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Raul H. Zambrano, MD, FACHE
CMO
Lutheran Hospital
Fort Wayne, Ind.
Q: Tell us about your current position and your primary responsibilities at your organization.
A: I am the CMO for Lutheran Hospital in Fort Wayne, Ind. I oversee quality, safety, credentialing and privileging, peer review and clinical operations for our 390-bed hospital, transplant center, level II trauma center, obstetrics and pediatric hospital, and other services.
Q: Why is hospital-physician integration an important topic to address right now and what role does physician leadership play in it?
A: We’re at a watershed moment right now in the transition of care in the U.S. While the industry shifts from fee-for-service to value-based models, physicians are shifting from independent practice to being employed. Moreover, mergers and acquisitions are rapidly occurring in support of growth, and the challenge is integrating these various paradigms.
Much of this is happening without much forethought or communication among the physicians and hospitals who deliver the care, creating huge gaps in the ability to provide efficient, cost-effective, high-quality care. Physician leaders—who understand both clinical and administrative operations, as well as the history of healthcare in the U.S.—are crucial for engaging and aligning these groups and can serve as liaisons and arbitrators.
Q: What are the biggest challenges hospitals face regarding physician leadership?
A: First, many physician leaders find it difficult to define their roles and responsibilities due to the lack of clear job descriptions. Even when available, an overwhelming majority of physician leaders feel these descriptions inaccurately reflect their day-to-day work, based on feedback I’ve received. Job descriptions should include specific language outlining expectations, responsibilities, spheres of control and how physician leaders should interact with medical staff, governing bodies and other leaders.
Another challenge for many physician leaders is that they continue to practice full time while serving in leadership roles. Although I believe physician leaders should continue to practice in some capacity in order to fulfill their passion for medicine and keep their connection with other physicians, effectively serving in both roles full time is not sustainable. As a field, we need to acknowledge the value of physician leadership and then accommodate physician leaders by allotting them a reasonable amount of protected time to serve in these roles.
Q: What strategies do you recommend for overcoming these and other challenges?
A: By nature, many physicians are used to being captains of their own ships. When physicians transition into leadership roles, however, they need to change this approach in order to be effective. Rather than coming to the table with nonnegotiable solutions, they need to come to the table ready to solve problems in a much more strategic and inclusive fashion. This means presenting a problem with supporting data and then refereeing a productive conversation to come to a consensus.
Reeducation is another key strategy for physicians and leaders. For instance, medical staff should have a good understanding of the bylaws and organization’s structure, so they know how the organization works and feel empowered under that structure. Likewise, it’s important to reeducate independent and contracted physicians on the hospital’s administrative practices, so they understand these unique nuances and are better aligned with the medical staff.
Moreover, communication within and among medical staff, independent and contracted physicians, and physician leaders is crucial for engaging and aligning these different groups.
Q: What role has ACHE played in your professional development?
A: ACHE has made a huge difference in my professional development. It has taught me how to structure my career path and be successful in my role. Several years ago, I was fortunate to complete the Thomas C. Dolan Executive Diversity Program. At the time, I was working as a CMO for the U.S. Department of Veterans Affairs. Although the VA has an excellent leadership program, it didn’t offer much insight into the private side of healthcare. During that year, I learned how to navigate the rules of the private system and build relationships. I also learned how to socialize and acclimate to the C-suite environment, which was culturally different from what I was accustomed to at the VA and as a physician. Attending and presenting at Congress and remaining active within ACHE has been invaluable for networking but also for the many other opportunities it offers to help me problem solve and interact with other members.
Editor’s Note: Dr. Zambrano is an ACHE Faculty Associate, speaking at ACHE Choice programs on various physician leadership development topics. Contact Catie Russo, ACHE Program Specialist at crusso@ache.org, for additional information to schedule Dr. Zambrano for a professional development opportunity at your organization.
Dyad Leadership: Shared Team Responsibility
By Alan T. Belasen, PhD
The ability to provide focused care for patients and deliver population health at a lower cost per capita with high reliability requires many things—clinical integration, higher efficiency, effective EHR software, and data sharing—but, most importantly, it requires top-notch teamwork. In the dyad leadership model, teamwork expands the traditional roles of clinicians and staff members to share in the decision-making process.
Working collaboratively is particularly important for accountable care organizations and patient-centered medical homes. Physicians, nurses, social workers and case managers must coordinate care that is safe, timely, effective and efficient as part of a multidisciplinary team.
Highlighted here are a few practices physician leaders can implement to help develop and improve teamwork within the dyad leadership model.
