interna marketing within organizations and the impact this has on the customer experience. Deveop an integrated marketing communications pan for a new heath care service/product focused on achieving deep customer focus. n Decision-making. Gain an understanding of systematic and heuristic-based decision-making processes, and when they tend to occur. Be abe to identify common decision-making biases and how to prevent their occurrence. Be famiiar with techniques designed to enhance decision-making in group settings. physicianeaders.org 71

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