When the Iowa Health System board of directors decided to transition from a hospital-centered organization to a physician-led enterprise, it recognized that physicians would need leadership skills training. What was not foreseen: The IHS Physician Leadership Academy would help create the close alignment between administrators and physicians that every health system is desperate to achieve.

"The PLA has exceeded my expectations in driving our vision," says Alan S. Kaplan, M.D., vice president and chief medical officer of the 14-hospital system. "It has created trust between the physicians and the system, and I think the impact is huge."

The academy is not your standard continuing medical education program. Physicians compete for admission — only 36 of 85 applicants were chosen for the first class in September 2010 — and the curriculum is extensive. Participants complete 118 hours of on-site sessions and online courses over a 10-month period.

"Every physician is expected to take a proficiency test after each course, as opposed to just showing up," Kaplan says.

The coursework covers financial management and business planning as well as such leadership skills as managing physician performance and leading teams. Each participant is required to partner with experienced physicians and administrators to carry out a project that plays into the health system's strategic plan. For example, one physician implemented computerized provider order entry in a critical access hospital.

IHS hired a physician-education vendor to deliver the basic courses, but many on-site sessions include IHS-specific information.

"If they are learning about the integrated delivery system, they are able to hear from subject matter experts and then hear from Dr. Kaplan, from [IHS CEO and President] Bill Leaver and from others in our system as to how this specifically relates to us," says Emily Porter, the system's vice president of people excellence.

A second class of 40 physicians graduates this year, and Kaplan expects to start a new class every year. The academy is expensive and time-consuming to administer, but worth the effort, he says. He could not provide exact costs.

In a graduation video for the PLA, cardiologist Todd Langager, M.D., a graduate of the first class, shared the kind of insight that system executives want to hear. "As physicians, we all think we are delivering high-quality care," he said. "What I learned through this is that, despite our best intentions, sometimes we are not. That was a very important and enlightening course."