Coursework prepares physicians to lead in new era
By JULIE MINDA
Under health care reform, many physicians will have to develop a new skill set. Increasingly, they will be practicing under delivery models focused on population health, accountable care and provider collaboration. Under these models, they must be adept at serving in leadership roles, working on multidisciplinary teams, building relationships and thinking operationally.
Wheaton Franciscan Healthcare has launched a program to equip its physicians with these types of skills.
The work of hospitalists such as Dr. Vijay Nagarajan, seen here with a patient at Wheaton Franciscan - St. Joseph in Milwaukee, is one of the strategic topics being addressed by a small group of physicians preparing for leadership roles in the Wheaton Franciscan Healthcare System.
"Looking into the future, we saw that we needed a much larger cadre of physicians with business skills — we want them to engage in management and governance" functions, said John Oliverio, president and chief executive of the Wheaton, Ill.-based system that has 15 hospitals and three long-term care facilities in three states.
"As we move into health care reform … physicians have to be involved" in systemic change at a deep level, he said.
Wheaton's 18-month Physician Ministry Leadership Development Program includes course work on leadership and group projects that improve health care delivery. The inaugural cohort of 31 Wheaton physicians began the program in April.
"We're developing home-grown physician leaders," said Brenda Bowers, Wheaton chief nursing officer and senior vice president.
Making a difference
Wheaton executives came up with the idea for the program when they recognized several years ago that there is a gap between many physicians' training and what is expected of them in the new health care environment. They saw that "some physicians are clinicians at heart, who evolved into management roles but never had formal leadership training," said Oliverio.
Rita Hanson, Wheaton chief medical officer and senior vice president, said "medical training's focus is inherently on the individual patient; it's not about looking at populations of patients or about collaborating on teams. The skill set to be a leader is a different skill set" than what is taught in medical school.
Also, said Bowers, there are some physicians who need to assume leadership roles, because of how health care delivery is evolving, but who are reluctant to do so. "Research shows that many physicians don't want to be leaders, and we want to change that, and show them that … physicians can make a difference" in leadership, Bowers said.
Chief executives of Wheaton facilities nominated physicians for the program, and then those who were interested in participating had to apply and interview to join the cohort. While Wheaton facilities have both employed and contracted physicians, only employed physicians were chosen for the inaugural cohort. Future cohorts may include contracted physicians.
The first participants are from facilities throughout the Wheaton system; most are practicing physicians with leadership responsibilities or poised to take on such responsibilities. The cohort includes primary care providers, specialists and physician executives.
Spiritual grounding
The group first met at a kickoff event in April at the motherhouse of the Wheaton Franciscan sisters, the system's founding sponsors. A Wheaton sister described how the congregation established the system's health care facilities beginning in the late 1800s and how those facilities are part of a ministry that the sisters now are entrusting to lay leaders. Oliverio said, "We wanted to make it clear (to the physicians) that it is the responsibility of the laity to carry on the work of the sisters," since the sisters are declining in number.
Program participant Dr. Bogdan Pudzisz said the presentation by the Wheaton Franciscan sister was the first time he had heard about how the sisters built the health care ministry and were entrusting it to the laity even though he's been with Wheaton for 15 years. Pudzisz chairs the department of internal medicine at Wheaton Franciscan Healthcare–All Saints in Racine, Wis.
Also at the inaugural meeting, Oliverio and other executives explained the basis of the physician leadership program and its importance to the success of Wheaton's strategic plan.
Learning and execution
Since April, cohort participants have been meeting face to face, online and by phone for classes taught by instructors from the American College of Physician Executives, the Sg2 consulting group and by Wheaton senior executives. Course work covers Wheaton's organizational structure, professional and management skills, relationship-management and self-awareness. The physicians learn how to negotiate relationships with people to achieve Wheaton's goals, motivate others, analyze people's personality styles and collaborate. Participants get continuing professional education credits that can be used toward a master of business administration degree.
This summer, Wheaton assigned program participants to small groups that will work on "capstone projects," or initiatives tied to some element of Wheaton's strategic plan. Each group of several physicians from various locations will examine one of the 10 capstone projects, develop an initiative to address the issue and then help implement the initiative at Wheaton facilities. Each group has a senior executive sponsor.
Currently the breakout groups are meeting in person, by phone and online to research their capstone projects. They will develop the projects for presentation to the full group next summer. The capstone projects, said Bowers, "are rigorous projects that are aligned with our strategic plan and are meaningful" to Wheaton's success.
Pudzisz is on the team charged with working with Wheaton administration to develop a budget-neutral compensation plan for primary care physicians. The plan must align with population health management goals at Wheaton. Pudzisz said it's too early to say how the project will unfold, but currently his group is thinking about how it will be difficult for physicians to give their time to population health approaches, when they already are pulled in so many directions. The group may look at how to compensate physicians appropriately while keeping in mind their need for a work-life balance.
Mounting enthusiasm
Hanson said the physicians in the leadership training program "are getting a richer appreciation for the complexity of the system and gaining an appreciation for the role of administration."
Bowers said the physicians "are building relationships, and the silos are coming down. They used to just work with people in their local areas, but they are now on teams with others" from throughout the system. Also, she said, "It's no longer 'administration versus physician,' and that is not happenstance."
Pudzisz said he appreciates the chance to get to know what senior leaders are thinking and how decisions are made — and how physicians can be a part of decisions. "I'm glad the organization is asking us what we think — it's not common to be asked. We need to give our thoughts, or someone will jump in and do it for us."
Capstone project areas
- Hospitalist strategy and acute care discharge
- Physician retention and recruitment
- Medical staff governance
- Physician engagement
- Physician compensation
- Business line action plans
- Influenza vaccination
- Quality metrics
- Interprofessional collaboration and population health
- Operational excellence