2015_NCHL_Physician Leadership Development Programs Best Practices Case Studies

NATIONAL CENTER FOR HEALTHCARE LEADERSHIP

2 Best Practices in Physician Leadership Development Programs

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National Center for Healthcare Leadership 3

Introduction .............................................................................................................................................. 5

Best Practices in Physician Leadership Development: Henry Ford Health System .................................. 7

Who They Are: Brief Overview ............................................................................................................. 7

Overview of Physician Leadership Development at HFHS ................................................................... 7

An In-Depth Look at PLI ........................................................................................................................ 8

Impact of Programs to Date ............................................................................................................... 12

Critical Success Factors and Other Lessons Learned .......................................................................... 13

Best Practices in Physician Leadership Development: North Shore-LIJ ................................................. 15

Who They Are: Brief Overview ........................................................................................................... 15

Overview of Physician Leadership Development at NSLIJ .................................................................. 15

Review of Program Offerings .............................................................................................................. 16



Best Practices in Physician Leadership Development: Sutter Health ..................................................... 25

Who They Are: Brief Overview ........................................................................................................... 25

Overview of Physician Leadership Development at Sutter ................................................................ 25

Review of Program Offerings .............................................................................................................. 27




Best Practices in Physician Leadership Development Programs CASE STUDIES


Introduction

Meeting the challenges facing healthcare organizations today requires not just great leaders, but

great physician leaders. The most successful organizations are fundamentally re-thinking and

redesigning care delivery at the front lines of medicine.

They are rapidly transitioning from a volume-based, fee-for-service system characterized by episodic,

sometimes unnecessary care, to one focused on managing the health of populations through

proactive care management and adherence to evidence-based guidelines and protocols, facilitated by

cutting-edge information technology and clinical-decision support. Physician leaders can be the

catalyst for organizations to navigate the transition and achieve the “efficient use of scarce resources

while maintaining strong clinical quality and patient focus.”1

Recognizing the importance of effective physician leadership, the National Center for Healthcare

Leadership’s (NCHL) Physician Leadership Development (PLD) Council decided in 2013 to focus its

efforts on deepening its understanding of internal PLD programs at hospitals and health systems. This

effort culminated in the publication of a white paper, Physician Leadership Development Programs:

Best Practices in Healthcare Organizations,2 which lays out 10 recommendations for implementing

effective PLD programs:

Ensure that the organization’s executive leaders actively support the PLD program

Directly link the PLD program with the organization’s strategic priorities

Use the PLD program to build and expand physician and inter-professional relationships

Align and integrate the PLD program with existing learning and leadership programs

Hold ongoing conversations with existing and emerging physician leaders

Design the curriculum to support the organization’s desired competencies/capabilities

Use both internal and external faculty

Employ effective learning methods

Provide coaching, mentoring, and other support whenever possible

Evaluate and refine the program using metrics tied to organizational performance

As a follow-up to this paper, members of the NCHL PLD Council felt it was important to offer real-

world examples of organizations that have followed many of these best practices.

1 Mountford J, Webb C. When clinicians lead. The McKinsey Quarterly. February 2009. McKinsey & Company.

2 National Center for Healthcare Leadership, Physician Leadership Development Programs: Best Practices in Healthcare

Organizations, 2014.


Henry Ford Health System (HFHS), which serves more than one million residents of Southeast

Michigan, offers its own Physician Leadership Institute program as part of the HFHS Corporate

University. This comprehensive 8-month program builds strong leadership and management

skills in high-potential physicians, and, like at NSLIJ, has allowed HFHS to retain its top physician

leaders and fill the vast majority of its leadership positions internally.

North Shore-LIJ Health System (NSLIJ), which serves 7 million residents of Long Island,

Manhattan, Staten Island, and Queens, launched the Physician Leadership Institute in 2010 as

part of its Center for Learning and Innovation. The Institute offers multiple programs to

physician leaders throughout the organization, including the Physician High Potential Program,

which has led to significant improvements in emotional intelligence among participants and has

helped NSLIJ retain its top physician leaders and fill vacant leadership positions internally.

Sutter Health, a non-profit, integrated health system serving more than 100 communities in

Northern California, offers a broad array of leadership development programs that serve all

levels of physician and non-physician leaders. Known as the “Signature Series,” these programs

have generated high levels of satisfaction, retention, and promotions among participants;

increased self-ratings on the various competencies targeted; and allowed Sutter to make

substantial progress in addressing real-world problems and priorities faced by the organization.

A brief introduction to each of these case studies appears on the following page.


Best Practices in Physician Leadership Development: Henry Ford Health System

Who They Are: Brief Overview

The Henry Ford Health System (HFHS) is a not-

for-profit, integrated health system based in

Detroit. Founded in 1915 by Henry Ford, HFHS

provides a full spectrum of health services,

including acute, specialty, primary, and

preventive care; behavioral health services;

home health and hospice care; skilled nursing

care; and community health services.

With annual revenues of over $4.5 billion

(2013), HFHS serves more than one million

residents of Southeast Michigan through a

provider network that includes six hospitals

(including its flagship facility, Henry Ford

Hospital), 37 outpatient medical centers, 22

pharmacies, and various other specialty facilities

and care sites.

HFHS also operates a health plan with over

675,000 members. The health system employs

more than 23,000 individuals (making it the fifth

largest employer in the Detroit metropolitan

area), including 1,200 physicians in the Henry

Ford Medical Group (HFMG). HFHS also has over

5,500 affiliated physicians, volunteers, and

students.

As one of the nation’s leading health systems,

HFHS has received numerous awards, including

the Malcolm Bridge National Quality Award and

the Eisenberg Patient Safety and Quality Award.

It has been recognized by various organizations,

including U.S. News & World Report, the

National Business Group on Health, Becker’s

Hospital Review, the Centers for Medicare and

Medicaid Services, the Premier Hospital

Alliance, and the American Medical Group

Association.

Overview of Physician Leadership

Development at HFHS

As depicted in the chart below, HFHS University

serves as the overall organizational

development arm for the system, developing,

implementing, and administering curriculum-

based programs to support employees, existing

leaders, and those with the potential to become

leaders, with the goal of building organizational

capacity and value.

Established in 2011, the Physician Leadership

Institute (PLI) serves as the primary vehicle

within HFHS University for developing physician

leaders, with a focus on serving “high-potential”

physicians who exhibit the skills and desire to

become leaders within the organization. To

date, four cohorts that collectively include 62

physicians have completed the 8-month PLI

program. A second program, known as

Fundamentals of Physician Leadership, is a one-

day workshop that serves as a prerequisite to

PLI and an orientation to physicians new to

leadership.

As the following chart suggests, HFHS physicians

also have access to several other leadership

development programs. These programs

generally target administrative leaders, but also

set aside spots for physicians.


They include the New Leader Academy (which

serves newly promoted or hired leaders), the

Leadership Academy (which targets mid-level

leaders) and the Advanced Leadership Academy

(which historically served 30 to 40 leaders at a

time, including 5 to 8 physicians). Advanced

Leadership Academy and Leadership Academy

launch on alternate years.

As part of ongoing efforts to evaluate and

improve program offerings, each of these

academies is currently being updated for

alignment to current HFHS strategic priorities.

An In-Depth Look at PLI

Spanning an 8-month period, PLI is a

comprehensive program designed to build

strong leadership and management skills in

high-potential physicians. As the descriptions

below illustrate, HFHS has structured PLI in

accordance with most if not all of the 10

recommendations laid out by NCHL for

implementing effective leadership development

programs.

