sitian Leadership Develo

Transcription

1 sitian Leadership Develo BY JOHN M. BUELL Ddient:

2 High-performing physician leaders are critical in this era of health reform. Well-developed physician leaders can help healthcare organizations achieve goals for improved quality of care and financial success. For hospitals and health systems to make significant improvements in the value of care provided, it is critical that physicians become involved in clinical process improvement efforts, which require a teambased approach, according to experts such as John R. Combes, MD, president and COO, Center for Healthcare Covernance, and senior vice president, American Hospital Association (AHA), Chicago, and James A. Rice, PhD, FACHE, former executive vice president, Covernance and Physician Leadership, Integrated Healthcare Strategies, Minneapolis; vice chairtnan. The Covernance Institute, San Diego; and project director for Management Sciences for Health, Cambridge, Mass. You may be asking yourself, however, how can my organization develop physician leaders so that they are part of a team when physicians historically have been trained to make fast, smart, independent decisions with minimum amounts of clinical information? "Physicians are captains of the ship in the OR and ED, and all of their didactic and bedside learning has been about clinical processes, clinical systems and making independent decisions," says Rice. Getting physicians to change won't be easy, say Combes and Rice, but there are factors already in place that demand healthcare

3 Physician Leadership Development organizations develop better physician leaders and more of them. Catalysts and Need for (tianqe Physician leadership isn't a new concept. Many hospitals use physician academies and universities to train physicians to become executives. The idea, though, isn't widespread. But efforts are under way to change that. In 2009, a group within the AHA felt strongly that the organization needed to look at ways it could help develop physician leaders, similar to its focuses on governance and quality of care issues. "We put together a group to look at creating strong relationships with physicians and moving physicians away fix)m the idea of being a customer of the organization and toward being a partner in delivering care and helping the organization transform care," says Gombes. What came out ofthat group is AHA's Physician Leadership Forum, which Gombes leads, designed to work more closely with the medical community to identify best practices and deliver value-based care. A prominent organization such as the AHA saying that physician leaders are needed to transform the delivery of care isn't the only impetus for change. Other major factors contributing to the need for physician leaders are chronic diseases. which, to treat effectively, will require physicians to work in groups and interdisciplinary teams to manage the care process, according to Rice. Ghronic diseases fall into four major areas: cancer, cardiac, neurosciences and orthopedics, and account for more than 70 percent of the money flowing into acute-care hospitals and doctors' offices, says Rice. "Hospital executives should be open to working with physicians as partners around the care of the patient, and we have to trust the physician that he or she can be part of a team and build that up from our perspectives as well." -JohnR.(ombes, HD, (enter for Healthcare Governance, American Hospital Association "The logic is more chronic diseases require teams to intervene and manage the care and associated costs, and this calls for more physician leaders who are comfortable, confident and competent with leading groups, teams, process improvement activities and new clinical service lines," he says. "To get at this modern equation of value for money improved clinical outcomes, better patient experience and better safety those three dimensions of quality have to be achieved in a cost-effective way," says Rice. "To do that we can't have administrative people squeezing out administrative fat. More importantly, we need to redesign processes in which we make diagnoses and create interventions to improve the care delivery process, and we need more effectively trained clinical leaders to accomplish this. "We finally recognized that we need to redesign our delivery systems," continues Rice. "To deliver better value for money in a chronic disease area, we must be able to have a smooth, seamless and integrated delivery system. When patients with chronic diseases go to the hospital, the doctor's office or the ER and then are discharged to their home, assisted living or skilled-nursing facility, few systems are ready, willing and able to manage the movement of these patients in and out ofthat delivery system." Competencies Required With the need established for developing physician leaders, what are the competencies required for physicians to be effective leaders? Rice says hard skills such as financiáis and strategic planning are important for physicians to obtain, but softer skills teamwork, self-awareness, interpersonal interaction, conflict management and change management are even more vital. 20 Healthcare Executive JAN/FEB 2012

