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2 Best Practices in Physician Leadership Development Programs
Copyright 2015 National Center for Healthcare Leadership. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means electronic or
mechanical, including photocopy, recording, or any information storage and retrieval system, without written permission.
National Center for Healthcare Leadership 3
Introduction .............................................................................................................................................. 5
Best Practices in Physician Leadership Development: Henry Ford Health System .................................. 7
Who They Are: Brief Overview ............................................................................................................. 7
Overview of Physician Leadership Development at HFHS ................................................................... 7
An In-Depth Look at PLI ........................................................................................................................ 8
Impact of Programs to Date ............................................................................................................... 12
Critical Success Factors and Other Lessons Learned .......................................................................... 13
Best Practices in Physician Leadership Development: North Shore-LIJ ................................................. 15
Who They Are: Brief Overview ........................................................................................................... 15
Overview of Physician Leadership Development at NSLIJ .................................................................. 15
Review of Program Offerings .............................................................................................................. 16
Impact of Programs to Date ............................................................................................................... 21
Critical Success Factors and Other Lessons Learned .......................................................................... 23
Best Practices in Physician Leadership Development: Sutter Health ..................................................... 25
Who They Are: Brief Overview ........................................................................................................... 25
Overview of Physician Leadership Development at Sutter ................................................................ 25
Review of Program Offerings .............................................................................................................. 27
Impact of Programs to Date ............................................................................................................... 30
Critical Success Factors and Other Lessons Learned .......................................................................... 31
NATIONAL CENTER FOR HEALTHCARE LEADERSHIP
Best Practices in Physician Leadership Development Programs CASE STUDIES
National Center for Healthcare Leadership 5
Introduction
Meeting the challenges facing healthcare organizations today requires not just great leaders, but
great physician leaders. The most successful organizations are fundamentally re-thinking and
redesigning care delivery at the front lines of medicine.
They are rapidly transitioning from a volume-based, fee-for-service system characterized by episodic,
sometimes unnecessary care, to one focused on managing the health of populations through
proactive care management and adherence to evidence-based guidelines and protocols, facilitated by
cutting-edge information technology and clinical-decision support. Physician leaders can be the
catalyst for organizations to navigate the transition and achieve the “efficient use of scarce resources
while maintaining strong clinical quality and patient focus.”1
Recognizing the importance of effective physician leadership, the National Center for Healthcare
Leadership’s (NCHL) Physician Leadership Development (PLD) Council decided in 2013 to focus its
efforts on deepening its understanding of internal PLD programs at hospitals and health systems. This
effort culminated in the publication of a white paper, Physician Leadership Development Programs:
Best Practices in Healthcare Organizations,2 which lays out 10 recommendations for implementing
effective PLD programs:
Ensure that the organization’s executive leaders actively support the PLD program
Directly link the PLD program with the organization’s strategic priorities
Use the PLD program to build and expand physician and inter-professional relationships
Align and integrate the PLD program with existing learning and leadership programs
Hold ongoing conversations with existing and emerging physician leaders
Design the curriculum to support the organization’s desired competencies/capabilities
Use both internal and external faculty
Employ effective learning methods
Provide coaching, mentoring, and other support whenever possible
Evaluate and refine the program using metrics tied to organizational performance
As a follow-up to this paper, members of the NCHL PLD Council felt it was important to offer real-
world examples of organizations that have followed many of these best practices.
1 Mountford J, Webb C. When clinicians lead. The McKinsey Quarterly. February 2009. McKinsey & Company.
2 National Center for Healthcare Leadership, Physician Leadership Development Programs: Best Practices in Healthcare
Organizations, 2014.
6 Best Practices in Physician Leadership Development Programs
Henry Ford Health System (HFHS), which serves more than one million residents of Southeast
Michigan, offers its own Physician Leadership Institute program as part of the HFHS Corporate
University. This comprehensive 8-month program builds strong leadership and management
skills in high-potential physicians, and, like at NSLIJ, has allowed HFHS to retain its top physician
leaders and fill the vast majority of its leadership positions internally.
North Shore-LIJ Health System (NSLIJ), which serves 7 million residents of Long Island,
Manhattan, Staten Island, and Queens, launched the Physician Leadership Institute in 2010 as
part of its Center for Learning and Innovation. The Institute offers multiple programs to
physician leaders throughout the organization, including the Physician High Potential Program,
which has led to significant improvements in emotional intelligence among participants and has
helped NSLIJ retain its top physician leaders and fill vacant leadership positions internally.
Sutter Health, a non-profit, integrated health system serving more than 100 communities in
Northern California, offers a broad array of leadership development programs that serve all
levels of physician and non-physician leaders. Known as the “Signature Series,” these programs
have generated high levels of satisfaction, retention, and promotions among participants;
increased self-ratings on the various competencies targeted; and allowed Sutter to make
substantial progress in addressing real-world problems and priorities faced by the organization.
A brief introduction to each of these case studies appears on the following page.
National Center for Healthcare Leadership 7
Best Practices in Physician Leadership Development: Henry Ford Health System
Who They Are: Brief Overview
The Henry Ford Health System (HFHS) is a not-
for-profit, integrated health system based in
Detroit. Founded in 1915 by Henry Ford, HFHS
provides a full spectrum of health services,
including acute, specialty, primary, and
preventive care; behavioral health services;
home health and hospice care; skilled nursing
care; and community health services.
With annual revenues of over $4.5 billion
(2013), HFHS serves more than one million
residents of Southeast Michigan through a
provider network that includes six hospitals
(including its flagship facility, Henry Ford
Hospital), 37 outpatient medical centers, 22
pharmacies, and various other specialty facilities
and care sites.
HFHS also operates a health plan with over
675,000 members. The health system employs
more than 23,000 individuals (making it the fifth
largest employer in the Detroit metropolitan
area), including 1,200 physicians in the Henry
Ford Medical Group (HFMG). HFHS also has over
5,500 affiliated physicians, volunteers, and
students.
As one of the nation’s leading health systems,
HFHS has received numerous awards, including
the Malcolm Bridge National Quality Award and
the Eisenberg Patient Safety and Quality Award.
It has been recognized by various organizations,
including U.S. News & World Report, the
National Business Group on Health, Becker’s
Hospital Review, the Centers for Medicare and
Medicaid Services, the Premier Hospital
Alliance, and the American Medical Group
Association.
Overview of Physician Leadership
Development at HFHS
As depicted in the chart below, HFHS University
serves as the overall organizational
development arm for the system, developing,
implementing, and administering curriculum-
based programs to support employees, existing
leaders, and those with the potential to become
leaders, with the goal of building organizational
capacity and value.
Established in 2011, the Physician Leadership
Institute (PLI) serves as the primary vehicle
within HFHS University for developing physician
leaders, with a focus on serving “high-potential”
physicians who exhibit the skills and desire to
become leaders within the organization. To
date, four cohorts that collectively include 62
physicians have completed the 8-month PLI
program. A second program, known as
Fundamentals of Physician Leadership, is a one-
day workshop that serves as a prerequisite to
PLI and an orientation to physicians new to
leadership.
As the following chart suggests, HFHS physicians
also have access to several other leadership
development programs. These programs
generally target administrative leaders, but also
set aside spots for physicians.
8 Best Practices in Physician Leadership Development Programs
They include the New Leader Academy (which
serves newly promoted or hired leaders), the
Leadership Academy (which targets mid-level
leaders) and the Advanced Leadership Academy
(which historically served 30 to 40 leaders at a
time, including 5 to 8 physicians). Advanced
Leadership Academy and Leadership Academy
launch on alternate years.
As part of ongoing efforts to evaluate and
improve program offerings, each of these
academies is currently being updated for
alignment to current HFHS strategic priorities.