Rigorous Selection Process Tied to Talent

Management, Succession Planning

To participate in PLI, physicians must be

employed by the Henry Ford Medical Group, a

self-governed organization within HFHS, or

contractually employed in one of the HFHS

community hospitals. To avoid serving

physicians at or near retirement, eligible


individuals must have less than 20 years of

experience after having completed medical

school or a doctorate degree. Candidates must

be nominated by a clinical department chair and

complete an application. The nomination

process is announced in a live meeting of HFHS

department chairs, through senior physician

program leaders, and in the medical group’s

newsletter.

Chaired by the CEO of the Henry Ford Medical

group, the PLI selection committee makes final

decisions based on candidate applications and a

review of results from HFHS succession planning

and talent management processes. The number

of individuals accepted to the program has

increased over time, with 12 participants in

2011 (the first year of the program), 15 in both

2012 and 2013, and 20 in 2014.

Diverse Teams

Prior to starting the program, PLI leaders divide

each year’s cohort into 4- or 5-person teams

that work together on a Capstone Project. This

process is designed to ensure that each team

has a diverse mix of individuals with respect to

their background (medical versus surgical versus

research), primary work location (hospital

versus ambulatory care), demographics (race,

gender, and/or ethnicity), and personality styles

(as determined by initial assessments conducted

at the start of the program; see below for more

details).

Broad-Based Curriculum

PLI’s curriculum is intended to prepare

physicians to manage effectively in the

challenging, complex environment in which

HFHS operates. More specifically, it aims to

promote the following competencies:

Business planning/operations and financial

management

Strategic visioning and planning

Project and group management

Quality and process improvement

Ethics and regulatory compliance

Service line management

Listening and communication skills, including

how to manage crucial conversations among

professionals

Change management, including ways to

influence others and promote change

Monthly Full-Day Sessions Making Use of

Multiple, Interactive Learning Methods

As depicted in the chart on the next page, the

cornerstone of PLI is a series of full-day sessions

held each month that focus on a variety of

“hard” and “soft” management, business, and

leadership skills. After launching the program

with a focus on didactic lectures, PLI has

migrated toward use of more interactive

learning methods, including case studies.

Participants read materials in advance

(accessing them online) and then spend the bulk

of class time discussing and building on what

they have read. Going forward, PLI leaders plan

to introduce additional blended learning

methods, including use of social media and

other forums to encourage interaction inside

and outside the classroom.


Pre- Session Meet and Greet: Welcome to PLI! Building a Learning Community Incoming PLI members meet with Senior Physician Leadership, Finance Leadership, HFHS Corporate University Leadership, and PLI Alumni Leaders from Previous Cohorts

Session #1: Leadership Pre-work: Self-Awareness Assessments: Emotional Intelligence (EI) and Strength Finders, Forming EI/Strength-Based Teams EI and Strength Finders: Overview HFMG Physician Leadership, HFHS Culture of Development Business Plan: Capstone Project, Team-Based Action Learning Project Overview Group Project Management Strategies

Session #2: Management Skills Avoiding Leadership Pitfalls: Leadership vs. Management Talent Management: Hiring, Employee Development, Managing Challenging Conversations, Performance Improvement Influencer Part 1: Changing Vital Behaviors, Identifying Opinion Leaders System-Level Improvement Projects: Business Plan, Selection and Assignments

Capstone Project Support Sessions: Business Plan Proposal, Team-Based Action Learning Project Break Out Session/Support: Collaboratively Building a Business Plan Within a Team Half Day Session #1: Assignment/Orientation with Finance and Subject Matter Expert Coaches Break Out Session: Collaboratively Building a Business Plan Within a Team Half Day Session #2: Finance and Subject Matter Expert Coaches, Project Update

Session #3: Influence Influencer Part 2: Six Sources for Supporting Organizational Change, Integrating Influencer into Business Planning Process Business Plan: Project Update

Session #4: Appreciative Inquiry and A New Land: The Physician Leader, Building Networks and Teams Organizational Change: Appreciating/Valuing the Best of What Is, Envisioning What Might Be Dialoguing: What Should Be, Innovating What Will Be Managing Oneself, How Every Organization Is Structured, Culture, How People Connect, Tasking for Teamwork

Capstone Project Rehearsal Presentation: The Business of Healthcare Business Plan Proposal “Rehearsal” Team Presentations: HFHS Budget Oversight Committee New or Improved System Services: Delivering Project Proposals, Receiving Feedback

Session #5: Quality/Safety Human Factors Engineering, Process Improvement, Risk Management and Sentinel Events, Data and Analytics, Leading Quality Efforts (Panel)

Session #6: Graduation Celebration & Capstone Project Graduation Day: Final Capstone Project--Business Plan Proposal and Final Team Presentation to System Leaders and Peers Celebration Lunch with Faculty, Leaders, and Peers

Additional Support for PLI Members and Teams Individual Support: Two EI Coaches: 2 to 3 hours of Coaching Support; Development of Learning Plan Capstone Project Team Support: Coaching from Subject Matter and Finance Coaches on System-Level Projects


Capstone Project on Issue Facing HFHS

Each team completes a Capstone Project. For

the first two years of the program, physicians

came up with their own ideas for projects based

on personal knowledge in their areas of

specialty. Beginning in the third year, program

leaders began suggesting potential projects that

had surfaced as strategic priorities for HFHS.

Throughout the project, the team interacts with

subject matter experts within HFHS who are

tackling the problem.

Going forward, the plan is to have team

members join (or perhaps lead) real-world

committees and workgroups carrying out these

projects, thus enabling them to see their work

through to its culmination. Teams work under

the ongoing guidance of a finance and business

mentor who teaches various business skills, such

as how to calculate return on investment (ROI)

and net present value. These mentors provide

guidance during two scheduled half-day sessions

and at other times as needed. The half-day

sessions were added in 2013 after program

leaders realized that physicians faced significant

difficulties scheduling meeting time outside the

program.

At the end of the project, teams present their

findings, first in a practice session to the

system’s budget oversight committee, and then

in a final session to senior leaders and

department chairs. The practice presentation

used to be done in front of peers; this approach

was changed to allow for more constructive

feedback.

Emotional Intelligence Assessment and

Support

Working with external consultants and coaches,

participants go through an initial 360-degree

survey of their emotional intelligence (Hay

Group’s Emotional and Social Competency

Inventory or ESCI assessment) linked to 4

domains:

1. Self-awareness

2. Self-management

3. Social awareness

4. Relationship management

The process includes a self-evaluation and

assessments by supervisors, peers, and direct

reports. Based on the assessment results, the

certified coach works with the participant to

develop a learning plan and then provides

coaching and support around that plan. This

process typically consists of an upfront two-hour

session, followed by one or two additional one-

hour sessions. All results are kept confidential so

as to allow participants to learn and practice in a

safe environment.

“Physicians are generally not introspective enough, and try to avoid introspection as much as possible. But the emotional intelligence assessment and coaching uncovered some issues and elements that I never would have picked up on my own. It forced me to be introspective and pay attention to valuable feedback.”—Farzan Siddiqui, MD, participant in HFHS PLI program


Strengths Assessment

Participants also complete a Gallup

StrengthsFinder Assessment with guidance from

an internal organizational development coach to

help understand their strengths. Strengths are

mapped on a team roster so that every

participant has a sense of his or her own

strengths and those of their teammates. The

roster is also used to assemble balanced, diverse

project teams.

