Leading by Design: Lessons for the Future From 25 Years of the Executive Leadership in Academic Medicine (ELAM) Program for Women

The Hedwig van Ameringen Executive Leadership in Academic Medicine (ELAM) Program for Women is designed to promote the careers of senior female leaders in academic health care in a way that ultimately seeks to transform culture and promote gender equity far beyond the careers of its participants. In an era of increased awareness of gender inequity within academic medicine, the longevity of the ELAM program raises several important questions. First, why is such a program still needed? Second, what exactly does it do, and what has been its influence on its participants and beyond? And third, what lessons can ELAM's example provide to help guide the medical profession as it strives to promote gender equity in the field? In this Invited Commentary, the authors seek to answer these questions from the perspective of a recent program participant and the current program director. The authors review the evidence that identifies how women, even today, face accumulating disadvantage over the course of their academic careers, stemming from repeated encounters with powerful unconscious biases and stereotypes, societal expectations for a gendered division of domestic labor, and still-present overt discrimination and sexual harassment. They describe ELAM's approach, which builds the knowledge and skills of the women who participate in the program, while also intentionally raising their visibility within their home institutions so that they have opportunities to share with institutional leaders what they have learned in ways that not only promote their own careers but also support gender equity in the broader environment. The authors conclude by offering thoughts on how ELAM's model may be leveraged in the future, ideally in partnership with the numerous professional societies, funding agencies, and other organizations that are committed to accelerating the rate of progress toward gender equity at all levels of academic medicine.

Leadership in Ophthalmology: The Role of Physician-MBAs

PURPOSE

As American health care evolves, an increasing number of doctors are pursuing MBAs. However, relatively little is known about how business training translates into their future careers. This study characterizes ophthalmologists who have completed MBAs and identifies opportunities for physician leadership in the field.

DESIGN

Cross-sectional study.

METHODS

We identified 120 ophthalmologists who hold MBAs. We searched each individual's online profiles to collect information on demographics, training, and professional activities.

RESULTS

Physician-MBAs in ophthalmology are 80% male; 80% are fellowship trained; and 28% are in primarily nonclinical roles and 55% participate in significant nonclinical activity. Hospital administration is most common (31%), followed by pharmaceutical administration (7%) and consulting (5%). Older ophthalmologist-MBAs were more likely to work in nonclinical roles, with 79% of those who completed residency before 2000 engaged in significant nonclinical activity compared to 30% of those who completed residency after 2000. The most common employers of physician-MBAs in ophthalmology are academic medical centers (43%), large group practices (30%), and private practices (13%).

CONCLUSIONS

The majority of ophthalmologist-MBAs work in primarily clinical roles, although a sizable proportion hold nonclinical positions. Moving forward, we anticipate an increased role for physician leaders in health care administration, policy, and entrepreneurship. While formal management training is not necessary for these roles, a growing number of physicians have sought out MBAs to support their nonclinical interests.

Medical student healthcare consulting groups: A novel way to train the next generation of physician-executives

Meeting the challenges of the evolving healthcare environment requires leadership of physicians well-trained in clinical medicine and healthcare management. However, many physicians lack training in business and leadership. While some residency programs have management tracks, training at the medical school level is currently lacking. We developed the Hopkins Health Management Advisory Group, an extracurricular program at Johns Hopkins University School of Medicine that exposes medical students to healthcare management and fosters development of leadership skills. Teams of students work directly with health system executives on 3-6 month-long projects using management consulting principles to address problems spanning health system domains, including strategy, operations, and quality improvement. Since the program's inception, 23 students have completed seven projects, with 13 additional students currently working on three more projects. Sponsors leading six out of seven completed projects have implemented recommendations. Qualitative survey respondents have found the program beneficial, with students frequently describing how the program has helped to develop professional skills and foster knowledge about healthcare management. These early assessments show positive impact for both students and the institution, and suggest that such programs can train students in management early and concurrently in their medication education by immersing them in team-based health system projects.

