Leadership Dyads have been touted as the solution to the challenge of executing complex initiatives in hospitals and health systems. Meaningful physician leadership has been found to be the missing component in some of these implementations. The thinking goes that partnering a strong executive with an engaged physician can overcome physician resistance to such new programs. But not all leadership dyads are created equal.
What Is Dyad Leadership?
As described in a 2015 Advisory Board Article, dyad leadership is “…a partnership where an administrative or nurse leader is paired with a physician leader, bringing together ‘the best of both worlds’ of skills and expertise.” According to that report, the use of dyads in health care has become more common over the past decade.
The purported benefits of a leadership dyad include:
- Two leaders with complementary skills can be more effective than any one leader;
- The dyad ensures optimal use of each leader’s time and effort; and,
- It improves engagement and reduces stress.
I don’t agree with all of these assumptions. Yes, complimentary skills are useful. But there is an equal risk that two leaders attending the same meetings and duplicating their work could result in wasting valuable resources.
Enhanced engagement of physicians seems more likely. But whose stress level is going to be reduced when working on these high priority projects under the usual budgetary constraints and tight deadlines?
I’m intrigued by the number of articles written about the frustrations of medical practice. It makes for good reading, because it resonates with many physicians. From bloggers writing about maintainance of certification and regulations that are destroying medicine, to articles on KevinMD about burnout, physicians are not shy about complaining. But maybe it’s time to stop complaining and start leading.
If you stop in any hospital doctor’s lounge, you will certainly hear a lot more complaining. We complain about electronic medical records, complicated billing requirements, regulations, lawsuits, the difficulties of running a medical practice or working for a large institution.
Much of the complaining is warranted. But complaining without taking action is the characteristic of a victim. What we need in healthcare is leadership, not victimhood. And true leaders jump into action and skip the whining part completely.
Complaining Is Not Leading
What does complaining accomplish? For years, I’ve read surveys showing that physicians are unhappy. They’re planning to retire early. Physician numbers should be declining. They won’t recommend a career in medicine to their students or family. Fewer students will choose the medical profession.
But, I don’t see increasing numbers of physicians quitting. Retirement rates have not gone up. The number of medical schools has grown. So has the number of students applying to medical schools.
I’ll admit that physicians are unhappy. If you ask any physician what they don’t like, you’ll get a list of 10 or 20 things that are wrong with “medicine.”
My question is this: What are we going to do about it?
Micromanagement can be defined as a management style that involves closely monitoring and/or controlling how employees do their jobs.
It’s a poor management technique that wastes time, fails to utilize our staff’s full potential, and causes resentment and frustration in those being controlled.
… the highway!
It is one of the 4 things that drive employees crazy, according to Dan Rockwell.
My practice had become a burden. My patients seemed annoying and overly demanding. I was living alone in a small duplex, feeling isolated. I was sleeping more than usual, yet fatigued most of the time. Any resiliency had been stretched and tested and was wearing thin.
My usual optimism was gone. I did not become overtly suicidal, but I began to have thoughts about what it would be like if I was no longer “around.”
I started this series by discussing the attitudes or perspectives that physician leaders should understand and adopt. I would like to complete it with a description of some practical skills that you should seek to learn or enhance. If you are early in the journey, you can try to observe these skills in others as you’re preparing to be a better physician leader.
This is a process. Like any new realm of learning, we follow a path from awareness, to understanding, knowledge, competence, and eventually, mastery. This process may take years to complete.
The Chief Operating Officer and I asked the Director of the Laboratory, Sheila, to join us to discuss a challenge she was experiencing with her staff. I was still learning the ropes about working with directors of hospital departments like the Lab. The COO was quite good at sorting through difficult issues and building strong teams.
The director was very frustrated. She spoke about a particularly difficult employee. Peter had been working as a laboratory technician for many years. Every few months he would become the center of some drama in the department. He would be “written up” and then not be heard from for several months.
Several events this week inspired me to think about preparing to be a better physician leader.
A colleague reminded me about the upcoming Spring Institute and Annual Meeting of the American Association for Physician Leadership. I had just completed registering myself. And I volunteered to act as an ambassador, assisting with introducing speakers and helping to support the meeting.
Networking with colleagues and old friends will be fun. And I look forward to spending time in New York City with my wife, Kay, when I am not attending educational sessions.
As vice president of the local nonprofit hospice board, I had the privilege of chairing the board meeting because the president was out-of-town. It was interesting to observe how the board members, many of them leaders in their own organizations, communicate with one another and run some of the subcommittees to which they are assigned. It is a very effective team.
I am sometimes asked: what does a CEO look for in a CMO? I’ve heard this discussed at the American Association for Physician Leadership (AAPL) meetings and American College of Healthcare Executives (ACHE) meetings, and it was a topic of discussion during the week-long tutorial for the Certified Physician Executive (CPE) qualification. I’ve looked at dozens of job descriptions which also provides insight into identifying the essential abilities the CEO wants in a Chief Medical Officer.
There is no one set of skills or abilities, of course. Each organization and CEO will be looking for a set of skills to meet its unique needs. But there are some common themes.
After the hospitalist movement began, it wasn’t on the radar at our 300-bed hospital for many years. Robert Wachter and Lee Goldman made the case for dedicated hospital-based physicians years earlier. And as DRG payments failed to keep up with inflation, and inpatient care became more complicated and costly, it seemed our medical staff was not becoming any more efficient with inpatient care.
The Chief Operating Officer and I were meeting one day, and the Director of the Laboratory was asked to join us to discuss a staff challenge she had been having. As the director for the laboratory, she reported to me. We met regularly to discuss progress on her goals, any issues with the medical staff, and the other usual challenges that might arise. I was hoping to learn more about using a leader’s two most important skills by observing my COO.
I was still learning the ropes about working with directors for critical hospital departments like the Laboratory. The COO was quite adept at sorting through difficult issues and building strong teams.
The lab director was very frustrated. She began talking about a particularly difficult employee who had repeatedly stirred up trouble in the department. Peter had been working as a laboratory technician for many years. Every few months it seemed he would be the center of some drama in the department. He would be “written up” and then not be heard from for several months until the next issue.
The employee had certain skills and certifications that would make him difficult to replace. So, in spite of his repeated involvement in various kerfuffles that impaired the morale of the department, he never received more than a slap on the wrist for his transgressions.
As healthcare executives, we must communicate clearly and effectively. This can be difficult at times. One-on-one communication is fairly straightforward. But how do we communicate regularly with dozens of physicians, hundreds of constituents, or thousands of patients? And how can it be done in a way that encourages a two-way dialogue? Perhaps healthcare executive blogging is the answer.
As chief medical officer, one of my primary challenges was connecting with the members of the medical staff. I regularly needed to inform them about initiatives undertaken by the organization, new mandates by accrediting agencies, upcoming staffing changes and dozens of other issues.
Over the years, I have witnessed some minor disasters that could have been averted with a little better communication and planning. Some of these nightmares were of my doing. Some were by other overconfident leaders who could not find the time nor self-discipline to engage in the fierce conversations that were needed to avert them. But bad things can happen when you fail to communicate consistently.
One of the more common traps I’ve seen involves the contract termination of a well established hospital-based group. This most often occurs with emergency medicine, hospitalist, anesthesia or radiology groups. Either the group is unhappy with its old contract, or hospital executives are dissatisfied with the group’s performance. The CEO, COO or CFO, following months or years of frustration, declares in a closed senior executive meeting, “we need to look for a new group!”
These failed transitions cause chaos in the involved patient care arenas, unhappy medical staff and delays in care. Several conditions exist that lead to this political nightmare for the CEO and board.