Strategic Use of Internal and External

Faculty

Senior HFHS physicians and administrative

leaders teach most of the workshops and

frequently partner as dyads to ensure subject

matter expertise and overall quality of training.

This approach also ensures that participants

have the opportunity to regularly meet, interact

with, and learn from HFHS and Henry Ford

Medical Group senior executives and physicians.

Physician and administrative leaders within

HFHS are expected to be teachers. In fact, the

system CEO in 2010 established a cascaded goal

for all leaders to commit to a “culture of

development” and set the expectation that

leaders be teachers. As a result, many senior

leaders, including the system’s chief medical

officer (CMO), the CEO of the Henry Ford

Medical Group, the chief operating officer for

the system, and department chairs, regularly

lead classroom sessions. In addition, the system

CMO attends virtually every session, often

staying for most or all of the day.

PLI also makes liberal use of external partners

and faculty to strengthen the program in areas

where HFHS lacks internal resources and

capacity. To that end, the Hay Group oversees

the emotional intelligence training; and Vital

Smarts administers “influencer training” (the

focus of the June session and part of the

September session).

Impact of Programs to Date

To date, the programs have shown the

following:

Overall satisfaction scores from PLI

participant evaluations average 4.6 out of

5.0 Likert scale

94% percent of those graduating from PLI

remain at HFHS, a higher retention rate than

existed among physician leaders before the

program began, and a higher rate than

among HFHS employed physicians as a

whole

56% of PLI graduates to date have been

promoted after their completion of the

program

In addition, HFHS is beginning to see traction

with its Capstone Projects and hopes to soon

have quantifiable data documenting a positive

ROI as these projects continue to be aligned

more strategically to system priorities. PLI

graduates have proven to be a great resource to

the HFHS “Physician Partner” program by

volunteering to mentor physicians new to HFHS

as part of their onboarding process. PLI

graduates are also sought after to fill various

committee seats within the system’s quality and

governance structures. In recognition of their

commitment to leadership development, HFHS

was recently recognized as a winner of the 2014

Best Organizations for Leadership Development

(BOLD) award from NCHL.


Critical Success Factors and Other

Lessons Learned

As the program descriptions illustrate, HFHS has

embraced most if not all of the 10

recommendations laid out in the NCHL white

paper, and doing so has played a key role in the

success of its programs. In particular, program

leaders highlight the following as having been

central to the program’s success:

Making sure senior physician and

administrative leaders are “at the table”:

Consistent with NCHL’s recommendation to

ensure leadership support, HFHS senior

administrative and physician leaders have

been highly involved in planning, delivering,

and advocating for the program. Their visible

role serves as a strong signal of the

importance of physician leadership

development to current and would-be

participants. For example, the CMO’s

presence at every PLI session is noticed by

participants; one participant noted that

seeing the system CMO, CEO, chief quality

officer, and department chairs at various

sessions impressed him greatly, particularly

the degree to which they engaged in the

substance.

Clearly defining roles and decision-making

processes: Whenever multiple senior

leaders come together on a project, some

ambiguities will exist as to everyone’s role in

the process, particularly with respect to

decision-making. Consequently, efforts

should be made to discuss and define roles

and responsibilities up front and meet

regularly with key stakeholders to review

milestones and identify clear expectations

regarding next steps and accountabilities.

Continually evaluating and refining

program offerings: No program will be

perfect from the outset. Program leaders

need to regularly elicit feedback from

participants and other stakeholders in an

effort to identify opportunities to improve

program offerings. In addition as noted

earlier, several programs within HFHS

University are currently being updated as a

result of cycles of improvement focused on

better strategic alignment between training

and new areas of focus within the system’s

annual strategic plan.

For example, a “meet-and-greet” event was

recently added to the beginning of the PLI

program. During this session, PLI alumni

meet with the incoming class in an effort to

get to know each other and to share their

experiences. In addition, another half-day

session with coaches and subject matter

experts was recently added to the

curriculum to provide additional support to

the Capstone Project teams and their efforts

to align with key system priorities.

Using mixed learning methods, making use

of emerging technologies: Following NCHL’s

recommendation to use mixed learning

methods, HFHS program leaders have been

looking for ways to leverage mobile and

social media technologies to encourage

more interactive discussion both inside and

outside of the classroom. They are also

looking at opportunities to use software to


assist with coaching and MOOC (massive,

online open courses) technology to

introduce off-hour opportunities (e.g.,

evenings, weekends) for learning and

interaction.

Maximizing mentoring/coaching and other

support, particularly with alumni:

Consistent with NCHL’s recommendation,

HFHS provides a significant amount of

coaching and mentoring to participants,

including looking for ways to leverage

program alumni as a source of support. The

aforementioned “meet-and-greet” session

can be a good way to get alumni involved,

although their participation should ideally

continue throughout the program via email

and other mechanisms.

Looking outside the organization for best

practices, faculty: Consistent with NCHL’s

recommendation, HFHS makes use of

external faculty as needed to supplement

internal resources. Program leaders have

also visited and brought back ideas from

other organizations; for example, after a trip

to the Cleveland Clinic, they decided to

incorporate a new topic into the PLI

curriculum--“mindful” leadership.

Being patient: The development of effective

PLD programs does not happen overnight,

but rather takes substantial time and effort.

In time, this effort should produce a

significant ROI.


Best Practices in Physician Leadership Development: North Shore-LIJ Health System


North Shore-LIJ (NSLIJ) is the product of the

1997 merger of two independent hospitals ‐

North Shore University Hospital, which opened

in 1953 with 185 beds, and Long Island Jewish

Medical Center, which opened the following

year with 215 beds. NSLIJ serves 7 million

residents of Long Island, Manhattan, Staten

Island, and Queens.

With annual revenues of roughly $7 billion and a

workforce of more than 48,000 employees

(making it the largest private employer in New

York State), NSLIJ is the second‐largest non‐

profit secular healthcare provider in the nation,

the largest integrated healthcare system in New

York State, and the largest healthcare provider

in its region. With the support of more than

9,400 physicians, over 10,000 nurses, over 1,200

medical students, and more than 1,500 medical

residents and fellows, NSLIJ operates or is

affiliated with 18 hospitals and also offers a

wide range of primary and specialty care

services through a network of mental health,

long‐term care, rehabilitation, outpatient

surgery, home care, and hospice care facilities

and programs.

NSLIJ also has its own insurance program, a

corporate university that houses a large

simulation and patient safety center, and a

world‐renowned research institute. NSLIJ

maintains affiliations with several regional

medical schools and opened its own school of

medicine in 2011 in cooperation with Hofstra

University.

NSLIJ has received various prestigious awards,

including the National Quality Forum’s 2010

Healthcare Quality Award, The Joint

Commission’s Codman Award, and the Pinnacle

Award from the Healthcare Association of New

York State. DiversityInc has ranked NSLIJ as one

of the nation’s top 10 health systems for

diversity and inclusion practices, and as one of

the top 10 companies for veterans. Modern

Healthcare has ranked it 31st on its list of the

nation’s top 100 integrated health networks. In

addition, individual hospitals and facilities within

NSLIJ have been recognized by many respected

organizations, including IPRO (New York’s

Medicare quality improvement organization),

the Healthcare Association of New York, the

Joint Commission, AARP’s Modern Maturity

magazine, U.S. News & World Report, JD Power

& Associates, the American Nurses Credentialing

Center, and the Centers for Medicare &

Medicaid Services.


