The Rise of the Physician Leader
timothy_signorelliThe roles of the physician leader and the administrative leader are evolving in new ways. Historically, the physician leader devoted extra time to committees, to being the spokesperson for the medical group, and to chairing meetings. With complexity increasing and change rampant throughout health care, organizational leadership needs are growing. What does it take to be an effective physician leader today? To provide effective, timely care in an increasingly transparent and resource-constrained environment, vast systems of care must be coordinated and linked with communication, teamwork, efficient transmission of information, and effective utilization of resources. Understanding how the system produces outcomes and how to affect those outcomes (both clinical and financial) is a new challenge. The need is growing for leadership rooted in clinical expertise. Physicians are best suited to evaluating or developing quality measures, and they have the clinical knowledge to detect which measures really affect patient health. At the same time, leadership requires broader and deeper knowledge and skills. If we are to achieve true coordination at all stages of health-care delivery, then we need the perspective that experienced clinicians provide. At the same time, physician leaders need to adapt to an enterprise view (as opposed to a one-patient-at-a-time view) and translate that to practicing physicians and caregivers. Integrating physicians’ clinical competence with financial, business, and systems competence is a key imperative. There are currently around 65 joint MD–MBA degree programs in the country, compared with only a handful in the 1990s. This reflects recognition of the need for broader skill sets. What It Takes Effective leadership requires an understanding of the enterprise that includes its governance, regulatory/risk-management, operations, planning, marketing, financial, human-resources, and IT domains. It also requires interpreting the outside world to the organization and representing the organization to the outside world—including patients, hospitals, other health-care providers, payors, government agencies, the business community, and the public. According to physician leaders with whom I have worked, the challenges are many; preserving collegial relationships—while making sure that the hard calls are made—is one. While patient-care decisions are often made on the spot, practice leadership requires more time to flesh out issues, get others’ input, and wait for other entities to respond. One learns to be patient, to avoid reaching a conclusion too quickly, and to be sure that all the right stakeholders are involved in major decisions. An accomplished physician leader (who moved from private practice to hospital leadership and then to an integrated-care system) notes that simple, common-sense approaches to running a private practice do not translate to large, complex organizations. Moving past telling employees what to do and developing the ability to influence others’ behavior in the correct direction involves learning a new language, although common sense is still valuable. While reimbursement challenges are cited as the top concern in a survey¹ of CEOs at the Top 100 Hospitals, the next priority is physician alignment (engaging high-quality physicians to accomplish goals). This invariably gives rise to the need for physician leaders who can hold relationships while meeting the strategic needs of the organization. Business writer/lecturer Ram Charan, MBA, PhD, has observed that while knowledge in the domain areas is fundamental, the basic unit of work, for leaders, is dialogue in which the leader engenders intellectual honesty and trust in the connection between people. Put another way, the effectiveness of a physician leader shows up as authentic conversation with individuals and teams. It also is captured in the deep-democracy concept of psychotherapist Arnold Mindell, PhD, in which making decisions involves ensuring that every voice is heard—including voices outside the meeting room. The Nonphysician Leader The advancement of the physician leader’s role in practice settings presents a question that some practices have already answered in the affirmative: Has the traditional role of the administrative practice CEO become obsolete? While this is occurring in practices, there is an opportunity for administrative leaders to play a key role in partnering with physician leaders. The 10,000-hour rule that Malcolm Gladwell popularized (in his book Outliers²) reflects the reality that for physicians to make this transition effectively, there is a lot of learning (and unlearning) that needs to be accomplished. The physician who continues to maintain clinical responsibilities will find that learning to be a long road. Administratively trained leaders can be invaluable in partnering with physician leaders (sometimes as reflectors, coaches, and guides) as they navigate new territory. This requires administrative leaders to examine and hone their leadership competencies as well. As a leader, whether physician or administrator, you must maintain awareness in three key areas. First, be self-aware; know your patterns of thinking, communicating, and problem solving. Invest in the additional learning that will provide a foundation for your leadership, and be aware of what is going on in you when you are having high-stakes conversations with others. Second, be other aware by being truly open to listening, engaging, and communicating. I once heard it said that people don’t care what you know until they know you care. Third, be sky aware, as a meteorologist would put it. Be open to the environment that the organization lives in and serves. This is critical to recognizing patterns—and synergistic opportunities to further the mission, vision, and performance of the organization. Timothy F. Signorelli, MHFM, FACMPE, is the president of Balancia, LLC, Minneapolis, Minnesota, a health-care executive coaching and development company.