How To Develop Leadership For The Medical Practice

Transcription

1 Leadership for the Medical Practice Submission date: August 7, 2013 Myra L. Miller, FACMPE HISTORICAL *note this paper is being submitted in partial fulfillment of the requirements for ACMPE Fellowship

2 Title: Leadership for the Medical Practice EXECUTIVE SUMMARY: This paper seeks to explore the history of management development, collaboration, program design and professional impact of a healthcare organization s innovative efforts to meet their demand for leadership development. Professional development programs have been in existence in the workforce as far back as the beginning of documented history. The apprenticeship system, at its most basic form, formulates the progression of self development to one ultimate goal. No matter the skill, the system sets to form the participating person into a master craftsman. Since the American Industrial Revolution in the early 1900s, industries of all types have embraced the ideology of management development to secure success. During this time, professional development organizations such as the American Management Association and the National Management Association established themselves as a source of training expertise for management to meet the growing needs for production. One industry that did not have immediate growth in the training and development of formal management organizations was that of the healthcare industry. The slow growth of these programs mirrors that of the slow progression of formal medical institutions. With the changing perception from sick houses to hospitals, the need for strong administrators of these facilities followed. Healthcare management organizations evolved with the growing platform of development opportunities as seen through formal education programs and training courses. Management trainings, in the broad sense, were basic and non-industry specific. Emphasis was placed on the development of mid-to-executive level development. Degrees held by the executive level individuals across the nation were mainly general business 1

3 degrees or graduate level business degrees. Specificity of healthcare related business degrees did not evolve until healthcare education credentialing organizations, such as Association of University Programs in Health Administration and Commission on Accreditation of Healthcare Management Education, began to stress the importance to educational institutions to develop degrees to meet the need of the industry. Though formal, high level management training programs began to evolve, the area of mid-level management lacked the necessity to meet many organizational needs. As a result, many of the healthcare professional development organizations began to create their own management essential training programs. These programs range from online learning opportunities to seminar-style events. While widely successful, these programs requirements were prohibitive for many. Some require membership to the organization while others are expensive. As a result of these constraints felt by many, one organization saw the necessity to develop their own program due to the specificity of their needs. This organization and a local university aligned to develop an academic program in response to the need to move from management to leadership in medical practices in order to serve a new and rapidly expanding healthcare delivery model. The result of this alignment produced substantial benefits for the healthcare organization s management capabilities, as well as, a shared reward between the two organizations as being an innovative leader in their perspective industries. 2

4 Professional Development Introduction Professional development programs have been in existence since the beginning of documented history and were designed to meet the demands of industry needs. These programs were created and structured with specific information to progress one from the simplest form into a master of their craft. a. The apprenticeship system, at its most basic form, formulates the progression of self development to one ultimate goal. No matter the skill, the system formed the participating person into a master craftsman. This cycle of progression mirrors the advancement of any product or idea. From concept to production, there are stages along the progression that optimize efficiency and effectiveness of the desired end product. These optimization stages are critical for success, but they are not limited to the initial development. Continual product or professional improvement ensures that refinement is a necessity to meet the demands of an ever changing landscape. Whether the landscape or medium be driven by a consumer or industry, development and progressive refinement drive success. Education Reform Since the American Industrial Revolution, industries of all types have embraced the ideology of management development to secure success. The increase in workforce and demand for consumer products created the necessity of a leader or foreman that oversaw the process from creation to final product. During this time, most Americans attended schools for no more than a few years and were often content with the most rudimentary literacy and numeracy skills. Rural dominance of the educational system landscape drove the lack of formal educational opportunities to drive management success. As the economy transformed 3

5 from one of agriculture to mass production, the nation became increasingly urbanized. Many Americans left the small farms to pursue new opportunities in the urban sector shifting the education system from the rural communities to the cities. These profound changes and need for formal education occurred in the name of expertise and efficiency. New age-graded schools with lockstep curricula became the standard. During the first decade of the 1900s, higher education institutions witnessed similar changes. The American educational institution saw a transition to a new modern university system. This university institution offered its students a curriculum that was focused on practice, technology and economics while demonstrating a renewed interest in research. This renewed interest was not just that of science and the arts, but it also included operations and design. The American university system was the initial refinement of students that met the demands in leadership of the Industrial Revolution. Progression and development needs would shortly follow. The response for this need would come in the form of professional development organizations that would provide expertise and guidance to meet the increase in industry specific demands (American Decades, 2001). Management Evolution During this time, businesses were run by technicians, owners and managers, many of whom had little or no grasp of basic management techniques and little notion of the importance of human relations. In fact, many believed that the term manager meant nothing more than the maximum movement of goods for maximum selling price at minimum costs. The business and production concepts were commonly found through managers of the time, but the missing components incorporated in today s definition of a manager were not as 4