Development at NSLIJ

In 2001, NSLIJ created the Center for Learning

and Innovation (CLI), a corporate university

offering personal and professional development

opportunities to its workforce. Like many

corporate universities, CLI began by providing

various leadership development programs.


Traditionally, relatively few physicians took

advantage of these offerings.

Faced with an increase in the pace of change

and external demands and buoyed by the

success of several NSLIJ leadership development

programs for administrators, NSLIJ’s CEO felt

that the organization needed to involve

physicians in the leadership decisions that help

to sustain growth and success into the future.

To facilitate their involvement, CLI needed to

offer programs specifically targeted at

physicians. These efforts led to the 2010 launch

of the Physician Leadership Institute (PLI). As

depicted in the chart below, PLI offers a wide

array of programs that collectively serve

physician leaders at all levels of the

organization. These programs aim to recruit,

develop, and retain the talent necessary to

achieve NSLIJ’s organizational goals by

developing the necessary skill sets among

physicians to allow them to prosper in highly

visible leadership positions.

Review of Program Offerings

PLI initially began in 2011 with two programs

and has subsequently added programs in

response to physician requests and identified

needs of the organization. What follows is a

detailed look at PLI’s first and largest offering,

the Physician High Potential Program, along with

brief overviews of its other major programs. As

the descriptions below illustrate, PLI follows

most if not all of the 10 recommendations laid

out by NCHL for implementing effective

leadership development programs.

Physician High Potential Program

The Physician High Potential program is a two-

year program that focuses on giving physicians

the skills and capabilities they need (including

“softer” skills) to be successful leaders in a

rapidly changing, tumultuous environment.

Formal Nomination and Selection Process

In PLI’s first year of operation, program leaders

asked senior executives and medical directors to

send their “best” physicians to the program, and

a cohort of 55 physicians began in July (so as to

follow the traditional academic calendar). For

the second cohort, program leaders decided to

create a more formalized structure for

acceptance into the program, creating a

standard application process that required

someone to nominate an individual for the

program. This process yielded over 100

applications, with 32 being chosen to

participate. The same process was used for the

third cohort, which again yielded approximately

100 applications, 19 of which were accepted for

the program.


The decision to start with a large cohort (55) and

then reduce class size over time was deliberate.

The goal initially was to enroll multiple

individuals from each system hospital, so as to

create a certain “buzz” about the program. Once

the physicians and their leadership became

engaged, it became clear that smaller class sizes

would allow for more personalized education;

ensure that those selected truly had strong

leadership potential; and maximize the chances

that graduates would have near-term leadership

opportunities available to them within the

system. In addition, beginning with the second

cohort, the decision was made to start the

program in January, so as to align this program

with NSLIJ’s clinical and administrative high-

potential program, thus promoting interactive

touch points and collaboration between the two

groups.

Program Curriculum

As depicted in the diagram below, the two-year

program begins with of a combination of

leadership assessments to identify individual

participant’s competencies and gaps. Executive

coaches and mentors use the assessment

results, along with an individual development

plan, as a platform to begin to capitalize on

strengths and close the gaps. Physicians spend a

lot of time honing their clinical craft and often

acknowledge a gap between their clinical and

leadership skills. Coursework, therefore,

provides participants with the knowledge

needed to be successful leaders, through hands-

on project work, other learning experiences

(often as part of multidisciplinary teams), and

interactions with NSLIJ senior leaders and

external faculty and

organizations.

Key components of the

curriculum are detailed

below:

▪ Up-front assessments:

The program begins with

several assessments of

critical leadership

competencies, including a

360-degree assessment

(with participants choosing

who rates them), a Myers-

Briggs personality

assessment, and an

assessment measuring

emotional intelligence and

individual conflict


management style. The theory behind the

use of upfront assessments is two-fold: first,

physicians often state that they do not

receive much feedback related to their

leadership style, and these assessments

provide reliable, valid feedback that helps

them understand how their behaviors and

preferences may affect their effectiveness as

leaders. Second, assessment results lay the

groundwork for much of the rest of the

program, which focuses on supporting

participants in leveraging strengths and

addressing the gaps identified.

Coaching and mentoring: NSLIJ uses an

external executive coaching agency to

focus on delivering career-transition

guidance to the most talented

physicians. All leaders find themselves

confronted with challenges and

obstacles in reaching organizational

objectives, and executive coaching

allows for a more personalized approach

to learning. Because there is no

reporting relationship between physician

and coach, physicians find it easier to ask

for explanations, demonstrations, and

other assistance to meet their needs.

They can ask questions that build on

existing knowledge and further develop

their understanding, and, with their

coach’s support and guidance, apply new

knowledge and skills in their day-to-day

work. These 2.5-hour sessions occur

monthly, alternating between group and

individual sessions.

Highly interactive coursework: Classroom

work typically occurs on a monthly basis,

with 10 classes per year, each lasting 4 to 6

hours. (Sessions are skipped in August and

around the end-of-year holidays.) Among

others, topics covered include leading and

influencing organizational teams,

organizational behavior, economics and

finance, improvement science, leadership

and influence, strategy and environment,

performance coaching and feedback, and

customer service, with some topics being

split into two sessions (beginner and

advanced). Faculty generally consists of

internal subject matter experts/leaders,

although external speakers are sometimes

used to supplement the knowledge base and

bring in examples from non-healthcare

industries.

For example, a leader from Citicorp

participates in the economics and finance

module, speaking about how industry

transformation requires innovative

solutions, including new global investment

opportunities in healthcare. Coursework

avoids lectures and other didactic methods;

instead participants receive pre-session

readings (e.g., books, articles, case studies)

and then use class time for discussions and

simulations. The beginning of a course

reviews the pre-work to ensure that

individuals have a firm grasp of the

knowledge and can apply it to the case and

to NSLIJ.

Sessions always end with a debriefing that

ties lessons back to the individual and

his/her role in the organization and to

specific skills and tools that physician leaders

need. As necessary, participants are broken


into smaller groups of no more than 10

individuals to facilitate interaction and

discussion.

Multiple out-of-classroom opportunities to

engage with system leaders: Participants

are encouraged to take advantage of a wide

array of out-of-classroom opportunities and

to engage with senior leaders throughout

the organization to learn more about how

the different parts of the organization

operate. For example, participants can sit in

on meetings of the system board, the

medical board, executive directors/service

line chairs, and the finance department;

they can also attend meetings of the system-

wide quality, strategic planning, and

performance improvement committees to

learn more about how they function.

Participants periodically receive invitations

to breakfast meetings with senior leaders,

such as the system CEO (to discuss strategy),

chief medical officer (CMO), chief operating

officer, medical school dean (physician-in-

chief), and the heads of information

technology, social media, and other areas.

During the two-year program, the typical

participant will attend approximately 50 of

these sessions (roughly two per month),

which gives them tremendous exposure to

and interactions with individuals and parts

of the organization they would not normally

get.

Exposure to external organizations:

Participants have an opportunity to spend

time outside NSLIJ at partner organizations,

such as taking courses or participating in

programs at Harvard, Cornell, the Institute

for Healthcare Improvement, or the National

Quality Forum. At present, program leaders

are working to create opportunities for

participants to spend a few weeks

embedded in other leading-edge

organizations (e.g., Kaiser Permanente, Rush

University Medical Center, Cleveland Clinic,

Mayo Clinic) as part of an “external

rotation.”

