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What physician executives and health care organizations should expect from each other. (The Evolving Role of the Physician Executive).

AS THE CHIEF EXECUTIVE Officer of the American College of Healthcare Executives, the international professional society for nearly 30,000 health care executives, I am increasingly asked by our members what attributes they should look for when hiring physician executives and what they should expect of them once they are on the job. Similarly, from ACHE's physician executives, who number roughly 500 and represent a growing segment of our membership, I am asked what they should expect from the health care organizations that employ them.

Today, interest in defining the role of the physician executive and ensuring this individual is effectively integrated into the organization is high for good reason--the ranks of physician executives are growing. By physician executives, I am referring to physicians who hold full-time management roles, typically with a title like vice president of medical affairs.

Yet despite the growing number of physician executives, there appears to be some confusion or at least ambiguity about what this individual should bring to the table and what role he or she should play in the organization. Although the answers to these questions will certainly vary depending on the size and structure of the employing organization, a number of expectations should be considered reasonable and important in virtually all situations.

What health care organizatians should expect of physician executives

1. Demonstrated clinical and management skills

Quite simply, health care organizations should seek out physician executives who have both excellent clinical skills and demonstrated management ability. Implicit in the statement "excellent clinical skills" is the assumption that the individual not only completed medical school and a residency program, but that he or she subsequently practiced medicine. "Real-world" experience is important for an obvious reason-if physician executives are to have credibility with the medical staff and work effectively with physicians, they will need to demonstrate more than just a theoretical understanding of the medical staffs priorities and concerns.

Demonstrated management ability includes a comfort level based on education (and preferably job experience) in a variety of management disciplines, such as finance, strategic planning and management, marketing, operations research, and information management. Ideally, a physician executive should have either a master's degree in business or health administration.

2. Comfort level with participatory decision-making

The truly effective physician executive will not only have both clinical and management talent but will be able to integrate these two quite different orientations. In particular, physician executives who have recently left the practice of medicine will need to demonstrate the ability to strike a balance between individual and group decision-making. Whereas clinical training emphasizes autonomy, health care management often requires a more participatory approach. In hiring for physician executive positions, health care organizations will look for indications that the candidate recognizes and Is able to shift from Individual to collaborative decision-making as appropriate.

Further, while physicians are trained to be risk-averse in the interest of their patients, as physician executives they will need to modify their attitude. This Is not to say they should suddenly throw caution to the wind, but calculated risks are acceptable, albeit advisable, in health care management positions.

3. Superb interpersonal skills

Health care organizations not only look for physician executives who are comfortable making decisions collaboratively. They also need to have superb interpersonal skills that enable them to work with diverse "key constituencies" within the organization--from other senior executives to the medical staff to the nursing staff. This goes beyond intrinsic attributes that a health care organization would expect of virtually any candidate it was considering--integrity, trustworthiness, and conviction. Certainly, the physician executive must exemplify these qualities, but there is more that is required.

The physician must demonstrate a high degree of "emotional intelligence.' In his newest book, Working with Emotional Intelligence, Daniel Coleman defines emotional intelligence as the capacity for recognizing our own feelings and those of others, for motivating ourselves, and for managing emotions well in ourselves and in our relationships. (1) In any management position, success is predicated on 10 percent mastery of technical skills and 90 percent on interpersonal skills--and while this statement may sound like hyperbole, it is very true. Anecdotal evidence suggests it is very much the case for physician executives, given the gap they bridge between the medical staff and management.

When health care executives seek out physician executives to bridge the gap between the medical staff and management, they are looking for individuals who can communicate effectively between the two groups on issues where medicine and management intersect--such as in the realms of quality improvement and outcomes measurement. Health care organizations want to hire individuals who have the interpersonal skills to effectively communicate with the medical staff that management's decisions are not intended to compromise patient care for the sake of cost reductions. In turn, health care organizations want physician executives who will raise their awareness of clinicians concerns without fear of reprisal.

We would all like to believe that our interpersonal skills are just as polished as our technical skills. We also know, largely from working with others who view themselves this way, that how we perceive ourselves is often quite different than how others see us. One way to gain an accurate perspective is for physician executives (and other members of the management team) to participate in 360[degrees] assessments, where their interpersonal skills are evaluated by superiors, colleagues, and subordinates. Increasingly, health care organizations are turning to 360[degrees] assessments to help "red flag" any interpersonal issues that may be impeding the effectiveness of the management team.

