We talked to clinical leaders, health care executives, and clinician members of the NEJM Catalyst Insights Council for a closer look at the leadership training and approaches that work best for today’s health care organizations.
Early on in her career, Kathy Mahoney, MD, MBA, medical director for the Division of Health Care Quality at Baystate Health, a nonprofit integrated health care system serving over 800,000 people in western New England, had an interest in management and improvement processes. Her informal business skills had helped her rise to the top of her OB/GYN practice, but it took returning to school for an MBA to compete for health system leadership positions.
“I had credibility in my practice and amongst my peers, but I didn’t have it out in the broader world,” Mahoney says. “I did an MBA so folks knew I had some type of knowledge that set me apart.”
Mahoney isn’t alone. In our recent NEJM Catalyst Insights Council Leadership survey, 20% of respondents say the top leadership in their organization holds an MD-MBA or other combination of medical and non-medical degrees. The top choice in the survey—which was completed by clinical leaders, health care executives, and clinicians—was MD, MD-MPH, or other combination of medical degrees, at 28% of respondents.
Mahoney credits her MBA for enhancing her interpersonal skills—which survey respondents consider a top attribute to successfully lead a health care organization or physicians—as well as her ability to manage people and teams effectively, where non-clinical leaders are considered to have a slight advantage, she says. “I could manage my local peers but they were homogenous – much different than where I am now in a health system with 12,000 employees,” she says. “My MBA helped me understand how I communicate to others and to be more inclusive and understanding of other perspectives and to actively seek them out.”
A different take comes from Michael R. Wasserman, MD, CMD, Chief Medical Officer at Los Angeles–based Rockport Healthcare Services, which provides administrative and consulting services to post-acute care facilities throughout California and Texas. He says the MBA is not a cure-all for what ails physician leadership. He sees many physicians get an MBA but then find they can’t translate what they’ve learned to their organization’s needs, he says. “I actually worry the MBA becomes a crutch. If our business schools are so good, why is our health care industry so screwed up?”
Wasserman thinks physician leaders would be better served learning how to integrate quality care into workflow. “As a clinician, I know what quality care looks like, so I then have to figure out, how do I make that happen in a way that’s cost-effective and productive,” he says.
For instance, he believes the CMO position is not properly used in most organizations. “They often are clinical figureheads, when they should be used operationally as a bridge between quality clinical care and operations and finance,” he says.
Nathan A. Merriman, MD, MSCE, Director of Endoscopy and Chair of the Physician Leadership Network at Christiana Care Health System, a nonprofit that includes two hospitals with more than 1,100 patient beds, a home health care service, and a network of primary care physicians headquartered in Newark, Del., says health care organizations must provide protected time for leadership—both individual and team-based leadership development.
Merriman, who also helped to establish the Delaware Center for Digestive Care private practice in Newark, says the fee-based model has made it difficult for physicians to train for and take on leadership roles. “Our delivery model is so entrenched in fee-for service that this type of disruption is uncomfortable at the practice level,” he says.
Physicians historically have been measured individually by number of procedures and office visits, which leaves limited time for dedicated leadership development, according to Merriman. “As we move toward patient-centric, provider-sensitive, and system-aware health care redesign, we need a leadership dyad approach that gives physicians space to learn and improve their knowledge base and leadership experiences in HR/finance and operations, now more than ever,” he says.
Mahoney is another proponent of the dyad model, which pairs clinical and administrative leaders for better results. In all, 85% of Insights Council members find this model extremely effective, very effective, or effective. Mahoney thinks it would be difficult to provide quality medical care without the accompanying operational process and infrastructure to deliver that care. For instance, she says clinical and business skills would be required to determine appropriate use of an expensive medical device or high-cost pharmaceuticals. “It might be appropriate for a few cases, but not all cases,” she says, pointing out that a dyad model can lead to informed guidelines.
Wasserman likes the dyad model in theory, but he says poor communication between clinical and business leaders can handicap it. “The only way to get physicians to listen is to have that message delivered by other physicians, but a lot of visionary physicians are unable to translate their vision to the operational and finance side,” he says, adding, “It’s a bit of a catch-22.”
He believes the entire system of physician leadership development needs to be revamped. Physicians should be trained as team leaders because most tend toward using a top-down leadership model. He also believes the CEO should oversee the dyad model, making sure that the CMO and CFO (or other clinical/administrative combinations) work well together.
Baystate Health’s Mahoney sees approaches to leadership development changing. For instance, her organization is making it a mission to support the next generation of physician leaders, identifying promising talent and sending them to an in-house leadership academy.
“Leadership used to be a black box, but now physicians must understand it and be trained for it,” she says. “Just because you’re an expert clinician doesn’t mean you have the skills to bring a whole team together. You have to be able to build relationships and foster them.”
Read and download the full report: Leadership Survey: Ability to Lead Does Not Come from a Degree. Learn more about the Insights Council.