6 predominant. Professional development organizations such as the American Management Association and the National Management Association established themselves as a source of training expertise for management to meet the growing needs for production. Founded in 1913, the American Management Association, originally known as the National Association of Corporation Schools, formed to provide educational and management development services to businesses, government agencies and individuals (American Management Association, 2013). The National Management Association, originally known as the National Association for Foreman, was founded in 1925 with the intent of improving management skills (National Management Association, 2009). Both organizations offered courses focusing on communication, leadership, marketing, sales, human resources, finance and accounting. Each one of these courses, though smaller at the time of inception, was key to the success of managers and managers of growing industries of the time. Management theories and styles have developed with increasing awareness of the demands necessary to meet the industry requirements. Since the Industrial Revolution and the development of formal educational programs, the term manager and the responsibilities that accompany have transformed. From s, the demands for a manager were tied strongly to the operations of the particular facility. Managers of the time had strong occupational knowledge about the organization s products or services. Their need was to oversee the production cycle and the staff necessary to perform the task. Because formal educational institutions were beginning their own transformation period, managers of the time were experienced-based and lacked formal education and management fundamentals. These positions simply directed necessary tasks. 5

7 Management Education Development Over the next couple of decades, universities and management organizations flourished. Managers of the time started to instill the components necessary to effectively manage their company. The training focus shifted from simply ordering demands to truly understanding the business. Universities and professional development organizations across the United States began developing programs with intense training and focus on strategic planning, finance, sales, accounting and human resources skill strengthen tactics. Though many of these components were theoretical ideologies at the time, the development of formal protocols set the foundation for educational institutions programs for generations to come. Present day management training has taken on an emphasis of leadership training, not manager training. This shift in training philosophies is substantiated by a growing movement to differentiate between the two categories, manager and leader. Historically, managers were seen as one that manages tasks or processes. Educators and businesses have moved away from this philosophy and placed emphasis on growing managers into leaders. Leaders are able to incorporate the key management skills previously mentioned, but they are also able to cultivate supervisory responsibilities, coaching and mentoring of their subordinates. The basis for effective management is effective self-management. This piece is the missing link between a leader and a manager. Leadership training has taken on both a broad training aspect as well as an industry specific training to focus on the needs of the business. Though rapid development occurred for general business management, one industry that did not evolve as quickly was the healthcare industry. 6

8 Healthcare Management Evolution Healthcare management as an acknowledged career field has largely followed the development of medical science and expansion of hospitals throughout the United States. Until the late 1890s, care provided in facilities, which are now known as hospitals, focused on taking care of the sick, not improving the health of a patient. The facilities of the time were more commonly known as sick houses and were founded to care for those who were poor or had no caregivers. The development of antisepsis and anesthesia, modern surgery, and discovery of antibiotics in the early 1900s, quickly transformed sick houses into places that could cure and relieve suffering. Hospital expansion grew from 170 to approximately 7,000 simply through the development and improvement of the care delivery system. With rapid expansion of these care facilities, the need for oversight quickly grew (Healthcare Administration: Historical Background, 2012). Healthcare administrators during this time of expansion were commonly known as superintendents and held other clinical roles. In fact, many of the early administrators were physicians and nurses but lacked the formal training necessary to effectively run the business aspects of their facilities. To meet the demand for professionally trained managers, universities during this time quickly began developing healthcare specific courses that were designed to meet the clinical and business aspects of the healthcare industry. Marquette University was the first institution to meet the growing demand for formal educational programs designed for the complexity of the healthcare industry. The program was founded in 1927 but failed to progress due to participation and eventually closed the following year. Though the program did not succeed, Marquette s quick response in developing the program 7

