Programs of Promise:Physician Leadership Academies

Integrated Healthcare StrategiesAlignment & Engagement Support for High Performance Healthcare Providers

James A. Rice, Ph.D., FACHEPractice Leader

Governance and Leadership

Vice ChairmanThe Governance Institute

612.337.1307

jim.rice@ihstrategies.com

Please dial: (641) 715-3222access code 187-366-641

to join the conference call if you haven’t done so already.

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Programs of Promise:Physician Leadership Academies

• Need for Leaders

• Competencies

• Methods

• Support to Sustain Success

Please dial: (641) 715-3222access code 187-366-641

to join the conference call if you haven’t done so already.

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What do boards and Executive Teams acknowledge is one of their key strategic imperatives for success?

Establishing, developing & supporting physician leaders that help build physician alignment with the performance goals of the enterprise.

Please dial: (641) 715-3222access code 187-366-641

to join the conference call if you haven’t done so already.

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Physician Leadership Development Process

Future Operating

Environment

Threats, Challenges & Opportunities

Number & Types of

Physician Leaders

Attributes of Physician Leaders

Methods to Select,

Support & Develop

Physician Leaders

Selection by Election

Selection by Appointment

Pay-for-Performance

sophisticated patients

chronic care

calls for quality & safety

competition for patients

competition for physicians & employees

public results reporting

Arenas of threat or opportunity include:

•continuity of care

•quality outcomes

•patient satisfaction

•physician morale for process improvement

•employee pride for sustained system enhancements

•demands for cost effectiveness

•need for market respectLeadership Development

Current Complexity in Accountabilities & Compensation Among Hospital Physician Leaders

External Demand for Competence & Performance:

IRS, Stark, State Attorneys General, Media,

Internal:

Results, Fairness, Alignment

Please dial: (641) 715-3222access code 187-366-641

to join the conference call if you haven’t done so already.

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Active Medical Staff

BOD Appoints Medical Staff

COSCOS-E

Primary Care

Division

Medical Division

Surgical Division

Behavioral Division

Hospital Based

Division

Past COS

MDOC

BOD Structures Divisions

System Board

Hospital Board

Hospital or System CEO

Med Staff Committees

Burn

By-Laws

Cancer

Credentials

Infections

Inter-disc Practices

Med Records

O.R.

Patient Care

Rx Therapeutics

Quality Peer

Rad Safety

Trauma

Fam Pract

Gen Med

Peds

Ob Gyn

Psych

34 Sections in 5 Divisions

Emergency

Radiology

Pathology

Anes.

CVT

Gen Surg

Plastic

ENT

Neuro Surg

Ortho

Ophthal

Dent Oral

DDS MD

Podiatry

Urology

Allergy

Cardiology

Derm

Endo

G.I.

HemOnc

Neuro

Nephro

Inf Disease

Occ Med

PM & R

Pulmo

Rheum

Rad Therapy

Group Compacts

VPMA

56 Medical Directors

Clinical Programs

Anesthesia

Bariatrics

Behav Inpt

Breast Health

Burn Unit

Card Cath

Card Cath

CCU/Telem

Card Rehab

Perinatal

Plastic Surgery

PM & R

Radiology

Radiology HSC

SICU

ED

Care Management

Card Research

Card EP

Heart Failure Clinic

Card Outreach

Card Clinics

Card Nuclear

Sleep Lab

Surgery 1

Surgery 2

Surgery Gen Call

Surgery Vascular

Surgery Trauma

EEG/EMG

GI Lab

Infection Control

Infec Diseases

Informatics 1

Informatics 2

Intensivist

MICU

Neurology

Neuro Dx Lab

Neuro Surgery

Trauma

Urology

Pediatrics

Pathology

Palliative Care 2

Ortho Gen

Ortho Trauma

Orthopedics

Onc Outreach

Oncology

Occ Med

OB/GYN Peri

OB/GYN GSS

Card Non Invasive Lab

Hospitalists Palliative Care 1

Current Complexity in Accountabilities & Compensation Among Hospital Physician Leaders

Med Education Programs

Emergency

Family Med

Occupational Med

Podiatry

Int Med

Ob Gyn

Gen Surgery

Neuro

Ophthal

PM & R

EMT

Radiology

Plastics

Ortho

Anesthesia

Psych

University

Medical Executive Committee

Market Realities

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Why clear and lean physician leadership structure?

