Cultivating Effective Physician Leaders

Transcription

1 Physician Executive Council Cultivating Effective Physician Leaders Taylor Hurst Consultant Physician Executive Council

2 Sitting at a Critical Intersection of Influence Successful Engagement Efforts Depend on Physician Leader Partners 6 Two Critical Traits for Influencing Physicians Clinical Credibility Physician Leaders Organizational Authority Source: HR Investment Center interviews and analysis.

3 Physician Leader Ranks Not Always Up to the Challenge 7 8 out of 9 Prefer Physician Leaders to: Organizational priorities that physicians are more confident in physician leaders to manage Implement evidence-based standards Reduce unnecessary care Introduce new protocols for diagnosis and treatment Manage primary care shortages Manage rising costs of care Form strategic partnerships and ventures Negotiate with payers Respond to increased transparency Improve Clinical Operations Forward Strategic Imperatives Physicians interested in leadership roles N=12,600 44% Hospitals with less than 10% of physicians involved in leadership responsibilities N=292 67% Source: Navigant Healthcare, Survey: The Value of Physician Leadership, 2015; Betbeze P, Physician Alignment: The Collaborative Care Disconnect, HealthLeaders Media, September 2011; Advisory Board Survey Solutions national physician engagement database, 2016; HR Investment Center interviews and analysis.

4 8 Occupying a Murky Middle Between Clinicians and Managers Physician Leadership Really Is Different Practicing Physicians Physician Leaders Non-physician Leaders Typical Leadership Role Informal only Formal title, vague assignments Formal and defined Performance Goals Largely individual Often ambiguous and illdefined Defined organizational outcomes What They Want to Learn About Best clinical practice How to lead within evolving care delivery systems How to hit unit goals and manage staff Support Infrastructure Robust clinical team Minimal Robust staff support Source: HR Investment Center interviews and analysis.

5 Cultivating Effective Physician Leaders 9 Cultivating Effective Physician Leaders Enhancing Physician Leader Development 1. Hybrid Leadership Training 2. Physician Leadership Experience Forums 3. Strategic Leadership Coaching Partnerships Targeting Development Efforts to High Potentials 4. Innate Leadership Skills Assessment 5. Sudden-Loss Leader Identification Source: HR Investment Center interviews and analysis.

6 Leadership Training a Logical Foundation When Offered, Organizations Pursue One of Two Distinct Approaches 10 Two Common Approaches to Physician Leader Development Physician-specific Training All-leader Training Source: HR Investment Center interviews and analysis.

7 Isolating the Advantages of Each Model 11 Primary Differentiators Between All-Leader and Physician-Specific Training All-Leader Physician-Specific Exposes physicians to general leadership skills Skills Development Targets unique physician skill gaps Builds relationships with administrative leaders Relationship Building Builds a strong physician cohort Limits need to duplicate training courses Logistical Convenience Coordinated around hectic physician schedules Source: HR Investment Center interviews and analysis.

8 Practice #1: Hybrid Leadership Training Unique Paths, Same Solution Two Organizations Achieve Hybrid Model From Different Start Points 12 Focus of Leadership Training Relationship Building vs. Targeted Content Relationship Building With Administrative Leaders All-Leader No Training North Shore-LIJ ThedaCare True Hybrid Physician-Specific North Shore-LIJ 1 : Physicians included in portions of pre-existing leader development activities in addition to physician-specific curriculum ThedaCare: Content specific to physician issues, but training focused on physician-administrator dyads to foster teamwork Targeted to Most-Relevant Physician Leadership Skills 1 Now known as Northwell Health. Source: North Shore-Long Island Jewish Health System, Great Neck, NY; ThedaCare, Appleton, WI; HR Investment Center interviews and analysis.