An In-Depth Look at PLI
Spanning an 8-month period, PLI is a
comprehensive program designed to build
strong leadership and management skills in
high-potential physicians. As the descriptions
below illustrate, HFHS has structured PLI in
accordance with most if not all of the 10
recommendations laid out by NCHL for
implementing effective leadership development
programs.
Rigorous Selection Process Tied to Talent
Management, Succession Planning
To participate in PLI, physicians must be
employed by the Henry Ford Medical Group, a
self-governed organization within HFHS, or
contractually employed in one of the HFHS
community hospitals. To avoid serving
physicians at or near retirement, eligible
National Center for Healthcare Leadership 9
individuals must have less than 20 years of
experience after having completed medical
school or a doctorate degree. Candidates must
be nominated by a clinical department chair and
complete an application. The nomination
process is announced in a live meeting of HFHS
department chairs, through senior physician
program leaders, and in the medical group’s
newsletter.
Chaired by the CEO of the Henry Ford Medical
group, the PLI selection committee makes final
decisions based on candidate applications and a
review of results from HFHS succession planning
and talent management processes. The number
of individuals accepted to the program has
increased over time, with 12 participants in
2011 (the first year of the program), 15 in both
2012 and 2013, and 20 in 2014.
Diverse Teams
Prior to starting the program, PLI leaders divide
each year’s cohort into 4- or 5-person teams
that work together on a Capstone Project. This
process is designed to ensure that each team
has a diverse mix of individuals with respect to
their background (medical versus surgical versus
research), primary work location (hospital
versus ambulatory care), demographics (race,
gender, and/or ethnicity), and personality styles
(as determined by initial assessments conducted
at the start of the program; see below for more
details).
Broad-Based Curriculum
PLI’s curriculum is intended to prepare
physicians to manage effectively in the
challenging, complex environment in which
HFHS operates. More specifically, it aims to
promote the following competencies:
Business planning/operations and financial
management
Strategic visioning and planning
Project and group management
Quality and process improvement
Ethics and regulatory compliance
Service line management
Listening and communication skills, including
how to manage crucial conversations among
professionals
Change management, including ways to
influence others and promote change
Monthly Full-Day Sessions Making Use of
Multiple, Interactive Learning Methods
As depicted in the chart on the next page, the
cornerstone of PLI is a series of full-day sessions
held each month that focus on a variety of
“hard” and “soft” management, business, and
leadership skills. After launching the program
with a focus on didactic lectures, PLI has
migrated toward use of more interactive
learning methods, including case studies.
Participants read materials in advance
(accessing them online) and then spend the bulk
of class time discussing and building on what
they have read. Going forward, PLI leaders plan
to introduce additional blended learning
methods, including use of social media and
other forums to encourage interaction inside
and outside the classroom.
10 Best Practices in Physician Leadership Development Programs
Pre- Session Meet and Greet: Welcome to PLI! Building a Learning Community Incoming PLI members meet with Senior Physician Leadership, Finance Leadership, HFHS Corporate University Leadership, and PLI Alumni Leaders from Previous Cohorts
Session #1: Leadership Pre-work: Self-Awareness Assessments: Emotional Intelligence (EI) and Strength Finders, Forming EI/Strength-Based Teams EI and Strength Finders: Overview HFMG Physician Leadership, HFHS Culture of Development Business Plan: Capstone Project, Team-Based Action Learning Project Overview Group Project Management Strategies
Session #2: Management Skills Avoiding Leadership Pitfalls: Leadership vs. Management Talent Management: Hiring, Employee Development, Managing Challenging Conversations, Performance Improvement Influencer Part 1: Changing Vital Behaviors, Identifying Opinion Leaders System-Level Improvement Projects: Business Plan, Selection and Assignments
Capstone Project Support Sessions: Business Plan Proposal, Team-Based Action Learning Project Break Out Session/Support: Collaboratively Building a Business Plan Within a Team Half Day Session #1: Assignment/Orientation with Finance and Subject Matter Expert Coaches Break Out Session: Collaboratively Building a Business Plan Within a Team Half Day Session #2: Finance and Subject Matter Expert Coaches, Project Update
Session #3: Influence Influencer Part 2: Six Sources for Supporting Organizational Change, Integrating Influencer into Business Planning Process Business Plan: Project Update
Session #4: Appreciative Inquiry and A New Land: The Physician Leader, Building Networks and Teams Organizational Change: Appreciating/Valuing the Best of What Is, Envisioning What Might Be Dialoguing: What Should Be, Innovating What Will Be Managing Oneself, How Every Organization Is Structured, Culture, How People Connect, Tasking for Teamwork
Capstone Project Rehearsal Presentation: The Business of Healthcare Business Plan Proposal “Rehearsal” Team Presentations: HFHS Budget Oversight Committee New or Improved System Services: Delivering Project Proposals, Receiving Feedback
Session #5: Quality/Safety Human Factors Engineering, Process Improvement, Risk Management and Sentinel Events, Data and Analytics, Leading Quality Efforts (Panel)
Session #6: Graduation Celebration & Capstone Project Graduation Day: Final Capstone Project--Business Plan Proposal and Final Team Presentation to System Leaders and Peers Celebration Lunch with Faculty, Leaders, and Peers
Additional Support for PLI Members and Teams Individual Support: Two EI Coaches: 2 to 3 hours of Coaching Support; Development of Learning Plan Capstone Project Team Support: Coaching from Subject Matter and Finance Coaches on System-Level Projects
National Center for Healthcare Leadership 11
Capstone Project on Issue Facing HFHS
Each team completes a Capstone Project. For
the first two years of the program, physicians
came up with their own ideas for projects based
on personal knowledge in their areas of
specialty. Beginning in the third year, program
leaders began suggesting potential projects that
had surfaced as strategic priorities for HFHS.
Throughout the project, the team interacts with
subject matter experts within HFHS who are
tackling the problem.
Going forward, the plan is to have team
members join (or perhaps lead) real-world
committees and workgroups carrying out these
projects, thus enabling them to see their work
through to its culmination. Teams work under
the ongoing guidance of a finance and business
mentor who teaches various business skills, such
as how to calculate return on investment (ROI)
and net present value. These mentors provide
guidance during two scheduled half-day sessions
and at other times as needed. The half-day
sessions were added in 2013 after program
leaders realized that physicians faced significant
difficulties scheduling meeting time outside the
program.
At the end of the project, teams present their
findings, first in a practice session to the
system’s budget oversight committee, and then
in a final session to senior leaders and
department chairs. The practice presentation
used to be done in front of peers; this approach
was changed to allow for more constructive
feedback.
Emotional Intelligence Assessment and
Support
Working with external consultants and coaches,
participants go through an initial 360-degree
survey of their emotional intelligence (Hay
Group’s Emotional and Social Competency
Inventory or ESCI assessment) linked to 4
domains:
1. Self-awareness
2. Self-management
3. Social awareness
4. Relationship management
The process includes a self-evaluation and
assessments by supervisors, peers, and direct
reports. Based on the assessment results, the
certified coach works with the participant to
develop a learning plan and then provides
coaching and support around that plan. This
process typically consists of an upfront two-hour
session, followed by one or two additional one-
hour sessions. All results are kept confidential so
as to allow participants to learn and practice in a
safe environment.
“Physicians are generally not introspective enough, and try to avoid introspection as much as possible. But the emotional intelligence assessment and coaching uncovered some issues and elements that I never would have picked up on my own. It forced me to be introspective and pay attention to valuable feedback.”—Farzan Siddiqui, MD, participant in HFHS PLI program
12 Best Practices in Physician Leadership Development Programs
Strengths Assessment
Participants also complete a Gallup
StrengthsFinder Assessment with guidance from
an internal organizational development coach to
help understand their strengths. Strengths are
mapped on a team roster so that every
participant has a sense of his or her own
strengths and those of their teammates. The
roster is also used to assemble balanced, diverse
project teams.
