Advertisement

Talent management and physician leadership training is essential for preparing tomorrow's physician leaders

Open ArchivePublished:December 19, 2013DOI:https://doi.org/10.1016/j.jvs.2013.10.074
      Talent management and leadership development is becoming a necessity for health care organizations. These leaders will be needed to manage the change in the delivery of health care and payment systems. Appointment of clinically skilled physicians as leaders without specific training in the areas described in our program could lead to failure. A comprehensive program such as the one described is also needed for succession planning and retaining high-potential individuals in an era of shortage of surgeons.
      Talent management and leadership development is quickly becoming a major initiative in American medical schools. Medical schools are increasingly expending time and resources to developing physician-leaders, while physicians are revealing an interest in becoming leaders of a department, medical college, hospital, or health care organization. In 1993, for instance, there were six MD-MBA programs in the United States; in 2009, there were 51; in 2012, there were 64.
      • Ackerly D.C.
      • Sangvai D.
      • Udayakumar K.
      • Shad B.
      • Kalman N.
      • Cho A.
      • et al.
      Training the next generation of physician-executives: an innovative residency pathway in management and leadership.

      Association of MD MBA Programs. Mailing list instructions. Available at: http://mdmbaprograms.com/10.html. Accessed January 18, 2013.

      Background

      Physicians are in a unique position to lead health care organizations because they are committed to treatment of the patient and prevention of illness. A study by McKinsey in the London School of Economics used interviews with managers and department heads in the United Kingdom National Health Service to determine management and leadership performance. They found that hospitals with the most clinician involvement in management affairs performed 50% higher on drivers of performance, such as effectiveness of overall management, performance management, and leadership compared with hospitals with little clinical leadership.

      Castro PJ, Dorgan SJ, Richardson B. A healthier health care system for the United Kingdom. McKinseyQuarterly.com; February 2008. Available at: http://www.governance.com.au/board-matters/fx-view-article.cfm?loadref=2&article_id=687E2C71-071A-40F1-9E015149F1DAAE16. Accessed January 7, 2013.

      While there is often a gulf and sometimes contentious relationship between hospital administrators and clinical practitioners, the physician-leaders' clinical background gives them credibility with the medical staff, while their administrative skills allow them to respond to health care reform, changes in reimbursement, and newly created integrated delivery systems such as accountable care organizations, medical homes, and bundled payment models.
      • Falcone R.E.
      • Satiani B.
      Physician as hospital chief executive officer.
      Combining leadership skills and training with their clinical expertise, they have the potential to become powerful and influential leaders capable of seeing new possibilities, inspiring others, breaking down silos, creating a new vision of health care delivery, and transforming their vision into reality.
      While some medical schools and health care organizations provide comprehensive, coherent, and relevant leadership training programs, often what passes as leadership development in some hospitals and medical schools is a hodge-podge of classes and lectures lacking coherence, logical progression, comprehensiveness, and relevance presented on a variety of leadership and administrative topics. The episodic nature of the instruction is rarely successful in developing effective physician-leaders.
      A typical career path for a physician who has become an administrator of a department or leader of a health care organization is that he or she was recognized as an excellent clinician, teacher, or researcher. While laudable, these skills are not the competencies needed to lead departments or health care organizations at this time. The newly promoted physician may lack financial, change management, communication, motivational, team building, risk management, and leadership skills. Furthermore, many of the activities of the successful physician, from treating patients to conducting research, are often done as a sole and autonomous professional. Consensus building, leading group activities, developing a shared vision, and forging partnerships are often not a part of his or her training or experience. The unfortunate result is that the physician's performance in his or her new role is often mediocre or worse.
      • Lazarus A.
      Professional and career issues in administrative medicine.
      • Stoller J.K.
      Developing physician-leaders: a call to action.
      The demands, complexity, and responsibilities of a modern health care organization are too important to be left to “accidental leaders.”
      • Ackerly D.C.
      • Sangvai D.
      • Udayakumar K.
      • Shad B.
      • Kalman N.
      • Cho A.
      • et al.
      Training the next generation of physician-executives: an innovative residency pathway in management and leadership.

