A N UPDA T E M A RK HERTLING , D BA LTG , US A RM Y ( RETIRED ) - - PowerPoint PPT Presentation

G RO WING

[ PHYSIC IA N] LEA D ERS…

A N UPDA T E

M A RK HERTLING , D BA LTG , US A RM Y ( RETIRED )

Mark Hertling, DBA LTG, US Army (Retired)

A G EN DA

 REV IEW THE BA C KG RO UN D  W HA T SO M E HO SP ITA LS D O  O UR C O URSE O BJEC TIV ES& EXEC UTIO N  REC EN T RESEA RC H & RELA TED M ETRIC S

Where It All

Started

The C EO / C MO to ME (2014): WE WANT O UR DO C T

O RS T O BE INC LUDED IN DEC ISIO N- MA KING … A ND WE WA NT T HEM T O LEA D MULT I- DISC IPLINA RY T EA MS!

MY E ARL Y BF O:

PHYSI CI ANS

AR E L IKE

SOL DI E RS

Bo th Ha ve

Profe ssiona l Re quire me nts

• Code of ethics and prescribed set of values
• Unmatched knowledge, skills, attributes and

competence

• Prescribed standards, with a requirement to

discipline and dismiss those who do not adhere to the professions standard's and behaviors

• Constant training and education in prescribed skills,

values, knowledge and attributes (SVKA’s)

• A prescribed function within a society which cannot

be performed by others because it requires unique leadership

• Doctors live by a CODE OF ETHICS, but no prescribed VALUES.
• Doctors are required to have unmatched COMPETENCE in a BODY OF SKILLS, KNOWLEDGE,

VALUES & ATTRIBUTES, but there is desire for increasingly lower associated costs of

medicine, with more served, in an era of increased technological advancement.

• The Healthcare Profession has STANDARDS that must be reinforced, but they vary and

there are different approaches on how to discipline (and dismiss) professionals who do not adhere to prescribed procedures, norms and behaviors.

• There is a requirement for CONSTANT TRAINING AND EDUCATION in SKA’s (but currently

more emphasis is on the science than the art in healthcare)

• Doctors have a UNIQUE RESPONSIBILITY which cannot be performed by others in society, yet

they are 1/3 of the healthcare INTER PROFESSIONAL BODY…AND OTHERS ARE INTERFERING IN

WHILE DRIVING HEALTHCARE IN COMPETING DIRECTIONS.

But the re a re C ha lle ng e s…

“ C O ULD YO U DESIG N AND EXEC UTE A C O URSE PART-TIME? ” “ TRUST ME, THIS WILL BEC O ME THE MO ST IMPO RTANT THING YO U DO HERE!”

FIRST CLASS, 2014 CLASS OF 2019

How Is Healthcare Tackling Physician Leader Development?

W HA T SO M E HO SPITA LS D O …

TOP 50 NON-PROFIT HOSPITALS IN U.S.

(“Top” Defined by “Number of Beds,” Range: 2478-830) Letter to CEO asking for Survey Participation, with request for Leader Development Point of Contact Participation:

• 16 (32%) committed to sharing information
• 11 (22%) admitted to not having any leadership program
• 1 (2%) unwilling to share information about their program
• 22 (44%) did not respond to query

Hertling, Dennis, Bartlett (2018). Approaches to Physician Leadership Training at Top NonProfit

• Hospitals. Physician Leader Journal, November 2018

W HA T SO M E HO SP ITA LS D O …

Various types of people in charge of Healthcare Leader Development:

• Within Organizations: HR, COO, Chief of Org Eff/Leadership, CMO
• 2 of 16 use Consultants
• 5 have ”fly away” programs, 4 of those for physicians only

Spectrum of “Start of Program” from “just now” to 12 years running. Average was 3.1 years in operation Length of Leader Development Program Varies:

Medium Course Time: 32 Hrs Course Length: Span of 3-18 Months Range: 1 hr/week-5 hrs/month-1 weekend/qtr Mean: 9.4 months, Medium 9 Months

So m e

C ritic a l

Fin d in g s Re g a rd in g P ro g ra m s

11 of 16 hospitals reported they had “programs for physicians:”