Strategic Use of Internal and External
Faculty
Senior HFHS physicians and administrative
leaders teach most of the workshops and
frequently partner as dyads to ensure subject
matter expertise and overall quality of training.
This approach also ensures that participants
have the opportunity to regularly meet, interact
with, and learn from HFHS and Henry Ford
Medical Group senior executives and physicians.
Physician and administrative leaders within
HFHS are expected to be teachers. In fact, the
system CEO in 2010 established a cascaded goal
for all leaders to commit to a “culture of
development” and set the expectation that
leaders be teachers. As a result, many senior
leaders, including the system’s chief medical
officer (CMO), the CEO of the Henry Ford
Medical Group, the chief operating officer for
the system, and department chairs, regularly
lead classroom sessions. In addition, the system
CMO attends virtually every session, often
staying for most or all of the day.
PLI also makes liberal use of external partners
and faculty to strengthen the program in areas
where HFHS lacks internal resources and
capacity. To that end, the Hay Group oversees
the emotional intelligence training; and Vital
Smarts administers “influencer training” (the
focus of the June session and part of the
September session).
Impact of Programs to Date
To date, the programs have shown the
following:
Overall satisfaction scores from PLI
participant evaluations average 4.6 out of
5.0 Likert scale
94% percent of those graduating from PLI
remain at HFHS, a higher retention rate than
existed among physician leaders before the
program began, and a higher rate than
among HFHS employed physicians as a
whole
56% of PLI graduates to date have been
promoted after their completion of the
program
In addition, HFHS is beginning to see traction
with its Capstone Projects and hopes to soon
have quantifiable data documenting a positive
ROI as these projects continue to be aligned
more strategically to system priorities. PLI
graduates have proven to be a great resource to
the HFHS “Physician Partner” program by
volunteering to mentor physicians new to HFHS
as part of their onboarding process. PLI
graduates are also sought after to fill various
committee seats within the system’s quality and
governance structures. In recognition of their
commitment to leadership development, HFHS
was recently recognized as a winner of the 2014
Best Organizations for Leadership Development
(BOLD) award from NCHL.
National Center for Healthcare Leadership 13
Critical Success Factors and Other
Lessons Learned
As the program descriptions illustrate, HFHS has
embraced most if not all of the 10
recommendations laid out in the NCHL white
paper, and doing so has played a key role in the
success of its programs. In particular, program
leaders highlight the following as having been
central to the program’s success:
Making sure senior physician and
administrative leaders are “at the table”:
Consistent with NCHL’s recommendation to
ensure leadership support, HFHS senior
administrative and physician leaders have
been highly involved in planning, delivering,
and advocating for the program. Their visible
role serves as a strong signal of the
importance of physician leadership
development to current and would-be
participants. For example, the CMO’s
presence at every PLI session is noticed by
participants; one participant noted that
seeing the system CMO, CEO, chief quality
officer, and department chairs at various
sessions impressed him greatly, particularly
the degree to which they engaged in the
substance.
Clearly defining roles and decision-making
processes: Whenever multiple senior
leaders come together on a project, some
ambiguities will exist as to everyone’s role in
the process, particularly with respect to
decision-making. Consequently, efforts
should be made to discuss and define roles
and responsibilities up front and meet
regularly with key stakeholders to review
milestones and identify clear expectations
regarding next steps and accountabilities.
Continually evaluating and refining
program offerings: No program will be
perfect from the outset. Program leaders
need to regularly elicit feedback from
participants and other stakeholders in an
effort to identify opportunities to improve
program offerings. In addition as noted
earlier, several programs within HFHS
University are currently being updated as a
result of cycles of improvement focused on
better strategic alignment between training
and new areas of focus within the system’s
annual strategic plan.
For example, a “meet-and-greet” event was
recently added to the beginning of the PLI
program. During this session, PLI alumni
meet with the incoming class in an effort to
get to know each other and to share their
experiences. In addition, another half-day
session with coaches and subject matter
experts was recently added to the
curriculum to provide additional support to
the Capstone Project teams and their efforts
to align with key system priorities.
Using mixed learning methods, making use
of emerging technologies: Following NCHL’s
recommendation to use mixed learning
methods, HFHS program leaders have been
looking for ways to leverage mobile and
social media technologies to encourage
more interactive discussion both inside and
outside of the classroom. They are also
looking at opportunities to use software to
14 Best Practices in Physician Leadership Development Programs
assist with coaching and MOOC (massive,
online open courses) technology to
introduce off-hour opportunities (e.g.,
evenings, weekends) for learning and
interaction.
Maximizing mentoring/coaching and other
support, particularly with alumni:
Consistent with NCHL’s recommendation,
HFHS provides a significant amount of
coaching and mentoring to participants,
including looking for ways to leverage
program alumni as a source of support. The
aforementioned “meet-and-greet” session
can be a good way to get alumni involved,
although their participation should ideally
continue throughout the program via email
and other mechanisms.
Looking outside the organization for best
practices, faculty: Consistent with NCHL’s
recommendation, HFHS makes use of
external faculty as needed to supplement
internal resources. Program leaders have
also visited and brought back ideas from
other organizations; for example, after a trip
to the Cleveland Clinic, they decided to
incorporate a new topic into the PLI
curriculum--“mindful” leadership.
Being patient: The development of effective
PLD programs does not happen overnight,
but rather takes substantial time and effort.
In time, this effort should produce a
significant ROI.
National Center for Healthcare Leadership 15
Best Practices in Physician Leadership Development: North Shore-LIJ Health System
Who They Are: Brief Overview
North Shore-LIJ (NSLIJ) is the product of the
1997 merger of two independent hospitals ‐
North Shore University Hospital, which opened
in 1953 with 185 beds, and Long Island Jewish
Medical Center, which opened the following
year with 215 beds. NSLIJ serves 7 million
residents of Long Island, Manhattan, Staten
Island, and Queens.
With annual revenues of roughly $7 billion and a
workforce of more than 48,000 employees
(making it the largest private employer in New
York State), NSLIJ is the second‐largest non‐
profit secular healthcare provider in the nation,
the largest integrated healthcare system in New
York State, and the largest healthcare provider
in its region. With the support of more than
9,400 physicians, over 10,000 nurses, over 1,200
medical students, and more than 1,500 medical
residents and fellows, NSLIJ operates or is
affiliated with 18 hospitals and also offers a
wide range of primary and specialty care
services through a network of mental health,
long‐term care, rehabilitation, outpatient
surgery, home care, and hospice care facilities
and programs.
NSLIJ also has its own insurance program, a
corporate university that houses a large
simulation and patient safety center, and a
world‐renowned research institute. NSLIJ
maintains affiliations with several regional
medical schools and opened its own school of
medicine in 2011 in cooperation with Hofstra
University.
NSLIJ has received various prestigious awards,
including the National Quality Forum’s 2010
Healthcare Quality Award, The Joint
Commission’s Codman Award, and the Pinnacle
Award from the Healthcare Association of New
York State. DiversityInc has ranked NSLIJ as one
of the nation’s top 10 health systems for
diversity and inclusion practices, and as one of
the top 10 companies for veterans. Modern
Healthcare has ranked it 31st on its list of the
nation’s top 100 integrated health networks. In
addition, individual hospitals and facilities within
NSLIJ have been recognized by many respected
organizations, including IPRO (New York’s
Medicare quality improvement organization),
the Healthcare Association of New York, the
Joint Commission, AARP’s Modern Maturity
magazine, U.S. News & World Report, JD Power
& Associates, the American Nurses Credentialing
Center, and the Centers for Medicare &
Medicaid Services.