Program Director Perceptions of the General Surgery Milestones Project

OBJECTIVE

As a result of the Milestones Project, all Accreditation Council for Graduate Medical Education accredited training programs now use an evaluation framework based on outcomes in 6 core competencies. Despite their widespread use, the Milestones have not been broadly evaluated. This study sought to examine program director (PD) perceptions of the Milestones Project.

DESIGN, SETTING, AND PARTICIPANTS

A national survey of general surgery PDs distributed between January and March of 2016.

RESULTS

A total of 132 surgical PDs responded to the survey (60% response rate). Positive perceptions included value for education (55%) and evaluation of resident performance (58%), as well as ability of Milestones to provide unbiased feedback (55%) and to identify areas of resident deficiency (58%). Meanwhile, time input and the ability of Milestones to discriminate underperforming programs were less likely to be rated positively (25% and 21%, respectively). Half of PDs felt that the Milestones were an improvement over their previous evaluation system (55%).

CONCLUSIONS

Using the Milestones as competency-based, developmental outcomes measures, surgical PDs reported perceived benefits for education and objectivity in the evaluation of resident performance. The overall response to the Milestones was generally favorable, and most PDs would not return to their previous evaluation systems. To improve future iterations of the Milestones, many PDs expressed a desire for customization of the Milestones' content and structure to allow for programmatic differences.

Making Management Skills a Core Component of Medical Education

Physicians are being called upon to engage in greater leadership and management in increasingly complex and dynamic health care organizations. Yet, management skills are largely undeveloped in medical education. Without formal management training in the medical curriculum, physicians are left to cultivate their leadership and management abilities through a haphazard array of training programs or simply through trial and error, with consequences that may range from frustration among staff to reduced quality of care and increased risk of patient harm. To address this issue, the authors posit that medical education needs a more systematic focus on topics related to management and organization, such as individual decision making, interpersonal communication, team knowledge sharing, and organizational culture. They encourage medical schools to partner with business school faculty or other organizational scholars to offer a "Management 101" course in the medical curriculum to provide physicians-in-training with an understanding of these topics and raise the quality of physician leadership and management in modern health care organizations.

Assessing Career Outcomes of a Resident Academic Administrator, Clinician Educator Track: A Seven-Year Follow-up

OBJECTIVE

This study reports the academic outcomes, including scholarly productivity, of the graduates of one residency training track for future clinician educators and academic administrators. Since its implementation in 2008, the Academic Administrator, Clinician Educator (AACE) track at Western Psychiatric Institute and Clinic - UPMC has grown in popularity with reports of participants achieving post-graduate academic success; however, there has been no prior assessment of outcomes.

METHODS

In 2015 all graduates of the track were surveyed using an anonymous, web-based survey. Twenty-nine total graduates were surveyed RESULTS: Twenty-four graduates responded to the survey (83% response rate). The graduates are very active in academic psychiatry with 23 (96%) holding an academic appointment with different administrative roles, medical director (50%) and training director (17%) being the most frequent. Participants have also been active in pursuing scholarship with 80% presenting their scholarly projects at local and national conferences and producing post-graduate, peer-reviewed articles (50%).

CONCLUSION

This study underscores the benefits of a clinician educator track and suggests areas for future growth.

PHYSICIAN LEADER COMPENSATION SHOWS SLOW GROWTH, ADVANCED DEGREES, CERTIFICATION PROVIDE A BOOST

Gain insight on compensation, incentives, allocation of time and responsibilities for physicians in leadership and those considering a management role.

The Importance of Continuing Education for Transplant Coordination Staff

Continuous quality improvement activities are necessary to achieve excellence at any institution. The Başkent University Hospitals have implemented continuous in-service training programs to improve all health services provided. Also, continuing medical education programs are being instituted in organ procurement and transplantation centers. In addition to receiving basic orientation and training upon hiring, transplant coordination staff complete forms that detail their current training status, further job training needed, and other courses of interest. The information is used to monitor skill levels, to determine the success of educational programs, and to identify further education that is needed. Our aim is to improve the quality of transplant coordination activities and increase organ donation at the hospitals in our network through effective monitoring and evaluation of continuous in-service training. These training programs enhance staff members' understanding of and participation in procedures related to transplantation and improves the total quality of the transplantation process. In the near future, this training model may be used to improve the donor hospital education program in Turkey.

