Building physician managers and leaders: a model.

A needs assessment identified leadership, management, and interpersonal skills as training and development areas for hospital's physician executives. Training sessions were developed and occurred quarterly over a two-year period. Development strategies were designed to enhance transfer of learning from the classroom setting and incorporated personalized coaching sessions, development of a peer mentoring program, group redesign of the performance appraisal process, strategic planning, and performance feedback sessions. The comprehensiveness of the approaches taken in this program is critical to successful training and development efforts of physician executives.

Because of physicians' understanding of health care environments from the practitioner perspective, the physician executive is a valuable resource in the management of health care systems. In addition, physician managers have a high degree of legitimacy with their colleagues.(1)

According to Tabenkin,(2) the critical concern is how to enhance the role of physicians in managing health care resources. Unfortunately, physicians have been largely overlooked because of their lack of training and experience in management. An American Hospital Association survey entitled "1989 Survey of Hospital Medical Staff Organization" found that only 32 percent of the responding hospital CEOs provided leadership training for elected and appointed medical staff leaders or heads of departments.(3)

The Hospital Environment

In order to prepare physician executives for key leadership roles in the organization, a management training and development program was initiated at Minneapolis Children's Medical Center, a 148-bed tertiary, private regional children's referral hospital in Minneapolis, Minn. This hospital requires extensive cross-disciplinary functions among multiple professions to efficiently and effectively care for patients. The training and development program was conducted for clinical directors, as well as chiefs of service who also practiced in a pediatric specialty, in the following areas: neonatology, intensive care, developmental pediatrics, behavioral pediatrics, adolescent medicine, general pediatrics, chronic care, pulmonology, and emergency pediatrics. Two psychologists and a social worker were included in the program. The term "physician executive" will be used throughout this article, because most members of the group were physician executives.

Critical Dimensions for Training and Development

These medical and clinical directors work in dyadic management teams with managers and have mutual administration duties. In order to determine the specific needs of this group, a needs assessment was conducted, using interviews with key management staff and a competency study based upon an extensive literature search. The following dimensions were identified as the most significant training and development issues for the group:

* Management skills.

* Leadership skills.

* Interpersonal skills, both individual and group.

Management skills training focused on day-to-day managerial practices, incorporating short-range solutions to issues, establishing effective decisionmaking practices, implementing performance management, and administering selected programs and policies. Leadership skills training focused on teaching physician executives to think strategically, to influence the performance of others, to create a vision for the organization, and to design small and large system changes. Individual and group interpersonal skills were formatted around dimensions of organizational culture and individual and small group dynamics.

Core Content of the Program

As a result of the needs assessment process, the content of the program included:

* The unique role of the physician executive as practitioner, leader, and manager.

* Organizational culture and its influence on managerial and leadership effectiveness.

* Dynamics and differences in clinicians and managers.

* Situational leadership concepts integrated with multiple skillbuilding.

* Team building paradigms and issues.

* Group dynamics and effective meeting management skills.

* Performance management in group and individual settings.

* Effective problem-solving and decision-making.

* Effective employment interviews.

* Development of critical negotiation skills.

* Models of strategic planning and effective applications.

A Comprehensive View of the Program

According to the findings of one study of physician managers, "the more experience and training in management physicians have, the more competent they feel in management."(2) While training is an important dimension, it may not be as effective as training and development. Training focuses on assisting individuals to do their jobs more effectively through a variety of generic strategies.(4-5) The management development function focuses on the long-term, strategic, and leadership needs of the organization by broadening individuals and providing them with new perspectives. Development, in general, focuses on "learning for the general growth of the individual and/or the organization."(5) In addition, development may focus on specific interventions for selected problems and/or issues.

A total of eight management training seminars was conducted by one of the authors (hereafter referred to as "the consultant") in 1990 and 1991. The seminars were conducted quarterly; each session was approximately 6 hours in length. Participants in each of the sessions ranged from 10 to 18; the variance in the number attending was caused by emergencies and the on-call schedules of participants.