Overview of Physician Leadership
Development at NSLIJ
In 2001, NSLIJ created the Center for Learning
and Innovation (CLI), a corporate university
offering personal and professional development
opportunities to its workforce. Like many
corporate universities, CLI began by providing
various leadership development programs.
16 Best Practices in Physician Leadership Development Programs
Traditionally, relatively few physicians took
advantage of these offerings.
Faced with an increase in the pace of change
and external demands and buoyed by the
success of several NSLIJ leadership development
programs for administrators, NSLIJ’s CEO felt
that the organization needed to involve
physicians in the leadership decisions that help
to sustain growth and success into the future.
To facilitate their involvement, CLI needed to
offer programs specifically targeted at
physicians. These efforts led to the 2010 launch
of the Physician Leadership Institute (PLI). As
depicted in the chart below, PLI offers a wide
array of programs that collectively serve
physician leaders at all levels of the
organization. These programs aim to recruit,
develop, and retain the talent necessary to
achieve NSLIJ’s organizational goals by
developing the necessary skill sets among
physicians to allow them to prosper in highly
visible leadership positions.
Review of Program Offerings
PLI initially began in 2011 with two programs
and has subsequently added programs in
response to physician requests and identified
needs of the organization. What follows is a
detailed look at PLI’s first and largest offering,
the Physician High Potential Program, along with
brief overviews of its other major programs. As
the descriptions below illustrate, PLI follows
most if not all of the 10 recommendations laid
out by NCHL for implementing effective
leadership development programs.
Physician High Potential Program
The Physician High Potential program is a two-
year program that focuses on giving physicians
the skills and capabilities they need (including
“softer” skills) to be successful leaders in a
rapidly changing, tumultuous environment.
Formal Nomination and Selection Process
In PLI’s first year of operation, program leaders
asked senior executives and medical directors to
send their “best” physicians to the program, and
a cohort of 55 physicians began in July (so as to
follow the traditional academic calendar). For
the second cohort, program leaders decided to
create a more formalized structure for
acceptance into the program, creating a
standard application process that required
someone to nominate an individual for the
program. This process yielded over 100
applications, with 32 being chosen to
participate. The same process was used for the
third cohort, which again yielded approximately
100 applications, 19 of which were accepted for
the program.
National Center for Healthcare Leadership 17
The decision to start with a large cohort (55) and
then reduce class size over time was deliberate.
The goal initially was to enroll multiple
individuals from each system hospital, so as to
create a certain “buzz” about the program. Once
the physicians and their leadership became
engaged, it became clear that smaller class sizes
would allow for more personalized education;
ensure that those selected truly had strong
leadership potential; and maximize the chances
that graduates would have near-term leadership
opportunities available to them within the
system. In addition, beginning with the second
cohort, the decision was made to start the
program in January, so as to align this program
with NSLIJ’s clinical and administrative high-
potential program, thus promoting interactive
touch points and collaboration between the two
groups.
Program Curriculum
As depicted in the diagram below, the two-year
program begins with of a combination of
leadership assessments to identify individual
participant’s competencies and gaps. Executive
coaches and mentors use the assessment
results, along with an individual development
plan, as a platform to begin to capitalize on
strengths and close the gaps. Physicians spend a
lot of time honing their clinical craft and often
acknowledge a gap between their clinical and
leadership skills. Coursework, therefore,
provides participants with the knowledge
needed to be successful leaders, through hands-
on project work, other learning experiences
(often as part of multidisciplinary teams), and
interactions with NSLIJ senior leaders and
external faculty and
organizations.
Key components of the
curriculum are detailed
below:
▪ Up-front assessments:
The program begins with
several assessments of
critical leadership
competencies, including a
360-degree assessment
(with participants choosing
who rates them), a Myers-
Briggs personality
assessment, and an
assessment measuring
emotional intelligence and
individual conflict
18 Best Practices in Physician Leadership Development Programs
management style. The theory behind the
use of upfront assessments is two-fold: first,
physicians often state that they do not
receive much feedback related to their
leadership style, and these assessments
provide reliable, valid feedback that helps
them understand how their behaviors and
preferences may affect their effectiveness as
leaders. Second, assessment results lay the
groundwork for much of the rest of the
program, which focuses on supporting
participants in leveraging strengths and
addressing the gaps identified.
Coaching and mentoring: NSLIJ uses an
external executive coaching agency to
focus on delivering career-transition
guidance to the most talented
physicians. All leaders find themselves
confronted with challenges and
obstacles in reaching organizational
objectives, and executive coaching
allows for a more personalized approach
to learning. Because there is no
reporting relationship between physician
and coach, physicians find it easier to ask
for explanations, demonstrations, and
other assistance to meet their needs.
They can ask questions that build on
existing knowledge and further develop
their understanding, and, with their
coach’s support and guidance, apply new
knowledge and skills in their day-to-day
work. These 2.5-hour sessions occur
monthly, alternating between group and
individual sessions.
Highly interactive coursework: Classroom
work typically occurs on a monthly basis,
with 10 classes per year, each lasting 4 to 6
hours. (Sessions are skipped in August and
around the end-of-year holidays.) Among
others, topics covered include leading and
influencing organizational teams,
organizational behavior, economics and
finance, improvement science, leadership
and influence, strategy and environment,
performance coaching and feedback, and
customer service, with some topics being
split into two sessions (beginner and
advanced). Faculty generally consists of
internal subject matter experts/leaders,
although external speakers are sometimes
used to supplement the knowledge base and
bring in examples from non-healthcare
industries.
For example, a leader from Citicorp
participates in the economics and finance
module, speaking about how industry
transformation requires innovative
solutions, including new global investment
opportunities in healthcare. Coursework
avoids lectures and other didactic methods;
instead participants receive pre-session
readings (e.g., books, articles, case studies)
and then use class time for discussions and
simulations. The beginning of a course
reviews the pre-work to ensure that
individuals have a firm grasp of the
knowledge and can apply it to the case and
to NSLIJ.
Sessions always end with a debriefing that
ties lessons back to the individual and
his/her role in the organization and to
specific skills and tools that physician leaders
need. As necessary, participants are broken
National Center for Healthcare Leadership 19
into smaller groups of no more than 10
individuals to facilitate interaction and
discussion.
Multiple out-of-classroom opportunities to
engage with system leaders: Participants
are encouraged to take advantage of a wide
array of out-of-classroom opportunities and
to engage with senior leaders throughout
the organization to learn more about how
the different parts of the organization
operate. For example, participants can sit in
on meetings of the system board, the
medical board, executive directors/service
line chairs, and the finance department;
they can also attend meetings of the system-
wide quality, strategic planning, and
performance improvement committees to
learn more about how they function.
Participants periodically receive invitations
to breakfast meetings with senior leaders,
such as the system CEO (to discuss strategy),
chief medical officer (CMO), chief operating
officer, medical school dean (physician-in-
chief), and the heads of information
technology, social media, and other areas.
During the two-year program, the typical
participant will attend approximately 50 of
these sessions (roughly two per month),
which gives them tremendous exposure to
and interactions with individuals and parts
of the organization they would not normally
get.
Exposure to external organizations:
Participants have an opportunity to spend
time outside NSLIJ at partner organizations,
such as taking courses or participating in
programs at Harvard, Cornell, the Institute
for Healthcare Improvement, or the National
Quality Forum. At present, program leaders
are working to create opportunities for
participants to spend a few weeks
embedded in other leading-edge
organizations (e.g., Kaiser Permanente, Rush
University Medical Center, Cleveland Clinic,
Mayo Clinic) as part of an “external
rotation.”