Delegate nonclinical tasks. A recent study of medical practices found that teams could foster collaboration by delegating more of physicians’ nonclinical tasks to other staff, soliciting staff input on workflow modifications and feeding data back to the team, expanding the roles of medical assistants and nurses, and holding regular team huddles. By delegating more nonclinical tasks, physician leaders engage staff in workflow redesign and establish a safe culture for feedback and questions. Task delegation works best when it is introduced incrementally and when physicians start with assigning routine tasks to other members of the team, such as nurses and medical assistants. Additionally, assigning roles to team members helps increase their job satisfaction and allows physicians more time to focus on the complex needs of patients.
Cross-train team members on shared responsibilities. Providing cross-training to potential leaders on how to change care processes may help PCMHs enhance performance and meet the needs of patients. How? Cross-training allows members to earn each other's trust, coach one another and substitute roles. This reciprocity allows team members to anticipate and support mutual goals as well as benefit from each other’s unique expertise and perspectives for shared achievements.
Promote teamwork and open communication. Promoting a culture of safety, open communication and teamwork cannot occur without a commitment to transparency. Open communication allows team members to anticipate the needs of others, adjust to each other’s actions and adopt a shared understanding of each other’s responsibilities. When clinical and nonclinical staff collaborate effectively, it results in improved care coordination, reduced medical errors and higher patient satisfaction.
Assess teamwork across important behavioral characteristics. There are eight behavioral characteristics of effective teamwork: team development, team leadership, promoting cooperation, facilitation of meetings, conflict resolution, ethical actions, meeting team goals and sustainable excellence. Asking team members how they perceive their team in light of these characteristics and comparing their responses against how they would like to see their team, can help dyad leaders identify gaps between the current and desired responses. Self-assessment allows leaders and individual team members to evaluate their personal strengths and weaknesses. At the unit level, ratings are aggregated into a single table to assess team coherence. Dyad leaders can use these assessments to map responses, discuss the results with the team, explore the team’s learning experience and underscore the options for continuous improvement. Assessments like these help leaders prioritize and focus training and development programs on “hot spot” areas that require the most improvement.
Teamwork involves shared responsibility, mutual trust and enhanced communication. When clinical and nonclinical staff collaborate effectively, healthcare teams can prevent medical errors, improve safety culture and achieve better patient outcomes.
Editor’s Note: Learn more on this topic in Belasen’s new book, Dyad Leadership and Clinical Integration: Driving Change, Aligning Strategies.
Alan Belasen, PhD, is a professor of management and healthcare leadership at the State University of New York Empire State College in Saratoga Springs. (abelasen@esc.edu).
Hone Physician Leadership Skills in Sunny San Diego
Support your career development at the San Diego Cluster, Nov. 4–7, by choosing a seminar from one or both of the two-day sessions offered. During the seminar “Physician and Executive Partnerships: Hard Facts, Soft Skills,” attendees will learn ways to reconcile the business objectives of healthcare with the transcendent values at the heart of clinical care. Another seminar offered, “Professional Burnout in Healthcare: Lead Your Organization to Wellness,” will examine the difference between burnout and stress, the three main symptoms of burnout and how to recognize it in oneself and others. Learn more and register today.
Explore other upcoming education opportunities at ache.org/Education.
Support Your PA and NP Colleagues
Support physician assistants and nurse practitioners with formalized leadership training through the ACHE/CHLM Leadership Collaboration. This package is designed to bring high-quality, convenient, on-demand education and an opportunity to experience ACHE membership for PAs and NPs, who are playing an increasingly important role in value-based healthcare. The ACHE/CHLM Leadership Package includes 12 on-demand self-study courses, one six-week online seminar, four webinars or webinar recordings, and complimentary ACHE membership through the end of 2020. Learn more about the education material here.
Mentorship
As you progress in your role as a physician leader, consider using a mentor. Learn more about finding a mentor or becoming a mentor yourself as part of the Leadership Mentoring Network.
Connect With Forum Members
Looking to connect with your Forum colleagues? You can locate them at the ACHE Member Directory. Scroll down to the "CEO Circle/Forums" drop-down menu in the directory, select "Physician Executives Forum" and look for the "PE" icon beside their names.
Explore Physician Leader Career Resources
ACHE is committed to supporting our physicians and clinicians transitioning to healthcare executive roles. We invite you to explore the Resources for Physician Executives section of the ACHE Career Resource Center to find Health Administration Press books, career resources and self-assessments that support the unique career development needs of physicians and members with clinical backgrounds.
Shannon N. Barnet
Marketing Specialist, Member Services
American College of Healthcare Executives
300 S. Riverside Plaza, Suite 1900
Chicago, IL 60606
(312) 424-9458
sbarnet@ache.org
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Please note that any views or opinions presented in this online newsletter are solely those of the author and do not necessarily represent those of ACHE.