Real-world Leadership Project: During the

second year, each physician applies the skills

and knowledge learned in the program

through a “real-time” leadership project.

Working either as individuals or as part of a

project team or task force, participants

tackle a real problem facing NSLIJ. For

example, participants have joined existing

NSLIJ task forces focused on reducing sepsis

and improving the provision of care during

advanced illness. In one case, a group of five

participants from the same hospital formed

a team and worked with others in that

hospital to address a specific problem it was

facing. In the most recent cohort, a group of

internal medicine and emergency

department (ED) physicians joined their

respective specialty representatives in

focusing on improving handoffs from ED

physicians to hospitalists.

Other Program Offerings

In addition to the Physician High Potential

Program, NSLIJ offers various other programs

through PLI, each targeted at a different

audience of physician leaders:


Medical Director Education Program:

Launched in 2011, this 18-month program

consists of six half-day interactive sessions

(one each quarter) in which medical

directors focus on the “softer skills” of

leadership. Topics include conflict

management/resolution, change

management, team-building, and how to

influence others. Like the Physician High

Potential Program, this program includes

upfront assessments of personality (through

the Myers Briggs Type Inventory) and

emotional intelligence to assist in addressing

identified gaps. The curriculum is open only

to hospital and nursing home medical

directors within NSLIJ.

Joint Chair Education Program: This

program brings together the tertiary hospital

department chairmen for two to three hours

every quarter to focus on the issues and

challenges they have identified as affecting

their success as leaders. The content for this

program was developed in conjunction with

its participants. The chairmen filled out a

learning needs assessment and picked topics

(from a comprehensive list) they believed

would help them be more effective in their

current role. The program content featured

the six most frequently mentioned topics,

along with one chosen by the medical

leadership (leading and influencing

organizational teams). Like the programs for

medical directors and high-potential

physicians, this program focuses on

leadership styles as seen through

assessments of personality (again using the

Myers-Briggs Type Indicator) and emotional

intelligence.

Chief Resident Education Program: Serving

as a chief resident represents the first

leadership experience for many physicians.

This one-day program (7 am to 5 pm)

focuses on providing leadership education to

these individuals. Topics covered include

emotional intelligence and how to coach,

mentor, and provide others with feedback.

The goal is to help chief residents learn to

assess the performance of other residents

(both clinically and interpersonally), provide

constructive feedback, and address

problems when they arise.

The first half consists of case-based

interactive discussions, while the second half

focuses on learning, through role-playing,

how to deal with junior residents with

specific issues or problems. Common role-

play scenarios might be someone dealing

with a mental health issue or substance

abuse problem, or someone who has

difficulty working with peers as part of an

interdisciplinary team.

Physician Administration Fellowship

Program: Launched in early 2014, this

program is similar to the NSLIJ

Administrative Fellowship Program, which is

aimed at non-clinicians with an advanced

degree in business or public health. During

this year-long fellowship, participants are

immersed in the two worlds of physician

leadership: the clinical environment and the

administrative environment. The curriculum


is focused on allowing participants to learn

through experiences. Consequently, each

week the fellow spends 50 percent of

his/her time working administratively in one

of four rotations and the other 50 percent

performing clinical duties (i.e., providing

direct patient care).

This program gives physicians the

opportunity to do quarterly rotations

through various parts of the organization,

such as finance, hospital administration,

academic affairs, or the insurance arm of

NSLIJ. Applications must be submitted

almost a year in advance.

Community Hospital Leadership: This

program is offered as an adjunct to physician

leaders at NSLIJ’s community hospitals, in

recognition of the unique issues they must

deal with in this type of facility.

Course topics are designed to help them

respond to the issues community hospitals

face on an ongoing basis, such as

transferring patients to higher levels of care

and the need to rely on community partners,

especially nursing homes and assisted living

communities. There is no set schedule, with

part-day sessions being created as specific

issues arise. Consequently, one month may

feature two programs, each focused on a

specific topic, while the next month may

have none. Sessions typically draw many

physicians from NSLIJ’s community hospitals,

although the target audience varies

depending on the specific topic being

discussed.


PLI evaluates a variety of measures in assessing

the impact of its program offerings, with specific

metrics varying by program. Common measures

used include growth in emotional intelligence,

professional development, retention,

advancement within the organization, and

developing bench strength. Analysis of this data

shows that PLI programs are clearly having a


positive impact on the individual participants

and on NSLIJ as an organization. Launched only

three years ago, PLI has greatly expanded its

program offerings in response to the high

demand and rapidly increasing attendance. For

example, the Joint Chairs initiative came about

after several department chairs requested its

creation after having attended the Medical

Director Education Program.

Hard data related to PLI’s impact comes

primarily from the Physician High Potential

Program, which, as shown in the chart below,

has helped participants significantly improve

various components of their emotional

intelligence. (The data below comes from pre-

and post-program assessments of the 55

physicians who participated in the first cohort,

from July 2011 to June 2013.)

Similar levels of improvement in emotional

intelligence have been seen among those

participating in the program for medical

directors, although the sample size for this data

is fairly small as there is only one medical

director in each facility.

Participants also seem to be highly satisfied with

the PLI programs. For example, data from the

first cohort of the Physician High Potential

Program show that all 55 participants gained

new knowledge and would recommend the

program to a colleague, and that 95 percent

believe the program has better prepared them

for a leadership role and/or expanded

responsibilities. The following quotes from

participants are illustrative of these feelings:

“The thought that went into the curriculum

is evident. The ability to take general

concepts and apply them to the decision-

making processes occurring in hospitals and

medical offices on a day-to-day basis was

very helpful, and the interactive workshops

provided excellent opportunities for learning

new skills at many different levels.”

“The program has expanded my intellectual

horizon with an analytical approach to

leadership skills and the value of training in

this area. I have been given new awareness

of the importance of physicians taking on

leadership roles, and appreciate the

administration’s interest in providing us with

the skills to do so. This is a refreshing

program, and very important in the

complicated world of medicine today. The

innovative approaches taught here will likely

contribute enormously to the successful

management of a complex health system.”

From NSLIJ’s perspective, PLI programs have

helped in retaining physician leaders and filling

leadership positions. Between 96 and 97

percent of participants in the first three cohorts

of the Physician High Potential Program remain

at NSLIJ, and the vast majority of internal

physician leadership positions that have become

available have been filled by graduates of this

program. External organizations have also taken

note of PLI programs. NSLIJ was one of NCHL’s

2014 Best Organizations for Leadership

Development (BOLD) award winners. Several

program graduates have been successfully

recruited by other organizations in North

Shore’s competitive market, and in its inaugural

year, the Physician High Potential Program

received the Brandon Hall Group’s Gold Award

for Best Leadership Training Program.



Lessons Learned

As the earlier program descriptions illustrate,

NSLIJ has embraced most if not all of the 10

NCHL recommendations, and doing so has

played a key role in the success of its programs.

In particular, program leaders highlight the

following as having been central to the

program’s success:

Ensuring senior physician support: While

the impetus for a program can come from a

senior administrator, long-term success will

not be possible without physician partners

and champions. Consistent with NCHL’s

recommendation to ensure executive

support, senior physician champions have

been critical to the success of NSLIJ’s

programs.

For example, NSLIJ’s CMO serves as a vocal

advocate for all PLI programs, and not only

attends many of the classroom offerings, but

also teaches in the programs. Several

participants in the Joint Chairman and High

Potential programs have become faculty

members for PLI programs, thus contributing

to the ongoing education of future leaders.

