The Basics of Advancing Physician Leadership in a Changing Health Care Landscape
Over the past twenty years, numerous articles have been dedicated to the need to advance the role of physicians in leading “health systems change efforts.” Little has been done, however, to prepare residents or practicing physicians formally to become leaders of practice teams or incorporate organizational settings. After a recent training session I led, a practicing physician of 30 years stated that he had not received any formal leadership training since residency, and with all the changes in health care since then, he recognized the importance of the physician’s role.
While the focus of health care still is on helping individual patients, physicians also must understand how to navigate the system’s challenges related to payment reform, pay-for-performance, population management, improving patient satisfaction, quality improvement and fundamentally how to work as a member/leader of a team. These challenges have created the need for a particular focus in physician training, moving from that of an independent, autonomous decision maker to a collaborative member of a health care team. A successful practicing physician now requires management and leadership capabilities, business and human resource management, team building and communication skills.
Leadership skills are developed over time and are both an organizational and individual endeavor. Leadership requires creating and sharing a vision for the future while developing the culture of the organization. Several questions should be addressed and clarified when defining leadership within an organization:
- What will health care delivery look like as we move from volume-based payment to value-based payment systems in day-to-day operations?
- How does the vision relate to the mission of the organization?
- How do the mission and vision statements relate to the organization’s values?
- How successfully has change been managed in the past?
- What communication processes must be put in place to facilitate changes and to make changes stick?
- How will roles change for team members, including the patient?
- How will these changes be communicated and how will leadership receive team member feedback on the changes?
- How will conflict and role confusion be managed?
- What accountability system will hold team members responsible for the changes in roles?
Most of these questions do not require additional training at the outset. What is required, however, is awareness that processes and roles must change and that there must be a commitment to dedicating and preserving time to plan, implement and evaluate the success of these changes. Leadership development would then require the introduction of more formal and specific training to meet the individual and organizational goals for the development of leadership abilities, including addressing external influences such as broader health care drivers (population management), payment structures and technology advancements.
Physicians must additionally recognize that changes in leadership abilities of this magnitude do not occur overnight and will require frequent review and refinement. Too often, changes are directed from an authoritative perspective: implemented too quickly without input or feedback from those involved in carrying out the changes. Encouraging physician involvement in the development of processes and goals (administrative and clinical) improves buy-in from physicians and increases accountability for the outcomes. Using data in a continuous quality improvement process has proven to be a major driver in refining and reinforcing systems changes.
No one person (physician or administrative personnel) will have the complete tool box required to lead and manage the practice of the future. Successful health care systems have designed, implemented and revised, on an ongoing basis, a variety of processes to improve leadership capacity and move their organization toward the future. A few examples of processes are presented below:
- Implement onboarding programs for experienced physicians to mentor providers new to the organization on standards of care, best practices, how to work in an interdisciplinary team. Such programs additionally incorporate continuous performance and quality improvement processes and enhance skill sets related to patient engagement and to the provision of services. Included in these programs are opportunities for both informal and formal roles in leadership and the evaluation of outcomes from an administrative and clinical perspective.
- Create a dyad team made up of a physician and an administrative leader for management of groups of practices. A dyad team will share responsibility for ensuring communication of organizational goals and process changes to practice level team members. Other responsibilities include: maintaining team functions through appropriate staffing, delivering quality improvement data as related to organizational goals and representing system concerns and potential solutions to corporate leadership.
- Create an internal leadership development program influenced by the system’s organizational values and mission and driven by an interdisciplinary approach. These programs include primary care physicians, members of hospital and practice leadership, nursing, specialists and other disciplines as deemed appropriate in driving change across the system. One part of this type of program may include a 360 degree performance evaluation which allows for input from superiors, subordinates and peers.
Building a leadership training program based on the organization’s vision, mission and values, assessing current strengths and opportunities related to leadership capability and formulating a clear plan forms the foundation for building and sustaining leadership in the health care organization of the future. Several common complaints of which to be aware when building a formal physician leadership training program include: the level of expense, the time taken away from the practice of medicine, inevitable frustration with the difficulty in applying content to the sponsoring organization and the “cookbook” approach many programs push that often are not applicable to specific organizations or individuals.
In the broadest scope, physician leadership training must be embedded in undergraduate curricula, continue during medical school and residency and become a part of ongoing medical education throughout active care delivery to foster the best leaders our physicians can be.
Elaine Skoch, PCMH-CCE is a CAFP consultant, board certified Nurse Executive at the advanced level and recognized as a PCMH Clinical Content Expert by the National Committee for Quality Assurance.
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