Analysis of the NEJM Catalyst Insights Council Survey on Leadership Training and Development. Qualified executives, clinical leaders, and clinicians may join the Insights Council and share their perspectives on health care delivery transformation.
By Gary S. Kaplan and Stephen Swensen
Leadership is teachable, and leadership development and training are important, according to NEJM Catalyst’s recent Insights Council survey on the topic. Yet the same survey reveals that more than half of respondents think their organizations’ efforts to develop and train leaders are lacking in quality and time commitment.
Gary Kaplan, MD, Chairman and CEO at Virginia Mason Health System in Seattle, finds these results concerning, especially as the complexity of delivering health care continues to increase. “Leadership doesn’t just happen,” he says. “We need strong leaders for greater focus and to execute improvement work in organizations and the health care industry overall.”
The survey, conducted among a qualified group of U.S. executives, clinical leaders, and clinicians who are directly involved in health care delivery, finds that while 86% of respondents say leadership can be taught, fewer than half have a net positive feeling about the quality of training and development their organization provides.
Stephen Swensen, MD, MMM, former Medical Director of Leadership and Organization Development at Mayo Clinic and lead advisor for NEJM Catalyst’s Leadership theme, says this disconnect is very problematic. Most organizations “don’t understand the business case for developing leaders or have too short term an outlook because of narrow margins or businesses that operate quarter to quarter.
“What they don’t see is that coaching, mentoring, and role modeling — all the fundamentals of leadership — are a good investment and there is a solid business case for training and development,” he says.
Survey respondents say three particular topics are most important for leadership education and training: collaboration/team-building skills (selected by 53%), change management/process improvement (51%), and communication (44%).
Kaplan is a firm believer that “leaders facilitate the success of the people they lead.” When he took the reins at Virginia Mason 20 years ago, he formalized leadership training, developing “content and a body of knowledge that could be taught and learned,” he says. The approach is heavy on experiential learning rather than didactic learning. Virginia Mason now has a framework for talent development and succession planning at all stages of professional development, including among emerging leaders.
He has found over the years that the key is for leaders, who are often inclined or encouraged to be advocates for their teams, to evolve to become sponsors of change and improvement, and to help the organization achieve its mission and vision. That means bringing them out of department silos and dedicating resources to their development as overall leaders. “If you don’t truly place value on it and instead tell leaders, ‘We want you to be leaders, but we aren’t going to change personal productivity expectations or free up your time,’ then you are not taking action to support the rhetoric,” Kaplan says.
Freeing up time for leadership program participants is the top challenge facing leadership education and training efforts, by a large margin, according to survey respondents (chosen by 40%). The top approach to leadership training is to do it internally (56%).
Swensen and Kaplan both subscribe to the philosophy that leadership is 70% doing, 20% coaching and mentoring, and 10% formal training such as classes.
Swensen advocates Action Learning as a way around the difficulty of time constraints. In the Action Learning framework, leaders perform their day-to-day work as usual, alongside a multidisciplinary team of leaders-in-training. “They are not doing simulations or lectures; they are doing work that needs to be done anyway while building social capital with one another and receiving real-time feedback from senior leaders and improvement experts,” he says.
For those executives who worry about the cost of leadership development programs, Swensen says internal “train the trainer” coaching, in which people attend external training and then bring that expertise in house, can be done at a relatively low cost.
At the organizational level, Swensen says, all clinicians should understand their leadership pathway when they are brought on board. This approach, which is used at Mayo Clinic, motivates people and is a way to avoid the language of “us versus them,” which often afflicts professionals who are left off a leadership trajectory or treated like an “employee,” he says.
Kaplan stresses that leadership cultivation shouldn’t be only for clinicians. “We had a director of finance at Virginia Mason who had never set foot in a lab, but she was a great leader. We gave her experiential opportunities outside of her comfort zone, and she is now the administrative director of pathology and laboratories,” he says. “There are lots of ways that people can play in the leadership domain and not be CMO or Chief of Medicine. You just have to meet people where they are and help them develop their skills.”
Kaplan is also a proponent of seeding leadership training into medical school curricula. “Even if clinicians don’t aspire to become titled leaders, they will be the heads of care teams and other groups and would benefit from leadership skills,” he says.
Swensen is bullish on the impact that leadership development can have on organizations when they truly invest in it. “Successful leaders tend to have greater emotional intelligence, are less likely to get burned out, and elicit a better patient experience, including physical wounds healing faster,” he says.
VERBATIM COMMENTS FROM SURVEY RESPONDENTS
What is the most effective leadership education and training initiative you know of? Why is it effective?
“What: Anything is better than nothing. It’s an ongoing process. I am currently undergoing training to become a certified executive coach and can see the value of gaining insight to your own personality and then others and understanding that there are theories and principles of good leadership, team management, and communication. Physicians are trained technically and it does not prepare people well for leadership or functioning well in a more complex organization.
Why: You gain insight into your personality and learn about different personality types and understand how that can influence interaction, implementation, etc.”
“What: Anything that is provided by an outside source (not internal or company driven).
Why: It is extremely effective due to our company building a bubble around us. They’ve hired inept people to make clinical and procedural decisions affecting the more clinically trained, intelligent, and experienced personnel. Our company does not recognize this as a problem. The company continues to turn a blind eye to this fact, encouraging this practice to continue and accusing their underlings of being difficult employees. This is the very first thing I noticed when I stepped foot on our ‘campus.’”
Why: Greatest failure at a management level.”
“What: Having a strong mentor who teaches and coaches.
Why: It’s 1:1.”
“What: Certificate in leadership for health care transformation…a mini MBA, which gives you insight into some of the aspects of health care leadership from multiple lenses.
Why: Short 1-day sessions, for a defined time, with leaders in field and other physicians in an atmosphere of mutual learning. Allows for networking and also understanding other points of view while working thru real life examples.”
“What: Clinician feedback.
Why: Duh!…So people can learn from their decision-making!”
Download the full report for additional verbatim comments from Insights Council members.
Charts and Commentary
by NEJM Catalyst
We surveyed members of the NEJM Catalyst Insights Council — who comprise health care executives, clinical leaders, and clinicians — about leadership training and development. The survey explores the existence, importance, and quality of formal leadership training for clinical leaders, executives, administrators, clinicians, educators, and researchers; opportunities for formal coaching, mentoring, or role modeling; the most important areas of development for leadership education and training; the top challenge facing leadership education and training efforts; and whether leadership can be taught. Completed surveys from 736 respondents are included in the analysis.
Slightly more than two-thirds of respondents’ organizations offer a formal leadership training program (68%). One clinician, who paid out of pocket for third-party training, says opportunities to apply that knowledge within the organization “largely don’t exist” and, therefore, plans to move.
Internal leadership training programs are the top approach used at Insights Council members’ organizations, by a wide margin. One clinical leader says the organization’s peer leadership cohort for faculty allows individuals to develop their own leadership skills and create a strong peer network that helps support the success of the group. “Most of the participants are still in our organization at higher-level leadership roles,” the respondent says.
Download the full report to see the complete set of charts and commentary, data segmentation, the respondent profile, and survey methodology.
Join the NEJM Catalyst Insights Council and contribute to the conversation about health care delivery transformation. Qualified members participate in brief monthly surveys.