1. To increase the effective empowerment of physician leaders to be more fully engaged in the processes of developing the clinical care and economic vitality polices and procedures;

2. To increase the likelihood that the physician leadership will be more transparent and understandable to physicians and hospital staff;

3. It will be easier to attract and retain the best and brightest physicians into leadership roles;

4. The physician leaders will more likely be successful and find satisfaction in their leadership roles; and

5. The physician leaders will be more effective and accountable to the mission and strategic plans of the hospital

How can hospitals invest to support physician leader development?

Beyond physician comp and fair market valuePrograms of Promise.To proactively design and support the development, compensation and performance enhancement of physician medical directors, medical staff leaders and clinical chairpersons.

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Physician Leadership Academies:

Assessed over 20 Programs: e.g.,American College of Physician ExecutivesBaylor HealthMayoPeaceHealthCedars SinaiCleveland ClinicSt. Thomas Physicians Leadership CollegeAdvisory BoardSeveral MBA and Executive Ed SchoolsInternational Health Leadership Program in Cambridge England

Survey Results on Factors that Facilitate and Frustrate Physician Leader Effectiveness

Input from over 400 hospital leaders

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Factors That Frustrate Success?

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Factors That Frustrate Success?

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Factors That Facilitate Success?

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Physician Leadership Academies

CompetenciesLearning Methods

Competencies

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Competencies

Beyond strong clinical skills, the Healthcare Leadership Alliance recommends 300 competencies five key common domains:

Communication and relationship management; Leadership; Professionalism; Knowledge of the health care environment; And Business knowledge and skills.

See www.healthcareleadershipalliance.org

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Competencies

“Back Wheel” Competencies1

Patient care

System-based practice

Professionalism

Medical knowledge

Practice-based learning and improvement

Technical: accounting, planning, contracting, project management etc

“Front Wheel” Competencies2

Interpersonal EffectivenessLeading others (coaching)

Communication & Style

Leading and managing change

Building relationships

Versatility with groups in various venues

1 See e.g., American College of Medical Practice Executives (ACMPE)2 Baylor Health Care System

SelfAwareness

Learning Methods

Coaching or mentoringOn-the-job-experiencesFunding participation in on-campus leadership

trainingSkill building workshopsVolunteerism in other health related

organizationsSelf-study via books, audio tapes, video tapes

and distance learningDegree programs

Learning Philosophy 1.

Rely on small groups of physician cohorts for group learning, but encourage interdisciplinary projects and case studies, according to

Learning Philosophy 2.

Emphasize real-time case studies of serious challenges that relate to enhance patient experience, process improvements and measurable economic gain

Learning Philosophy 3.

Rely on a mix of in-house expert faculty with outsourcing to local business schools, national health leader associations or professional firms

Learning Philosophy 4.

Require short sessions such as a two- to four-hour spread during several weeks to encourage applications in real-world settings and to be respectful of physician time.

Learning Philosophy 5.

Cautious reliance on new digital learning tools, such as Webinars, Pod casting, Teleconferencing and dedicated Web sites for Knowledge Downloads and Expert Bulletin Boards.

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Academy: One Part of Comprehensive Program

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Physicians Leadership Academy

Building Blocks for Enhanced Physician Leadership

Quality & Patient SafetyPay for PerformanceIntegrated Care SystemsCost EffectivenessAttract & Retain Excellent Clinicians and Staff

Leader Positions Defined1

Position Descriptions2

Recruit for Competencies3

Performance Metrics4

Orientation5

Development6

Support7

Performance Reviews8

Recognition & Rewards9

Periodic System Refinements10

Strategic Imperatives:

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Mod 1: Clarify strategic directions for your physician leadership initiatives:

1. Review your most recent strategic and financial plans.2. Forecast your competitor moves for growth.3. Review your current incentive compensation philosophy

and systems for executives and physicians.4. Identify your key frustrations with physician/hospital

alignment and collaboration.5. Define preliminary strategic vision and goals for your

enhanced “Physician Leadership Performance Plan.”

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Mod 2: Establish workplan to audit and establish your enhanced PLS™:

1. Review board, CEO and CMO strategic motivations and priorities for enhanced physician leadership programming.

2. Define scope of work via number of physician leader positions to be reviewed, and expected degree of consultant involvement in program development and implementation.

