Post on 24-Nov-2021
Physician Executive Council
HR Advancement Center
How health care leaders can
address the leadership gender gap
Veena Lanka, MD, MPH
Research Partner
© 2019 Advisory Board • All rights reserved • advisory.com
2
Women physician executives—few reach the top
Source: “Fixing the Gender Imbalance in Health Care Leadership”, Harvard
Business Review, https://hbr.org/2018/10/fixing-the-gender-imbalance-in-
health-care-leadership; Physician Executive Council interviews and analysis.
Percentage of women physicians by role
3% of CMOs are women
6% of department chairs are women
9% of division chiefs are women
© 2019 Advisory Board • All rights reserved • advisory.com
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Women physicians achieve better outcomes
Source: Kacik Alex, “Few Women Reach Health Care Leadership Roles”, Modern Healthcare,
https://www.modernhealthcare.com/operations/few-women-reach-healthcare-leadership-roles;
Tsugawa Y et. al, Comparison of Hospital Mortality and Readmissions Rates for Medicare
Patients Treated by Male vs Female Physicians”, JAMA Intern Med, 77, no. 2 (2017): 206-213;
Physician Executive Council interviews and analysis.
1) Based on data analysis of hospitalized Medicare beneficiaries.
Patient results were compared with those cared for by male
physicians within the same hospital.
2) In a survey of 200 hospital and health system executives.
3) Of hospital and health system executives.
Improved clinical outcomes
Women physicians have
5% lower readmission risk
than male physicians1.
Women physicians
have 4% lower mortality
risk than male physicians.
64%Believe3 turnover would
decrease at their
organization with
greater gender parity2.
59%
Believe3 their
organization would be
more profitable with
greater gender parity.
Improved business outcomes
© 2019 Advisory Board • All rights reserved • advisory.com
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Women physicians rarely considered for leadership
1) Of nearly 200 hospitals and health systems surveyed.
2) In a poll of 3,200 male and female executives.
Of executives said women have
been overlooked due to gender at
their organization2
55%
Of executives said women do not
self-promote as strongly as men
54%
Gender’s influence on
promotion trajectories
Source: Kacik Alex, “Few Women Reach Health Care Leadership Roles”, Modern
Healthcare, https://www.modernhealthcare.com/operations/few-women-reach-healthcare-
leadership-roles; Green Jeff, “Managers Pick Mini-Me’s of Same Race, Gender”, Bloomberg,
https://www.bloomberg.com/news/articles/2019-01-08/managers-pick-mini-me-proteges-of-
same-gender-race-in-new-study; Physician Executive Council interviews and analysis.
Percent of executives1 who say
they invest more in junior people
of the same race and gender
71%
© 2019 Advisory Board • All rights reserved • advisory.com
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Most women leave medicine too early in their tenure
Source: Paturel, A, et al., “Why Women Leave Medicine”, AAMC,
https://www.aamc.org/news-insights/why-women-leave-medicine;
Physician Executive Council interviews and analysis.
“When you invest more
than a decade of your life
to learn a skill and you’re
willing to walk away from
that early in your career,
that’s more than a red flag.
It’s a burning fire.”
Sasha Shillcutt, MD,
University of Nebraska
Medical Center
Gender
harassment
Percentage of women exiting medicine or
going part-time within six years of residency
40%
Salary
inequity
Gender
bias
Work-family
conflict
© 2019 Advisory Board • All rights reserved • advisory.com
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Catchall term ‘work-life conflict’ masks the real drivers
Source: Physician Executive Council interviews and analysis.
Decreasing career potential coupled with increasing stressors create natural exit points
Resident Early Career Motherhood Mid-Career Broken Rung Tenured
• Shorter
rec letters
• Fewer Grants
Medical
Student
• Salary Inequity
• Fewer
conference
invites, research
citations, funding
• Disparaging
Treatment
• Sexual
harassment
• Primary caregivership
• 8.5hrs more
housework/week
• Breastfeeding/
Pumping
discrimination
• Motherhood Penalty
• Inflexible hours,
location
• 71% report burnout
• Sexual harassment
• Fewer Mentors
• Salary Gap
Widens
• Fewer leadership
opportunities
• Greater burnout
• Gender
Discrimination
• Tapped for
‘supportive
leadership’ roles
• Not included in
CEO Pipeline
• Fewer P&L
responsibilities
• Fewer industry
event invitations
• Fewer media
features
• Leadership
Bias
• Settle into
Non-CXO
roles
• Round two
primary
caregivership
© 2019 Advisory Board • All rights reserved • advisory.com
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How health system leaders can flip the script
Source: Physician Executive Council interviews and analysis.