      Program description

      To overcome this traditional pattern and to create physician leaders, the Department of Surgery at The Ohio State University Wexner Medical Center developed a Talent Management and Leader Development Academy (TMALDA) to provide a coherent, comprehensive, and relevant development program for physicians who wish to assume administrative or leadership roles in their departments, medical colleges, hospitals, or health care organizations (eg, HMOs, medical insurance companies, life sciences industry, medical device manufacturers, and pharmaceutical firms). The success of the surgically oriented program has led the College of Medicine to offer a second iteration, which started in 2013, called the Faculty Leadership Institute (FLI), which is open to all faculties in the college of medicine.
      The TMALDA program created in the Department of Surgery is 18 months in duration, consisting of 4-hour seminars offered once a month on topics designed to develop physician-leaders. The first group of participants started in September 2011 and “graduated” in April 2013. The curriculum was based on the recommendations of faculty from the College of Medicine, the Ohio State Univeristy Fisher College of Business, and the Humanities College at The Ohio State University, as well as surveys and literature addressing physician leadership competencies.
      • Ackerly D.C.
      • Sangvai D.
      • Udayakumar K.
      • Shad B.
      • Kalman N.
      • Cho A.
      • et al.
      Training the next generation of physician-executives: an innovative residency pathway in management and leadership.
      • Stoller J.K.
      Developing physician-leaders: a call to action.
      • Schwartz R.A.
      • Poggi C.A.
      • Gillis S.A.
      • Hoisinger J.A.
      Programs for the development of physician leaders: a curricular process in its infancy.
      The sessions cover the areas of leadership and talent development listed in Table I. Seminars are taught equally by internal faculty and nationally recognized experts from outside the University, including speakers from the Mayo Clinic, Baylor College of Medicine, and prominent consulting firms.
      Table ITopics and core knowledge covered in talent management and leader development program
      Adapted from American College of Healthcare Executives Competency Assessment Tool 2013.
      TopicCore knowledge
      Leadership competencyLeadership skills and behavior, styles and technique; key barriers to effective leadership; establish and support organizational vision; promote commitment to the values; set personal example.
      Strategic planning and visionOrganizational dynamics, political realities and culture; strategic planning processes development and implementation; strategic business analysis; choosing an effective strategy, balancing risks and rewards.
      Financial managementBasic accounting, financial management and principles; financial statements; principles of operating, project and capital budgeting, financial controls; revenue generation and capital funding; assessing financial rewards and risk; time value of money; cost volume profit analysis.
      Business planningTechniques for business plan development, implementation and assessment; defining problems/opportunities, forecasting and SWOT analysis; comparative analysis strategies; methods of evaluating alternatives.
      Communication skillsPrinciples of communication, public relations; communicate organizational mission, vision, objectives and priorities, utilize human and technical resources, business communications, provide and receive constructive feedback, present data analysis; build collaborative relationships, effective interpersonal relations (medical staff, suppliers, other stakeholders).
      Change managementPromote and manage change; identifying stakeholders early; explore opportunities for the growth and development of the organization on a continuous basis; promote contiguous organizational learning/improvement; anticipate and plan strategies for overcoming obstacles; overcoming resistance to change; tolerance for ambiguity.
      Quality of care and patient satisfactionBenchmarking techniques; clinical pathways structure and function; national quality initiatives including patient safety; customer satisfaction principles and tools; patient communication systems; quality improvement framework; quality planning and management; publicly available outcomes; patient satisfaction scores.
      Team buildingCreating an organizational climate that encourages teamwork; assessing the organizational values and culture; the social style model.
      Negotiation and problem solvingRange of negotiations; types of negotiations; quantifying stakes for parties involved; facilitation/negotiations: mediation, negotiation and dispute resolution techniques, team-building techniques, labor relation strategies, build effective physician and administrator leadership, facilitate conflict and alternative dispute resolution, facilitate group dynamics, process, meetings and discussion groups.
      Stress/burnout and lifestyles issuesPhysician concerns; satisfaction/unsatisfaction; causes of burnout; common gripes; management of time and inefficiencies; balance; tips to avoid burnout; develop and implement policies and procedures with physicians to address physician behavioral and burnout issues.
      Human resources and talent managementOrganizational policies and procedures; human resources laws and regulations; recruitment and retention strategies; selection techniques; compensation and benefit practices, conflict resolution and grievance procedures; defining staff roles, responsibilities and job descriptions; evaluate and manage employee efficiency and productivity.
      Diversity for health care leadersWorking definitions of diversity and meanings in organizations; what it is not; why diversity; strategies to support and increase diversity; individual level: address cultural competence and countertransference; issues of power and privilege.
      Health care lawBasic contracts, federal and state court system, legal procedures and litigation; Stark, anti-kickback law and false claims act; restrictive covenants; physician employment models; impact of health reform.
      Medical ethicsOrganizational culture and behavior; organizational ethics; duties and obligations in health care administration; contractual obligations of health professionals; patient rights; corporate compliance programs; conflicts of interest; HIPAA; substance abuse.