Real-world Leadership Project: During the
second year, each physician applies the skills
and knowledge learned in the program
through a “real-time” leadership project.
Working either as individuals or as part of a
project team or task force, participants
tackle a real problem facing NSLIJ. For
example, participants have joined existing
NSLIJ task forces focused on reducing sepsis
and improving the provision of care during
advanced illness. In one case, a group of five
participants from the same hospital formed
a team and worked with others in that
hospital to address a specific problem it was
facing. In the most recent cohort, a group of
internal medicine and emergency
department (ED) physicians joined their
respective specialty representatives in
focusing on improving handoffs from ED
physicians to hospitalists.
Other Program Offerings
In addition to the Physician High Potential
Program, NSLIJ offers various other programs
through PLI, each targeted at a different
audience of physician leaders:
20 Best Practices in Physician Leadership Development Programs
Medical Director Education Program:
Launched in 2011, this 18-month program
consists of six half-day interactive sessions
(one each quarter) in which medical
directors focus on the “softer skills” of
leadership. Topics include conflict
management/resolution, change
management, team-building, and how to
influence others. Like the Physician High
Potential Program, this program includes
upfront assessments of personality (through
the Myers Briggs Type Inventory) and
emotional intelligence to assist in addressing
identified gaps. The curriculum is open only
to hospital and nursing home medical
directors within NSLIJ.
Joint Chair Education Program: This
program brings together the tertiary hospital
department chairmen for two to three hours
every quarter to focus on the issues and
challenges they have identified as affecting
their success as leaders. The content for this
program was developed in conjunction with
its participants. The chairmen filled out a
learning needs assessment and picked topics
(from a comprehensive list) they believed
would help them be more effective in their
current role. The program content featured
the six most frequently mentioned topics,
along with one chosen by the medical
leadership (leading and influencing
organizational teams). Like the programs for
medical directors and high-potential
physicians, this program focuses on
leadership styles as seen through
assessments of personality (again using the
Myers-Briggs Type Indicator) and emotional
intelligence.
Chief Resident Education Program: Serving
as a chief resident represents the first
leadership experience for many physicians.
This one-day program (7 am to 5 pm)
focuses on providing leadership education to
these individuals. Topics covered include
emotional intelligence and how to coach,
mentor, and provide others with feedback.
The goal is to help chief residents learn to
assess the performance of other residents
(both clinically and interpersonally), provide
constructive feedback, and address
problems when they arise.
The first half consists of case-based
interactive discussions, while the second half
focuses on learning, through role-playing,
how to deal with junior residents with
specific issues or problems. Common role-
play scenarios might be someone dealing
with a mental health issue or substance
abuse problem, or someone who has
difficulty working with peers as part of an
interdisciplinary team.
Physician Administration Fellowship
Program: Launched in early 2014, this
program is similar to the NSLIJ
Administrative Fellowship Program, which is
aimed at non-clinicians with an advanced
degree in business or public health. During
this year-long fellowship, participants are
immersed in the two worlds of physician
leadership: the clinical environment and the
administrative environment. The curriculum
National Center for Healthcare Leadership 21
is focused on allowing participants to learn
through experiences. Consequently, each
week the fellow spends 50 percent of
his/her time working administratively in one
of four rotations and the other 50 percent
performing clinical duties (i.e., providing
direct patient care).
This program gives physicians the
opportunity to do quarterly rotations
through various parts of the organization,
such as finance, hospital administration,
academic affairs, or the insurance arm of
NSLIJ. Applications must be submitted
almost a year in advance.
Community Hospital Leadership: This
program is offered as an adjunct to physician
leaders at NSLIJ’s community hospitals, in
recognition of the unique issues they must
deal with in this type of facility.
Course topics are designed to help them
respond to the issues community hospitals
face on an ongoing basis, such as
transferring patients to higher levels of care
and the need to rely on community partners,
especially nursing homes and assisted living
communities. There is no set schedule, with
part-day sessions being created as specific
issues arise. Consequently, one month may
feature two programs, each focused on a
specific topic, while the next month may
have none. Sessions typically draw many
physicians from NSLIJ’s community hospitals,
although the target audience varies
depending on the specific topic being
discussed.
Impact of Programs to Date
PLI evaluates a variety of measures in assessing
the impact of its program offerings, with specific
metrics varying by program. Common measures
used include growth in emotional intelligence,
professional development, retention,
advancement within the organization, and
developing bench strength. Analysis of this data
shows that PLI programs are clearly having a
22 Best Practices in Physician Leadership Development Programs
positive impact on the individual participants
and on NSLIJ as an organization. Launched only
three years ago, PLI has greatly expanded its
program offerings in response to the high
demand and rapidly increasing attendance. For
example, the Joint Chairs initiative came about
after several department chairs requested its
creation after having attended the Medical
Director Education Program.
Hard data related to PLI’s impact comes
primarily from the Physician High Potential
Program, which, as shown in the chart below,
has helped participants significantly improve
various components of their emotional
intelligence. (The data below comes from pre-
and post-program assessments of the 55
physicians who participated in the first cohort,
from July 2011 to June 2013.)
Similar levels of improvement in emotional
intelligence have been seen among those
participating in the program for medical
directors, although the sample size for this data
is fairly small as there is only one medical
director in each facility.
Participants also seem to be highly satisfied with
the PLI programs. For example, data from the
first cohort of the Physician High Potential
Program show that all 55 participants gained
new knowledge and would recommend the
program to a colleague, and that 95 percent
believe the program has better prepared them
for a leadership role and/or expanded
responsibilities. The following quotes from
participants are illustrative of these feelings:
“The thought that went into the curriculum
is evident. The ability to take general
concepts and apply them to the decision-
making processes occurring in hospitals and
medical offices on a day-to-day basis was
very helpful, and the interactive workshops
provided excellent opportunities for learning
new skills at many different levels.”
“The program has expanded my intellectual
horizon with an analytical approach to
leadership skills and the value of training in
this area. I have been given new awareness
of the importance of physicians taking on
leadership roles, and appreciate the
administration’s interest in providing us with
the skills to do so. This is a refreshing
program, and very important in the
complicated world of medicine today. The
innovative approaches taught here will likely
contribute enormously to the successful
management of a complex health system.”
From NSLIJ’s perspective, PLI programs have
helped in retaining physician leaders and filling
leadership positions. Between 96 and 97
percent of participants in the first three cohorts
of the Physician High Potential Program remain
at NSLIJ, and the vast majority of internal
physician leadership positions that have become
available have been filled by graduates of this
program. External organizations have also taken
note of PLI programs. NSLIJ was one of NCHL’s
2014 Best Organizations for Leadership
Development (BOLD) award winners. Several
program graduates have been successfully
recruited by other organizations in North
Shore’s competitive market, and in its inaugural
year, the Physician High Potential Program
received the Brandon Hall Group’s Gold Award
for Best Leadership Training Program.
National Center for Healthcare Leadership 23
Critical Success Factors and Other
Lessons Learned
As the earlier program descriptions illustrate,
NSLIJ has embraced most if not all of the 10
NCHL recommendations, and doing so has
played a key role in the success of its programs.
In particular, program leaders highlight the
following as having been central to the
program’s success:
Ensuring senior physician support: While
the impetus for a program can come from a
senior administrator, long-term success will
not be possible without physician partners
and champions. Consistent with NCHL’s
recommendation to ensure executive
support, senior physician champions have
been critical to the success of NSLIJ’s
programs.
For example, NSLIJ’s CMO serves as a vocal
advocate for all PLI programs, and not only
attends many of the classroom offerings, but
also teaches in the programs. Several
participants in the Joint Chairman and High
Potential programs have become faculty
members for PLI programs, thus contributing
to the ongoing education of future leaders.
