1. ©This article originally appeared in Healthcare Strategy Alert! Issue 2, 2010, published by the Forum for Healthcare Strategists. All rights reserved.
Physician alignment strategies have been at the top of
the healthcare executive’s agenda for years. As mounting
attention to healthcare costs, quality, and access drives
interest in new delivery and payment models, hospital and
physician alignment has become even more important.
Successful alignment demands effective physician leaders—
and a growing number of healthcare organizations are looking
at how they can build the talent they’ll need to take their
organizations into the future.
TAKEnote
Leading the Way to a
More Aligned Future
Increasingly, healthcare organizations
and physicians are pursuing alignment
strategies that better integrate financial,
clinical, and operational interests. After
all, such strategies offer the best hope for
mastering ongoing economic, regulatory,
and competitive pressures. Now, calls for
new delivery and financing models, with
or without the passage of health reform
legislation, heighten the need for greater
alignment.
Strong physician leaders working in
partnership with nonphysician healthcare
leaders will drive the development and
implementation of effective models, at
both the organizational and broader
system level. To be sure, the involvement
of physician leaders is key to the success
of practice acquisitions, employment
models, service line strategies, clinical
integration models, and ACOs.
Forward-thinking healthcare organizations
are working hard to nurture and develop
physician leaders with the competencies
required to effectively fulfill leadership
roles. This issue examines some
successful approaches, as well as
principles for inspiring “integrative”
leadership and engaging physician
leaders in organizational strategies.
Read on for expert insights to help guide
your organization into a more aligned
future. And mark your calendars for the
Hospital & Physician Relations Executive
Summit, October 13-15, 2010, in
Phoenix, AZ.
Judy Neiman, President
Forum for Healthcare
Strategists
Developing Great
Physician Leaders
By Debbie Reczynski
“To achieve cost, quality, and access
goals, and have a more successful
healthcare system, we need physician
leaders who are well-trained, well-
supported, and have the knowledge
and wisdom to help alignment
succeed,” says James A. Rice, PhD, Vice
Chairman, The Governance Institute,
and Practice Leader, Governance and
Leadership, Integrated Healthcare
Strategies, Minneapolis, MN. “Healthcare
organizations have the necessary
physician talent, but they need to
nurture and support it if we are going
to get the kind of integration and change
needed to truly reform and improve
healthcare, both at the institutional
level and an overall system level.”
That means not only grooming physicians
for formal roles, such as chief medical
officer, vice president of medical affairs, or
medical directorships, but also the informal
roles. “There are so many more physicians
involved today in informal leadership
roles, such as leading a task force, a
performance committee, or a quality
initiative. Those are the roles that are really
going to make or break an organization’s
success in moving toward becoming
a high-performance organization or
integrated model,” Rice says.
And, often, physicians assigned to those
roles aren’t necessarily prepared to be
leaders. “The competencies needed to
lead really have very little to do with
the competencies needed to be a
great doctor or a great scientist,” says
James K. Stoller, MD, MS, Chair of
the Education Institute and Executive
Director, Leadership Development,
Cleveland Clinic Foundation, Cleveland,
OH. “In most traditional medical
centers, promotion to leadership posts
is usually based on clinical or scientific
competencies, such as the number of
grants obtained, or papers published, or
professional stature. While these are very
important, they are not the sum and
substance of leadership. Great leaders
have a different skill set.”
Bridging that gap will require “more
on-the-job training and an education
pathway to cultivate physician executives
and develop the skills they need to work
more effectively with other leaders in
the organization,” adds David Hefner,
Senior Advisor, Association of American
Medical Colleges (AAMC), Washington,
DC. “Physicians selected to lead need
training in the art of decision making
and in understanding the economic
trade-offs of different decisions. They
need to understand human resource
principles and the fundamentals of
business. Understanding the relevant
vocabularies and issues is essential for
establishing credibility with other leaders

2. ©This article originally appeared in Healthcare Strategy Alert! Issue 2, 2010, published by the Forum for Healthcare Strategists. All rights reserved.
