Not All Leadership Dyads Are Created Equal

The False Promise of Poorly Constructed Health System Dyads

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.

leadership dyads partnership co-management

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?

4 Tactics for Building Trust and Inspiring Your Team

You must lead by modeling vulnerability

It was both exciting and intimidating to participate in weekly operational and strategic meetings as a new member of the team. One of the first things I observed was how the CEO was building trust among the team members at almost every meeting.

I was the newly appointed vice president for medical affairs (VPMA). I had convinced our CEO that is was time to add a formal physician leader to the executive team. It was 1999, and most hospitals of similar size and scope had a full-time VPMA or CMO (chief medical officer).

There were several members of the executive team that had never worked with a physician executive. And that was not the only reason that trust was a bit of a challenge. Each of the executives in the room were focused more on their own division and its performance than on the performance of the executive team as a whole. Adding a physician to the mix added a whole new level of discomfort.

Effective Teams Crave Conflict

Productive Conflict Creates Better Decision-Making

team conflict

When I first joined the executive team at my hospital as its VPMA (vice president for medical affairs), little did I know that conflict would become a welcome part of the job. One of the most challenging aspects was learning to contribute more openly in weekly strategic meetings. I had some exposure to strategic planning meetings as a hospital board member and on various committees in my state medical society.

But this was different. The CEO, COO, CFO and seven or eight VPs met weekly to discuss strategic initiatives and other challenging issues. I was intimidated by the fact that we would be making decisions that affected thousands of employees and patients, residents and clients.

So I was sometimes reluctant to jump into the conversation. The CEO was good about encouraging me to contribute during the meetings. Truthfully, I mostly listened carefully for the first year of meetings, adding little until I began to feel more comfortable with the process.

My reticence was in part due to my introverted nature. I was also a perfectionist and self-conscious about comments I thought might be seen as unwelcome or unhelpful.

It was not until several years later, after the CEO that hired me had moved on, that the new CEO led us through a concerted effort to improve our functioning as a team. We started by working on trust, as I previously discussed in Lack of Trust in the C-Suite. When we felt that trust had improved, the team moved to the second building block of effective teams described by Patrick Lencioni in Five Dysfunctions of a Team: Conflict.

Six Signs of Lack of Trust in the C-Suite

Lack of Trust Cannot Be Addressed If It Is Not Recognized


A primary skill that a new physician executive needs relates to working in teams: to effectively lead teams and to be an able team member. Lack of trust will kill the effectiveness of an executive team. If team members aren’t comfortable with expressing their truths, the team will perform poorly.

The definition of trust that we used in our executive team followed the definition given by Peter Lencioni in The Five Dysfunctions of a Team: A Leadership Fable. It basically centered around developing a team in which each member trusted themselves and each other enough to allow for vulnerability. Our team spent over a year working on trust. Our CEO pushed us to create a team that could fully explore difficult issues and utilize the gifts of each team member.