Developing Physician Leaders

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Physician engagement is paramount as hospitals and health systems navigate the transition from volume to value. But engagement alone won’t be enough to ensure organizational success. As the hospital field tackles clinical integration, population health and performance improvement to drive transformational change, physician leadership is crucial.

And its value is obvious, says Ana Pujols McKee, M.D., executive vice president and chief medical officer of the Joint Commission. “Physician engagement and leadership is different at higher-performing organizations,” she says, where they play an active role in setting and achieving the organization’s vision.

Peter Angood, M.D., president and CEO of the American Association for Physician Leadership, notes that “the current shift in health care has resulted in greater physician engagement and increased physician interest in leadership roles.” The main challenge is that few physicians are adequately equipped to handle those responsibilities. “As more physicians prefer to be employed, we need to be more proactive to ensure that they have adequate physician management training,” Angood says.

McKee concurs. “Most physician leaders are tossed into their roles without any prep work,” she says. “They are not sufficiently prepared to take on their new responsibilities.”

In the past, hospitals looked for physicians with strong clinical skills, high volume and likability. Now the focus is also on physician leaders with exceptional people skills, capable of communicating effectively and building trust and buy-in across multidisciplinary groups. Management training and knowledge of leadership principles are important ingredients for success. “Physician leaders must be able to build, collaborate, motivate and move strategy in the right direction,” says Angood.

The onus falls on hospitals to help find and develop the best candidates. “More successful physician leadership development programs spend time on the people aspect, rather than the business side,” says John Combes, M.D., senior vice president and chief medical officer of the American Hospital Association and chief operating officer of the AHA’s Center for Healthcare Governance. Building knowledge of the business side, including finance and human resources, remains important, of course, but so does building self-awareness and emotional intelligence to lead and influence positive change within the organization.

A big challenge is competition for physicians’ time. To earn their interest, it’s best to focus on the patient, Combes advises. “It’s important to show them that their development as leaders is essential for the success of the organization as a clinical enterprise, and not simply as a business enterprise,” he says.

Physician competencies: From top doctor to physician leader

The competencies that make an individual a good physician are not the same competencies that make a physician a great leader. However, the heart of being a good physician leader is being a good physician.

Physician Core Competencies

1. Medical knowledge: Exhibit proficient knowledge of biomedical, clinical and cognate sciences and application of patient care.
2. Patient care: Provide compassionate, appropriate, effective patient care.
3. Practice-based learning and improvement: Continually assess and evaluate patient care practices and assess and assimilate scientific evidence.
4. Systems-based practice: Provide cost-conscious, effective medical care. Promote patient safety.
5. Professionalism: Demonstrate a commitment to carry out responsibilities. Adhere to ethical principles. Be sensitive to a diverse patient population.
6. Interpersonal and communication skills: Demonstrate skills that result in effective communication exchange. Work effectively with other members of the health care team.
7. Use of informatics: Use informatics to enhance patient care delivery.

Next-Generation Core Competencies

In addition to the standard physician core competencies, physicians need to develop and enhance the following skills to be effective leaders as the health care delivery system transformation continues.

1. Systems theory and analysis: Identify ways to improve the quality and safety of patient care through greater care coordination and process improvement.
2. Use of information technology: Effectively use information technology to improve the quality and safety of patient care.
3. Cross-disciplinary training and multidisciplinary teams: Understand and respect the skills of other practitioners.
4. Expanded knowledge: Develop greater understanding of population health management, palliative and end-of-life care, resource management and medical economics, health policy and regulation.
5. Interpersonal and communication skills: Further enhance interpersonal and communication skills to become a true member of the team. Demonstrate empathy and understanding of cultural and economic diversity. Practice excellent customer service. Improve time management. Enhance conflict management skills and provide effective performance feedback. Improve emotional intelligence, self-awareness and relationship management.

Source: “Lifelong Learning: Physician Competency Development,” AHA’s Physician Leadership Forum, 2012

Physican leadership development Q&As

What are the first steps in creating a physician leadership development program?

It’s crucial for hospitals and health systems to provide development opportunities to ensure a pipeline of effective physician leaders within the organization. The programs should align with the organization’s mission and vision, and physician leaders should be well-versed in the organization’s goals and strategic direction, and be able to communicate the message effectively. Support from senior leaders is essential for these development programs to succeed, as is physician involvement in the program’s creation.

What are the types of leadership development programs?

Physician leadership development programs can take many forms. Some hospitals and health systems create formal leadership development programs that run anywhere from six to 24 months. Physicians are selected or can apply to participate in these programs, which typically comprise both online and in-person training, as well as practical application and ongoing mentoring and coaching. Numerous organizations offer leadership development programs or seminars designed to grow physician leaders.

Why is a physician leadership development program so important?

• Increases physician engagement and satisfaction
• Improves collaboration among team members
• Creates alignment on vision and strategic direction
• Enhances care coordination and quality of care
• Facilitates clinical integration

What are the challenges facing the creation of a physician leadership program?

Resources: Physician leadership development programs vary in cost. Hospital- or hospital system-based leadership development programs are resource-intensive, but allow for the program to be tailored to the organization’s needs. Seminars or other programs may require travel in addition to the program cost.

TIME: Physician schedules are already packed. Time spent on leadership development means time away from patients and other duties.

CULTURE: Physician leadership training requires a shift in mindset from what most doctors were taught in medical school. Success as a physician leader does not rest on personal accomplishment, but rather on the ability to lead and influence others.

Sources: H&HN research

Key steps toward developing physician core competencies

The development of physician core competencies begins during medical training. However, medical training and residency programs focus primarily on the development of technical skills and clinical knowledge. Until the development of physician core competencies is fully embraced during training and residency programs, hospitals and health systems must provide opportunities for physicians to adopt and enhance their skills.

Foster continuous learning

Provide training and development opportunities to help physicians enhance their core competencies. Establish a physician leadership program to improve leadership skills and management techniques. Provide team-based training and practice team-based rounding.

Develop focus

Integrate the core competencies into the credentialing, privileging and peer-review process.

Enhance physician alignment

Identify opportunities for greater physician involvement in hospital operations.

Provide performance improvement training

All members of the care delivery team should be educated in performance improvement techniques to ensure continuous quality improvement.

Source: “Lifelong Learning: Physician Competency Development,” AHA’s Physician Leadership Forum, 2012

Case Study: Mountain States Health Alliance, Johnson City, Tenn.

Mountain States Health Alliance is an integrated delivery system with 13 hospitals in four states. In 2010, the organization revamped its physician leadership program to help build bench strength across its various entities. “We were looking for ways to involve our physicians,” says Morris Seligman, M.D., senior vice president and chief medical officer. “We want them to be part of the team, to help lead and drive important initiatives and strategy across the organization.” The resulting Physician Leadership Academy comprises seven to eight courses over a two-year period. Participants are nominated by the hospital CEOs and CMOs. “We look for physicians who show promise or express interest in wanting to help lead,” Seligman says. The courses are primarily in-person with online makeup sessions available. The hospital CEOs attend sessions to develop shared learning and to enhance engagement. Seligman recommends providing opportunities to involve former participants in the program through social and networking events.