Making Today's Dyad Models Work

Editor’s Note: The following is excerpted from “When Two Become One: The Dyad Model of Today.”

The dyad leadership model is widely used across healthcare, from oversight of medical practices to hospitals and health systems at the regional, service line or single site level. Dyads have obvious benefits. "You get two perspectives on all issues, whether clinical or operational," says Patrice Weiss, MD, a WittKieffer physician executive consultant who has served in various dyad roles throughout her career in academic medicine. In other words, two heads are usually better than one, especially when the two have complementary competencies and areas of expertise.

"That's when the magic happens," says Michael Michetti, JD, COO of Everside Health and another veteran of dyad roles as an operations leader working with a physician leader. "The two individuals bring different skill sets and perspectives to make the sum greater than the parts."

With the trend toward value-based care and push to incorporate evidence-based medical insight into operational and strategic decision-making, dyad leadership now makes even more sense. Here are a few reasons why:

• Today's increasingly matrixed organizations depend less on hierarchy and thus lend themselves to decision-making by dyads or even multidisciplinary teams.
• Independent medical groups, to effectively compete today, are adding operational leadership, thus blending the wisdom of career administrators with the status and technical expertise of physician leaders.
• New payment models under value-based care require leadership with the understanding of clinical care delivery through clinical protocols and heightened care standards.
• The need for embedded, operationalized quality metrics requires a unified approach from practitioners and non-physician leaders.

"If done correctly, dyads can really help an organization fine-tune and balance the demands of quality, safety and physician engagement with operational excellence, metric goals and strategy alignment," says Michetti. "Without dyads there are really two parallel structures, administrative operations and physician interests. Dyads transition situations that could be sources of tension into opportunities for synergy."

Leadership Competencies and Skills for Dyad Leadership

It is typically the partners and their shared relationship that determine success. The selection of the right leaders is critical to the eventual success or failure of dyad arrangements. 

The basics of a strong dyad relationship include mutual respect, a shared sense of mission, aligned values, open communication, and complementary strengths and weaknesses. As with any partnership, an imbalance or fatal flaw in any of these factors undermines the union.

In speaking with dyad leaders across healthcare—within physician practices as well as hospital and health systems—we have tapped into other personality traits that are essential in both partners if the relationship is to thrive. They include:

• An embrace of servant leadership.
• Comfort in a shared governance model.
• High EQ.
• Courage and humility.

"The two partners must be equals and respect each other," says Anthony Aquilina, DO, chief physician executive, WellSpan Health, who has also held dyad roles. "They must have a unified voice that speaks clearly and consistently to organizational values and goals."

"You have to be willing to converse and meet with others outside of your initials" (i.e., MD), notes Dr. Weiss. "You can't have a mindset that doctors are responsible for doctors and that administrators lead administrators."

Creating the Right Organizational Infrastructure

In addition to selecting the right leaders, organizations instituting dyad models must set the stage for their success. Critical factors include:

• Organizational commitment. Dyad success requires organizational leadership to fully embrace the model, write Daniel Zismer and James Brueggemann of Essentia Health. "The dyad becomes a part of the cultural fabric of the organization; 'it is how we do it here.' "
• KPIs. Organizations should set key performance indicators and metrics (for quality, patient safety, finances, etc.) by which a dyad can measure its success. The KPIs also provide both partners with joint goals to align around.
• Regular review and continuous improvement of the partnership. We recommend that the two partners regularly review their responsibilities and working relationship to progressively fine-tune it. What's working and what's not? What gray areas exist that produce confusion? Are we both growing in our capabilities and capacities as leaders?
• Coaching. The investment in a coach to assist the dyad pair in evaluating their work and relationship can pay dividends just as it would for an individual executive, lending objectivity to how the dyad is performing, patching up conflicts and focusing on collective improvement.
• Succession planning. Organizations that embrace dyads can integrate their key concepts into succession efforts, allowing executives time to anticipate and acclimate to an eventual paired leadership structure.
• Recruiting with dyad leadership in mind. Executive candidates can be evaluated not just for their individual expertise and potential but also for their ability to participate in a dyad should they be hired.
• Psychometric assessment. Related to the above, today's leadership assessments can pinpoint qualities in executives such as communicativeness and cooperativeness, which bode well for their ability to thrive in dyad roles.

The success of dyad leadership depends on how each arrangement is structured but also prominently on the specific individuals involved, the organizational context within which they operate and how their relationship evolves. As the partners grow together over time, the whole can certainly be greater than the sum of the two parts.

Shelly Carolan is managing partner of WittKieffer's Investor-Backed Healthcare Practice.