The first two parts of this series highlighted the attributes that make physician leaders successful, and the ones that get in their way. This week I focus on how best to identify and develop future physician leaders. We, as a nation, do a poor job providing the expertise physicians…
The first two parts of this series highlighted the attributes that make physician leaders successful, and the ones that get in their way. This week I focus on how best to identify and develop future physician leaders.
We, as a nation, do a poor job providing the expertise physicians need to take on leadership roles. Jay Conger of Claremont McKenna College jokingly calls our approach the “French school of swim instruction.” Throw people into the deepest part of the pool, trust that one way or another they will figure out how to reach the edge, and don’t worry if they swallow a lot of water in the process.
There are better ways.
As noted by David Bronson, M.D., of Cleveland Clinic Regional Hospitals, and Edward Ellison, M.D., medical director and chairman of the board of the Southern California Permanente Medical Group, “For decades, America’s top-ranked medical schools have had stellar reputations as being among the best in the world. Their undergraduate and graduate curricula stress clinical excellence, technical innovation and professional accountability in delivering high quality care to patients. Unfortunately, basic principles of business management and leadership have rarely—if at all—been included in medical school curricula.”
Taking The Right Approach
A five-part series on physician leadership, published in Healthcare: the Journal of Delivery Science and Innovation, offers some additional rewarding insights along these lines. The research comes from the Council of Accountable Physician Practices (CAPP), consisting of 28 of the nation’s largest—and best—medical groups, including the Mayo Clinic , Geisinger Health System and Kaiser Permanente .
CAPP, for which I have the privilege to serve as chairman, was formed in part to help develop physician leaders across the United States. These large multi-specialty medical groups understand the importance of physician leadership, and recognize the unique ability of physician leaders to achieve superior quality outcomes for patients. CAPP members are committed to developing the next generation of physician leaders who can help transform American healthcare and embrace the technological and operational opportunities that exist today.
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In keeping with that commitment, CAPP collected these complementary case studies. Although each medical group takes a slightly different approach, there are common best practices in how to recruit, develop and retain effective physician leaders. Most important, all of these medical groups have a clear strategy and operational plan for doing so, and each has taken the time and made the financial investments required.
In my Forbes columns, I generally avoid focusing on Kaiser Permanente. But this week, because the topic is unique—and because of Kaiser Permanente’s success in harnessing physician leadership to transform American healthcare—I make an exception.
A Model for Physician Leadership
In my role as CEO of The Permanente Medical Group (TPMG), I devote considerable time and effort to supporting physician leadership development activities. More than a decade ago, TPMG established one of the largest physician leadership training programs in the nation. Creating such an elaborate infrastructure is expensive and takes a long time to reap benefits. Of the approximately 9,000 physicians currently in our medical group, more than 2,000 have received formal leadership training, a reflection of how crucial these skills are to our success.
TPMG is a self-governed organization, and along with Kaiser Foundation Hospitals and Kaiser Foundation Health Plan forms Kaiser Permanente. The physicians and 34,000 staff members within TPMG provide health care to nearly 4 million Kaiser Permanente members in Northern California. Over the last decade, strong physician leadership has established Kaiser Permanente as a national leader in quality, personalized service and technologically enabled medical care.
Geographically distributed across Northern California are 19 Kaiser Permanente medical centers, consisting of a hospital and hundreds of associated medical offices. Each medical center has a “physician in chief” (PIC) accountable for its overall operations. This physician leader reports to me (and I, in turn, report to an all-physician Board of Directors). Each PIC is responsible for nearly a billion dollars of cost structure, and must ensure the highest quality of patient care is provided, both within the hospital and in the medical offices.
Reporting to the PIC are “assistant physicians in chief” (APICs), who oversee crucial operational areas such as quality, access, IT, service and HR. Reporting to the PICs, in addition, are the chiefs of the clinical services such as pediatrics, radiology and orthopedics. This organizational structure facilitates the integration of all of aspects of a patient’s healthcare, and encourages innovations and best practices to spread rapidly.
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The Steps To Training Leaders
The leadership journey for most physicians in TPMG begins within their clinical departments. Most physicians take on some aspect of departmental leadership responsibility early in their careers. This is crucial because potential future leaders can be identified while still young and given the opportunity to prepare for larger roles over time.
Once physicians take on a leadership role, they begin to understand what leadership entails. In their new roles, they are personally mentored by the chief or an assistant chief. And they gain skill and receive additional training in their regularly scheduled peer group meetings.