Physicians want to be meaningfully engaged in learning, with an
opportunity to apply principles and see immediate results.”
“
within the organization as well as with
other physicians.”
Then there’s the interpersonal side of
leadership. Team-building, listening,
communicating—those skills need
development, too, if physicians are
going to be effective team leaders and
collaborators. So, how can healthcare
organizations approach the challenge of
developing physician leaders?
Make it Practical
First, understand how physicians want
to learn. “Research from the U.S. as well
as overseas indicates that physicians
want to learn leadership skills the same
way they learn to practice medicine,”
says Rice. “They want to be meaningfully
engaged in learning, with an opportunity
to apply principles and see immediate
results. What’s needed is an approach
that is the equivalent of the bedside
learning physicians receive during their
clinical training.”
In addition, by engaging physicians in
multiple short training sessions over an
extended period of time, they are able to
take the lessons, apply them in practice,
observe the results, and bring any issues
or concerns back to future training
sessions. “This is the crux of effective
physician leadership training,” adds Rice.
And, it’s the approach used by successful
in-house leadership academies at
numerous health systems, including
Cleveland Clinic and Carilion Clinic.
Physicians who are selected for the
Cleveland Clinic Academy’s “Leading
in Health Care” program work over the
course of a 10-month period to develop
a business plan for a real initiative that
Cleveland Clinic could conceivably
undertake to enhance some clinical or
organizational function. “The first session
is a retreat where all of the physicians
enrolled in the course come in with
ideas for projects they’d like to work on
and present them to the group,” says
Stoller. “The ideas are evaluated by the
group and six are selected for further
development based on the enthusiasm
generated, along with input from Clinic
department heads.”
Over the next 10 months, participants
meet one Friday a month to develop and
apply the skills necessary to complete
their projects. “Working in teams of
five or six, they prepare business plans,
financial analyses, and marketing plans.
They conduct a SWOT analysis and
evaluate IT needs for their idea,” Stoller
adds. The monthly sessions are led by
Cleveland Clinic executives from relevant
areas, who can frame the discussion in
the context of the organization’s culture.
“For example, when finance is taught, the
discussion has to be framed in terms of
such things as the right margin to look
at—operating or profit—or whether
budgets are joint or separate,” explains
Stoller.
The program offers both individual and
organizational benefits. “It’s very personal
and practical, and produces a very
concrete deliverable,” says Caryl A. Hess,
PhD, Director, Cleveland Clinic Academy.
“At the end of the program, these high-
potential physicians have developed
16 leadership competencies, ranging from
emotional intelligence to understanding
the Clinic culture and environment to
business skills. Plus, they’ve created a fully
formulated business plan that they can
take back to their respective Institutes for
implementation.”
For the organization, the program not
only builds a sustainable pipeline of
leaders, it’s also an important forum for
cultivating innovation. “Many of the
projects introduced through the course
have already been implemented, and
some are still being analyzed for their
potential,” Hess notes. A diabetic center,
a department of molecular pathology,
and an adult hospitalist program are just
a few that have gained traction.
Carilion Clinic, Roanoke, VA, also builds
physicians’ leadership knowledge and
skills through a 10-month sequential
program that focuses on internal issues
and projects. Physicians who are selected
for the Physician Leadership Academy
attend a series of seminars and “learning
cafes” and complete a business planning
project that is endorsed by their clinical
department chair.
“The more you can do in the context of
your present reality, the more effective
it’s going to be,” says Mark Greenawald,
MD, Medical Director, Office of
Professional Development, Carilion
Clinic. “So, the modules are timed to
coincide with organizational events such
as business planning, budgeting, and
Continued on next page

3. ©This article originally appeared in Healthcare Strategy Alert! Issue 2, 2010, published by the Forum for Healthcare Strategists. All rights reserved.
Continued from page 3
performance reviews, and physicians
bring their own scorecards and budgets
to the session. Sessions are led by
leaders from within Carilion so that the
discussion focuses on real issues for the
organization.”