4 Physician LeaJersliip Development: Physician leadership is increasingly performed in groups, teams and a variety of venues, according to Rice, which include small offices, large clinics, hospitals, diagnostic centers, surgical teams, health plans and community-health enhancement programs. Daniel R. Stultz, MD, FACHE, president and CEO, Texas Hospital Association, Austin, has served as a physician leader for more than 20 years. An internist, he took a job in 1988 as the medical director of a rehabilitation unit, where, for the first time, he was able to look at the patient via a team approach. "With the nature of inpatient rehab, you have team meetings where you have a physical therapist, occupational therapist, speech therapist and physicians and nurses all in a staff meeting discussing a patient with a complicated illness make progress or in some cases not make progress," says Stultz. "I was exposed to those team staffing meetings each week. I was amazed at what the speech therapist contributed in terms of swallowing disorders. I had never taken advantage of their skiuset before. Team meetings are very effective at caring for patients." Stultz admits that for many physicians, working in a team environment won't be easy. "In a clinical sense, we were trained to be the doctor, and we told nurses what "Hore (liionic diseasps need teams to intervene and manage the (are and the costs, and this needs more physician leaders who are comfortable, confident and competent v^ith leading groups, teams, process improvement activities and nev/ clinical service lines." -James A. Rice, PhD, fa[ ][, The Governance Institute, Hanagement Sciences for Health, and formerly of Integrated Healthcare Strategies we wanted done, and for the most part they would follow our instructions. Medical schools in my day didn't teach us to work in teams or in staff settings, where we have multiple professionals in a room. But working in a team environment, I ate it up and enjoyed it from the first minute. I thought it was the best way to practice medicine." Other competencies that will be required for effective physician leadership are understanding healthcare trends and critical thinking. Ronald L. Kaufman, MD, FACHE, FACP, CMO for California/Nebraska Region of Tenet Healthcare, Anaheim, Calif, has worked as a physician executive for more than 20 years. Competencies that have served him well are the ability to understand healthcare performance trends and effectively communicating how those trends relate to a larger physician community from a physician perspective. "Physicians presenting this information can be more effective," says Kaufman. It's important to understand trends, says Kaufman, because physicians and hospitals frequently get mired in daily fire drills without a clear understanding of how each performance improvement initiative fits into the larger picture. "So what happens is we have daily issues that pop up between hospitals and physicians, and we focus on individual events and review them separately rather than looking at overall performance trends and then benchmarking them against external metrics." Kaufman got his first taste as a physician executive when he volunteered to participate in contract negotiations with health insurers. "From that point I got increasingly involved in those discussions and learned that managers and physicians spoke two languages: the financial perspective and the patientcare perspective. I thought it would be easier for me to learn financiáis rather than financial folks going through clinical training," Kaufman, who earned an MBA himself, says, laughing. "I love being a physician executive," says Kaufman, a rheumatologist with an academic 22 Healthcate Executive JAN/FEB 2012

5 medical center practice, having spent 30 years on the faculty at the University of Southern California in roles from clinician to senior associate dean for administration. "It wasn't that I disliked taking care of patients one at a time, but 1 felt I could have more of an impact on a larger group of patients working with the health system." Stultz, too, gained executive experience negotiating with health plans, and a competency he believes is important to have is something most physicians already possess: critical thinking. "Physicians can bring objectivity to the business world that most don't realize they have," says Stultz. "I'm talking about their approach to diagnosis, which has to be done objectively." Another competency to be an effective physician executive, according to Kaufman, is the ability to acquire meaningful data and analyze and develop informational reports. "Working in a team environment, I ate it up and enjoyed it from the first minute. I thought it was the best way to practice medicine." -Daniel R. Stultz, M D J M, iexas Hospital Association which would be benchmarked against an external comparative set and shared with physicians and hospital executives. "It would be for the joint performance of the enterprise, not just the hospital or physician practice," he says. ; From a C-suite perspective, Carrie Owen Plietz, FACHE, CEO of Sutter Medical Center in Sacramento, Calif., which is part of parent organization Sutter Health, says it's difficuk for her to say which competencies physician leaders should possess because each physician is unique. "Some are inherently collaborative, and some want to move immediately toward making a decision, while others want to get to a consensus." But as organizations like Sutter Medical Center and nearly every other hospital in the country face issues associated with health reform, such as caring for a specific population and providing accountable care, the mindset is shifting about what makes not only an effective physician leader but an effective healthcare delivery system. "It's about learning together and offering physicians the opportunity to gain skills not offered in medical school," says Plietz. "And Healthcare I'.xecutive 2 3 JAN/FEB2012