      Final case study
      HIPAA, Health Insurance Portability and Accountability Act; SWOT, strengths, weaknesses, opportunities, and threats.
      Sessions are highly interactive. Attendees are enthusiastic and receptive students: they are anxious to acquire new skill sets, think in terms of new paradigms, adopt new ways of viewing health care, and learn a new language. Participants were divided into teams, each with four to six individuals to work on projects throughout the year and in-class discussions. Teams also presented their projects and prizes were awarded based on scores by three judges (B.S., R.R., and J.S.).
      The Program Director works with facilitators who are given specific instructions about the core knowledge to be covered for each module, which is 3.5 hours and includes about a 20-minute break. The session on leading change involves a six-stage model which addresses issues such as anticipating change, achieving buy-in from employees, constructing a change plan, overcoming resistance, implementation of a change program, and evaluation methods. Due to the importance of quality management in fully integrated health systems of the future, two modules are devoted to quality of care and improving the patient experience. Sessions on ethical issues, negotiation strategies, and conflict management involve case studies based on the instructors' experiences.
      The program also includes several projects that students undertake in teams. The three selected project topics reflect current issues facing health care leadership: “Creating an ACO”; “Leading a Hospital Merger”; and “Improving Healthcare Delivery Systems.” The assignments demand that physicians consult medical leaders, conduct their own research, and work in collaboration. Their oral presentations are attended by College of Medicine faculty and senior administrators.
      Selection of the first 24 candidates for participation in the program began by sending a detailed description rationale of the program to surgical department chairs throughout the College of Medicine. Goals, subject matter, expected outcomes, and a list of instructors with their areas of expertise were included. The program organizers met with the chairs to further explain the program, answer questions, and get their support and commitment to allow faculty to attend the program. The chairs were asked to nominate physicians who were in the early-to-mid part of their careers and whom they felt had potential to become effective leaders (Table II). Funding was provided by participant fees paid by each department.
      Table IIParticipant departments and their roles
      Department (No. of faculty)Roles of participants upon starting the program
      General Surgery (2)Director of fellowship, second participant promoted in administrative role since program completion
      Pediatric Surgery (2)Section Chiefs
      Plastic Surgery (2)Young faculty, no assigned administrative role yet
      Otolaryngology (4)Young faculty, no assigned administrative roles, picked by Chair
      Obstetrics and Gynecology (1)Director of division
      Orthopedics (2)Both section chiefs (trauma and oncology)
      Neurosurgery (2)Subspecialty leaders
      Critical Care, Trauma, and Burns (1)Section Chief
      Ophthalmology (2)Young faculty, no assigned administrative role but deemed promising leaders by Chair
      Oral and Maxillofacial Surgery (1)No assigned role yet, picked by Division Chief to participate
      Urology (3)All three <10 years in practice, one leading a section
      Cardiothoracic Surgery (1)Administrative role planned by Division Chief
      Vascular Surgery (1)Endovascular program director
      The response from department chairs has been enthusiastic. For the FLI, more than twice the number of physicians was nominated than could be accommodated by the 30 slots available. Both the TMALDA and the FLI program do not require physicians to make a binary decision: do I pursue a clinical career or an administrative career? Physicians in the TMALDA program have not given up their medical or surgical practices. In fact, the program has enhanced their leadership development, according to reviews by the department chairs after completion of the program. The leadership program also addresses succession planning, a key to continued and effective leadership over time. The leadership program addresses another significant issue facing health care: succession planning. Talent management and succession planning constitute a systematic process for preparing people to meet an organization's needs for leadership and talent over time. They are designed to ensure the continued effective performance of an organization by developing the skills and competencies of high-potential individuals to assume leadership positions in the future.
      • Ready D.A.
      • Conger J.A.
      • Hill L.A.
      Are you a high potential?.
      Failure to prioritize talent management and succession planning often leads to a steady attrition of high-potential individuals or to the retention of people with outdated skills or both. With the current shortage of physicians and vascular surgeons, it is imperative to identify future physician leaders and to create developmental programs to close the gap between their current skills and abilities and those needed for higher-level positions.
      • Satiani B.
      • Williams T.E.
      • Go M.
      Predicted shortage of vascular surgeons in the United States: population and workload analysis.
      Evaluation of this program is as important as it is difficult. In the absence of national norms for measuring physician-leader progress, we have taken a short-term and longitudinal approach. Students are asked to evaluate the program and their progress. Their immediate supervisors are also asked if they have observed administrative growth, increased skill levels, and changes in behavior. Longitudinally, the career paths and achievements of the participants shall be tracked.
      A successful physician leadership program must remain flexible and adaptive. Subject matter in future offerings may be revised based on new challenges in health care, the effects of health care reform, and changes in delivery and payment systems. In the FLI, student evaluation includes a 360-degree assessment.