• Give women physicians
exposure to early career
leadership development
• Establish unbiased
succession management
• Identify and address culture
and incivility issues among
medical staff
• Understand women physicians’
individual career goals—and
uncover any barriers to
achieving them
Retain them past
early career hurdles
Create a path to
leadership pipeline
Early career women physicians1 Tenured women physicians2
© 2019 Advisory Board • All rights reserved • advisory.com
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Begin with identifying and measuring drivers of turnover
1) Staff respond with “yes” or “no” to the question: Are you likely to
retire, move out of your current region, or go back to school full
time in the next three years?
Source: Advisory Board Survey Solutions’ National Employee Engagement Database; Branham L, The Seven
Hidden Reasons Employees Leave, New York: Amacom, 2005, 3; “Global Generations, A Global Study on
Work-Life Challenges Across Generations,” EY (2015): 12-13; Talent Development research and analysis;
Physician Executive Council interviews and analysis.
Interpersonal relationships 1Poor team dynamics may create
distrust and a feeling of disconnection
Career growth and development 2Lack of real or perceived opportunities for growth
or promotion undermines attachment to role
Job content 3A poor fit between responsibilities and skills
leads to frustration and dissatisfaction
Workload and stress 4Demands and insufficient support lead
to burnout and departure
Where we often have control
15%Of staff say they will likely retire,
move, or go back to school full
time in the next three years1
12%Of staff leave for financial reasons
Limited number plan to
leave for personal reasons
Compensation rarely
the deciding factor
Where we have less control
© 2019 Advisory Board • All rights reserved • advisory.com
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Start with feedback from women physicians
Source: HR Advancement Center interviews and analysis;
Physician Executive Council interviews and analysis.
Focus group road map:
Introduction
(10 minutes)1
Get feedback on root causes
(25 Minutes)2
Discuss solutions
(25 minutes)3
Closing and next steps
(2 minutes)4
Root cause flipchart:
• Pre-write the problem and the goal.
• Pre-write one of your root causes at the
top of each page. Throughout the
discussion, document comments from the
group below each root cause. If the group
surfaces a strong root cause that you
hadn’t previously considered, document it
on a separate page.
Solutions flipchart:
• Pre-write ground rules for the session.
• Create a “parking lot” for ideas that
are out of scope for your discussion,
have this page visible during the root
cause discussion.
• Use the subsequent pages
to document solutions.
© 2019 Advisory Board • All rights reserved • advisory.com
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Deploy stay interviews to uncover career goals
and unique barriers
Source: Talent Development research and analysis;
Physician Executive Center interviews and analysis.
Learn what they
value the most
• Are there any
responsibilities they don’t
want to let go of?
• What skills do they
consider most critical to
their development over the
next year?
• Is there something you can
do to make this job feel
more fulfilling to them?
1
Understand the different
frustrations they
are facing
• What frustrations do they
have that they would
not put up with in the
long term?
• What’s one thing that
might make them not
want to work here?
• How can you better meet
their needs or fix existing
problems with their
current job?
2
Surface tension between
key life events and their
future goals
• Where do they see their
life going in the next
three years?
• What challenges might
that create for them in
their current role?
• How can you
best support their
progress toward their
future goals?
3
Three key aspects of the stay interview
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After stay interviews, address top concerns
If they say: You might:
Source: Talent Development research and analysis;
Physician Executive Council interviews and analysis..
“I’m passionate about
improving patient experience
but not sure how the business
side works.”
Connect them to a mentor or shadowing
opportunity with an administrative leader
or involve them in an ongoing effort.
“As a single parent and/or the
primary caregiver to an aging
relative I need to be home on
weekends and nights.”
Explore part-time or flexible work options for
work schedules—and/or help find a new role
in the organization that fits their schedule
“I’m concerned I’ll never get
the opportunities I need to
prove myself as a leader.”
Solicit them to lead new performance
improvement initiatives or give them
ownership over part of the rollout
for a new technology or process
“My infant has complex
medical needs and my eight
week maternity leave is not
enough to return to work.”