A Process, Not a Class
For their projects, Carilion physicians
choose a real-life issue or problem from
their clinical area. “It may be something
they would be doing anyway, or that
they know needs to be done, but weren’t
sure they had the skills to complete,”
says Sheila Stark, PhD, Director, Office
of Professional Development, Carilion
Clinic. The classroom instruction
provides knowledge and skills to
help program participants complete
their projects. Greenawald and Stark
provide a consistent source of support
throughout the program, and even after
the program is over. Each participant is
also paired with a mentor, often a clinical
department chair, medical affairs officer,
or other Carilion leader, who serves as
an additional resource for independent
leadership development.
But leadership development is not a
meeting, class, or event, it’s a process—
and the program reflects that. “The
modules are connected so that skills
and competencies can be reinforced
over the whole 10 months,” Greenawald
says. To establish continuity, he and
Stark attend every session and work
with faculty beforehand to help each
instructor see how his or her session fits
with the rest. And, Stark adds, “The goal
of the business planning project is not
so much the outcome, but developing
the process skills required to effectively
implement a project plan. So there is
a lot of emphasis on such elements
as getting buy-in and working more
collaboratively.”
Once a course ends, physician leaders
still require support to ensure that skills
become embedded. “That’s something
we’re working on,” Stark says. “It doesn’t
just happen.” For instance, once a month,
or every other month, a leader from
within the organization or from the
community or the board of directors is
invited to have a dialogue with physicians
who have completed leadership training.
“It’s an opportunity to talk about their
experiences in trying out their skills and
gain some new insights from experienced
leaders,” Stark adds.
In addition, at both Carilion Clinic and
Cleveland Clinic, these intensive programs
are just one piece of a larger leadership
development strategy. Both offer a
range of leadership and management
courses open to physicians and staff
across the organization, along with other
professional development initiatives.
For instance, Hess describes “Leading
in Health Care” as the middle rung of
a developmental pyramid. Above it is
a leadership rotation for high-potential
physicians and at the base is the Cleveland
Clinic Academy, which offers more than
60 courses paralleling the curriculum
covered in “Leading in Health Care.” “This
is where you have a pervasive impact,”
says Hess. “The courses are open to all
physicians, administrators, and nurses
with a master’s degree or higher, and more
than 2,000 have benefited to date. So, even
if someone is not selected for ‘Leading in
Health Care,’ they still have an opportunity
to learn essential business skills and
develop the leadership competencies
required of effective leaders.”
Don’t Forget the ‘Soft’ Side
While the business competencies
typically taught in executive education
programs are important, what really
makes a difference in training effective
physician leaders are the “softer skills,”
notes Rice. “The best programs work
with physicians on self-awareness,
dialoguing, listening, group management,
problem solving, delegating, and the art
and science of managing projects.”
That’s certainly the case at Carilion Clinic
and Cleveland Clinic. “We designed our
program around a model of emotional
intelligence and self-awareness,” says
Greenawald. “Physicians spend time
looking at themselves and their leadership
style and learning that we are not all wired
the same. We talk about self-leadership
and self-management. We explore how
a leader takes his or her leadership
tendencies—both good and not so
good—and uses them in relating to
others.”
It’s not just a matter of lecturing about
these softer skills, but practicing them as
well. Program directors and instructors
at Carilion and at Cleveland Clinic model
desired behaviors in the classroom,
and both organizations include a
360 leadership assessment and time
with a trained leadership coach as part
of their programs. “Participants use a
personality profiling tool to understand
their leadership style, and work with a
coach to understand the results and
what they mean. Then, over the course
of the 10-month program, participants
learn how to apply the results as they
work through other material in the
curriculum,” Greenawald notes.