9 Contrasting Key Program Features Mixed-Curriculum Approach vs. Dyad-Centered Approach 13 Components of Hybrid Leadership Development Programs Organization Development Philosophy Participants Sample Curriculum North Shore- Long Island Jewish Incorporate physicians into most relevant allleader development activities to promote collaboration; supplement with physician-specific justin-time skills training 50 physician participants, broken into four tiers: emerging, team leaders, operational leaders, and strategic leaders Integrated: Business/administrative training (e.g., budgeting) Monthly executive forums with facility CEOs Tri-monthly CEO breakfasts Separate: Physician-specific skills training (e.g., reform, emotional intelligence, conflict resolution) External and group coaching Individual capstone project ThedaCare Address physician likelearning needs, improve physicianadministrator dyad effectiveness through team-development and topical training 20 physicianadministrator dyad pairs from nine call groups and ED, five senior physician leaders Dyad Development: Strengths-identification assessment Aligning dyad responsibilities with system priorities workshop Start-stop-continue dyad feedback exercise Skill-Building: Meeting management skill-building Staff development training (e.g., conflict management, coaching) Source: North Shore-Long Island Jewish Health System, Great Neck, NY; ThedaCare, Appleton, WI; HR Investment Center interviews and analysis.

10 Overview of Hybrid Leadership Development Programs 14 North Shore-LIJ Health System 5,600-bed, 15-hospital system based in Great Neck, New York; employs 2,000 physicians Implemented two-year, physician-specific leader development program to supplement existing all-leader development opportunities Physicians nominated by medical chairs, selected based on diversity of experience, specialty, and facility; 50 physicians participate in each program Skill-specific classes offered weekly over month-long period to accommodate physician schedules; no class longer than four hours in duration At beginning of program, physicians complete personal assessment identifying relative strengths, weaknesses; target curriculum to individual needs ThedaCare 362-bed, five-hospital system based in Appleton, Wisconsin; employs 200 physicians Implemented dyadic learning process with physician leaders and practice administrators to enhance effectiveness of leader dyads through team-building, skills training Training includes leadership dyads from nine specialty-specific call groups and ED physicians; approximately 45 individuals participate in each class Mandatory full-day classes held twice yearly at off-site location; classes taught by OD Specialist and Senior Medical Director of Physician Services In addition to dyadic development, all physicians must attend week-long retreat on introspective leadership in first year of employment Source: North Shore-Long Island Jewish Health System, Great Neck, NY; ThedaCare, Appleton, WI; HR Investment Center interviews and analysis.

11 Which Path to Take? Preferred Approach Depends on Organizational Starting Point 15 Focus of Leadership Training Relationship Building vs. Targeted Content All-Leader True Hybrid Relationship Building With Administrative Leaders No Training Targeted to Most-Relevant Physician Leadership Skills Physician-Specific Source: HR Investment Center interviews and analysis.

12 Additional Implementation Guidance 16 Key Elements of Effective Physician Leadership Training Recommended Content: Budget operations and financial management Strategic visioning Business planning Change management and innovation Project management Listening and communication skills Health care economics Ethics and regulatory compliance Quality and process improvement Conflict management Managing disruptive physicians Performance management and goal setting Limited Time Commitment Limit class length to ideally two, at most four, hours; consider offering evening courses, multiple offerings of same class to accommodate physician schedules Clear Prioritization Clearly delineate courses physicians should definitely attend, as well as those that they should NOT attend Multi-Modal Learning Incorporate various learning methods (e.g., small-group discussion, skill enhancement workshops, real-time case studies) to appeal to a wide range of physician learning styles High Bar Limit training to exclusive group of high-performing, interested physicians; targeting physicians with greatest potential better use of resources, plays to physicians natural competitiveness Follow-up Consider supplementing formal training with optional follow-up (e.g., roundtable discussions, book clubs on leadership topics) to further engrain physician leadership skills Source: Advisory Board Talent Development, HR Investment Center interviews and analysis.

13 Advisory Board Approach to Physician Leadership 17 Three Critical Elements for Physician Leader Success Right Mindset See self as leader Want to get involved, solve problems Willing to defend unpopular decisions Right Skills Ability to lead through influence, not fiat Grasp of business and finance fundamentals Strong change leadership skills Next-level collaboration techniques Right Knowledge How the market (and organization) is changing Emerging payment models Physicians role in care redesign True drivers of consumer choice and loyalty Source: Advisory Board Talent Development.