Understand their needs and help explore
leave and disability benefits that might
apply. Consider starting a volunteer time
bank program for employees to fund each
other’s leave.
© 2019 Advisory Board • All rights reserved • advisory.com
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A supportive culture benefits business too
Source: Medical Group Strategy Council Interviews & analysis;
Physician Executive Council interviews and analysis.
Examples:
• Patients with high risk of
readmissions and utilization
• Patients with multiple chronic
co-morbidities
Dual purpose of primary care segmentation
Provide the best place for
physicians to practice medicine
Provide the best place for
patients to receive care
Immediate care
Traditional primary care
Virtual and digital care
Complex care
Examples:
• Women’s health
• Executive health
• Concierge medicine
Examples:
• Retail segments
• Embedded within
medical group practices
Examples:
• Video and e-visits
• AI platforms
NorthShore allows physicians to self select into primary care specialties
© 2019 Advisory Board • All rights reserved • advisory.com
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Tips for facilitating a stay interview
Block your calendar for 15
minutes after each stay interview
to identify one to two action steps;
share clear next steps with the physician
Check-in again with the physician
three weeks from the interview to
review your action steps—and tweak
if necessary
Practice active listening
during the check-in
Follow up in one month to confirm your
actions steps were put into practice and
are making a difference
Source: Talent Development research and analysis;
Physician Executive Council interviews and analysis.
Schedule time with your own leader,
peers in your network, or HR to
brainstorm ways to make the role more
appealing and clear away obstacles
Tee up the conversation in
advance and send the questions
you’ll ask ahead of the meeting
Schedule another stay interview
conversation in six months to make
sure you stay up to date on what’s
important to them
Don’t try to problem-solve in the
moment; instead, use the time to
ask questions and learn about the
physician’s priorities, frustrations,
and hopes for the future
Before and during the interview: After the interview:
© 2019 Advisory Board • All rights reserved • advisory.com
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Examining your own culture: Difficult yet necessary
Source: Advisory Board Survey Solution Database, 2017;
HR Advancement Center interviews and analysis; Physician
Executive Council interviews and analysis.
1) Based on an employee’s agreement with the statement “I am likely to
be working for this organization three years from now.”
2) Tend to Disagree, Disagree, or Strongly Disagree.
Percentage of first-year staff who strongly agree
with the statement: “I am likely to be working for this
organization three years from now.”1
18% 18%
46%
First-year staff who
disagree they have
good personal
relationships with
coworkers
First-year staff who
disagree they receive
the necessary support
from employees to
succeed in their work
2 2
First-year
staff overall
Benefitting from an
outside perspective
“It can be the canary in the mine—
people working in the environment
that are not aware of the negative
culture. Sometimes it takes someone
from the outside to see there is
a problem.”
Debbie Wilson, VP/ Chief Nursing Officer
Saint Luke’s Hospital of Kansas City
© 2019 Advisory Board • All rights reserved • advisory.com
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Survey clinicians to identify unsupportive environments
Source: Saint Luke’s Hospital of Kansas City, Kansas City, MO; Nursing Executive
Center interviews and analysis; Physician Executive Council interviews and analysis.
1) The Heavenly Seven is copyrighted by Dr. Cole Edmonson, DNP, RN, FACHE, NEA-
BC, FAAN and Joyce Lee, MSN, RN at Texas Health Presbyterian Hospital Dallas.
Based on your last shift, rate your agreement
with the following statements:
1. I felt welcome on the unit
2. Someone offered help when I needed it
3. If floated again, I would enjoy returning to
this unit
4. I had the resources I needed to complete
my assignment
5. I witnessed someone expressing
appreciation to another for good work
6. Staff showed concern for my well-being
7. I received appreciation for my work
Saint Luke’s Hospital of Kansas City’s
“Heavenly Seven” Survey¹
Incivility Survey Sample interventions on units
with unsafe learning environments
Add additional
FTEs
Conduct focus
groups with staff
Sponsor team-
building retreat
Coach
ineffective leaders
© 2019 Advisory Board • All rights reserved • advisory.com
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Retaining early career women physicians
Discussion Questions for Leaders and Changemakers
Source: Physician Executive Council interviews and analysis.
• Do you know the top reasons why women physicians at your organization are
turning over or going part-time?