Starting small and expanding over time:
NSLIJ began with two programs (Physician
High Potential and Medical Director) and
then added offerings over time, often in
response to requests from stakeholders
within the organization. By starting with one
or two offerings, leaders can answer the key
question—“if I build it, will they come?”—
before investing too heavily in programs for
which there is little interest.
Tailoring program to user needs: While the
generic leadership development curriculum
tends to be fairly standard across
organizations, educational offerings must
match the vision and needs of those who
will be using them. If not, sponsors will not
continue nominating individuals and
participants will not extol the virtues of the
programs to others.
Focusing on experiential learning methods:
Consistent with NCHL’s recommendation to
use a mix of learning methods, NSLIJ
employs a variety of adult learning
methodologies and provides experiential
learning, including use of interactive
methods in the classroom (e.g., case
discussions, simulations) and ample
opportunities for physicians to gain
exposure and have experiences outside the
classroom.
Making the program a corporate priority:
Stakeholders within the organization need to
understand that physician leadership
development is taken seriously by those at
the top. NSLIJ has done this through the
following activities: creating formal
nomination, application, and vetting
processes for would-be participants; holding
a graduation ceremony for participants that
is attended by senior leaders from both
individual sites and the system as a whole
(including the CEO); and highlighting and
branding PLI within the larger CLI.
Maintaining close relationships with talent
management department: At NSLIJ, talent
24 Best Practices in Physician Leadership Development Programs
management personnel provide their
expertise during the nomination/sponsor
process by having site-based human
resource executives encourage clinical and
non-clinical leaders to nominate participants
and by reviewing applications for the
programs. They also participate actively in
the programs, teaching topics in areas
where they are subject matter experts and
serving as coaches and mentors. In addition,
on three separate occasions during the two-
year Physician High Potential Program,
talent management leaders and the
leadership of the PLI meet with the medical
leaders who have oversight responsibility for
each participant. During these meetings,
they discuss each participant’s strengths,
opportunities for development, and specific
goals and objectives to be added to
development plans.
These discussions ensure that the site (local)
leaders are keyed into the program, and that
participants receive appropriate
coaching/mentoring in their daily work to
round out and reinforce their development.
In addition, this process allows local leaders
to make sure that individual participants get
exposed to internal and external
experiences that are meaningful to their
work, and gives them the chance to assist in
matching program graduates with
appropriate leadership positions within
NSLIJ when they become available.
Being flexible and accepting that not all
priorities will be funded: In any
organization, competing priorities and
scarcity of resources will sometimes mean
that the priorities of those running physician
leadership development programs will not
be the same as those of senior
administrators and others who control
resource allocation decisions.
Continually evaluating and refining
offerings: The best programs critically
evaluate their programs, refining them
based on both successes and failures. As
noted, PLI uses pre-and post-program
assessments of emotional intelligence, pre-
and post-360˚ assessments, talent
management sessions, and end-of-program
surveys and evaluations. PLI leaders critically
evaluate each program on an annual basis
and make improvements as necessary to
ensure that they continue to meet NSLIJ
organizational and strategic goals.
National Center for Healthcare Leadership 25
Best Practices in Physician Leadership Development: Sutter Health
Who They Are: Brief Overview
Headquartered in Sacramento, Sutter Health is a
non-profit, integrated health system serving
more than 100 communities in Northern
California. With annual revenues of $9.6 billion
(2013), Sutter employs nearly 50,000 individuals
and is affiliated with roughly 5,000 physicians
through the Sutter Medical Network and
approximately 2,500 additional independent
physicians who are part of the medical staffs of
Sutter hospitals. Sutter operates 24 hospitals
that collectively have almost 4,500 acute care
beds, 33 outpatient surgery centers, 8 cardiac
centers, 9 cancer centers, 5 acute rehabilitation
centers, 9 behavioral health centers, and 4
trauma centers. In 2013, Sutter launched a
health plan, Sutter Health Plus, which has been
enrolling members since October of that year.
Sutter Health has received many awards,
including the Malcolm Baldrige National Quality
Award, the College of Healthcare Information
Management Executives’ Innovator of the Year
Award, and the CHART Certificate of Excellence
Award. The Lewin Group, Consumer Reports,
and U.S. News and World Report have ranked it
among the top-performing health providers. The
National Business Group on Health, Modern
Healthcare, The Leapfrog Group, HealthGrades,
and The Joint Commission have honored
individual Sutter Health hospitals for the quality
of their services.
Overview of Physician Leadership
Development at Sutter
Through Sutter Health University (a corporate-
level department), Sutter offers a broad array of
leadership development programs that serve all
levels of leadership within the organization,
including clinical and non-clinical leaders. At
Sutter, leadership development operates as part
of a larger talent management strategy that also
includes talent planning and acquisition,
leadership development, performance
management, and succession management. The
goal is to prepare high-potential individuals by
giving them the skills they need to succeed at
the next level of leadership at Sutter.
Emerging leaders: Individuals who are not currently in formal leadership or management roles, but who may be playing such a role for a specific project, program, or committee
New or established leaders: Managers of
people or budgets (often for a site, department or local service line), such as program managers, assistant and medical directors, section/department chiefs, and other clinical leaders
Senior/executive leaders: Managers of multiple business functions or an enterprise-level service line, such as directors, vice presidents, presidents, and other c-suite leaders
26 Best Practices in Physician Leadership Development Programs
Collectively, Sutter Health’s major leadership
development offerings are part of a collection
known as the “Signature Series,” which includes
several programs specifically for physicians and
others open to physicians, administrators,
and/or other non-physician leaders. By design,
programs for physicians new to leadership tend
to bring doctors together with their physician
peers, while those for senior physician leaders
give them the opportunity to work with non-
physician peers so they learn a multidisciplinary
approach to leadership and gain a broader
perspective on organization-wide priorities and
strategies. While programs vary in terms of
selection process, target audience, size, length,
curriculum, and other elements, they all provide
participants with an opportunity to meet and
interact over a period of several days or months
with communities of leaders from across the
system, allowing them to learn from each other
and to partner and collaborate on real-world,
Sutter-specific projects and activities. As
depicted in the chart below, the curriculum for
all programs incorporates the “4 E’s” of
development: education, experience, exposure,
and exploration, with a heavy emphasis on the
“Physician leadership development occurs within the broader context of Sutter’s overall organizational strategy and leadership development work with all employees and disciplines. It is also part of our
larger talent management strategy.”—Yvonne Gardner, Vice President of Talent Management
National Center for Healthcare Leadership 27
latter three so that physicians learn primarily by
doing and interacting with others rather than by
listening to lectures.
Review of Program Offerings
As noted, several Signature Series programs
exclusively serve physicians, while others bring
together physician and non-physician leaders.
Several programs target specific levels of
physician leadership3, as outlined below:
Introduction to Physician Leadership
This program serves high-potential, “front-line”
physician leaders who are either new to
leadership or who want to be more effective in
their leadership role. It focuses on developing
“soft skills” that allow physicians to be effective
leaders, including emotional intelligence,
interpersonal skills, leadership, team-building,
and building the leader mindset. Supervisors or
sponsors invite physicians to apply for the
program. Each program serves 30 physicians
who attend four day-long sessions (one a month
for four months). Prior to starting, participants
complete a personality assessment (DISC®) and
reading assignments. The classroom sessions are
structured as workshops that pair didactic
methods with small-group activities and
homework assignments that give participants
the opportunity to apply the skills, concepts,
and tools learned in the classroom.