Creating Leaders

Participants in the Texas Medical Association's Accountable Care Leadership Program learn about communication skills, teamwork, and population health management. The program helps physicians adapt in a rapidly changing environment that demands more accountability and proof of value for the health care dollar. The program targets early- to mid-career practicing physicians who recognize they need new tools to survive and thrive in the new environment.

Expanding the scope of leadership training in medicine

All physicians take a leadership role at some point in their career-some exert influence in their practices and communities as informal leaders, and others hold formal leadership roles to which they are appointed or elected. These formal leadership roles convey power to those individuals who hold such positions. Formal leadership, however, is limited in its influence unless it is accompanied by a series of personal and interpersonal competencies that characterize both formal and informal leaders.Many physicians who do not hold formal leadership roles will be called on to provide (or will wish to provide) informal leadership at various times in their careers. Both formal and informal leaders should be trained in the personal and interpersonal competencies necessary for effective leadership to advance the principles-driven and values-oriented goals inherent in the health care enterprise.In this article, the author defines leadership and describes the characteristics of formal and informal leaders, then discusses the types of leadership and the power derived from different leadership roles. He concludes by arguing in favor of expanding the scope of leadership training to include informal as well as formal leaders.

Evaluation of a nursing home medical director's curriculum for geriatric medicine fellows

OBJECTIVES

To describe the evaluation of a nursing home medical directorship curriculum for geriatric medicine fellows.

DESIGN

Six first-year geriatric medicine fellows from the University of Hawaii program participated in this educational intervention.

INTERVENTION

A medical directorship curriculum based on the American Medical Directors Association's description of the roles and responsibilities of the medical director. Seven 1-hour sessions covering core topics were delivered in case-based format, with the opportunity to practice application.

MEASUREMENTS

The curriculum's impact on learner's knowledge, attitudes, skills, and abilities was evaluated using pretests and posttests. The curriculum was evaluated using a structured individual feedback interview after the completion of this curriculum. Pre-post mean scores for attitudes and skills/ability items were compared using paired t tests. A summary of comments from fellows' interviews was tabulated.

RESULTS

Fellows showed a significant improvement in knowledge scores after the intervention (63.33% correct before the intervention and 76.67% correct after the intervention, mean change = 13.33%, P = .03). The mean overall scores for attitudes and skills/ability items increased from 4.72 to 5.33 (change = 0.61, P = .11), and 2.67 to 3.83 (change = 1.17, P = .009), respectively. Comments from the interviews were positive and fell into 3 categories. First, fellows felt that they achieved a good knowledge base. Second, they gained a better understanding of the roles and responsibilities. Last, all participants felt the curriculum was very practical and helped them feel more prepared to become medical directors.

CONCLUSIONS

An innovative curriculum for nursing home medical direction provided for first-year geriatric medicine fellows had a significantly positive impact on their knowledge, ability, and skills. The curriculum was effective in helping fellows better understand and apply what they learned regarding the roles and responsibilities in medical direction.

Forecasting emergency department arrivals: a tutorial for emergency department directors

This article is a tutorial for emergency department (ED) medical directors needing to anticipate ED arrivals in support of strategic, tactical, and operational planning and activities. The authors demonstrate our regression-based forecasting models based on data obtained from a large teaching hospital's ED. The versatility of the regression analysis is shown to readily accommodate a variety of forecasting situations. Trend regression analysis using annual ED arrival data shows the long-term growth. The monthly and daily variation in ED arrivals is captured using zero/one variables while Fourier regression effectively describes the wavelike patterns observed in hourly ED arrivals. In our study hospital, these forecasting methods uncovered: long-term growth in demand of about 1,000 additional arrivals per year; February was generally the slowest month of the year while July was the busiest month of the year; there were about 20 fewer arrivals on Fridays (the slowest day) than Sundays (the busiest); and arrivals typically peaked at about 10 per hour in the afternoons from 1 p.m. to 6 p.m., approximately. Because similar data are routinely collected by most hospitals and regression analysis software is widely available, the forecasting models described here can serve as an important tool to support a wide range of ED resource planning activities.