• Do you have conversations in place for routinely uncovering these reasons?
• How does your organization currently identify sources of incivility and
toxic culture?
• When sources of incivility or toxic culture are identified, how does your
organization typically respond? Are there ways to hold people accountable?
• If you were a female physician experiencing harassment, bias, work-family
conflict, etc., would you know who or where to go for support?
© 2019 Advisory Board • All rights reserved • advisory.com
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How health system leaders can flip the script
Source: Physician Executive Council interviews and analysis.
• Give women physicians
exposure to early career
leadership development
• Establish unbiased
succession management
• Identify and address culture
and incivility issues among
medical staff
• Understand women physicians’
individual career goals—and
uncover any barriers to
achieving them
Retain them past
early career hurdles
Create a path to
leadership pipeline
Early career women physicians1 Tenured women physicians2
© 2019 Advisory Board • All rights reserved • advisory.com
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Actively connect women to leadership opportunities
Source: “Women Leaders of the Future”, Korn Ferry,
https://www.kornferry.com/perspective-women-leaders-of-the-future;
Physician Executive Council interviews and analysis.
Three barriers to leadership development
Few opportunities to
hone leadership skills
You can have the most capable women…but if they don’t have the right experience they will always
be on the list for CEO but never get the job.”
Jane Stevenson, Vice Chair, Korn Ferry
Limited exposure to
executive leaders
Physician Leadership
Experience Forums
Lack of relationships
with current leaders
Strategic Leadership
Coaching Partnerships
Physician
Sounding Boards
© 2019 Advisory Board • All rights reserved • advisory.com
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Honing leadership skills with hands-on experience
LVHN targets one-on-one coaching to individual skill gaps
Strategic Leadership Coaching Partnerships
Source: Lehigh Valley Health Network, Allentown, PA;
Physician Executive Council interviews and analysis.
1) Specific Measurable Action-Oriented Realistic Timely.
Three key components of physician leader mentorship process
• Physicians identify 1-3
SMART1 learning goals
• Goals based on
self development,
organizational learning
• Physicians create action
plan for recording
criteria for success,
measurements,
goal milestones
• Physician, mentor meet
individually each month
• Mentor reviews goal
progress, offers
recommendations
Action plan
creation
Monthly
check-Ins
Learning goal
definition
Case in Brief: Lehigh Valley Health Network
• 988-bed, two-hospital system based in Allentown, Pennsylvania; employs 500
physicians
• High potential physician leaders eligible to participate in the Institute for Physician
Leadership, an internal leadership development and mentoring program; Institute
led by CMO and directed by internal OD consultant
• 40 physician fellows nominated for Institute by senior leadership every three years
© 2019 Advisory Board • All rights reserved • advisory.com
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Fellows select own coaches for compatibility
Seeking matches with common interests, expertise
Source: Lehigh Valley Health Network,
Allentown, PA; Physician Executive Council
interviews and analysis.
LVHN physician leader mentorship pairing process
Official
mentoring
partnership
lasts two
years
Participants create
mentorship
agreement
outlining terms,
committing to
productive
relationship
Fellows review
questionnaires,
identify top five
potential mentors
based on
interests,
learning goals
Mentors
complete
questionnaire
describing
leadership
experience,
strengths
CMO and OD
consultant match
physicians with
mentors based
on selections
© 2019 Advisory Board • All rights reserved • advisory.com
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Providing practical context rather than theoretical
Cleveland Clinic forums illustrate real-world application of skills
Source: Cleveland Clinic, Cleveland, OH; Physician
Executive Council interviews and analysis.
Participants
14 new and emerging
physician leaders,
scientists selected
based on department
director or
institute nomination
Content
Presenting leader
explains current role
in organization,
leadership journey,
day-to-day
responsibilities
Timeline
Group convenes one
full Friday each month
for six months; meets
with two or three
existing hospital
leaders each session
Lessons learned
At program conclusion,
each participant
creates leader
development plan and
has opportunity for
career coaching
Physician Leadership Experience Forums
Cleveland Clinic
• 3,119-bed, physician-led health system based in Cleveland, Ohio; employs 2,700 full-time physician
staff, 1,100 trainees
• Implemented Leadership Rotation Program to expose new and emerging physician leaders to
existing hospital leadership and leadership challenges, foster collaboration
• Each cohort meets with 20 physician and non-physician leaders across 6-month program
CASE EXAMPLE
© 2019 Advisory Board • All rights reserved • advisory.com
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Expanding your lens past the usual suspects
Source: Kettering Health Network, Kettering, OH;
Physician Executive Council interviews and analysis.