      Challenges faced in implementing program

      Although a commitment from Chairs was obtained to release faculty once a month for the various modules, individual surgeons felt obligated to deal with patients they had operated on and missed some sessions. We also had participants sign statements that they would abide by the attendance requirement, but no penalty was enforced other than keeping their fees. With a 75% attendance requirement, one participant decided to withdraw after three consecutive absences early in the program. Another participant withdrew more than halfway into the program for similar reasons.
      Another challenge was to try and hit a “sweet spot” in terms of asking facilitators to cover topics so the information would not be too basic or at too high a level. A survey done halfway through the program indicated that there were a couple of people who thought the content was either too basic or too hard. The same feedback was received about the length of the class (3.5 hours) and the extent of homework/reading given to participants.
      Finally, all teams formed at the beginning remarked that they had difficulty getting together to work on their projects. Perhaps use of new technologic aids such as Google work groups or Facetime, etc. would have solved this problem.

      Program evaluation

      Besides evaluating each facilitator and session, participants were asked to evaluate the entire program, topics, content, amount of work, physical environment, whether they would recommend this program to others, and areas of satisfaction and dissatisfaction. This was done halfway into the program and at the conclusion of all sessions. A summary of the final evaluation is shown in Table III.
      Table IIIQuestions on final evaluation returned by participants and brief summary of responses
      QuestionResponse summary
      Were you satisfied with the process, faculty, and educational materials employed in the program?Yes: 93%; one participant yes/no
      Name two things you liked the most about the program.Faculty; varied topics, topics not covered in school, small group discussions, interact with peers, comprehensiveness, several participants mentioned specific modules, seeing how medical center works
      Name two things you liked the least about the program.Group projects, long program, long sessions, lot of work, final project,
      What things would you like to see changed or improved?Shorten program, shorten session by 1/2 hour; no dinner break, more finance, module on retention/recruitment of faculty, fewer projects but more in-class work, teams could pick their own projects,
      Would you recommend this program to your peers?100%; two commented that this program is better suited for faculty planning career in hospital administration
      How has the program helped you in your current role? Be specific please.Improved leadership skills; improved negotiation skills; more self-awareness of leadership style, using team building in relationships and various roles, relationship with other faculty, more confidence in leadership roles, collaboration techniques, aware of emotional intelligence aspect now, networking with others would not have occurred otherwise, understand health care transformation/negotiations/health care law, etc