14 Practice #2: Physician Leadership Experience Forums Putting Leadership Skills in a Broader Context Cleveland Clinic Forums Illustrate Real-World Application of Skills 18 Key Elements of Leadership Rotation Program Participants Timeline Content Lessons Learned 14 new and emerging physician leaders, scientists selected based on department director or institute nomination Group convenes one full Friday each month for six months; meets with two or three existing hospital leaders each session Presenting leader explains current role in organization, leadership journey, day-to-day responsibilities At program conclusion, each participant creates leader development plan and has opportunity for career coaching Case in Brief: Cleveland Clinic 3,119-bed, physician-led health system based in Cleveland, Ohio; employs 2,700 full-time physician staff, 1,100 trainees Implemented Leadership Rotation Program to expose new and emerging physician leaders to existing hospital leadership and leadership challenges, foster collaboration Each cohort meets with 20 physician and non-physician leaders across 6-month program Source: Cleveland Clinic, Cleveland, OH; HR Investment Center interviews and analysis.

15 Exposing Participants to Diverse Perspectives Presenters Embody Cross-Section of Organizational Leadership 19 Sample Leadership Rotation Presenters Medical Chief of Staff Chair, Research Institute Chief Nursing Officer Chair, Education Institute VP of Human Resources Director of Construction Chief of Operations Director of Security Chief Financial Officer Chief Information Officer Environmental Services Director Source: Cleveland Clinic, Cleveland, OH; HR Investment Center interviews and analysis.

16 Additional Implementation Guidance 20 Key Elements of Leadership Experience Forums Common Starting Point Begin each presentation with parallel information: presenter s current role, leadership journey, day-to-day responsibilities Open Agenda Keep agenda open-ended where possible; allow participants to guide discussion based on topics of greatest interest Presenter Diversity Incorporate a wide variety of physician and non-physician leaders to expose participants to a range of leadership perspectives Structured Next Steps Link broader lessons learned to creation of individual leadership development plan over course of program Administrative Oversight Include administrative representative in sessions (e.g., HR, OD, Chair of Education Institute) when possible to monitor discussion, provide additional direction where necessary Team-Building Invite both new and emerging physician leaders to participate as space allows; promote discussion between participants to foster collaboration, relationship building Limited Frequency Avoid depleting presenter resources by offering program more than once per year; limit presentation time to two hours maximum Source: Cleveland Clinic, Cleveland, OH; HR Investment Center interviews and analysis.

17 Practice #3: Strategic Leadership Coaching Partnerships Honing Leadership Skills Through Hands-On Experience LVHN Targets One-on-One Coaching to Individual Skill Gaps 21 Three Key Components of Physician Leader Mentorship Process Learning Goal Definition Physicians identify 1-3 SMART 1 learning goals Goals based on self development, organizational learning Action Plan Creation Physicians create action plan for recording criteria for success, measurements, goal milestones Monthly Check-Ins Physician, mentor meet individually each month Mentor reviews goal progress, offers recommendations Case in Brief: Lehigh Valley Health Network 988-bed, two-hospital system based in Allentown, Pennsylvania; employs 500 physicians High potential physician leaders eligible to participate in the Institute for Physician Leadership, an internal leadership development and mentoring program; Institute led by CMO and directed by internal OD consultant 40 physician fellows nominated for Institute by senior leadership every three years 1 Specific Measurable Action-Oriented Realistic Timely. Source: Lehigh Valley Health Network, Allentown, PA; HR Investment Center interviews and analysis.

18 Fellows Select Own Coaches for Greatest Compatibility Seeking Matches With Common Interests, Expertise 22 LVHN Physician Leader Mentorship Pairing Process Mentors complete questionnaire describing leadership experience, strengths Fellows review questionnaires, identify top five potential mentors based on interests, learning goals CMO and OD consultant match physicians with mentors based on selections Participants create mentorship agreement outlining terms, committing to productive relationship Official mentoring partnership lasts two years Source: Lehigh Valley Health Network, Allentown, PA; HR Investment Center interviews and analysis.

19 Providing Fellows a Clear Picture of Coaching Options 23 LVHN Mentor Profile 1 For complete version of LVHN s Mentor Profile, please see the Appendix. 1 Mentor profile was under revision during the creation of this study. Source: Lehigh Valley Health Network, Allentown, PA; HR Investment Center interviews and analysis.