Kettering’s Physician Sounding Board
Meet with the CMO to discuss
specific initiatives relevant to
their specialty
Average time commitment
5-30 minutes, no more
than once a month
Informal group of 25-30
influential physicians who
occasionally provide input
to the CMO
The Physician Sounding Board should
represent the diversity of the medical
staff and include physicians across
specialties and sites of care
!
Physician Sounding Boards
© 2019 Advisory Board • All rights reserved • advisory.com
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Finding the non-usual suspects
Source: Kettering Health Network, Kettering, OH;
Physician Executive Council interviews and analysis.
Key questions to identify candidates
for physician sounding boards
• Who recently turned down a formal
leadership role that was offered to them?
• Whose opinions do physicians pay
attention to during meetings?
• Who is a consistent performer, but doesn’t
often have an opportunity to contribute?
• Who handles matters so well that they’re
rarely on your radar?
• Who is different from you, but
complements the team well?
• Who offers constructive process
improvement ideas?
Dr. David Doucette, Chief Medical Officer,
Kettering Physician Network
“I noticed in meetings that there were
some physicians who seemed to have a
lot of influence with their peers but who,
for one reason or another—maybe they
felt disenfranchised, didn’t have
enough time, or didn’t seem as
aligned—weren’t formal leaders.”
© 2019 Advisory Board • All rights reserved • advisory.com
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Common bias keeping women physicians off the list
Source: Grossman R, “The Care and Feeding of High-Potentials,” Society for Human Resource
Management, August 1, 2011; “Corporate Performance at Risk as Today’s Rising Talent Prepares to Jump
Ship,” Corporate Executive Board, June 1, 2010; HR Advancement Center interviews and analysis;
Physician Executive Council interviews and analysis.
Leader biases when selecting high-potential talent
Common
biases:
Potential
consequences:
“Mini-Me”
Younger version of current
leaders; similar qualities
and experiences
Staff distrust in
selection process
“Old Faithful”
Reinforcement
of status quo
Long-time employee; loyal
to leaders; has deep
institutional knowledge
“Ivy League”
Poor performance
in position
Highly intelligent; may hold
several degrees; performs
well in academia
© 2019 Advisory Board • All rights reserved • advisory.com
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Use succession planning to reduce promotion bias
Source: Garman AN, Tyler JL, “CEO Succession Planning in Freestanding U.S.
Hospitals: Final Report,” prepared for the American College of Healthcare
Executives, October 27, 2004; HR Advancement Center interviews and analysis;
2019 CMO Role Survey; Physician Executive Council interviews and analysis.
1) As defined by the American College of Health Care Executives
2) Of nearly 200 hospitals and health systems surveyed.
30%
“A structured process involving
the identification and preparation
of a successor for a given
organizational role that occurs
while that role is still filled.”
Definition of
succession planning1
Percent of CMOs2 have
not identified a successor
or succession plan
60%
Four key steps for implementing high-impact succession plans….
Identify
top talent
Customize
high-
potential
development
Personalize
onboarding
for new hires
Pinpoint
future
leadership
gaps
© 2019 Advisory Board • All rights reserved • advisory.com
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Standardize screenings to identify potential talent
Source: HR Advancement Center interviews and analysis;
Physician Executive Council interviews and analysis.
Vet top selectionsIdentify high-
performing staff
Final pool of potential
successors
Two screens to identify and vet leadership talent
Leadership
Potential Diagnostic:
Identify the top 25% of high-
potential leaders by assessing
a standardized set of behaviors
Group Hi-Po
Discussion Guide:
Narrow the list of physician
succession candidates to
the top 5%-10%
© 2019 Advisory Board • All rights reserved • advisory.com
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Identify high-performing physicians
Leadership Potential Diagnostic
Excerpt of Leadership Potential Diagnostic Questionnaire
Talent Questions Responses
1. Does this individual propose sound, defensible solutions to a
problem?
2. Does this individual collect information from all available
constituencies and sources prior to drawing conclusions?
3. Does this individual quickly learn complex concepts and then
apply them to his or her work?
