Physician Leadership, US Style

“Everyone here has the sense that right now is one of those moments when we are influencing the future” - Steve Jobs

Americans “get” Physician leadership. (UK Translation, physician = doctor)

There are a multitude of excellent examples in Boston alone, CEOs and presidents of large organizations. There is also huge variability and free will, but at most of the high performing organizations there is a similar leadership structure. 

At the top of the very best performing hospitals in the US, there is often a physician sitting as CEO versus a manager. They don’t move around, their tenure is usually decades, and most have come up through their organizations. Physician leaders are central to these health care organisations’ improvements.

Compare this to our dearth of Physician CEOs or the average lifespan of a UK CEO being a matter of a few years. Ask anyone in business what they would assume about a company based on the length of CEO life span.

Forbes analysed the career paths of CEOs at America's 100 most successful companies. 15 of the 100 joined their companies directly after leaving university. An additional 35 started their professional careers at the company they currently lead. Nine of the remainder either left and then rejoined later or were the founders of their company. Leadership is a learning journey, and failures are an integral part of it, I suspect these successful companies don’t just sack the CEO when things get a bit tough.

“If you’re good enough, you’re old enough”

Back to our “US” medical model, there are usually a series of medical directors of various departments sitting under these, not necessarily picked on the basis of fame, seniority or the numbers of publications they have had, but on their vision and ability to lead, communicate and improve the system.

At Geisinger, physician department heads get 20% or more of their paid time devoted to leadership. They have a managerial partner who does the administrative work. They are also directly reimbursed for approximately 20% of their salary, based on alignment with strategic organisational goals.

At Virginia Mason Medical Center, they have a talent management program that assesses their staffs’ potential; and then maps career pathways and succession planning thereafter. There is something very powerful in the continuity of leadership and nurturing leaders from within.

The value of having a ready-made replacement for anyone leaving, that can fill a vacancy immediately without the need for someone new to “learn the organisation” is countered with “where do your new ideas come from, if you don’t hire from the outside?”

Surely the happy medium is a few new hires but a lot of insider nurturing, and steady expansion.

The above examples demonstrate a very substantial commitment to quality, the development of leaders and are tangible lessons we can and should learn from.

There are a multitude of fantastic examples of training courses for physician leaders from most of the top US universities. They range in duration from a few weeks to 2 years and can cost from $60,000-200,000. They contain instruction on the tools to do the job of leading large health care organizations. The vast majority of attendees are from the US, and they are all physicians.

The major differences between these and the few, excellent UK High leadership courses (like High Potential Leaders-NHS South Central- Kings Fund) is the multi professional nature of the UK courses (I was one of only 4 doctors in a cohort of 15) and their availability; I will be attending parts of the US version in Spring, the comparison will be interesting.

It seems that in the US, they accept that healthcare culture change and improvement is difficult, particularly when addressing physicians. They recognize that doctors are often needed to change and challenge other doctors’ views; and they tailor the leadership learning opportunities to reflect this. In contrast, in the UK we have fewer Physician leaders, with the vast majority being administrators; and whether this is through choice or opportunity this is where things need to change.

We should remember that too much change, too often or growth, too fast can destroy the culture and quality of organisations.

“We pursued growth over the speed at which we were able to develop our people and our organization”- Akio Toyoda, President of Toyota 2010 explaining the uncharacteristic quality reduction that recently affected Toyota.

Change for the sake of change is not always the right or best thing, just the easy thing; and the hallmark of great leadership is sometimes saying “No”. It is up to us to step up to the mark and provide the counsel before things are “done to us”.

There are so many shining examples of US physician leaders that they inspire generations of students to follow in their footsteps.

"Management is doing things right; Leadership is doing the right thing” -Peter F Drucker

It will be exciting to see how we, in the UK, carry forward the quality agenda and how will this nascent academy will grasp this opportunity and help us deal with the potential conflict between great management and leadership.

How will it inspire those who could lead, to not just tentatively consider this exciting path, but to openly seek it out?