3 One additional program, The Art of Communicating with
Patients, does not focus on leadership per se, but rather on assisting front-line physicians in improving their communication skills with patients.
Physician LeaderLab®
This program serves high-potential emerging
and established physician leaders who are new
to their role (with at least six months’
experience), would benefit from additional
development opportunities, and/or are
experiencing some leadership-related
challenges. Physician champions, committee
chairs, section chiefs, medical directors, and
site/department leads often find this course
valuable. Supervisors or sponsors nominate
individuals for the program, and then play an
active support role once it begins. Six weeks
ahead of the classroom portion, participants
complete the Voices® 360-degree and Myers-
Briggs Type Indicator (MBTI®) assessments and
pre-reading assignments. The 2.5-day workshop
includes a variety of dynamic learning
approaches with a small group (typically 14
physicians), including didactic methods, small-
group activities, and a session with a
professional leadership coach. The focus is on
deconstructing the assessment results and using
them to create a personal development plan.
Participants also learn and apply leadership
concepts, the team characteristics model,
strategies for leading change, and techniques
for difficult conversations. Within 60 days of the
workshop, the coach and participant meet two
additional times. The sponsor also attends the
first of these sessions and offers feedback on
the assessment results.
Physician Leadership Symposium
Introduced in 2013, this annual two-day
symposium (starting on a Friday afternoon and
ending mid-afternoon Saturday) brings together
several hundred physician leaders (both
28 Best Practices in Physician Leadership Development Programs
established and up-and-coming leaders) to
create alignment, hear common messages, and
understand how they fit into the organization.
The goal is to create a community among
physician leaders, allowing them to build
relationships across facilities and departments.
The symposium is modeled after two similar
programs, one that targets the top 400 general
leaders (including 100 physicians) and a second
for approximately 3,500 managers from
throughout the organization. Day one features
presentations from the system CEO and chief
operating officer (COO), followed by external
speakers focused on a specific topic (e.g., use of
social media/networking to engage with
patients and families) and a dinner with
assigned seating where each table engages in a
problem-solving exercise related to a real
dilemma facing Sutter. Day two features
another external speaker, followed by a series
of breakout sessions, with attendees choosing
from available topics.
Executive Development for Physicians
This newly launched program serves high-
potential physician leaders already serving in
substantial, committed leadership roles, such as
a group vice president, medical director of an
enterprise service line, chief medical officer
(CMO), or clinical service vice president. Eligible
candidates are identified through Sutter’s
annual talent review and succession planning
process, nominated by a supervisor or sponsor,
and approved by a regional president or senior
vice president. Those chosen undergo a rigorous
assessment process that includes HoganLead©
(which gauges leadership potential), Voices®
360, and completion of other tools from the
American College of Healthcare Executives. They
also participate in a one-day simulation at the
Development Dimensions International®
Executive Acceleration Center. Once these
assessments and simulations are completed, the
remainder of the program is tailored to the
individual based on the results, including
coursework, assignments, and other
experiences and educational opportunities.
Participants work with an executive coach for 12
months, creating and implementing a series of
individual development plans. They also select
one or more mentors who provide guidance on
specific areas. Participants may also join
professional associations and/or take
coursework to address identified gaps.
Programs for Interdisciplinary Groups of
Leaders
Several Signature Series programs serve
physicians and non-physicians, giving senior
physician leaders the chance to interact and
work with administrators, nurses, and other
professionals (often as part of interdisciplinary
teams), and the opportunity to learn about,
appreciate, and work toward the goals and
strategic priorities of the system as a whole.
Accelerated Change Excellence
This program serves strong, high-performing
leaders, including senior managers, directors
and medical directors, vice presidents,
administrators, and other leaders, giving them
the experience of going through a specific
change project. Participants learn to create the
climate for, influence, and sustain change during
a 7-day classroom program delivered over five
months. For the duration of the change project,
National Center for Healthcare Leadership 29
participants are exposed to senior leaders and
change leaders, and receive one-on-one
coaching from a professional change leadership
coach.
Management and Clinical Excellence (MCE)
This program serves multidisciplinary teams of
individuals at the director or senior manager
level and above. The program consists of 8.5
classroom days over a 4-month period, along
with two pre-course webinars and three
monthly one-hour coaching calls. Participants
work as part of diverse teams, each of which
includes a patient or family member as an
advisor. These teams learn a common language,
skills, and approach to improvement, including
LEAN-based theories and techniques.
Participants present and receive feedback on
team-based improvement projects during the
last two classes.
Leadership Academy
This program targets those who have the
potential to serve in an executive-level role and
an immediate ability to increase their level of
responsibility; physicians represent roughly a
third of each group of participants. Candidates
are invited or nominated to participate as part
of Sutter Health’s annual succession planning
process. This 10-month executive readiness
program develops participants through
academic, experiential, and cohort-based
learning The curriculum includes reading and
discussing books, articles, and case studies that
describe current and classic thinking on leaders
and leadership development. Participants take
on several action learning projects throughout
the 10-month program, working in cross-
functional teams. Teams present their findings
and recommendations to Sutter Health
executive leaders. The full class also
collaborates to complete a Capstone Project,
including a white paper and presentation. All
participants work with an executive coach on
their individual development and receive 360-
degree feedback at the start of the program and
six months after program completion.
Leadership Academy is comparable in time and
effort to an executive MBA program.
Paired Leadership
Still in development, this program will address
an emerging need for Sutter—i.e., helping dyads
of physician and non-physician leaders learn to
function effectively as a management team.
Several years ago, Sutter leaders visited Virginia
Mason Medical Center in Seattle, Mayo Clinic in
Scottsdale, AZ, and other high-performing
organizations, where they learned about the
value of “dyad leadership” as a driver of
MCE provides a wonderful opportunity for physicians and non-physicians to work as partners on addressing and solving specific problems facing Sutter. It serves as a very powerful forum for physicians to make a quantum leap in their leadership skills. —Don Wreden, MD, Chief Medical Group Transformation Officer, Sutter Medical Group
This was one of the most significant learning experiences I’ve ever participated in. In fact I’m using many of the tools and techniques we were taught at Leadership Academy more and more every day with my medical group.”-- Sam Santoro, DO, President and CEO, Sutter East Bay Physicians Medical Group
30 Best Practices in Physician Leadership Development Programs
organizational success. After these visits, the
majority of Sutter’s affiliated medical groups
and foundations adopted the concept, pairing a
physician and administrative leader as a team
charged with running the department, care
center, or service line. This program will provide
an opportunity for these teams to develop
and/or refine the leadership, management, and
interpersonal skills necessary to be an effective
dyad. It will target dyads at all levels of the
organization, from physician-medical assistant
teams working with patients to CMOs and COOs
working together to run a large organization.
Impact of Programs to Date
As shown below, several of Sutter’s Signature
Series programs are rated highly by participants
and have led to improvements in the
competencies targeted:
Introduction to Physician Leadership: Since
December 2012, 97 percent of those who
have participated rate it as being of high
quality and 96 percent would recommend it
to a peer. On average, the 58 individuals
who have completed the program self-
report an average 27-percent increase in the
competencies targeted: emotional
intelligence, team development,
communication, performance management,
leading change, and motivating and
influencing others.
Physician LeaderLab®: Since February 2012,
100 percent of participants rate the program
as high quality and would recommend it to
their peers. On average, the 542 alumni who
have completed the program self-report a
42-percent increase in the competencies
targeted: the ability to maximize team
performance, the ability to lead change, and
interpersonal communications. Program
leaders believe the majority of physicians
who have completed Physician LeaderLab®
have come out as more effective leaders.