• Four conducted by external consultants, apart from executive program
• Four send physicians on available “fly-away” programs
• Three hospitals recently designed initiatives specifically for physicians
• Two of those three were ”interprofessional” programs
• Two “supported” physicians pursuing MBA/MHA not part of a program

For physician attendee selection:

• Five programs had attendees personally selected by CEO, COO, CMO
• Two took recommendations from Exec Med Staff
• One selects from recommendations received from Med Group
• One holds formal boards to select from volunteers (an annual program)
• Two…didn’t know how physicians were selected

Cost per physician:

• Range from $1,100 (estimated) to $20,000 (”fly-away”)*
• Cost of MBA/MHA “dependent” on school
• Average estimated cost from programs: $5,937/physician

O t h e r

C ritic a l

Fin d in g s Re g a rd in g P ro g ra m s

“What are your Objectives for the Program?”

• 4 of 16 hospitals could provide stated course objectives
• 2 of those 4 reflected extensive Admin-CMO coordination
• 1 of those 2 had completed path from resident-CMO requirements
• Disconnects between Program Objectives and CEO/CMO desires

“How are you measuring program effectiveness?”

• 7 used post-training surveys (5 were email “thoughts on the course”)
• 2 used physician/employee engagement score metrics and comments
• 1 was attempting to use HCAPCS scores
• 1 was continuously using pre-post course survey quantitative growth

comparison metrics and qualitative input from physicians/peers

Q the CEOs/CMOs: “Is Your Program Worth It?”

Now… What’s Your Assessment of Physician Leader Development?

The He a lthc a re Le a d e rship C ha lle ng e

What kind of leaders do we have…what kind do we want? What are the leadership attribut utes and c competencies we desire? What influence t technique wi will w work i k in h healthcare? How do we better develop diverse Healthcare Teams? Who are on the teams ms? How do we improve communication a and i information e exchange? What are the roles of formal al v versus i infor

• rmal

al leaders in healthcare? How do these leaders contribute to ‘improving t ng the o

• rganization’?

T RANSF ORMAT I ONAL

L e a de rship L e ade rship is the art o f

unde r standing mo tivatio ns, influe nc ing pe o ple , building te ams and c o mmunic ating pur po se in o r de r to ac c o mplish state d go als while impr

• ving the o r

ganizatio n

and c o ntr

ibuting to its c ultur e

AL L OF T HAT DRIVE S

PHYSICIAN L E ADE R

COURSE OBJE CT IVE S

• Understand leader attributes & competencies &

various influence techniques

• Enhance leadership & management skills
• Understand how to build teams, and lead up
• Positively contribute to population health and the

desired culture of the organization and the community

• Strengthen the healthcare leadership network

E XE CUT ION: “A WAY”

ADVE NT HE AT L H PHYSICIAN L E ADE R

COURSE E XE CUT ION

• Objective-based course design
• Physician participants are volunteers
• Sessions meet once per month for Six Months
• Five-hour monthly seminars
• Readings, Exercises, LSAs, Panels
• A 1 ½ day off-site exercise (the “staff ride”)
• Chatham House Rules; one excused absence
• Interprofessional mix (35-10-5)

C o u rse

A p p ro a c h

L e sson 1& 2 : Knowing Your se lf

T he Pro fe ssio n

 F

• ur Circ le Mo de

 L

e a de rship Attrib ute s a nd Co mpe te nc ie s

 Se lf Asse ssme nt (MBT

I ), Physic ia ns a s pa rt o f the pro fe ssio n

 Applic a tio n o f pe rso na l a nd pro fe ssio na l va lue s  He a lthc a re Culture

BOOKS

 ‘ L

e a de rship Se c re ts o f Attila T he Hun’

 ‘ F

ro m Va lue s to Ac tio n’ o r ‘ Be c o ming a L e a de r o f Cha ra c te r’

L SA:

L e sso n 1: “Ob se rve & Re po rt o n Attrib ute s/ Co mpe te nc ie s” L e sso n 2: “Va lue s”

2 OF 3 KEYS TO LEADING

ATTRIBUTES

WHO T HE L E ADE R IS

COMPETENCIES

WHAT T HE L E ADE R DOE

S

ATTRIBUTES COMPETENCIES

WHAT DO YOU KNOW, AND HOW DO YOU SE E T HE WORL D? HOW DO YOU GE NE RAT E T RUST BE T WE E N INDIVIDUAL S & WIT HIN T E AMS? HOW DO YOU BUIL D YOUR T E AMS? HOW DO YOU MAKE ST UF F HAPPE N! WHAT KIND OF PE RSON ARE YOU? HOW DO OT HE RS SE E YOU?