      Current status of leadership programs

      The emergence of physician-development programs must be seen as part of a larger, system-wide change in health care that requires fundamental re-examination of the structures, priorities, and professional relationships in hospitals and health care organizations. Hospitals and health care organizations, for instance, must revisit their governance structures, physician recruitment and promotion criteria, and career paths for physicians. An Advisory Board Company survey suggests that many hospitals have not prepared the ground for physician-leaders: when physician-leaders were recruited, 59% of the hospitals surveyed did not clearly define roles, responsibilities, and performance objectives for them, and 78% did not evaluate physician-leaders' performance against established goals.
      • Falcone R.E.
      • Satiani B.
      Physician as hospital chief executive officer.
      Physician-hospital relations must be strengthened, trust between them renewed, leadership opportunities made available, mutual expectations clarified, and a shared vision for the future created. Nonclinical executives must view physician-leaders as partners in serving the needs of patients, not as threats to their careers.
      • Dunham N.C.
      • Kindig D.A.
      • Schulz R.
      The value of physician executive role to organizational effectiveness and performance.
      Furthermore, increased attention must be given to identifying high-potential clinicians, grooming them through formal development programs, providing upward mobility, and including them in succession planning. This type of program is materially different than most MBA programs (Table IV). Training and experience also requires attention to emotional intelligence, consensus building, and conflict resolution. Success of the physician leader will of necessity require them to be engaged in clinical care, lest they be deemed “out of touch.” This requires special organizational skills and the ability to shift gears between varying responsibilities. Although some would argue that the time for this intensity of training should be in medical school, we favor training after completion of the residency and fellowship and ideally after a few years of practice. This experience not only provides maturity but also a point of reference for the “leader to be.” Our first year medical school class has instituted a “business” cluster and invites speakers several times a year. In addition, one of the authors (BS) has led a monthly Practice Management Seminar series for surgical residents, which is a credit course and encompasses a comprehensive curriculum over 24 months.
      Table IVComparison of topics covered at Ohio State Fisher School of Business Masters in Business Administration (MBA) program and Department of Surgery's Talent Management and Leader Development Academy (TMALDA)
      MBA core curriculumTMALDA topics
      Common topics
       AccountingFinancial management
       LeadershipLeadership competency
       StrategyStrategic planning and vision
      Different topics
       Marketing IBusiness planning
       Organizational behaviorCommunication skills
       Operations IChange management
       Finance IQuality of care and patient satisfaction
       Managerial economicsTeam building
       International businessNegotiation and problem solving
       Operations IIStress/burnout and lifestyles issues
       Finance IIHuman resources and talent management
       Marketing IIDiversity for health care leaders
       Data AnalysisHealth care law
       Flex core, major, and elective coursesFinal case study
      These are first-year MBA topics and vary from 1.5 to 2.5 credits. Most of the second year and a part of the first year has flexible core topics and electives.
      “Successful corporations,” according to John Kotter, one of the founders of change management as an academic discipline, “don't wait for leaders to come along. They actively seek out people with leadership potential and expose them to career experiences designed to develop that potential. Indeed, with careful selection, nurturing, and encouragement, dozens of people can play important leadership roles….”
      • Kotter J.
      What leaders really do.
      Health care as we know it will never be the same. Changes and initiatives required by the Patient Protection and Affordable Care Act, emerging technologies, new delivery systems, changes in reimbursement models, the rise of accountable care organizations and medical homes, demographic trends, the patient as consumer, and workforce challenges demand that hospitals and health care organizations become more inclusive in their leadership structure.