9 was followed by many other universities. Undergraduate programs rapidly grew and expanded into essential business programs offered to students (Haddock, 2002). Accrediting organization like the Association of University Programs in Health Administration (AUPHA) developed to regulate the curriculum provided by these universities. The AUPHA worked in coordination with the Joint Commission on Education for Hospital Administration to meet the fierce calling for the expansion of university expansion and provided detailed recommendations for content and organizations of the programs (AUPHA: History, 2013). It was not until 1934 before the first graduate level program was created.the University of Chicago is noted as the innovator of this graduate degree. Like the undergraduate level programs, accrediting bodies quickly developed to regulate the program design offered by the universities (Haddock, 2002). Another accrediting body that formed in response to the growing graduate level programs was that of the Commission on Accreditation of Healthcare Management Education (CAHME). CAHME s purpose for development served a similar role as AUPHA in the means of management of educational curriculum. As programs grew nationwide, the initial refinement of healthcare managers was established. The universities created the initial foundation for fundamental learning of those wanting to enter the healthcare industry. There was now a growing void of educational opportunities to those already in positions and those wanting to take alternative paths into management positions within a healthcare organization, hence the inception of the healthcare management professional organization. 8

10 Healthcare Focused Academic Associations Two of the earliest healthcare management professional academic organizations include the American College of Hospital Administrators and the National Association of Clinic Managers. Presently, both organizations have taken on new names including American College of Healthcare Executives and the Medical Group Management Association. The National Association of Clinic Managers, founded in 1926, is an organization focused on delivering social networking, professional education and a resource of expertise for the growing physician clinics. The organization transformed their name to the Medical Group Management Association in 1963 to effectively reflect the growing management segments found in group practice. Additional opportunities offered and developed by this organization include the American College of Medical Practice Executives (ACMPE), which is the certification organization developed to ensure the highest level of competency and education of medical practice executives. ACMPE also offers additional certification opportunities through its Fellowship program. This program is the highest honor a member of the organization can earn on a professional development level (MGMA- ACMPE: About, 2013). Founded in 1933, The American College of Hospital Administrators was the first professional association for hospital administrators, as an avenue for clinically trained and lay administrators to collaborate on hospital-related issues (ACHE:About, 2013). Both of these organizations are the premier resources for professional development of their segment in the healthcare industry. The number of professional academic organizations for healthcare executives has continued to grow over the years with the intent of improving the quality of health administration education. 9

11 Leadership Training Evolution Outside of the formal university setting and professional academic programs, many healthcare organizations have developed their own management essential training programs. These programs were created in response to the growing need of an individual healthcare system and are typically focused on resolving or driving change. The educational opportunities are delivered in mediums like self-learning courses, online learning certification and conference based training. Aimed at mid-to-executive level development, these options are often cost prohibitive and labor intensive for many healthcare systems. Due to the complexity of the healthcare industry, one organization saw the necessity to develop their own program to meet the specificity of their needs. This organization realized that with the rapid growth they were experiencing, the necessity to transform from a management to leadership mentality was critical for their continued success. The healthcare organization and a local university aligned to develop an academic program in response to the need to move from management to leadership in medical practices. This alignment between the two entities partnered senior leaders and subject matter experts from the healthcare organization with academic professionals in the development of an adult-learner focused certification program for leadership in the medical practice setting, tailored to the needs of the healthcare organization. After evaluating the current state of leadership within the organization and identifying the opportunities for improvement, the program participation was limited to existing practice managers and potential practice managers that were meeting the requirements necessary to become a leader in the organization. The focused group of participants aimed to shift current managers to leaders and promote potential leader 10

12 candidates into the next level of their career. The healthcare organization required the modules to encompass the elements of the Body of Knowledge as identified by the American College of Medical Practice Executives. A motivating factor for the healthcare organization was its stated value of excellence identified as leading in quality through expertise. The certificate program encouraged both continued academic pursuits and further preparation for the ACMPE board certification program. The healthcare organization leading the drive of this customized leadership training is comprised of a five hospital system with a multispecialty clinic physician group of over 350 physicians located in a saturated market with intense competition. The physician group leadership team initiated the creation of the program to ensure their success through highly effective leaders. The university that entered the partnership is a dynamic and comprehensive center of undergraduate, graduate and professional education that is on the leading edge of education not only in the geographical area but also the nation. The university is comprised of three campuses located throughout the state and offers eleven specialized schools and colleges. These schools include liberal arts, law, pharmacy, medicine, business, engineering, education, theology, music, nursing, and continuing and professional studies. Included in the university structure is an independent organization that is focused on enhancing the future of health care delivery and education. This segment of the university was the driving innovator in structuring the level of education and research necessary to develop the product to meet the needs of the healthcare organization. After designing the curriculum, both the healthcare organization and university implemented the leadership training program. The program consisted of ten training modules delivered in an online and classroom setting that spanned a 17 week period. To earn the certificate, participants have to complete 11