Starting small and expanding over time:

NSLIJ began with two programs (Physician

High Potential and Medical Director) and

then added offerings over time, often in

response to requests from stakeholders

within the organization. By starting with one

or two offerings, leaders can answer the key

question—“if I build it, will they come?”—

before investing too heavily in programs for

which there is little interest.

Tailoring program to user needs: While the

generic leadership development curriculum

tends to be fairly standard across

organizations, educational offerings must

match the vision and needs of those who

will be using them. If not, sponsors will not

continue nominating individuals and

participants will not extol the virtues of the

programs to others.

Focusing on experiential learning methods:

Consistent with NCHL’s recommendation to

use a mix of learning methods, NSLIJ

employs a variety of adult learning

methodologies and provides experiential

learning, including use of interactive

methods in the classroom (e.g., case

discussions, simulations) and ample

opportunities for physicians to gain

exposure and have experiences outside the

classroom.

Making the program a corporate priority:

Stakeholders within the organization need to

understand that physician leadership

development is taken seriously by those at

the top. NSLIJ has done this through the

following activities: creating formal

nomination, application, and vetting

processes for would-be participants; holding

a graduation ceremony for participants that

is attended by senior leaders from both

individual sites and the system as a whole

(including the CEO); and highlighting and

branding PLI within the larger CLI.

Maintaining close relationships with talent

management department: At NSLIJ, talent


management personnel provide their

expertise during the nomination/sponsor

process by having site-based human

resource executives encourage clinical and

non-clinical leaders to nominate participants

and by reviewing applications for the

programs. They also participate actively in

the programs, teaching topics in areas

where they are subject matter experts and

serving as coaches and mentors. In addition,

on three separate occasions during the two-

year Physician High Potential Program,

talent management leaders and the

leadership of the PLI meet with the medical

leaders who have oversight responsibility for

each participant. During these meetings,

they discuss each participant’s strengths,

opportunities for development, and specific

goals and objectives to be added to

development plans.

These discussions ensure that the site (local)

leaders are keyed into the program, and that

participants receive appropriate

coaching/mentoring in their daily work to

round out and reinforce their development.

In addition, this process allows local leaders

to make sure that individual participants get

exposed to internal and external

experiences that are meaningful to their

work, and gives them the chance to assist in

matching program graduates with

appropriate leadership positions within

NSLIJ when they become available.

Being flexible and accepting that not all

priorities will be funded: In any

organization, competing priorities and

scarcity of resources will sometimes mean

that the priorities of those running physician

leadership development programs will not

be the same as those of senior

administrators and others who control

resource allocation decisions.

Continually evaluating and refining

offerings: The best programs critically

evaluate their programs, refining them

based on both successes and failures. As

noted, PLI uses pre-and post-program

assessments of emotional intelligence, pre-

and post-360˚ assessments, talent

management sessions, and end-of-program

surveys and evaluations. PLI leaders critically

evaluate each program on an annual basis

and make improvements as necessary to

ensure that they continue to meet NSLIJ

organizational and strategic goals.


Best Practices in Physician Leadership Development: Sutter Health


Headquartered in Sacramento, Sutter Health is a

non-profit, integrated health system serving

more than 100 communities in Northern

California. With annual revenues of $9.6 billion

(2013), Sutter employs nearly 50,000 individuals

and is affiliated with roughly 5,000 physicians

through the Sutter Medical Network and

approximately 2,500 additional independent

physicians who are part of the medical staffs of

Sutter hospitals. Sutter operates 24 hospitals

that collectively have almost 4,500 acute care

beds, 33 outpatient surgery centers, 8 cardiac

centers, 9 cancer centers, 5 acute rehabilitation

centers, 9 behavioral health centers, and 4

trauma centers. In 2013, Sutter launched a

health plan, Sutter Health Plus, which has been

enrolling members since October of that year.

Sutter Health has received many awards,

including the Malcolm Baldrige National Quality

Award, the College of Healthcare Information

Management Executives’ Innovator of the Year

Award, and the CHART Certificate of Excellence

Award. The Lewin Group, Consumer Reports,

and U.S. News and World Report have ranked it

among the top-performing health providers. The

National Business Group on Health, Modern

Healthcare, The Leapfrog Group, HealthGrades,

and The Joint Commission have honored

individual Sutter Health hospitals for the quality

of their services.


Development at Sutter

Through Sutter Health University (a corporate-

level department), Sutter offers a broad array of

leadership development programs that serve all

levels of leadership within the organization,

including clinical and non-clinical leaders. At

Sutter, leadership development operates as part

of a larger talent management strategy that also

includes talent planning and acquisition,

leadership development, performance

management, and succession management. The

goal is to prepare high-potential individuals by

giving them the skills they need to succeed at

the next level of leadership at Sutter.

Emerging leaders: Individuals who are not currently in formal leadership or management roles, but who may be playing such a role for a specific project, program, or committee

New or established leaders: Managers of

people or budgets (often for a site, department or local service line), such as program managers, assistant and medical directors, section/department chiefs, and other clinical leaders

Senior/executive leaders: Managers of multiple business functions or an enterprise-level service line, such as directors, vice presidents, presidents, and other c-suite leaders


Collectively, Sutter Health’s major leadership

development offerings are part of a collection

known as the “Signature Series,” which includes

several programs specifically for physicians and

others open to physicians, administrators,

and/or other non-physician leaders. By design,

programs for physicians new to leadership tend

to bring doctors together with their physician

peers, while those for senior physician leaders

give them the opportunity to work with non-

physician peers so they learn a multidisciplinary

approach to leadership and gain a broader

perspective on organization-wide priorities and

strategies. While programs vary in terms of

selection process, target audience, size, length,

curriculum, and other elements, they all provide

participants with an opportunity to meet and

interact over a period of several days or months

with communities of leaders from across the

system, allowing them to learn from each other

and to partner and collaborate on real-world,

Sutter-specific projects and activities. As

depicted in the chart below, the curriculum for

all programs incorporates the “4 E’s” of

development: education, experience, exposure,

and exploration, with a heavy emphasis on the

“Physician leadership development occurs within the broader context of Sutter’s overall organizational strategy and leadership development work with all employees and disciplines. It is also part of our

larger talent management strategy.”—Yvonne Gardner, Vice President of Talent Management


latter three so that physicians learn primarily by

doing and interacting with others rather than by

listening to lectures.

Review of Program Offerings

As noted, several Signature Series programs

exclusively serve physicians, while others bring

together physician and non-physician leaders.

Several programs target specific levels of

physician leadership3, as outlined below:

Introduction to Physician Leadership

This program serves high-potential, “front-line”

physician leaders who are either new to

leadership or who want to be more effective in

their leadership role. It focuses on developing

“soft skills” that allow physicians to be effective

leaders, including emotional intelligence,

interpersonal skills, leadership, team-building,

and building the leader mindset. Supervisors or

sponsors invite physicians to apply for the

program. Each program serves 30 physicians

who attend four day-long sessions (one a month

for four months). Prior to starting, participants

complete a personality assessment (DISC®) and

reading assignments. The classroom sessions are

structured as workshops that pair didactic

methods with small-group activities and

homework assignments that give participants

the opportunity to apply the skills, concepts,

and tools learned in the classroom.

3 One additional program, The Art of Communicating with

Patients, does not focus on leadership per se, but rather on assisting front-line physicians in improving their communication skills with patients.