Clinicians' experiences of becoming a clinical manager: a qualitative study

BACKGROUND

There has been an increased interest in recruiting health professionals with a clinical background to management positions in health care. We know little about the factors that influence individuals' decisions to engage in management. The aim of this study is to explore clinicians' journeys towards management positions in hospitals, in order to identify potential drivers and barriers to management recruitment and development.

METHODS

We did a qualitative study which included in-depth interviews with 30 clinicians in middle and first-line management positions in Norwegian hospitals. In addition, participant observation was conducted with 20 of the participants. The informants were recruited from medical and surgical departments, and most had professional backgrounds as medical doctors or nurses. Interviews were analyzed by systemic text condensation.

RESULTS

We found that there were three phases in clinicians' journey into management; the development of leadership awareness, taking on the manager role and the experience of entering management. Participants' experiences suggest that there are different journeys into management, in which both external and internal pressure emerged as a recurrent theme. They had not anticipated a career in clinical management, and experienced that they had been persuaded to take the position. Being thrown into the position, without being sufficiently prepared for the task, was a common experience among participants. Being left to themselves, they had to learn management "on the fly". Some were frustrated in their role due to increasing administrative workloads, without being able to delegate work effectively.

CONCLUSIONS

Path dependency and social pressure seems to influence clinicians' decisions to enter into management positions. Hospital organizations should formalize pathways into management, in order to identify, attract, and retain the most qualified talents. Top managers should make sure that necessary support functions are available locally, especially for early stage clinician managers.

Physician leadership: a health-care system's investment in the future of quality care

The current state of health care and its reform will require physician leaders to take on greater management responsibilities, which will require a set of organizational and leadership competencies that traditional medical education does not provide. Physician leaders can form a bridge between the clinical and administrative sides of a health-care organization, serving to further the organization's strategy for growth and success. Recognizing that the health-care industry is rapidly changing and physician leaders will play a key role in that transformation, Hartford HealthCare has established a Physician Leadership Development Institute that provides advanced leadership skills and management education to select physicians practicing within the health-care system.

Perspective: physician leaders and their bases of power: common and disparate elements

Physicians hold numerous types of leadership positions in academic, executive, and/or clinical environments. To be successful, physician leaders must exert power, or social influence, as power is conceptualized in social psychology. The power of leaders accrues through their positions, expertise, or other factors, such as communication abilities or their ability to influence others to identify with the vision they espouse. This article discusses the types of leadership roles that physicians play and the power types they must apply in these roles. Crossing all leadership roles are a series of necessary personal characteristics and interpersonal competencies that result in what has been called "referent power," a more subtle form of social influence that is crucial for success regardless of position. Leadership training that includes practice in cultivating these personal characteristics and interpersonal competencies should be an essential component of medical and graduate medical education. Studying the types and nature of power also would be a valuable contribution to courses on professionalism in medical practice. Examples are provided of the types and uses of power that may be applied in the various leadership roles that physicians hold.

Using speed dating sessions to foster collaboration in continuing interdisciplinary education

INTRODUCTION

There are numerous examples of care gaps that could be reduced through enhanced knowledge exchange and practice collaboration between medical specialist physicians. In this paper, we report preliminary results on using speed-dating sessions (SDSs) to stimulate the development of continuing interdisciplinary education (CIDE) activities.

METHODS

In 2007, a 35-minute SDS was carried out during a 2-hour faculty development workshop to provide continuing medical education (CME) directors of Quebec's 35 medical specialist associations with a formal opportunity to quickly share clinical issues and goals. A post-workshop survey was used to assess participants' satisfaction and whether they had met new colleagues, learned about interdisciplinary issues, and discovered opportunities for collaboration. CME accreditation files were audited to assess the occurrence of CIDE activities in the year prior and the 2 years that followed the workshop. CME directors were called to assess whether the development of these activities was directly attributable to their participation in the SDS.