      Role of the Society for Vascular Surgery

      Physician-leaders, including vascular surgeons, are an extraordinary leadership resource, combining sound management with high medical standards, and they will play an increasingly significant role in addressing the challenges facing health care. The Society for Vascular Surgery must be at the forefront in offering opportunities to its members for developing management and leadership skills as outlined. This initiative has recently been started by the incoming President Dr Freischlag by forming a new committee on leadership. Educational activities to develop members as leaders may be a combination of cooperating with existing programs as well as a ground-up effort with an annual stand-alone meeting, which has a more intensive curriculum. The American College of Surgeons and the American Surgical Association co-sponsor a health policy and management scholarship for surgeons to attend the Heller School of Management at Brandeis University.

      American Surgical Association. ACS/ASA Health Policy and Management Scholarship. Available at: http://americansurgical.org/Health-Policy-and-Mgmt-Scholarship.cgi. Accessed August 22, 2013.

      Cooperative arrangements could also be made with the American College of Physician Executives to offer scholarships to selected members to complete a formal Certified Physician Executive CPE program, for instance.

      Certifying Commission in Medical Management. Certified physician executive. Available at: http://www.ccmm.org/. Accessed August 22, 2013.

      Author contributions

      Conception and design: BS, JS
      Analysis and interpretation: BS, JS, CE, RR
      Data collection: Not applicable
      Writing the article: BS, JS
      Critical revision of the article: BS, CE, RR
      Final approval of the article: BS, JS, CE, RR
      Statistical analysis: Not applicable
      Obtained funding: Not applicable
      Overall responsibility: BS

      References

        • Ackerly D.C.
        • Sangvai D.
        • Udayakumar K.
        • Shad B.
        • Kalman N.
        • Cho A.
        • et al.
        Training the next generation of physician-executives: an innovative residency pathway in management and leadership.
        Acad Med. 2011; 86: 575-579
      1. Association of MD MBA Programs. Mailing list instructions. Available at: http://mdmbaprograms.com/10.html. Accessed January 18, 2013.

      2. Castro PJ, Dorgan SJ, Richardson B. A healthier health care system for the United Kingdom. McKinseyQuarterly.com; February 2008. Available at: http://www.governance.com.au/board-matters/fx-view-article.cfm?loadref=2&article_id=687E2C71-071A-40F1-9E015149F1DAAE16. Accessed January 7, 2013.

        • Falcone R.E.
        • Satiani B.
        Physician as hospital chief executive officer.
        Vasc Endovasc Surg. 2008; 42: 88-94
        • Lazarus A.
        Professional and career issues in administrative medicine.
        Journal of Healthcare Leadership. 2009; 1: 1-5
        • Stoller J.K.
        Developing physician-leaders: a call to action.
        J Gen Intern Med. 2009; 24: 876-878
        • Schwartz R.A.
        • Poggi C.A.
        • Gillis S.A.
        • Hoisinger J.A.
        Programs for the development of physician leaders: a curricular process in its infancy.
        Acad Med. 2000; 75: 133-140
        • Ready D.A.
        • Conger J.A.
        • Hill L.A.
        Are you a high potential?.
        Harv Bus Rev. 2010; 88: 1-7
        • Satiani B.
        • Williams T.E.
        • Go M.
        Predicted shortage of vascular surgeons in the United States: population and workload analysis.
        J Vasc Surg. 2009; 50: 946-952
        • Dunham N.C.
        • Kindig D.A.
        • Schulz R.
        The value of physician executive role to organizational effectiveness and performance.
        Health Care Manage Rev. 1994; 19: 56-63
        • Kotter J.
        What leaders really do.
        Harvard, Cambridge, MA1999
      3. American Surgical Association. ACS/ASA Health Policy and Management Scholarship. Available at: http://americansurgical.org/Health-Policy-and-Mgmt-Scholarship.cgi. Accessed August 22, 2013.

      4. Certifying Commission in Medical Management. Certified physician executive. Available at: http://www.ccmm.org/. Accessed August 22, 2013.