Physician LeaderLab®

This program serves high-potential emerging

and established physician leaders who are new

to their role (with at least six months’

experience), would benefit from additional

development opportunities, and/or are

experiencing some leadership-related

challenges. Physician champions, committee

chairs, section chiefs, medical directors, and

site/department leads often find this course

valuable. Supervisors or sponsors nominate

individuals for the program, and then play an

active support role once it begins. Six weeks

ahead of the classroom portion, participants

complete the Voices® 360-degree and Myers-

Briggs Type Indicator (MBTI®) assessments and

pre-reading assignments. The 2.5-day workshop

includes a variety of dynamic learning

approaches with a small group (typically 14

physicians), including didactic methods, small-

group activities, and a session with a

professional leadership coach. The focus is on

deconstructing the assessment results and using

them to create a personal development plan.

Participants also learn and apply leadership

concepts, the team characteristics model,

strategies for leading change, and techniques

for difficult conversations. Within 60 days of the

workshop, the coach and participant meet two

additional times. The sponsor also attends the

first of these sessions and offers feedback on

the assessment results.

Physician Leadership Symposium

Introduced in 2013, this annual two-day

symposium (starting on a Friday afternoon and

ending mid-afternoon Saturday) brings together

several hundred physician leaders (both


established and up-and-coming leaders) to

create alignment, hear common messages, and

understand how they fit into the organization.

The goal is to create a community among

physician leaders, allowing them to build

relationships across facilities and departments.

The symposium is modeled after two similar

programs, one that targets the top 400 general

leaders (including 100 physicians) and a second

for approximately 3,500 managers from

throughout the organization. Day one features

presentations from the system CEO and chief

operating officer (COO), followed by external

speakers focused on a specific topic (e.g., use of

social media/networking to engage with

patients and families) and a dinner with

assigned seating where each table engages in a

problem-solving exercise related to a real

dilemma facing Sutter. Day two features

another external speaker, followed by a series

of breakout sessions, with attendees choosing

from available topics.

Executive Development for Physicians

This newly launched program serves high-

potential physician leaders already serving in

substantial, committed leadership roles, such as

a group vice president, medical director of an

enterprise service line, chief medical officer

(CMO), or clinical service vice president. Eligible

candidates are identified through Sutter’s

annual talent review and succession planning

process, nominated by a supervisor or sponsor,

and approved by a regional president or senior

vice president. Those chosen undergo a rigorous

assessment process that includes HoganLead©

(which gauges leadership potential), Voices®

360, and completion of other tools from the

American College of Healthcare Executives. They

also participate in a one-day simulation at the

Development Dimensions International®

Executive Acceleration Center. Once these

assessments and simulations are completed, the

remainder of the program is tailored to the

individual based on the results, including

coursework, assignments, and other

experiences and educational opportunities.

Participants work with an executive coach for 12

months, creating and implementing a series of

individual development plans. They also select

one or more mentors who provide guidance on

specific areas. Participants may also join

professional associations and/or take

coursework to address identified gaps.

Programs for Interdisciplinary Groups of

Leaders

Several Signature Series programs serve

physicians and non-physicians, giving senior

physician leaders the chance to interact and

work with administrators, nurses, and other

professionals (often as part of interdisciplinary

teams), and the opportunity to learn about,

appreciate, and work toward the goals and

strategic priorities of the system as a whole.

Accelerated Change Excellence

This program serves strong, high-performing

leaders, including senior managers, directors

and medical directors, vice presidents,

administrators, and other leaders, giving them

the experience of going through a specific

change project. Participants learn to create the

climate for, influence, and sustain change during

a 7-day classroom program delivered over five

months. For the duration of the change project,


participants are exposed to senior leaders and

change leaders, and receive one-on-one

coaching from a professional change leadership

coach.

Management and Clinical Excellence (MCE)

This program serves multidisciplinary teams of

individuals at the director or senior manager

level and above. The program consists of 8.5

classroom days over a 4-month period, along

with two pre-course webinars and three

monthly one-hour coaching calls. Participants

work as part of diverse teams, each of which

includes a patient or family member as an

advisor. These teams learn a common language,

skills, and approach to improvement, including

LEAN-based theories and techniques.

Participants present and receive feedback on

team-based improvement projects during the

last two classes.

Leadership Academy

This program targets those who have the

potential to serve in an executive-level role and

an immediate ability to increase their level of

responsibility; physicians represent roughly a

third of each group of participants. Candidates

are invited or nominated to participate as part

of Sutter Health’s annual succession planning

process. This 10-month executive readiness

program develops participants through

academic, experiential, and cohort-based

learning The curriculum includes reading and

discussing books, articles, and case studies that

describe current and classic thinking on leaders

and leadership development. Participants take

on several action learning projects throughout

the 10-month program, working in cross-

functional teams. Teams present their findings

and recommendations to Sutter Health

executive leaders. The full class also

collaborates to complete a Capstone Project,

including a white paper and presentation. All

participants work with an executive coach on

their individual development and receive 360-

degree feedback at the start of the program and

six months after program completion.

Leadership Academy is comparable in time and

effort to an executive MBA program.

Paired Leadership

Still in development, this program will address

an emerging need for Sutter—i.e., helping dyads

of physician and non-physician leaders learn to

function effectively as a management team.

Several years ago, Sutter leaders visited Virginia

Mason Medical Center in Seattle, Mayo Clinic in

Scottsdale, AZ, and other high-performing

organizations, where they learned about the

value of “dyad leadership” as a driver of

MCE provides a wonderful opportunity for physicians and non-physicians to work as partners on addressing and solving specific problems facing Sutter. It serves as a very powerful forum for physicians to make a quantum leap in their leadership skills. —Don Wreden, MD, Chief Medical Group Transformation Officer, Sutter Medical Group

This was one of the most significant learning experiences I’ve ever participated in. In fact I’m using many of the tools and techniques we were taught at Leadership Academy more and more every day with my medical group.”-- Sam Santoro, DO, President and CEO, Sutter East Bay Physicians Medical Group


organizational success. After these visits, the

majority of Sutter’s affiliated medical groups

and foundations adopted the concept, pairing a

physician and administrative leader as a team

charged with running the department, care

center, or service line. This program will provide

an opportunity for these teams to develop

and/or refine the leadership, management, and

interpersonal skills necessary to be an effective

dyad. It will target dyads at all levels of the

organization, from physician-medical assistant

teams working with patients to CMOs and COOs

working together to run a large organization.


As shown below, several of Sutter’s Signature

Series programs are rated highly by participants

and have led to improvements in the

competencies targeted:

Introduction to Physician Leadership: Since

December 2012, 97 percent of those who

have participated rate it as being of high

quality and 96 percent would recommend it

to a peer. On average, the 58 individuals

who have completed the program self-

report an average 27-percent increase in the

competencies targeted: emotional

intelligence, team development,

communication, performance management,

leading change, and motivating and

influencing others.

Physician LeaderLab®: Since February 2012,

100 percent of participants rate the program

as high quality and would recommend it to

their peers. On average, the 542 alumni who

have completed the program self-report a

42-percent increase in the competencies

targeted: the ability to maximize team

performance, the ability to lead change, and

interpersonal communications. Program

leaders believe the majority of physicians

who have completed Physician LeaderLab®

have come out as more effective leaders.

Executive Development for Physicians: The

one person who recently completed this

program demonstrated increased

competence in the areas targeted and a 37-

percent improvement in “readiness ratings,”

to the point that the individual is now

deemed ready for an executive-level

leadership position. One of two currently

enrolled participants has been promoted to

a next-level position, while the other has

been named a successor to such a position.