20 Coaching Pairs Equipped With Structured Resources 24 Mentoring Agreement Mentor/Fellow Expectations SMART Goals Worksheets For complete versions of LVHN s Mentoring Agreement, Mentor/Fellow Expectations, SMART Goals Worksheet, and SMART Goals Action Plan, please see the Appendix. Source: Lehigh Valley Health Network, Allentown, PA; HR Investment Center interviews and analysis.

21 Engaging the Physician Workforce 25 Cultivating Effective Physician Leaders Enhancing Physician Leader Development 1. Hybrid Leadership Training 2. Physician Leadership Experience Forums 3. Strategic Leadership Coaching Partnerships Targeting Development Efforts to High Potentials 4. Innate Leadership Skills Assessment 5. Sudden-Loss Leader Identification Source: HR Investment Center interviews and analysis.

22 Formal Development Yielding Mixed Results 26 Three Potential Outcomes of Physician Leadership Development Outcome High-Caliber Leader Short-Term Leader Ineffective Leader Description Candidate develops into quality leader, demonstrating strong leadership skills and ability to drive organizational vision Candidate develops into above-average leader, but tenure in role limited due to lack of interest in leadership responsibilities Candidate never develops into effective leader, demonstrates lack of inherent leadership skill or ability Source: HR Investment Center interviews and analysis.

23 Current Selection Process Often Casts Too Wide a Net Defined Screens Better Predictors of Leader Development Success 27 Comparing Two Methodologies for Physician Selection for Formal Development Approach Description Representative Selection Screens Representative Success Rate Wide-Net Approach In attempt to maximize number of physician leaders, organization includes wide variety of physicians in formal development Strong clinical skills Interest in leadership Participation in volunteer committees Influential opiniondriver Organizational tenure Fraction of graduates successful leaders; poor use of limited development resources Ends-Based Approach Organization selects candidates with desired leadership skills in mind Proven leadership aptitude, potential Demonstrated skills necessary for specific leadership role Majority of graduates successful leaders; strong return on investment Source: HR Investment Center interviews and analysis.

24 Practice #4: Innate Leadership Skills Assessment Selecting Candidates Based on Innate Leadership Ability Formal Assessment Targets Physicians for Further Development 28 The Nebraska Medical Center Nomination Process for Physician Leadership Development Acting physician leaders identify promising candidates in their area based on demonstrated leadership skill Formal assessment measuring five leadership competences completed for each identified candidate All assessments reviewed 1 ; selection based on three considerations: (1) overall score, (2) current role, (3) bench strength Final group of emerging leaders begins three-year development program including didactic training, external coaching Case in Brief: The Nebraska Medical Center 624-bed hospital located in Omaha, Nebraska; small employed physician population Implemented formal Leadership Qualities Profile to measure leadership potential of candidates for Physician Leadership Development Series 1 Medical Executive Committee consists of Physician Administrator, Program Director, Program Founder, Chief of Staff, and Vice Chief of Staff. Source: The Nebraska Medical Center, Omaha, NE; HR Investment Center interviews and analysis.

25 Evaluating Discrete Leadership Competencies 29 Leadership Qualities Profile Assessment outlines five leadership competencies: Professional Credibility Personal Commitment Quality Improvement Behaviors Institutional Linkages Strategic Vision Each competency supplemented by detailed supporting behaviors; behaviors rated on 1-5 scale For complete version of Leadership Qualities Profile, please see the Appendix. Source: The Nebraska Medical Center, Omaha, NE; HR Investment Center interviews and analysis.

26 Practice #5: Sudden-Loss Leader Identification Selecting Candidates Based on Role-Specific Skill Sets Maine Medical Physician Chiefs Identify Future Successors 30 Overview of Successor Identification Process for Physician Leaders Each medical chief identifies physician with necessary skills to fill his/her role Chief, identified successor create action plan for developing critical competencies Successor s direct manager reviews, approves proposed action plan Final group of identified successors begin formal leader development program Case in Brief: Maine Medical Center 637-bed academic medical center located in Portland, Maine; employs 330 physicians Implemented physician leadership successor identification process for 25 chiefs of clinical practice in 2010, then expanded process to include medical directors Source: Maine Medical Center, Portland, ME; HR Investment Center interviews and analysis.

