Leadership

Building a New Kind of Leader for an Era of Cooperation

Article · November 29, 2017

UCLPartners, in London, England, is one of the largest academic health science partnerships in the world, encompassing more than 40 health care providers and universities that together serve a population of 6 million people in London and surrounding areas. Founded in 2009, UCLPartners brings together health professionals and academics from hospitals, community services, primary care, and university member organizations to work in partnership to translate proven interventions into population health gain and wealth creation.

In a system that traditionally puts institutions in competition with one another, UCLPartners created a new model for cooperation. Established as a nonprofit social enterprise, UCLPartners’ vision was aligned with similar global initiatives to close the gaps in translational medicine and deliver evidence more rapidly into practice at a population level.

Effective leaders for UCLPartners must have, in addition to the usual suite of leadership skills, an ability to foster cooperation among our member organizations. We must select clinicians to lead system-wide transformation and improvement, and to do so, we introduced a competency-based approach that evaluates candidates for a wide spectrum of personal characteristics and capabilities, rather than relying on the more traditional criteria of seniority, length of experience, and reputation.

At both the system level and the organization level, we need leaders who can make decisions based on what is best for the population, which is not always the same as what is best for their organization. (Our reconfiguration of stroke care in north central London is a good illustration of how the clinical evidence and patient benefit started to drive a new type of behavior in the system — looking at what can be achieved as a system rather than individual clinicians or organizations.) Most organizations have a power structure with a leader at the top who can command, or at least direct, people below, using a familiar toolbox of incentives, rewards and deterrents, and a standard suite of leadership skills. UCLPartners, as a collaborative partnership of equals, needs leaders to leverage change in the system through influence, without the hierarchical positioning; leaders must appeal to a greater concept and idea of achievement through a collective strength across the partnership. We need multidisciplinary leaders who have not only charisma, intelligence, and vision, but also considerable emotional intelligence, humility, moral courage, and the ability to listen and influence.

To respond to this need, we developed this competency framework. We developed it in a short time, as we had an immediate recruitment need for a Chief Medical Officer (CMO) to lead the development of a new Integrated Cancer System in 2011. We recruited a successful CMO using the framework. The CMO’s own use of the framework is described in the next section.

UCLPartners Leadership Competency Framework

Partial view of the UCLPartners Competency Framework. Click To Enlarge.

View the full UCLPartners Competency Framework.

 

The Assessment in Action: Two Examples of Large Initiatives Using the Competency Framework

1. The London Cancer Chief Medical Officer used the framework to fill 12 pivotal “Pathway Director” roles to lead the improvement of end-to-end pathways of care for cancer in various tumor groups, together serving a resident population of 3.5 million. The directors would be on loan from their home organizations for a period of 3 years, with a remunerated contractual commitment of 8 hours a week.

This was a 3-stage assessment process. First, candidates for these roles underwent psychometric testing (numerical, verbal, and abstract reasoning). Second, they attended an assessment day, conducted by an external ex-military company specializing in leadership assessment (using their own framework but our “influencing” competency). The final stage was a stakeholder interview followed by a formal interview panel including partner Chief Executives; both panels assessed the candidates against the UCLPartners framework.

The roles attracted more than 30 applicants, all highly experienced cancer clinicians from our partner organizations. All met specification criteria and were shortlisted and invited to attend the psychometric testing and assessment date. The caliber of candidates in terms of professional qualities was high. Given the variety of local organizational and professional cultures, it was no surprise that there emerged significant differences among the candidates when we assessed the “softer skills” such as listening, empowering others, and influencing. Throughout the process, it became clear that we were doing something profoundly disruptive by applying these new “soft” criteria in hiring decisions, and this disruption came with a cost that we had underestimated during the planning period. Even 2 years after the event, a partner HR Director suggested that the “blood was still fresh” in his organization. Despite the disruption, however, the process for the most part identified candidates who proved to be successful in their roles.

2.  This framework was also used in 2014 to recruit for clinical and managerial leadership positions for a specialized heart center in north central and east London that reconfigured cardiac services to improve patient and population outcomes.

The reconfiguration involved relocating acute cardiac services from one central London site within a large teaching hospital, and transferring services and staff to a new specialist center in a neighboring hospital that had a history of rivalry with the first. Our role in recruitment was to provide a neutral ground for selection of the best candidates from each site, and to recruit system leaders.

Because all leadership positions were open initially only to internal candidates from the existing partners providing cardiac services, the framework helped identify leadership skills that went beyond current positions and roles. For example, the lead nurse needed to engage her team in active research, and medical leaders needed to engage with the community, universities, and other health and social care partners. These new functions required strong influencing skills to get things done without traditional authority-based power, and to build teams around a vision. The framework helped us select candidates who had created a highly effective team. Though many factors contributed to the success of the Heart Centre, at the center of it were its people and teams.