We believe demonstrating early success at the departmental level is the best indicator of future leadership potential. Physicians who cannot make change happen effectively in their own specialty, with colleagues they interact with on a daily basis, are unlikely to be able to align and motivate physicians from other specialties. Often when a position as chief or APIC is vacated, the PIC look to an individual who has proven effective in this role to accept the expanded responsibility.
Beyond the training physicians obtain in their department and medical center, we provide four region-wide educational programs. Through these, we further train our people, particularly those with the highest potential and those taking on major new roles.
1. The TPMG Leadership Institute
Over a decade ago, through the leadership of Margaret Lapiz, vice president for strategy and operations integration, we created a series of structured training programs to prepare and support physician leaders as they advanced in their careers.
The curriculum is broad, concentrating on key management skills in areas such as culture, persuasion, negotiations, motivation and teamwork. The foundational courses—for which any of the 2,000 physician leaders, regardless of title, can enroll—are available in single-day and weekend sessions. And similar courses are offered to our approximately 2,000 managers and medical group administrators, expanding delivery system-wide communication and coordination.
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2. The Emerging Leaders Program
This second part of the institute, offered every other year, is for select individuals only. PICs nominate a total of 180 high-potential individuals who have been in TPMG for between five and 10 years.
They attend four residential sessions taught by experienced business school faculty from universities including Stanford, Berkeley, Harvard and the University of Chicago. Periodically over the two years, participants meet with their PICs to discuss application of the principles to the challenges that exist in areas such as quality, access or operational efficiency. Each participant is also responsible for completing a change initiative over the 24-month duration of the program. The pioneering work I described in a previous column on delirium began as just such a project.
More than half of the participants, within three years of finishing this program, take on a major medical center or regional leadership role.
3. The New Chiefs Program
Most often, the operational success of a clinical department correlates with the skill of its chief. For this reason, TPMG offers ongoing training, mentorship and knowledge-sharing opportunities to newly selected chiefs to maximize the probability of success.
Of course all new chiefs have already demonstrated leadership ability and received training in previous leadership roles, and most have obtained mentoring from the outgoing chief. Nonetheless, each new chief attends a week-long program with external academic faculty and internal experts. I personally teach a full day on strategy and operational excellence.
Once in the role, the new chief meets regularly with the PIC, and attends regional chiefs’ meetings with others in the same specialty. At these meetings, additional education is provided by regional experts both on clinical topics and ways to improve operational performance.
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4. The Annual Physician In Chief Educational Program
In my role as CEO, I am responsible for selecting the physicians in chief. The process is extensive, and begins with the identification of potential candidates, a week-long visit to the medical center and confidential one-on-one meetings with more than 100 physicians.
Once chosen, the PIC receives mentoring from experienced colleagues, regional leaders and the CEO. In addition, the person is provided with individual coaching and skill development training in important areas such as effective communication and finance. Once a year, all of the physicians in chief participate in a multi-day educational program focused on developing the skills needed to address the most pressing problems the organization faces.
The Role of Physician Leadership at Kaiser Permanente
Dr. Sharon Levine, a pediatrician and associate executive director in TPMG, is an example of a leader whose commitment has benefitted thousands of physicians and millions of patients. As the first woman member of the executive staff, Sharon created a program more than a decade ago to educate and otherwise support women physicians in leadership roles. Today, that program accounts for why nearly half of all leadership roles at TPMG are filled by women physicians.
More recently, Dr. Levine spearheaded our efforts to implement the nation’s most stringent conflict of interest policy. Our doctors are now prohibited from accepting anything, regardless of value, from for-profit drug and device companies. She led this crusade, despite physicians often liking gifts and free trips and meals, to ensure the trust of our patients. Of the 6,000 physicians who belonged to TPMG at the time, only two left as a result. This policy remains the gold standard in healthcare today.
Indeed, none of our investments in capital, medical technology or information technology over the past decade have yielded a higher return than our programs to select, train and develop physician leaders. And as the newest physician leaders take on ever more responsibility, the value of these educational efforts will increase exponentially for decades to come.
If every hospital and medical group across the United States invests the needed time and resources in physician leadership development, we as a nation may be able to transform the American healthcare system into something much better, fully capable of solving the challenges of today and tomorrow.
Dr. Robert Pearl is the CEO of The Permanente Medical Group, a certified plastic and reconstructive surgeon, and Stanford University professor. Follow him on Twitter: @RobertPearlMD.
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