L e sson 3 & 4 Dyadic L e ade r ship- - ‘L E ADING OT HE RS’ (to inc lude ‘L E ADING UP’)

 T

he influe nc e Mo de l

 I

nflue nc e T e c hniq ue s a nd the Art o f I nflue nc e

 Co mmunic a tio n me tho ds  L

e a ding yo ur “b o ss”

BOOKS

 ‘ 21 I

rre futa b le L a ws o f L e a de rship’

 ‘ L

e a ding Up: Ho w to L e a d Yo ur Bo ss So Yo u Bo th Win’

L SA: O

L sn 3: Ob se rving va rio us influe nc e te c hniq ue s; Co a c hing , Co unse ling a nd Me nto ring T e c hniq ue s L sn 4: Ob se rva tio ns o f yo ur le a de rship fro m yo ur te a m

THE INFLUENCE MODEL (THE 3D KEY)

T he “T a sk” fro m the le a de r o r the

• rg a niza tio n

T he individua l’ s re a so n fo r do ing

• o r no t do ing -

so me thing … a nd the ir a sso c ia te d le ve l o f e nthusia sm to c o ntrib ute Ho w the L e a de r influe nc e s

• the rs, a nd ho w

the le a de r c o mmunic a te s the g o a l o r ta sk

PURPOSE

MOTIV IVATIO ION INFLUENCE

L e sson 5 : L e a ding T e a ms

 T

e a m F

• rma tio n

 T

e a m Dyna mic s

 “F

ra ming ” to So lve Pro b le ms

 Org a niza tio na l Co ntrib utio ns

BOOK

 T

he L e a de rship Cha lle ng e

L SA: Ho w T

e a ms a re F

• rme d in yo ur spa c e

Who is ne e de d o n te a ms Ho w c a n te a ms a ddre ss the “T riple Aim”

Ge ttysb urg Ba ttle Sta ff Ride

L e sson 6: L e a ding the Org a niza tion & the Profe ssion

 Hospita l a nd Syste m Stra te g ic Ove rvie w  Ma rke t Orie nta tion  F

ina nc ia l a nd Budg e ting Stra te g ie s

 CE

O/ C- Suite Pa ne l

 Gra dua tion

M EA SUREM EN TS

• Mye r-Brig g s (MBT

I )

• Pre -Po st Re se a rc h Se lf-Surve ys
• L

e a de rship/ F

• llo we rship
• Co mmunic a tio n De live ry
• I

nfo rma tio n E xc ha ng e

• Suppo rtive Be ha vio r
• Ma sla c h Burno ut I

nve nto ry (1981)

• Pre -Po st “mini-360”
• Physic ia n Co lle a g ue
• Nurse Co lle a g ue
• Spo use

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A Mixe d-Me tho d Co mpa ra tive Study o f T wo Appro a c he s to Physic ia n L e a de rship De ve lo pme nt

K e y Que stio ns

• Will pa rtic ipa tio n in a n o utc o me s-b a se d physic ia n

le a de rship de ve lo pme nt pro g ra m c ha ng e the se lf- re po rte d le a de rship b e ha vio rs o f physic ia ns?

• Will pa rtic ipa tio n in a n o utc o me s-b a se d physic ia n

le a de rship de ve lo pme nt pro g ra m c o ntrib ute to b e ha vio ra l c ha ng e s tha t a re o b se rve d b y c o lle a g ue s o n the he a lthc a re te a m?