Six Years of Experience

The leadership framework has been used to recruit all levels of clinical and nonclinical roles at UCLPartners, and it has been shared with our member organizations. Though some competencies may not be relevant to a particular role, the overall framework helps focus our diverse recruitment panels, and we have found it consistent in articulating the values we looked for in our people.

The key aims of the management of UCLPartners programs is the same today as it was in 2009: working through a system of provider autonomy, alignment, collaboration, and sustainability. The competency framework has helped the organization to:

  • deliver on a shared vision across autonomous health care providers and universities — evidenced through consistent involvement and commitment of partners over time and through disruptive and complex change;
  • develop multidisciplinary leaders of character and competence to help align the system around a joint vision;
  • recruit leaders who can facilitate and stimulate existing people and resources to build trusted alliances with patient and carer networks and organizations; and
  • lead complex projects for a period and then manage their reintegration into the wider health system, ensuring a robust transfer of responsibility and governance.

Lessons Learned

  • Plan competency assessment processes in phases, allowing appropriate intervals for decision-making. When planning, it is easy to forget that sometimes decisions require reflection. In early days, we quickly learned that one needs 3 to 4 days, if not an entire week, between these assessments to allow for sufficient consideration.
  • Trust the framework, but invest in people. The assessment tool can measure leadership style and potential, but the organization must also plan to support leaders as they develop. Our Pathway Directors received and appreciated general and specialized training as well as executive-level mentors from across the health system.
  • Provide high-quality management support for clinical leadership roles. This support has helped us build and retain system leaders without traditional forms of compensation or scheduled time in their work week.
  • Divide up the responsibility for evaluating candidates. The framework includes many competencies, and not all are relevant to every role. We choose eight or nine that are most important for the role. The formal interview covers about five of them, with panels of stakeholders (including representatives from local health care providers and patients) looking at two, and the rest measured by psychometric or other types of testing.

New Call for Submissions ­to NEJM Catalyst

Connect

A weekly email newsletter featuring the latest actionable ideas and practical innovations from NEJM Catalyst.

Learn More »

More From Leadership

How to Have a High-Performing Employed Medical Group Without a Hospital Subsidy

It’s a generally accepted view that all hospital-employed physician groups are constitutionally incapable of operating without financial support from the hospital. PinnacleHealth Medical Group found that commonsense tactics can eliminate the need for hospitals to expend precious resources to support employed physicians.

Wanted: Talented, Energetic, Creative People to Work on Difficult, Boring Problems. No Perks.

Let’s admit the inconvenient, boring truth.

Physician Coaching: Clinicians Helping Clinicians on the Things That Matter Most

A physician coach reflects on who gets better, what works, and how to create a learning culture.

Jessica Dudley and Namita Mohta head shots

Professional Fulfillment: Where We Want to Be

How the CMO of Brigham and Women’s Physicians Organization combats burnout at her institution and empowers physicians with leadership skills.

Texas Medical Center Houston Methodist Checklist to Maintain Operations During Hurricane Harvey and Future Flood Events

Lessons in Leadership: How the World’s Largest Medical Center Braced for Hurricane Harvey

Due to learnings from previous hurricanes, five success factors kept the Texas Medical Center operational during one of the worst natural disasters in recent U.S. history.

Lessons in Leadership: How the BayCare Health System Withstood Hurricane Irma

BayCare’s extensive disaster preparations were crucial in weathering the storm.

The VA Is a Quality Leader, Contrary to Many People’s Assumptions

A defense of the Veterans Health Administration, from its former Acting Under Secretary.

Medicine Is Not Manufacturing

Treating medicine as just another business is to deny its soul, the essential element that has given patients comfort and relief for thousands of years.

Lessons in Leadership: Transformative Collaboration Across the Care Continuum

Collaborative relationships across settings are critical to optimizing care, yet difficult to achieve.

Repeal, Replace, Repair, Retreat — Republicans’ Health Care Quagmire

Republicans’ Senate misadventures with the Affordable Care Act offer a powerful reminder about the limits of political power in the United States.

Connect

A weekly email newsletter featuring the latest actionable ideas and practical innovations from NEJM Catalyst.

Learn More »

Topics

Economic Investment and the Journey to…

Early successes suggest that value-based purchasing programs can both transform employer-based health care and have…

Leading Transformation

167 Articles

We’re Not as Good as We…

Is the pace of change in health care going too fast, or too slow?

Leading Teams

118 Articles

The Importance of Leadership to Organizational…

Effective leadership is built on a solid foundation consisting of a clear mission, a vision…

Insights Council

Have a voice. Join other health care leaders effecting change, shaping tomorrow.

Apply Now