Another skill that’s often a challenge for
physicians is “followership.” “Because
physicians are trained to be highly
autonomous, they often aren’t good at
following. “That’s a big impediment to
team-building and collaboration, so we
spend time focusing explicitly on the idea
of followership,” says Stoller. “While it‘s
important to be a leader, it’s also important
at times to be a follower. We help
physicians understand that the roles have
to morph together to achieve successful
collaboration. It’s a matter of unfreezing
certain behaviors and refreezing toward a
more collegial mindset.”
Know What You’re
Working Toward
Not all healthcare organizations will
have the resources to develop their own
leadership training programs, but for
those that do, it’s well worth the effort.
“Think in terms of three to five years
and understand what the organization is
really trying to accomplish. If physicians
have no idea why it’s important to
develop these skills, they become
frustrated,” says Greenawald. “Make sure
they understand why physician leaders
are important in the context of your
organization and see the opportunities
down the road. The investment will
pay off in three, or five, or 10 years as

4. ©This article originally appeared in Healthcare Strategy Alert! Issue 2, 2010, published by the Forum for Healthcare Strategists. All rights reserved.
physicians going through the program
move on to become the organization’s
next section chief, department chair,
VPMA, or even the CMO.”
Those organizations that are not able
to build their own programs may be
able to take advantage of leadership
training offered by other healthcare
organizations, university programs, or
professional associations, such as AAMC
or ACPE. But the best place to hone
leadership skills will be on the job. “That’s
where physicians will learn to apply
the business acumen to problems that
may seem unsolvable,” advises Hefner.
“That’s where they’ll see the value of
strong interpersonal skills in building
teams, inspiring trust, and strengthening
collaboration around a shared vision. And,
that’s where they’ll learn to take risks, and
rebound from potential setbacks to move
the organization forward.”
The value of leadership training can
extend outside the organization as
well, stimulating collaboration and
innovation from a national as well as a
global perspective. “To be true leaders,
physicians need to be taught and given
the opportunity to excel in other areas of
leadership and management,” notes Hess.
“If you provide the opportunity to learn
and ignite the passion to lead effectively,
that’s really the true measure of success.” ◆ Cedars-Sinai Medical Center
◆ Alegent Health
◆ Baylor Health Care System
◆ Heartland Health
◆ Mayo Foundation
◆ Lehigh Valley Health Network
◆ Sanford Health
◆ Virginia Mason Medical Center
◆ Carilion Clinic
◆ Advocate Health Care
◆ Reliance on small groups of physician cohorts for group learning while
encouraging interdisciplinary projects and case studies
◆ Emphasis on real-time case studies of serious challenges that relate to enhancing
the patient experience, process improvements, and measurable economic gain
◆ Support of learning about self-awareness, listening, and dialoguing
◆ Reliance on a mix of in-house expert faculty with outsourcing and insourcing
with local business schools, national health leader associations, or professional firms
◆ Requirements for short, bite-size sessions of two or four hours, spread over
several weeks, to encourage applications in real-world settings and to be respectful
of physician time
◆ Cautious reliance on new digital learning tools such as webinars, podcasting,
teleconferencing, and dedicated websites for knowledge downloads and expert
bulletin boards
Research conducted by Integrated Healthcare Strategies on physician leadership
development programs, including those at 10 U.S. health systems (see list below),
uncovered the following key principles for maximizing physician engagement and
achieving the best results:
The following health systems participated in Integrated Healthcare Strategies’
study of physician leadership “Programs of Promise”:
Source
Integrated Healthcare Strategies. Enhanced Physician Alignment via Enhanced
Physician Leadership Development
Sources
Mark Greenawald, MD, can be reached
at opd@carilionclinic.org.
David Hefner can be reached at
dhefner@aamc.org.
Caryl A. Hess, PhD, can be reached at
hessc@ccf.org.
James A. Rice, PhD, can be reached at
jim.rice@ihstrategies.com.
Sheila Stark, PhD, can be reached at
opd@carilionclinic.org.
James K. Stoller, MD, MS, can be
reached at stollej@ccf.org.
To learn more about their programs, download the Programs of Promise white paper at
ihstrategies.com/knowledge_center.php#list.
Six Principles for Effective
Leadership Training