Physician executives should welcome the opportunity to participate in such an assessment, as well as attend educational programs on managerial effectiveness. Such activities should not be considered as "retribution," but rather as an indication that the organization is committed to your continued professional development and success.

4. Champion of the patient

This brings me to the final "universal" attribute that health care organizations look for in physician executives. They want physician executives who will be the champion of the patient. This is not to say that health care executives are not ultimately concerned with the quality of care and patient satisfaction. In fact, I truly believe the vast majority of those who chose careers in health care management were largely motivated by a desire to make a positive difference in the lives of others. At the same time, health care executives expect that physician executives will keep the interests of patients in full view at all times. And, they Want physician executives to make sure that neither the management team nor the medical staff unwittingly overlook the impact of their decisions on the patient in the course of their day-to-day activities.

What physician executives should expect of health care organizations

Just as health care organizations expect physician executives to: (1) have demonstrated clinical and management skills; (2) have a comfort level with participatory decision-making; (3) have superb interpersonal skills; and (4) be a champion of the patient, physician executives should have their own set of prerequisites from their employers.

1. Varied roles and responsibilities

While they are hired primarily to provide a critical link between the medical staff, management, and other key staff, health care organizations should also commit to Involving their physician executives in a broad range of initiatives--from management information system projects, to facility design, to planning and marketing. Not only does the physician executive benefit from such involvement, because it adds to his or her breadth and depth of knowledge, but the organization also stands to gain. Almost without exception, any management decision made within a health care organization directly or indirectly affects patient care. For that reason, involving physician executives in discussions, deliberations, and decision-making--be it as an advisor, task force member, or reactor--ensures that the patient care implications are fully considered.

2. Mentoring by other senior executives

Although the health care field has a long tradition of mentoring early careerists, we have not been nearly so conscientious about mentoring more senior careerists who have transitioned into different positions. In the case of physician executives, we have probably wrongly assumed that anyone who has the talent and stamina to succeed in becoming a doctor is not in need of mentoring. In some cases, physician executives, also fully aware that they had what It takes to become a doctor, have had the opportunity to be mentored but dismissed it as unnecessary.

The reality is that management savvy and clinical expertise are two vastly different disciplines. Further, mentoring among equals can be extremely valuable and should be embraced rather than dismissed. It is particularly important that health care organizations provide the "first-time" physician executive with a mentor or mentors. Although these physician executives are no doubt intellectually up to the challenge, since they have never been on "management's side of the table," they can gain a lot from the counsel of those who have such experience.

Who are the most appropriate mentors for physician executives? The answer is both a function of title within the organization and the mentoring abilities of the individuals holding those titles. In general terms, the CEO and COO are good candidates for mentoring the physician executive because of their seniority in the organization. At the same time, individuals like the CFO and CIO can be equally valuable mentors, because they can offer perspective in specialized areas.

An additional benefit of these mentoring relationships is that they afford those who mentor the physician executive with new insights as well. No doubt they can learn a lot from this senior executive who has a firsthand understanding of the needs and wants of the patient.

3. Lifelong learning

Without question, the health care organization has a responsibility to provide its physician executive, as well other members of its management team, with opportunities to continue to learn outside the walls of the organization. My experience suggests that physician executives should have opportunities to participate in both didactic education, such as seminars on management, managed care, and finance, as well as experiential programs that will help them develop their interpersonal skills.

Beyond participation in professional development programs, physician executives (again, like their colleagues on the management team) should also be given opportunities to participate in professional societies. Much the same as national and state medical societies were important to their careers when they practiced medicine, physician executives' membership and involvement in the American College of Physician Executives, American College of Healthcare Executives, and other professional societies provides unparalleled opportunities for both formal, targeted education and collegial interaction.

Finally, physician executives should be encouraged to contribute to the communities their organizations serve through civic involvement. By serving on local community boards, committees, and task forces, physician executives provide a valuable service to the community and also reap the personal rewards of such involvement.

4. Complete support of the management team

Perhaps the most critical and perfectly appropriate expectation physician executives should have of their health care organizations is the full, unwavering support of the entire management team. Just as the CEO is not the only one responsible and accountable for the financial performance of the organization, the physician executive cannot be expected to single-handedly ensure that goals associated with quality improvement, outcomes measurement. medical staff relations, and other related responsibilities are achieved.

Certainly, the physician executive should lead the way on meeting goals associated with these activities. It is reasonable to expect the physician executive to play an active role in creating an environment of trust and facilitating continuous communication between all parties. The rest of the management team, however, including the CEO and COO, must commit to providing the support and resources necessary for the physician executive to perform the job effectively.