27 Success Dependent on Several Key Program Features 31 Critical Elements of Successor Identification Process Key Element Physician-Identified Successor No Default Selection Detailed Action Plan Clear Role Definition Cohort Training Description Successors chosen by physician leader familiar with unique skill set required for the role, both administrative and clinical Existing physician leaders encouraged to leave successor space blank rather than select physician poorly suited for leadership; alerts organization to potential hole, prevents suboptimal use of development resources Action plan outlines critical competencies for role, includes specific timeline, directs successor towards necessary resources for skill development Existing physician leader and successor s manager coordinate ownership of successor development to ensure efforts are not duplicative or at cross-purposes Identified successors participate in formal leadership training as a group, rather than one-off skill-building; creates teambuilding, leverages economies of scale Source: HR Investment Center interviews and analysis.

28 Strategies for Promoting Physician Participation 32 Representative Approaches for Garnering Physician Involvement in Formal Leader Development Exclusivity CMO Encouragement Performance Accountability Compensation Leadership Access Limit attendance to small group of physicians; make participation an honor Promote attendance through senior physician leadership Hold physicians accountable for attendance in performance evaluation Pay physicians for time taken away from clinical responsibilities Grant participants greater access to organizational leaders Source: HR Investment Center interviews and analysis.

29 At Risk of Over-Selling Leadership Unrealistic Expectations of Role Can Derail Development Efforts 33 Range of Physician Assumptions About Leader Roles Overly Negative Accurate Overly Positive Physician Reaction: Uninterested in pursuing formal leader positions Organizational Impact: Difficulty finding willing physicians to take on leadership roles; leaders are self-selected without regard to innate ability Physician Reaction: Undergo extensive training only to discover lack of interest in actual leader responsibilities Organizational Impact: Development dollars wasted on physicians not well-suited to leadership roles Source: HR Investment Center interviews and analysis.

30 Providing a Reality Check Ensuring Selected Emerging Leaders Have Accurate Perception of Role 34 Three Strategies for Exposing Physicians to Leadership Responsibilities Leadership Shadowing Dedicated Committee Positions Leadership Boot Camp Physicians interested in leadership roles accompany existing leader, observe dayto-day responsibilities Organization dedicates select number of positions on committees for physicians interested in leadership roles Hospital offers crashcourse training preview for interested physicians covering core leadership skills, responsibilities Source: HR Investment Center interviews and analysis.

31 Questions? 35 Cultivating Effective Physician Leaders Enhancing Physician Leader Development 1. Hybrid Leadership Training 2. Physician Leadership Experience Forums 3. Strategic Leadership Coaching Partnerships Targeting Development Efforts to High Potentials 4. Innate Leadership Skills Assessment 5. Sudden-Loss Leader Identification Source: HR Investment Center interviews and analysis.

32 Key Executive Takeaways 36 Look for Synergies Many existing leader development strategies equally effective for physician leader development; organizations should extend existing offering to physicians where appropriate Supplement Classroom Training Risk of skill atrophy particularly acute for over-burdened physician leaders; provide context and individualized development outside the classroom to further engrain leadership skills, maximize impact of formal training Limit Time Commitment Physicians likely to decline development all together if too time intensive; cap course length, offer night sessions, and clearly delineate which offerings most and least relevant Focus on High-Potentials Not all physicians have innate leadership aptitude; best use of development dollars to target physicians with greatest potential for leadership success Create Accurate Perceptions of Leadership Ensure physicians fully understand leadership roles before investing development resources; participants with overly positive views likely to lose interest as program progresses Source: HR Investment Center interviews and analysis.

33 37 Inform Our New Physician Engagement Research Your Data-Driven Roadmap for Physician Engagement Review top engagement drivers for independent and employed physicians Pinpoint hotspots of physician engagement (and discontent) by specialty, tenure, age, and more Learn proven engagement best practices which map to specific engagement drivers Identify engagement strategies that aren t dependent on extensive infrastructure or resources Ensuring Top PEC s Physician the Drivers actions of Engagement Focus of your executive Drivers team reflect the goals and priorities of physicians Ensuring the actions of executive team reflect goals and priorities of physicians Effectively soliciting and responding to physician input Positioning the organization as a strategic partner to physicians Cultivating interest in physician leadership opportunities Recognizing physicians for excellent work To participate in a research interview, please Taylor Hurst, hurstt@advisory.com 2018 The Advisory Board Company advisory.com 28440C

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