Where is the transition from frontline clinician to clinical leader or executive? Does everyone entering health care leadership need an MBA, or can management training be sprinkled in and accelerated as leaders self-identify?
Reflecting on his path to leadership in health care, Richard Zane, Chief Innovation Officer for UCHealth System, describes how he at first had to become a competent clinician and then develop research and education portfolios before gaining opportunities in leadership. But, he says, “I found that as a leader I needed more skills in finance and in HR than I did in the three things that got me to those leadership positions.”
Harvard Business School Professor Raffaella Sadun says that not all health care leaders need an MBA — training can be provided as needed. “Not everybody has the luxury to be able to take, say, 2 years off to get an MBA.” But, she says, it’s important to embed clinicians in active day-to-day learning opportunities, “showing that it’s not just philosophy and it’s not just a matter of values, but it’s really a matter of behavior.”
One of the core components of being on a team is not just knowing how to lead, but knowing how to follow, points out Zane. Related to that, NEJM Catalyst Leadership Board Founder Tom Lee says he “got into a leadership role because I was a professor and I could look other professors in the eye and not blink as we talked about our need to do things.” But that academic credential was not enough to lead.
Over time, Lee began to appreciate the difference between strategy and operations — the difference between decision-making at the top of the organization versus what middle management does to enact those decisions. “That distinction between strategy and operational excellence, how to close that gap between the senior leadership and the front lines with really effective middle management . . . appreciating those differences is very important,” he says.
“Did you need to be an all-star NFL player to coach an NFL team, or could you have coached without being a player?” asks Zane.
Times have changed, Lee says. “People who became professors because they wrote a lot of papers, they’re being replaced by MD/MBAs in their 40s who actually have learned something about changing behavior in management and performance.”
Sadun cautions that training middle managers in leadership skills is not going to be effective without a commitment from the top that signals expected behaviors. “Culture, at the end of the day, is manifested in these day-by-day actions. Unless you have that type of belief and you show this type of belief to the organization, whatever training you do is not going to be effective. You need to have both; you need to have both the committed leadership and the provision of the skills or the training.”
From the NEJM Catalyst event Physicians Leading | Leading Physicians at Intermountain Healthcare, July 12, 2017.