Can physician executives become CEOs?

I am often asked whether physician executives can become CEOs. I answer this question much the same way as when I am asked whether any member of the management team has the "right stuff to lead a health care organization. Yes, some physician executives will indeed prove that they are eminently qualified to hold the top slot. Those physician executives who ultimately become CEOs will have the appropriate educational background (MBA or MHA) and the requisite training and experience, and will be able to demonstrate that they have the vision and leadership skills needed to succeed. Regardless of the path today's physician executives choose, their on-the-job effectiveness will be a function of both their personal commitment and dedication, as well as that of the health care organizations that employ them.

Acknowledgement

The author would like to gratefully acknowledge the contributions of Lynn D. Kahn, CHE, CAE, President of The Kahn Group, Ltd., in preparation of this article.

Reference

(1.) Coleman, Daniel. Working with Emotional Intelligence, New York, New York: Bantam Books, 1998.

RELATED ARTICLE: RECOMMENDED RESOURCES

WEBSITES

The American College of Healthcare Executives (ACHE)

An international professional society of nearly 30,000 health care executives. ACHE is known for its credentialing and educational programs, its Journal of Healthcare Management and Healthcare Executive magazine, as well as ground-breaking research and career development. ACHE s publishing division, health Administration Press, is a major publisher of books and journals on all aspects of health services management. Visit www.ache.org to learn more.

The American College of Physician Executives (ACPE)

The national professional and educational association of physicians in leadership and management positions throughout the health care field. The College is a nonprofit organization whose primary purpose is raising the standards of health care through management education and research. With more than 12,500 physician members, the College is recognized by the American Medical Association as the specialty society representing physicians in management. Visit www.acpe.org to learn more.

The Association of University Programs in Health Administration (AUPHA)

A not-for-profit association of university-based educational programs, faculty, leading executives, and provider organizations, whose interest is in the development and continuous improvement of health management education. For a list (with links) of AUPHAs bachelors and graduate programs in health administration, please visit the Member Programs page. Visit www.aupha.org to learn more.

BOOKS

1999-2001 Health Services Administration Directory of Programs

This guide to choosing an educational program in health administration features websites and email addresses for all programs, a detailed table presenting program offerings including distance education, long-term care, and non-traditional curricula across the membership. You can order the directory by calling AUPHA at 202/638-1448, ext. 110.$30.00 (plus $5 shipping and handling).

In Search of Physician Leadership

Edited by Barbara LeTourneau, MD, MBA, CPE FACPE, ACPE, 1998

This book will help both physicians and non-physicians better understand new physician leadership roles and the positive effect that shared management can have on the health care system. Members can obtain the book for $38 (non-member price is $43) by calling 800/562-8088 or visiting ACPE s website at www.acpe.org.

Networks and the Future of Medical Practice: Integrating Physician, Hospital, and Payer

by Derek van Amerongen, MD, MS, ACPE, 1998

This book is a philosophical and practical gide to a health care world in which managed care dominates and in which integrated systems of hospitals, physicians, and payers have been formed to add value to the health care product. Members can obtain the book for $38 (non-member price is $43) by calling 800/562-8088 or visiting ACPE s website at www.acpe.org.

Physician Networks: Strategy, Start-Up, ad Operation

By Richard Krohn, Health Administration Press, 1998

This is the ultimate how-to book for physician networks of all kind from IPAs to PSOs. Clear explanations and brief case examples guide readers to create risk-bearing networks that operate as the backone of integrated delivery systems. Call 312/845-9869 to order this book for $42 or visit www.ache.org.

Top Docs: Managing the Search for physician Leaders, Second Edition

By George F. Longshore, ACPE, 1999

This book serves as a manual for successfully completing a physician search. It systematizes what can become a very disjointed process, providing a clear track for those new to the search process and a wealth of information and necessary reminders to all. Members can obtain the book for $32 (non-member price is $42) by calling 800/562-8088 or visiting ACPE s website at www.acpe.org.

Thomas C. Dolan, PhD, FACHE, CAE

Thomas C. Dolan, PhD, FACHE, CAE, is President and Chief Executive Officer of the American College of Healthcare Executives in Chicago. He can be reached by calling 312/424-9365 or via email at executiveoffice@ache.org.
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No portion of this article can be reproduced without the express written permission from the copyright holder.
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Author:Dolan, Thomas C.
Publication:Physician Executive
Geographic Code:1USA
Date:Sep 1, 1999
Words:2734
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