6 Physician Leadership Development for healthcare executives, it's about making sure we are honestly using all the benefits physicians bring, which is quite a lot." Identifying and Developing Physician Leaders With competencies distinguished, the next step is identifying those with the potential to make effective physician executives and creating ways to develop them. "I love being an executive. I felt I could have more of an impact on a larger group of patients working with the health system." -Ronald L Kaufman, HD, fache, facp, Tenet Healthcare perspectives as well," says Gombes. "We need all the expertise around the table to build a health system that can meet the needs and achieve the outcomes patients deserve." forming a group made up of physicians already identified as leaders, senior managers and even a board member. "Then you have that group invest in training and developing those identified as physician leaders. Some will be formal, and others informal, leaders. Most hospitals are beefing up the medial staff office to support informal leaders. And much of this has to happen parallel to and outside of the medical office structure." "One thing GEOs and senior leaders can do is be more welcoming to physicians," says AHA's Gombes. "That will encourage physicians to be more participative." Gombes suggests GEOs orient new physicians more effectively into the overall hospital enterprise. "We need to change ourselves and not immediately put new physicians on on-call duty without giving them a great deal of support and clear expectations," he says. "There are lots of things we can do to create an environment for building the capacity for clinical leadership. "Hospital executives should be open to working with physicians as partners around the care of the patient, and we have to trust the physician that he or she can be part of a team and build that up from our The most successful systems identify physician leaders in an intentional way, according to Rice. They have a philosophical assertion about why they are doing it and the principles that guide how they are trying to do it. "You need to identify and prioritize the top 10 areas where physician leaders are needed," says Rice. "You also need to develop a philosophy of supporting physician alignment and create a job description and an ideal profile of competencies needed. You layer onto that their clinical skills and their capacity to incorporate the hard and soft skills associated with effective leadership." Next, Rice suggests nominating colleagues in their specialty. "Now you have 100 candidates," says Rice. To get this down to a manageable size, Rice recommends To identify physicians who would make effective leaders, Sutter Medical Genter and its parent, Sutter Health, initially let the process happen naturally. Random physicians were placed in teams on small projects to determine their potential for leadership. "Now we have moved from natural growth to forcing it along," says Plietz. "Otherwise, we weren't effectively looking at actively recruiting talent from within. We know they are out there. It's a matter of having your eyes and ears open for those development opportunities. Some are great at being leaders, and others don't want to be a leader. It's about recognizing that, too." Identifying physician leaders won't be easy, though, says Tenet Healthcare's Kaufman. "Finding a 26 Hcalthc.ire Executive JAN/FEB 2012