Executive Development for Physicians: The
one person who recently completed this
program demonstrated increased
competence in the areas targeted and a 37-
percent improvement in “readiness ratings,”
to the point that the individual is now
deemed ready for an executive-level
leadership position. One of two currently
enrolled participants has been promoted to
a next-level position, while the other has
been named a successor to such a position.
Leadership Academy: Of the 43 physicians
who have completed the Leadership
Academy between 2005 and 20144, 93
percent (40 out of the 43) have remained
with Sutter or an affiliated medical group,
and 40 percent (17 of the 43) have either
been promoted or taken on additional
leadership responsibilities within Sutter or
an affiliated medical group.
Anecdotally, several of the Signature Series
programs have had a profound, positive impact
on physician participants. For example, many
physicians who completed Physician LeaderLab®
have dramatically changed their leadership
approach, including several who realized that
the way they historically interacted with others
and approached issues got in their own way. At
the same time, the program convinced one
physician that he no longer wanted to pursue
National Center for Healthcare Leadership 31
leadership, which also was a “good outcome” as
it allowed the doctor to realize that he was most
happy and effective working outside of
leadership. In another example, a pediatrician
found that the Leadership Academy helped her
better understand both the art and science of
leadership, which in turn helped her feel less
overwhelmed by her role as department leader.
In fact, she came out of the program with such a
passion for leadership that the head of the
Sutter Medical Group created a new position for
her as medical director of recruitment and
retention for the group.
In addition, Sutter’s PLD programs have been
recognized by several outside organizations.
NCHL recently recognized Sutter as one of the
Best Organizations for Leadership Development
(also known as NCHL’s BOLD designation). In
2013, Brandon Hall recognized two Sutter
Signature Series programs. In addition, faculty at
Pepperdine University recently featured Sutter’s
talent management practices in a research
paper.
Finally, because of the direct tie between these
programs and real-world issues being faced by
Sutter, the Signature Series programs have had
generated tangible financial and other benefits
for the organization. For example:
Sutter’s Medicare Affordability project
began as a Capstone Project within the
Leadership Academy. A project team
focused on how to reduce the significant
losses (50 cents on every dollar) Sutter was
absorbing on Medicare patients. The team
developed tangible recommendations that
became the focus of a multi-year effort.
Many team members joined the task force
assigned to this issue, working with Sutter’s
COO, CMO, and other leaders. Ultimately,
the effort succeeded in reducing Medicare
costs by 50 percent while simultaneously
improving quality of care.
Initiated as part of MCE, Sutter’s Variation
Reduction program spread across the
system, leading to $30 million in cost savings
through the standardization of practices
across specialties.
Sutter’s Advanced Illness Management or
AIM program also began in MCE. Thanks in
part to a $13 million federal Innovation
Grant, AIM now operates throughout Sutter,
providing care to patients with chronic
illness and home-based care coordinated by
a multidisciplinary team.
Critical Success Factors and Other
Lessons Learned
As the earlier program descriptions illustrate,
Sutter Health has embraced all 10
recommendations laid out in the NCHL white
paper, and doing so has played a key role in the
success of its programs. In particular, program
“Physician LeaderLab® provides a very personal, often eye-opening experience to physicians who have been trained to be autonomous, independent decision-makers and likely never have experienced a 360-degree review. It gives them a chance to look objectively at how people interact with each other, including how their own behaviors may be undermining their success. They often come out of it very changed as people.”--Don Wreden, MD, Chief Medical Group Transformation Officer, Sutter Medical Group
32 Best Practices in Physician Leadership Development Programs
leaders highlight the following as having been
central to the program’s success:
Ensuring senior executive and senior
physician support: Consistent with NCHL
recommendations, Sutter’s CEO, CMO, and
other leaders are highly involved in the
programs, including the design,
development, implementation, and
evaluation of the various curricula. To
facilitate this process, Sutter’s Physician
Leadership Development Advisory Group
provides guidance to program leaders with
respect to PLD strategy and program
implementation. Consisting of senior
physician leaders, regional CMOs, group
medical directors and presidents, and others
from across the organization, this group
provides direction and input designed to
ensure that the PLD strategy aligns with the
overall organizational strategy, with the goal
of engaging physicians at every level and
ensuring they develop into strong leaders.
For example, in 2011, the group was
instrumental in the decision to phase out a
program focused on management skills and
to introduce one (Introduction to Physician
Leadership) focused more on interpersonal
skills (e.g., relationship-building, influence).
Needs had changed over time to the point
that resources need to be reallocated to
these softer—and in many ways more
important—skills. In addition, business
training could be delivered in other ways.
Making core programs personally relevant
to physicians: Physicians will engage in
programs that have personal relevance to
them. For example, the Physician
LeaderLab® program is an intensely personal
experience completely focused on the
individual, including the provision of
feedback from others. Similarly, the
Management and Clinical Excellence
program gives participants the opportunity
to work on an actual problem facing them.
In many cases, Sutter physicians do not get
paid for time spent in these programs, and
generally have to give up practice time to
participate. Sutter-affiliated medical groups
and foundations sometimes offer stipends to
participating physicians, with decisions
made at the local level.
To make this investment worth the
physicians’ time and energy, these programs
go beyond interesting discussions to focus
on achieving meaningful personal and
professional objectives.
Incorporating issues of relevance to the
organization: Consistent with NCHL’s
recommendation to link programs to
organizational priorities, the curriculum for
all programs is tailored specifically to Sutter,
including case studies, projects, and other
activities. Nothing is “made up,” and
participants get to see the results of their
work actually implemented within Sutter. In
many cases, they continue to work on
projects for multiple years without the allure
of compensation, doing so because they
have engaged in the problem and want to
see their hard work come to fruition.
National Center for Healthcare Leadership 33
Recognizing the need for a broad spectrum
of offerings: Physicians tend to be a very
heterogeneous group, and most
organizations tend to have a wide range of
leadership needs. Consequently, physician
leadership development programs need to
cater to this heterogeneity, as there is no
“one-size-fits-all” answer.
Starting with the basics: If starting a
program from scratch, initial offerings
should include a “Leadership 101” program
and a program focused on those with “high
potential” to be effective leaders. The
introductory course can be offered to the
large number of physicians who are early in
their leadership career (e.g., members and
chairs of committees and task forces), while
the high-potential course can provide an
intense, personal experience for those who
have a year or two of leadership experience
and exhibit high potential for the future.
Not reinventing the wheel: Much is already
known about how to develop and execute
effective physician leadership programs. For
example, Brent James, MD, a well-known
physician leader and quality improvement
expert at Intermountain, helped develop the
Management and Clinical Excellence
program at Sutter. Additional guidance for
several physician leadership development
programs came from James Stoller, MD, of
The Cleveland Clinic.
Providing opportunities to interact with
non-physicians: The best physician leaders
know how to interact with those who are
not doctors, including how to communicate
effectively and act as “humble advocates”
for change. As noted earlier, Sutter
purposely designed its offerings so that
those new to leadership spend most
program time with physician peers, while
mid-level and more senior physician leaders
work as part of multidisciplinary leadership
teams.
Leveraging external faculty who tailor their
material to the organization: Consistent
with NCHL’s recommendation to use a mix
of internal and external faculty, Sutter
contracts with many external faculty, in part
because the organization does not have the
internal resources to staff its many course
offerings. In many cases, external faculty
members have worked with Sutter for
decades and hence understand the
organization and tailor their materials
accordingly.
Emphasizing experience, exposure, and
exploration: Consistent with NCHL’s
recommendation to employ effective
learning methods, Sutter places heavy
emphasis on case studies, projects, and
other real-world activities, with limited use
of didactic education. Most courses require
participants to spend substantial time
working as part of teams outside the
classroom, which is where the “real
learning” occurs.
34 Best Practices in Physician Leadership Development Programs
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