13 90% of the course work in each module. For the face-to-face meetings, participants must attend a minimum of five hours of class time. Instructors for each online session set the parameters for the 90% completion. Each module includes a synchronous assignment and discussion as well as synchronous class sessions for the seven online modules. Each online module included at least one hour live chat session scheduled weekly for each online module. Each module required ten hours of work time/class time whether face-to-face or online. This meaning that during the meeting weeks, participants should be spending a minimum of ten hours working on assignments, responding to discussion prompts from the instructor and classmates. Students have the opportunity to evaluate each module upon completion. The program was structured around ten different learning modules that meet the three defined responsibilities of a healthcare administrator. These aforementioned responsibilities can be actualized as the oversight of business and financial operations, quality patient care, and the upholding of a company s culture. The modules were structured in outlining both foundational and advanced elements of which the organization felt important. The five modules pertaining to foundational elements include: organizational communication, human resources, effective interpersonal relationships, and consumer behavior. The remaining five modules embracing the advanced elements include: strategy and planning, information management, financial leadership, healthcare compliance and effective leadership. Each one of these modules builds upon the other with linking themes that were designed to strengthen the participants self awareness and professional development. The certificate program s success was constantly measured including a pre, mid and post assessment. These assessments were developed to ensure that the curriculum was meeting the needs of the participants as well as giving the university the ability to restructure 12

14 the program as needed. Faculty and staff were also utilized to provide feedback based on observations during and after the completion of the program. The periodic reviews were critical to the program s success as well as the continue offering of the certification for future candidates. The return on the investment for the healthcare organization is immeasurable due to the success of the program. Candidates were able to take their learned skills from the program and apply them to practice with the ability to see instant results within their clinics. The pilot cohort truly became the standard expectation of the organization s requirements from their clinic managers. Not only did the healthcare organization gain the ability to further educate their current practice leaders, but the organization was also able to leverage the program to accelerate the leadership development progression in those not already in a leadership role. After completion of the certification, the candidates were called upon to help lead the organization on many other initiatives. This perception of having colleagues helping to drive the success of the organization created a level of engagement from the other practice managers that promoted self-development. The university also experienced great success from the partnership of this program. The university gained a valuable and successful partnership that further strengthened their experience in the healthcare field. After the successful completion of the pilot cohort, both the healthcare organization and university agreed that it was vital to offer the program to additional candidates within the organization. Currently, the program is in the initial stages to begin accepting applicants for the second cohort. The program is scheduled to be offered on a two year cycle moving forward. 13

15 Conclusion This organization realized an apparent void in leadership training that met their needs. Through innovation and collaboration, the response to the issue has been a valuable success that will continue to develop to combat the ever changing economy. This organization exemplifies the movement that many healthcare organizations will begin to incorporate as the dynamics of the industry continue to change. The ability to adapt and create synergies with subject matter experts that can create a focused, concise program curriculum to meet a specific need will continue to flourish. Whether it is through professional development, academic programs or even higher education institutions, the future success of leaders within healthcare organizations will rely on the collaboration and development of programs that are applicable to their needs. Broad, overview-style programs that follow a general applicability format will become obsolete as the healthcare industry adjusts to the ever-changing landscape. 14

16 References A Brief History of Healthcare Management. ACHE. Cynthia Carter Haddock, (June 30,2013) ACHE: About. American College of Healthcare Executives ACHE.org (June 30, 2013) AMA: Our History. American Management Association AMAnet.org (April 25, 2013) AUPHA: History. Association of University Programs in Health Administration AUPHA.org (June 30, 2013) Healthcare Administration: Historical Background healthcareadministration.com. (June 26, 2013) MGMA-ACMPE: About. Medical Group Management Association MGMA.com (June 30, 2013) NMA History. National Management Association NMA1.org (April 25, 2013) "The 1900s: Education: Overview." American Decades Encyclopedia.com. (April 25, 2013). 15