Physician Strategy News: October-November '07
Developing Physician Leaders
Special thanks to Terrance McWilliams, M.D., VPMA of Newport Hospital, Newport, RI; Jeffrey Morris, M.D., M.B.A., VPMA of Wadsworth-Rittman Hospital, Wadsworth, OH; and Daniel Varga, M.D., Chief Medical Officer, SSM Healthcare-St. Louis for their observations and input.
Strong physician leadership has rarely been more important. And the need for outstanding leaders will only escalate as hospitals continue to work to improve quality and utilization and address the challenges of pay for performance.
But physician leadership has never been harder to develop. The interests of physicians and their hospitals are diverging. Economics and advancing technologies are bringing physicians into competition with hospitals. Other trends, such as hospitalists, are changing practice patterns and eroding historical relationships.
How are hospitals dealing with these issues? We talked with three physician executives to gain their perspective and observations.
What are the biggest challenges in developing physician leaders?
Getting physician leaders to see the big picture and move beyond their parochial concerns is a major challenge. Many physicians struggle to separate their personal agenda from their role as a leader, exacerbating the problem.
Another challenge is to define solutions that focus on "and" rather than "or", basically the ability to see win/win solutions. For example, how can we improve quality and improve finances simultaneously? Having that perspective is critical, as many physicians view clinical and financial issues as being in competition.
How you start physicians on the path to leadership is important. Giving them small but important leadership roles, such as specific projects, will test and grow their capabilities. It is essential that physician executives help younger physicians gain experience. And matching potential leaders to those problems is a challenge.
Selecting leaders who can work effectively in teams is crucial. Team decision making is frustrating because of the pace of decisions, and physicians are hardwired to make decisions quickly. Physician leaders must overcome that bias as they take on leadership roles.
Two other issues were mentioned as significant: 1) Training physicians to deal with disruptive peers; and 2) Building an understanding of physician/hospital interdependence.
What are the attributes of the best elected leaders you have worked with?
One key attribute is clinical skills. All agreed that great practitioners tended to have the credibility to be good leaders (although not all great practitioners are good leaders). Just as a .220 hitter cannot be the leader on a baseball team, clinical mediocrity is a barrier to success.
Institutional loyalty is also an important attribute. Shrinking active staffs mean fewer physicians in the hospitals. And as physicians compete with hospitals, the economic interests of the two diverge. These factors make it harder to develop leaders with this important attribute.
Personality is crucial. Physician leaders need to be even-tempered, non-dogmatic, good listeners, and deliberative decision makers. Self confidence is another critical trait, as it is easy for physicians to “blow with the wind”, bowing to political pressure from peers and non-clinical executives alike. Confidence helps a leader take a stand and stick to it.
Two types of conceptual ability were mentioned: First, the ability to create consensus through win/win decisions, as mentioned above. Seeing the opportunities for consensus building is invaluable. Second, the ability to see several steps beyond the issue at hand is important. Foreseeing unintended consequences, opportunities for compromise, and potential long-term advantages is a very helpful skill.
What steps need to be taken to develop these leaders?
One executive argued that physicians are well trained to be good leaders. They diagnose problems, treat, call in consultants when needed, and make judgments without complete data. And, increasingly, they are working in teams, something required to be a good leader, as mentioned above.
Giving young potential leaders something important to do is a key part of their development. Service line leadership is a good place to start. Senior physician leaders need to nurture and evaluate developing leaders, helping them to learn and apply these skills outside, their own service/area of expertise. This requires some level of accountability. One physician noted that this is easiest if the position is paid.
Focus on young, potential leaders and involve them in education programs. Key programs mentioned include conflict resolution, healthcare economics, and strategic planning. Part of the goal is to have them mix with physicians from other locations.
Mixing with other physicians is important, but interaction with the board is important as well. Exposing young physicians to these leaders, with their differing processes and perspectives, is useful in developing the young physician leaders.
