How Are Your Physicians Involved in Administrative Leadership?

Physicians play many administrative leadership roles at Tampa General Hospital and Yale New Haven Health.

Physician leaders at health systems and hospitals drive better quality, improve efficiency, and influence clinical practice, a pair of top physician executives say.

Physician leaders guide medical staffs and play key hospital leadership roles. They augment the work of nonphysician administrative leaders and bring a clinical perspective to administrative issues.

"For the hospital, we cannot solve problems well if we do not have the physicians' perspective," says Peggy Duggan, MD, executive vice president, chief physician executive, and chief medical officer at Tampa General Hospital. "Having physician leaders helps us understand how doctors work and what is going to work well for them. If we are going to drive better quality, improve efficiency, or optimize utilization of resources, we need physician voices. We need our physician leaders."

Tampa General is one of the largest hospitals in Florida, with more than 1,000 licensed beds and more than 8,000 team members.

Physicians play key administrative leadership roles for Tampa General's medical staff and the hospital as a whole, Duggan says.

For the medical staff, every clinical department at the hospital has physician leaders such as the chief of medicine and the chief of surgery who are elected by their peers. There is also a leadership team of physicians for the medical staff, which includes chief of staff, vice chief of staff, treasurer, and secretary. The medical staff leadership positions are a great way to grow as a physician leader because there are graduated leadership opportunities, Duggan says.

"Most of these leaders start as an ad hoc member of the medical staff officers, then people can move into formal leadership roles. These leaders learn every year, so it is a great way for physicians to gain leadership skills," she says.

In hospital administration, Tampa General has physician leaders in several areas such as hospital operations and care quality. Hospital departments also have physician leaders, Duggan says. "For example, in the neuroscience service line, we have a physician leader for stroke, a physician leader for spine surgery, and a physician leader for neuro critical care," she says. "We take clinically active physicians and part of their schedule includes administrative work such as making their portion of the service line more efficient, improving quality, and opening new programs."

Physician leaders are a crucial component of the administrative leadership at Yale New Haven Health, says Thomas Balcezak, MD, executive vice president and chief clinical officer at YNHH, which is an academic health system that features five hospitals.

Balcezak is the top physician executive for the health system. Each one of YNHH's five hospitals has a chief medical officer, who is the employed physician leader of the organized medical staff. There are elected medical staff leaders in each one of the medical executive committees at the hospitals. There are physician chiefs of each of clinical department who run the clinical operations and academic work for each of the departments.

The health system has many other physician leaders in key posts, he says. There is a vice president for clinical documentation and utilization review who reports to Balcezak. There is a health system chief quality officer who reports jointly to Balcezak and the chief physician executive, who is a Yale School of Medicine employee. There are several physicians who work in leadership roles in the information technology space. There is a clinical operations executive director who reports to Balcezak and works on clinical operations functions such as patient flow and length of stay.

At YNHH's hospital level, there are many physicians who serve as medical directors for inpatient and outpatient services. The medical directors report to the hospital CMOs.

Essential qualities of physician leaders

Physician leaders need to see beyond their own patients and their own practice, Duggan says.

"They should want to drive improvements in areas beyond their day-to-day clinical responsibilities," she says. "There are many phenomenal physicians who want to do clinical care and just that. That's what gets them up every day. Physician leaders must see the bigger picture beyond individual patient care. Obviously, physicians are focused on quality, safety, and patient experience, but physician leaders must be willing to understand the financial side of care. At Tampa General, they need to understand the financial challenges of running a hospital."

Communication skills are important in being a physician leader, Duggan says.

"You need to be able to make sense of the 'why' behind something we are doing and be able to communicate that to a broad audience," she says. "Temperament matters. We have an independent medical staff, so physician leaders must be able to understand the positions of our team members and be able to be patient when we are working on projects."

To influence clinical practice and how physicians work, it is crucial for a physician leader to have credibility as a clinician, Balcezak says.

"Physicians who did not do a residency or did not practice medicine shortly after residency really need a background in clinical practice and the respect of the practicing clinicians in order to influence them," he says. "They must have a background in clinical practice. A good physician leader must have a good grounding in whatever clinical discipline they have trained in. I prefer a physician leader who is a respected clinician."

Physician leaders must be equipped with emotional intelligence and values that align with the organization's values, Balcezak says.

"Physician leaders need to have emotional intelligence and need to be able to influence people because much of what we need to do to move the dial on quality, safety, and operations is not by fiat but by influence. In order to manage by influence, you must have emotional intelligence," he says. "Physician leaders need a moral compass that points in the right direction—meaning I want them to live the values of the organization."

Physician leadership development

In addition to grooming physician leaders in the medical staff's governance structure, Tampa General has a formal physician leadership program in a partnership with the Muma College of Business at the University of South Florida, Duggan says.

"Physicians learn leadership skills, leadership requirements, financial training, operational training, data analytics, and utilizing data," she says. "It is a broad educational platform, and the training lasts for about 18 months. There is also a capstone project—participants work on a project that is important to the operations of the hospital or one of our clinics that aligns with our strategic goals. We have broadened the program to include some of our advanced practice providers and administrative leaders, but it is primarily designed for physician leaders."

Tampa General also has less formal leadership development opportunities for physicians, Duggan says. There is a process improvement training program open to physicians, where doctors are selected for project work and develop their skills individually. And there are special projects with physician leaders that are led by Duggan, the chief quality officer, and the vice president of medical affairs.

The YNHH Institute for Excellence (IFE) provides leadership development programming for physicians and nonphysician administrators, Balcezak says.

"The IFE is our learning and teaching organization within the health system," he says. "The IFE helps our senior leadership team and the cascading levels of leadership below in succession planning and leadership development. The IFE has several programs. For example, seven years ago we committed to being a high-reliability organization, and the IFE provides high-reliability training. With regard to our patient experience, there are several IFE courses that we have about enhancing communication with patients."