Training addressed critical management skills and an understanding of leadership; emphasis was placed on theory, research, and practice-oriented perspectives in a classroom format. Techniques employed included lecture, case studies, videotapes, small and large group discussions, simulations, and behavioral modeling. The training program was tailormade to address the specific content areas noted above, incorporating an ongoing needs assessment process and feedback from participants. According to Rubin and Inguagiato,(6) tailor-made programs are "likely to meet the unique cultural and behavioral requirements for large-scale changes in an organization's work environment."

Management development strategies were applications-oriented and consisted of activities designed to provide leadership and management perspectives, transfer of learning from the classroom training, and generalization to a diverse range of applications.

* Personalized coaching sessions with the consultant regarding problems and issues experienced in his/her management practice were conducted with each physician executive.

* Because research has indicated that peer mentoring programs enhance development opportunities,(7) a peer mentoring program was established to contribute to participants' professional growth.

* Small group problem-solving showed participants how to influence critical dimensions within their own team or the larger organization in order to accomplish selected goals and objectives.

* Physician executives were involved in a redesign of their performance appraisal system that incorporated significant components of effective performance management.

* Improvement of physician executives' performance in conducting team meetings was accomplished by the consultant's attending selected team meetings led by physician executives, providing feedback and development suggestions related to their effectiveness as team leaders.

* Strategic plans were developed for selected units. The process allowed opportunities for the physician executive to learn how to facilitate strategic planning in the future.

Each physician executive could select from the above "menu" those strategies that would be most appropriate for enhancing his/her management practice.

Program Successes

The management training and development program has been successful in instilling a greater sense of awareness of the management function. Physician executives now understand that becoming an effective leader and manager is not just an intuitive process but is predicated on critical skills and dimensions. These skills and dimensions must be built not only on theory and research, but also on application to "real-world" problems the physician executive faces in his/her daily management practice.

Previous research conducted by the authors(8) regarding the effectiveness of the training sessions indicated that physician executives' perception of the management function had changed significantly and positively since entering the training program. This behavioral change may stimulate future, proactive changes in their performance. Of equal significance have been the responses from a number of nonparticipants that indicated observable, positive changes in both the role and performance of physician executives.

Research currently being conducted by the authors will assess the effectiveness of the development strategies that were established. The focus will be on changes in managerial performance that occurred as a result of personalized development strategies used by physician executives.

There is evidence that the program is effective and has stimulated an enhanced interest in learning more about leading and managing. Future methods will include greater participation and influence of physician executives in the content and process of the program as they become more adept at understanding the important role of the physician executive as leader and manager.

References

1. Sheldon, A. "Physician-Administrator Cooperation in the Postprofessional Era." Physician Executive 14(5):2-7, Sept.-Oct. 1988.

2. Tabenkin, H., and others. "Physician Managers: Personal Characteristics Versus Institutional Demands." Health Care Management Review 14(2):7-12, Spring 1989.

3. "Developing Physicians' Leadership Skills." Medical Staff Leader 20(1):4-5, Jan. 1991.

4. Bernhard, H., and Ingols, C. "Six Lessons for the Corporate Classroom," Harvard Business Review 66(5):40-6, Sept.-Oct. 1988.

5. Nadler, L. Designing Training Programs The Critical Events Model. Reading, Mass.: Addison-Wesley Publishing Co., 1982.

6. Rubin, I., and Inguagiato, R. "Training Excellence: An Organizational Approach." Physician Executive 17(2):42-5, MarchApril 1991.

7. Kram, K., and Isabella, L. "Mentoring Alternatives: The Role of Relationships in Career Development." Academy of Management Journal 28(1):110-32, March 1985.

8. Kusy, M., and Marr, T. "Learning and Performance Changes of Physician Executives: Evaluation of a Management Training and Development Program." Journal for Research on Learning in the Workplace 1(1):37-44, 1991.