Leadership Academy: Of the 43 physicians

who have completed the Leadership

Academy between 2005 and 20144, 93

percent (40 out of the 43) have remained

with Sutter or an affiliated medical group,

and 40 percent (17 of the 43) have either

been promoted or taken on additional

leadership responsibilities within Sutter or

an affiliated medical group.

Anecdotally, several of the Signature Series

programs have had a profound, positive impact

on physician participants. For example, many

physicians who completed Physician LeaderLab®

have dramatically changed their leadership

approach, including several who realized that

the way they historically interacted with others

and approached issues got in their own way. At

the same time, the program convinced one

physician that he no longer wanted to pursue


leadership, which also was a “good outcome” as

it allowed the doctor to realize that he was most

happy and effective working outside of

leadership. In another example, a pediatrician

found that the Leadership Academy helped her

better understand both the art and science of

leadership, which in turn helped her feel less

overwhelmed by her role as department leader.

In fact, she came out of the program with such a

passion for leadership that the head of the

Sutter Medical Group created a new position for

her as medical director of recruitment and

retention for the group.

In addition, Sutter’s PLD programs have been

recognized by several outside organizations.

NCHL recently recognized Sutter as one of the

Best Organizations for Leadership Development

(also known as NCHL’s BOLD designation). In

2013, Brandon Hall recognized two Sutter

Signature Series programs. In addition, faculty at

Pepperdine University recently featured Sutter’s

talent management practices in a research

paper.

Finally, because of the direct tie between these

programs and real-world issues being faced by

Sutter, the Signature Series programs have had

generated tangible financial and other benefits

for the organization. For example:

Sutter’s Medicare Affordability project

began as a Capstone Project within the

Leadership Academy. A project team

focused on how to reduce the significant

losses (50 cents on every dollar) Sutter was

absorbing on Medicare patients. The team

developed tangible recommendations that

became the focus of a multi-year effort.

Many team members joined the task force

assigned to this issue, working with Sutter’s

COO, CMO, and other leaders. Ultimately,

the effort succeeded in reducing Medicare

costs by 50 percent while simultaneously

improving quality of care.

Initiated as part of MCE, Sutter’s Variation

Reduction program spread across the

system, leading to $30 million in cost savings

through the standardization of practices

across specialties.

Sutter’s Advanced Illness Management or

AIM program also began in MCE. Thanks in

part to a $13 million federal Innovation

Grant, AIM now operates throughout Sutter,

providing care to patients with chronic

illness and home-based care coordinated by

a multidisciplinary team.


Lessons Learned

As the earlier program descriptions illustrate,

Sutter Health has embraced all 10

recommendations laid out in the NCHL white

paper, and doing so has played a key role in the

success of its programs. In particular, program

“Physician LeaderLab® provides a very personal, often eye-opening experience to physicians who have been trained to be autonomous, independent decision-makers and likely never have experienced a 360-degree review. It gives them a chance to look objectively at how people interact with each other, including how their own behaviors may be undermining their success. They often come out of it very changed as people.”--Don Wreden, MD, Chief Medical Group Transformation Officer, Sutter Medical Group


leaders highlight the following as having been

central to the program’s success:

Ensuring senior executive and senior

physician support: Consistent with NCHL

recommendations, Sutter’s CEO, CMO, and

other leaders are highly involved in the

programs, including the design,

development, implementation, and

evaluation of the various curricula. To

facilitate this process, Sutter’s Physician

Leadership Development Advisory Group

provides guidance to program leaders with

respect to PLD strategy and program

implementation. Consisting of senior

physician leaders, regional CMOs, group

medical directors and presidents, and others

from across the organization, this group

provides direction and input designed to

ensure that the PLD strategy aligns with the

overall organizational strategy, with the goal

of engaging physicians at every level and

ensuring they develop into strong leaders.

For example, in 2011, the group was

instrumental in the decision to phase out a

program focused on management skills and

to introduce one (Introduction to Physician

Leadership) focused more on interpersonal

skills (e.g., relationship-building, influence).

Needs had changed over time to the point

that resources need to be reallocated to

these softer—and in many ways more

important—skills. In addition, business

training could be delivered in other ways.

Making core programs personally relevant

to physicians: Physicians will engage in

programs that have personal relevance to

them. For example, the Physician

LeaderLab® program is an intensely personal

experience completely focused on the

individual, including the provision of

feedback from others. Similarly, the

Management and Clinical Excellence

program gives participants the opportunity

to work on an actual problem facing them.

In many cases, Sutter physicians do not get

paid for time spent in these programs, and

generally have to give up practice time to

participate. Sutter-affiliated medical groups

and foundations sometimes offer stipends to

participating physicians, with decisions

made at the local level.

To make this investment worth the

physicians’ time and energy, these programs

go beyond interesting discussions to focus

on achieving meaningful personal and

professional objectives.

Incorporating issues of relevance to the

organization: Consistent with NCHL’s

recommendation to link programs to

organizational priorities, the curriculum for

all programs is tailored specifically to Sutter,

including case studies, projects, and other

activities. Nothing is “made up,” and

participants get to see the results of their

work actually implemented within Sutter. In

many cases, they continue to work on

projects for multiple years without the allure

of compensation, doing so because they

have engaged in the problem and want to

see their hard work come to fruition.


Recognizing the need for a broad spectrum

of offerings: Physicians tend to be a very

heterogeneous group, and most

organizations tend to have a wide range of

leadership needs. Consequently, physician

leadership development programs need to

cater to this heterogeneity, as there is no

“one-size-fits-all” answer.

Starting with the basics: If starting a

program from scratch, initial offerings

should include a “Leadership 101” program

and a program focused on those with “high

potential” to be effective leaders. The

introductory course can be offered to the

large number of physicians who are early in

their leadership career (e.g., members and

chairs of committees and task forces), while

the high-potential course can provide an

intense, personal experience for those who

have a year or two of leadership experience

and exhibit high potential for the future.

Not reinventing the wheel: Much is already

known about how to develop and execute

effective physician leadership programs. For

example, Brent James, MD, a well-known

physician leader and quality improvement

expert at Intermountain, helped develop the

Management and Clinical Excellence

program at Sutter. Additional guidance for

several physician leadership development

programs came from James Stoller, MD, of

The Cleveland Clinic.

Providing opportunities to interact with

non-physicians: The best physician leaders

know how to interact with those who are

not doctors, including how to communicate

effectively and act as “humble advocates”

for change. As noted earlier, Sutter

purposely designed its offerings so that

those new to leadership spend most

program time with physician peers, while

mid-level and more senior physician leaders

work as part of multidisciplinary leadership

teams.

Leveraging external faculty who tailor their

material to the organization: Consistent

with NCHL’s recommendation to use a mix

of internal and external faculty, Sutter

contracts with many external faculty, in part

because the organization does not have the

internal resources to staff its many course

offerings. In many cases, external faculty

members have worked with Sutter for

decades and hence understand the

organization and tailor their materials

accordingly.

Emphasizing experience, exposure, and

exploration: Consistent with NCHL’s

recommendation to employ effective

learning methods, Sutter places heavy

emphasis on case studies, projects, and

other real-world activities, with limited use

of didactic education. Most courses require

participants to spend substantial time

working as part of teams outside the

classroom, which is where the “real

learning” occurs.



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2015_NCHL_Physician Leadership Development Programs Best Practices Case Studies

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