RESULTS

CME directors of 26 specialist physician associations attended the faculty development workshop. The vast majority of survey respondents (n = 18/20) were satisfied with the SDS and believed that this method was a stimulating and efficient way to meet new colleagues, quickly share clinical issues and goals, learn about unexpected but important interdisciplinary issues, and identify opportunities for CIDE collaboration. Sixty percent (12/20) reported having identified at least 1 opportunity for collaboration that was worth pursuing in the near future, and 19% of attending CME directors (5/26) developed a CIDE activity within 2 years, as compared with none in the previous year and for the 9 nonparticipating associations.

DISCUSSION

Results suggest that SDSs enhanced networking, knowledge exchange, and collaboration in continuing education among CME providers who participated in a faculty development activity on CIDE.

Training the next generation of physician-executives: an innovative residency pathway in management and leadership

The rapidly changing field of medicine demands that future physician-leaders excel not only in clinical medicine but also in the management of complex health care enterprises. However, many physicians have become leaders "by accident," and the active cultivation of future leaders is required. Addressing this need will require multiple approaches, targeting trainees at various stages of their careers, such as degree-granting programs, residency and fellowship training, and career and leadership development programs. Here, the authors describe a first-of-its-kind graduate medical education pathway at Duke Medicine, the Management and Leadership Pathway for Residents (MLPR). This program was developed for residents with both a medical degree and management training. Created in 2009, with its first cohort enrolled in the summer of 2010, the MLPR is intended to help catalyze the emergence of a new generation of physician-leaders. The program will provide physicians-in-training with rigorous clinical exposure along with mentorship and rotational opportunities in management to accelerate the development of critical leadership and management skills in all facets of medicine, including care delivery, research, and education. To achieve this, the MLPR includes 15 to 18 months of project-based rotations under the guidance of senior leaders in many disciplines including finance, patient safety, health system operations, strategy, and others. Developing both clinical and management skill sets during graduate medical education holds the promise of engaging future leaders of health care at an early career stage, keeping more MD-MBA graduates within health care, and creating a bench of talented future physician-executives.

Doctors who become chief executives in the NHS: from keen amateurs to skilled professionals

OBJECTIVES

To investigate the experiences of doctors who become chief executives of NHS organizations, with the aim of understanding their career paths and the facilitators and barriers encountered along the way.

DESIGN

Twenty-two medical chief executives were identified and of these 20 were interviewed. In addition two former medical chief executives were interviewed. Information was collected about the age at which they became chief executives, the number of chief executive posts held, the training they received, and the opportunities, challenges and risks they experienced.

SETTING

All NHS organizations in the United Kingdom in 2009.

RESULTS

The age of medical chief executives on first appointment ranged from 36 to 64 years, the average being 48 years. The majority of those interviewed were either in their first chief executive post or had stepped down having held only one such post. The training and development accessed en route to becoming chief executives was highly variable. Interviewees were positive about the opportunity to bring about organizational and service improvement on a bigger scale than is possible in clinical work. At the same time, they emphasized the insecurities associated with being a chief executive. Doctors who become chief executives experience a change in their professional identity and the role of leaders occupying hybrid positions is not well recognized.

CONCLUSIONS

Doctors who become chief executives are self-styled 'keen amateurs' and there is a need to provide more structured support to enable them to become skilled professionals. The new faculty of medical leadership and management could have an important role in this process.

Physicians with MBA degrees: change agents for healthcare improvement

Increasingly, physicians gravitating toward the fields of quality improvement and healthcare management are seeking MBA degrees to supplement their medical training. Approximately half of all U.S. medical schools offer combined MD-MBA degrees, and numerous executive MBA programs exist for physicians in practice. Physicians who enter management are considered change agents for healthcare improvement, yet they receive little support and encouragement from their medical teachers and practicing colleagues. This situation can be rectified by placing greater value on the role of business-trained physicians and subsidizing their tuition for business school.