• Do e s pa rtic ipa tio n in a physic ia n le a de rship

de ve lo pme nt pro g ra m c o ntrib ute to c ha ng e s in b e ha vio r o b se rve d b y the pa rtic ipa nts’ pe rso na l re la tio ns (spo use s/ pa rtne rs)?

• Do e s the type o f pro g ra m ma ke a diffe re nc e ?

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Physic ia n Pa rtic ipa nts

• Ro b ust Me ssa g ing fo r Vo lunte e r

s re sulte d in 122 physic ia n a pplic a tio ns fo r 85 c la ss

slo ts (nurse s a nd a dministra to rs a ssig ne d)

• Qua si e xpe rime nt ne c e ssita te s “c o unte r-b a la nc ing ” pa rtic ipa nts

Blue Group (Homogenous, 50 physicians)

• 14 women/36 men (28%/72% ratio)
• 21% Family practice
• 14% Surgeons
• 10% Obstetrics or OB/GYN
• 10% Internists
• 8% ED or Acute Care
• 10% Pediatric
• 5% Radiologist
• 10% Psychiatrist
• 12% “Unique” specialty (neurologist,

pulmonologist, etc) Green Group (IPE, 35 physicians, 10 nurses, 5 execs)

• 10 women/25 men (29%/71% ratio)
• 21% Family practice
• 17% Surgeons
• 8% Obstetrics or OB/GYN
• 8% Internists
• 16% ED or Acute Care
• 5% Pediatric
• 6% Radiologist
• 5% Psychiatrist
• 12% “Unique” specialty (neurologist,

pulmonologist, etc)

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E xpe c ta tio ns

Pre -Po st Co urse Pre -Po st Co urse

Do c to rs in Ho mo g e no us Co urse Do c to rs in Inte r- pro fe ssio na l Co urse

Se lf-Ra ting s o f I ndividua l L e a de rs’ Be ha vio r

Control Group 41

Pre-post surveys, within-subjects ANOVA indicators, participants and observer comparisons

3/30/2020 Dissertation proposal 43

SR PC NC S/P SR PC NC S/P

Descriptive Data Comparison

Doctors in Homogenous Course Doctors in Inter- professional Course

Pre-post test within-subjects ANOVA indicator for four burnout questions:

3/30/2020 Dissertation proposal 44

SR

Burnout D Data Comparison

3.05-2.32

• .73

3.0 2.75 2.50

3.13-2.72

• .41

Doctors in Homogenous Course Doctors in Inter- professional Course

Qua lita tive Que stio nna ire Re spo nse s

• Pa rtic ipa nt re spo nse s a sso c ia te d with the thre e le a de rship the me s

(le a de rship, c o mmunic a tio n a nd info rma tio n e xc ha ng e ) a nd the e ig ht ke y wo rds we re similar

and inte r c hange able in b o th g ro ups

• Pa rtic ipa nt re spo nse s re g a rding the the me o f “He a lthc a re Co lla b o ra tio n”

a nd the fo ur ke y wo rds o f te a m c o lla b o ra tio n, trust, mutua l re spe c t a nd

• rg a niza tio na l c o mmitme nt sho we d dissimilar

itie s

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E xa mple s o f Qua lita tive Re spo nse s

IPE Group (23 of 35 respondents):

• If we’re going to build strong healthcare teams, we need to better understand each
• ther. Our connection in this class – to include some of the heated discussion and

even one of the fights! – help us to do that.

• I have also really been surprised in meeting and engagement with the nurses and

administrators in our class who clearly have a different view than I thought they had about what is important about patients and what we need to do in healthcare.

• I was surprised and humbled when one of our administrators said that he had read

up on a medically complex issue, so he could understand what I as a physician, would face in caring for that patient.

Homogenous Group (19 of 50 respondents):

• I certainly hope this course will create a better environment within the organization. I

believe physicians have been craving some input, but it’s up to the Administration to truly allow a partnership.

• I am currently trying to match the influence technique you provided with the

appropriate groups I work with. I find that nurses are pretty responsive to “authoritative requests” and “pressures,” but I’m still trying to figure out what technique works best with specialty physicians and administrators.

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G RO W ING

[PHYSIC IA N] LEA D ERS

M A RK HERTLING