7 Physician Leadership Development: physician who wants to undertake this role, which puts them at odds with their peers, will be difficult," he says. "But they can be found. Physician leaders will step forward through medical staff leadership roles. Some may be adversarial and antagonistic toward administrators, but some will demonstrate a desire to be collaborative and work to find optimal solutions as opposed to the best solution for one side or the other. It's about finding that middle ground that improves the enterprise performance." Not every physician should be a leader, Kaufman adds. "It's a very different role. You have to want to do it and understand that the physician doesn't have all the answers to the delivery of healthcare. It really takes all of the disciplines to develop an effective product to improve lives in our community." Once you identify who would make ideal physician leaders, next is developing them to be effective leaders. While physicians' knowledge, skills and attitudes go far beyond their clinical skills, according to Rice, there is a need to change the training physicians get in medical school to incorporate leadership education. "That could take 10 years, though," "It's about learning together and offering physicians the opportunity to gain skills not offered in medical school. And for healthcare executives, it's about making sure we are honestly taking all the benefits of what i physicians bring." -Carrie Owen Plietz, FACHE, Sutter Medical Center says Rice. "We can't wait that long. What has to happen is hospitals and health systems must develop these capabilities themselves, which include offering physician leadership academies." Some organizations have developed physician leadership programs. Sanford Health in Fargo, N.D., is a good example, according to Rice. Sutter Health, too, offers a physician leadership academy and university. A few years back Sutter Health identified within its global integration strategy the need to put a great deal more emphasis on developing physician leaders. One progratn it offers is a leadership model that pairs strong physician leaders with strong executives. In 2005, Sutter Health developed its leadership academy, which trains both administrative leaders and up-and-coming physician leaders. "This is an annual graduate-level training program that brings together 25 different leaders from across the system," says Plietz. Associated with the academy and paired leadership program is Sutter Health university, where multiple levels of physicians gain leadership training. One of the courses offered is managing clinical excellence, in which all emerging physician leaders participate. They are partnered with two other clinical or administrative leaders. The course is for a shorter period of time than the leadership academy and focuses on a single project such as improving turnaround times. "Participants work through a process from beginning to end to understand not only how to work together as a team but also how to solve actual problems within the system," says Plietz. At Sutter Medical Center, physician leader candidates can take advantage of what is offered at Sutter Health University, but the local hospital also has a senior leadership team that includes 15 critical physician leaders and paid rnedical directors of each key service line. "We meet monthly and focus on strategy of the organization," says Plietz. "This past year we concentrated on strengthening physician engagement." 28 Hc.ilrhcare Executive JAN/1 EB 2012

8 Physician Leadership Development: Sutter Medical Center's physician engagement and leadership goals involve physicians beyond just including them in the organization's strategic discussions. Physician leaders there are involved in day-to-day critical issues. "We will have a more effective organization if physicians are truly engrained and part of the leadership team and not just that we need to get their input or approval on something at the last minute," says Plietz. "It is critical that they are part of the leadership infrastructure and strategy moving forward." While formal training through physician academies and other programs are effective at developing physician leaders, informal, on-thejob instruction, including working with mentors, is valuable, too. Texas Hospital Association's Stultz says he gained his executive development this way by working in the rehabilitation unit team on stroke and spinal cord injury patients. "I thought teamwork on the rehab unit was a very effective way to train me not only as an executive but as a physician," says Stultz. Tenet Healthcare's Kaufman gained much of his leadership development through mentorships with GEOs. He said all GEOs should serve in a mentoring role in the development of physician leaders so that physicians who choose to go into that role have a clear understanding of how the entire enterprise functions. This is important for the organization, he says, because a physician executive can communicate effectively between various functions within the hospital enterprise and ensure that the delivery of care is integrated with the financial performance of the organization. "I had some really good and effective mentors along the way, which included GEOs, GNOs and GOOs in that whole process," says Kaufman. Supporting Physician Executives The critical success factor of effective physician leaders is not only developing them but providing an environment that supports them. "Once we have an explicit and intentional recognition of why we want them and why we value them, then we start to develop them and provide an infrastructure to increase the probability of them being successful," says Rice. "We need them to be successful." The key elements of an infrastructure to support effective physician leaders are the following: an organizational philosophy that supports physician alignment; clear position descriptions; modern education and development; orientation to their responsibilities; staff support; technologies and tools to be effective at leading groups, teams and process improvement initiatives; a performance management system that is explicit about physician leaders' roles and responsibilities that also offers periodic reviews and 360 degree reviews of how they are performing; contingency plans on how to improve their skills; and incentive payment. Now that we have a supportive environment, the final step is delivering value in an era of increased accountability and transparency, according to Rice. "We have to be more formal in training and developing of our physician leaders. Our outputs and outcomes will be visible for everyone to see. If we hope to move those indicators in a more positive direction, we can't do it without physicians and physician leaders." Encourage physician leaders to take advantage of what their professional associations offer. The American Gollege of Physician Executives (AGPE) is the home for nearly 10,000 physicians committed to improving patient healthcare through exceptional physician leadership. AGPE is where physicians go to develop their leadership skills and enhance their careers. In addition, in 2012, AGHE, which includes more than 1,400 physicians among its more than 35,000 affiliates, will increase its efforts to provide resources to its physician executives. John M. Buell is a writer with Healthcare Executive. i Icalthcare F^xecutive JAN/FEB 2012

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