4. Can this individual be an effective and inspirational manager,
even with
difficult employees?
5. Does this individual remain calm even in stressful situations?
Ambition Questions Responses
6. Is it important to this individual to be promoted to a senior
leadership position at this or another organization?
7. Is this individual motivated by being evaluated against his or her
accomplishments, rather than shying away from accountability?
Audience: Distribute to
service line, facility, and
department leaders
Purpose: Identify the
top 25% of leaders with
the talent, ambition, and
engagement to succeed
in senior positions
Source: HR Advancement Center interviews and analysis;
Physician Executive Council interviews and analysis.
© 2019 Advisory Board • All rights reserved • advisory.com
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Vet top selections with a representative group
Group High-Potential Discussion Guide
Source: Bank of America, Charlotte, NC; HR Advancement Center interviews
and analysis; Physician Executive Council interviews and analysis.
Job Complexity
• How complex is the individual’s job relative to others at the same level or in
comparable functions?
Goal Complexity
• To what degree are the established goals more or less difficult or complex than
other similarly situated individuals?
Collaboration
• Does the individual collaborate with others and build mutual respect beneficial to
the hospital?
Skill Versatility
• Does the individual use skills and abilities beyond those commonly held by people in
similar roles?
Rare Talent or Expertise
• Does the individual possess skills or talent that are rare or uniquely valuable to
the hospital?
Reflects Leadership Values
• Does the individual model the hospital’s values?
• Does the individual value diversity and manage a diverse workforce?
• Does the individual enable others to contribute to their full potential?
Excerpt of Group Hi-Po Calibration Discussion Guide
Audience: Service line,
facility, and department
leaders should attend
these sessions
Purpose: Narrow the
list of succession
candidates to the top
5%-10%
© 2019 Advisory Board • All rights reserved • advisory.com
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Developing physician leaders
• How do you currently choose individuals to participate in your leadership
development and advancement programs? How do you reduce bias in selection?
• What’s the current ratio of males to females in your development programs?
• Are there experiences you wish you had earlier in your career, or experiences
you think are critical for emerging physician leaders to have today?
Discussion questions for physician leaders
Source: Physician Executive Council interviews and analysis.
Succession management
Leadership development
• What were the formal and informal aspects that were at play when you were
chosen for your role?
• How can you limit bias in choosing your own successor?
© 2019 Advisory Board • All rights reserved • advisory.com
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How health system leaders can flip the script
Source: Physician Executive Council interviews and analysis.
• Give women physicians
exposure to early career
leadership development
• Establish unbiased
succession management
• Identify and address culture
and incivility issues among
medical staff
• Understand women physicians’
individual career goals—and
uncover any barriers to
achieving them
Retain them past
early career hurdles
Create a path to
leadership pipeline
Early career women physicians1 Tenured women physicians2
© 2019 Advisory Board • All rights reserved • advisory.com
33
Conduct a unit civility index survey
to uncover toxic workplace culture
Audit your parental leave policy
Identify high-potential women physicians
for succession management efforts
Audit and expand opportunities for
women physicians to access leadership
development opportunities
Have one-on-one stay interviews
with key women physicians
Identify and test flexible scheduling
models to improve work life balance
Where do we go from here?
Source: Physician Executive Center interviews and analysis.
1) Contact your relationship manager to access resources
included in your membership.
Possible next steps1
© 2019 Advisory Board • All rights reserved • advisory.com
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Physician Executive Council membership
Source: Physician Executive Council interviews and analysis.
• Care team ROI
• Care variation reduction at scale
• Future of the physician workforce
• Next generation primary care
• Patient access, medical group referrals
• Physician engagement and burnout
• Population health ROI
Perennial research topics
• Integrated medical group benchmarks
• Data-driven roadmap for
physician engagement
• Tools to make the most of your APPs
• Population health resources library
• Create care standards frontline
physicians will embrace
Popular resources
96%Health systems with a
system-level physician
executive role
System-level
83%Physician execs
with expanding
cross-continuum
responsibilities
Cross-continuum
81%Of health system
executives cite
physicians as the most
important stakeholder
for change
Strategically vital
Today’s physician executive roles
2. Mobilize the physician
enterprise to drive
lasting impact
1. Prioritize tactics to tackle your
system-wide priorities
How we partner with physician executives