3. Convent meeting with CEO and executive team to a defined timetable to complete analyses and plans for enhanced physician leadership.

4. Review preliminary workplan, timetable, and budget with CEO/Board.

5. Publish final workplan, calendar, and budget.

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Mod 3: Audit Physician Leader Arrangements:

1. Review Medical Staff Structure2. Review Physician Co-Ventures3. Review Medical Director Jobs4. Review Physician Leader Compensation Arrangements5. Review systems for recruiting and developing physician

leaders

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Mod 4. Assess Physician Leadership Culture:

1. Interview selected leaders of board, management, and medical staff

2. Conduct Web Survey of Physicians3. Conduct Web Survey of Physicians4. Conduct Web Survey of Nurses5. Conduct Web Survey of Board and Management

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Mod 5: Design performance development program:

1. Establish organization chart of key physician leader jobs in medical staff; in physician co-ventures; and as needed to execute the organization’s strategic business and financial plan.

2. Define ideal physician leader competencies and code of conduct.3. Update all physician leader job descriptions and performance

metrics.4. Design physician leader recruitment plan.5. Design physician leadership development program, staffing, and

materials.

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Mod 6: Establish performance appraisal system:

1. Identify SWOT of existing physician leader appraisal system.2. Establish strategic vision and philosophy for physician leader

appraisal linked to formal development and to recognition and reward.

3. Design infrastructure for physician appraisal system.4. Conduct orientation to appraisal system.5. Develop and install final physician appraisal system (staff,

software, hardware, web-based manuals, user guides).

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Mod 7: Develop performance-based pay:

1. Define “Physician Leader Compensation Philosophy” with CEO and Board.

2. Document current base and incentive compensation for each physician leader and position.

3. Conduct analyses on appropriateness and reasonableness of base and incentive compensation for each physician leader and position.

4. Develop data base that links each leader’s performance expectations with pay arrangements.

5. Develop policies and procedures to link performance appraisal systems with incentive pay arrangements.

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Mod 8: Publish PLPP™ manual:

1. Conduct client evaluation of all results and systems associated with Mods 1 through 7.

2. Develop updated text on vision, philosophy, goals, and strategies for Physician Leadership Performance Program (PLPP).

3. Seek final CEO, board, and medical staff approvals of draft PLPPpolicy and procedure manual.

4. Produce print and digital versions of the PLPP manual.5. Distribute PLPP manual to leadership of organization.

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Mod 9: Orient leadership to PLPP:

1. Develop orientation program, calendar and materials.2. Schedule invitations for leadership of board, medical staff,

co-ventures, and managers to be introduced to final PLPP.3. Conduct board retreat on PLPP.4. Conduct medial staff leadership retreat on PLPP.5. Conduct manager retreat on PLPP.

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Mod 10: Install infrastructure for PLPP in “Physician LeadersNet™” website:

1. Develop staff to implement and administer PLPP within updated medical staff office.

2. Design enhanced medical staff intranet for access by members of active medical staff.

3. Design enhanced “Physician LeadersNet™” as hosted website is integrated into hospital intranet.

4. Publish educational and motivational materials to facilitate understanding and use of PLPP and “Physician LeadersNet™”.

5. Conduct six-month surveys on use and effectiveness of PLPP and “Physician LeadersNet™”.

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Questions

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Webinar Series Continues...

Webinar #3 – GLS: Executive Coaching for Healthcare LeadershipThursday June 19, 2008 10:00 AM CDT

Webinar #4 – GLS: Leadership Continuity: Ensuring the C-Suite Chairs are never Empty Thursday July 17, 2008 10:00 AM CDT

Webinar #5 – GLS: Helping Develop the CEO through the Performance Appraisal Thursday August 14, 2008 10:00 AM CDT

Webinar #6 – GLS: Governing Executive Compensation: It's more than just creating the Rebuttable Presumption Thursday September 11, 2008 10:00 AM CDT

Register at: www.IHStrategies.com

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More Information & Questions

Contact our specialists:

Jim Rice, Ph.D, FACHE – Executive Vice Presidentjim.rice@IHStrategies.com

Jay Justice - Senior Vice Presidentjay.justice@IHStrategies.com

Kurt Kastel – Senior Consultantkurt.kastel@IHStrategies.com

800-327-9335

A recording of this Webinar can be downloaded from our website’s Knowledge Center at www.IHStrategies.com