Forum Focus – Physician leadership: The implications for a transformed delivery system

This article first appeared in the February 2014 edition of H&HN magazine.

By John R. Combes, MD

As health care delivery enters a generation of transformation, effective collaboration between physicians and hospitals is more essential than ever.

Strong environmental forces are pushing the separate clinical and operational management models of today’s hospitals to find new ways to collaborate and create a clinical management structure that addresses the efficient use of scarce resources while maintaining strong clinical quality and patient focus. Increasingly, physicians are being called upon to bring their expertise to bear on the management of the clinical enterprise.

Today, approximately 5 percent of hospital leaders are physicians, and that number is expected to increase. Arguably, clinically trained leaders can offer significant insight into patient care, quality and safety issues based on their experience and training. In addition, when physician leaders partner with health care organizations, together they can drive better care coordination. However, until recently, a pathway for physicians to gain the competencies to lead a transformed delivery system was not clear.

As physicians continue to assume leadership roles and serve as drivers of the future health care enterprise, they will need to think long term, understand and be able to see the larger issues, promote collaboration, cultivate a team-based environment, and possess excellent communication and listening skills. On the journey from medical training to practice and leadership, physician leaders often receive little formal training in these skills. As the field continues to embrace leadership development of physicians, education on nonclinical areas such as visioning, managing people and finances, and population health management must and are being implemented at all levels of learning.

In July 2013, the AHA’s Physician Leadership Forum held a session in conjunction with the American College of Physician Executives on physician leadership and the implications for a transformed delivery system. The program included an overview of the changing landscape and the leadership competencies physicians will need to be effective partners with health care organizations to move toward a more accountable and efficient health delivery system. In addition, a panel of experienced physician executives shared insights on different leadership education modes and methods that have proven successful. The PLF published these proceedings, along with a literature review highlighting the need for physician leadership development and characteristics to consider for education programs. To access the full report, please visit

As the complexities of health care reform take shape, more physicians will be called upon to lead the change. Who better to address challenges faced by health care organizations today than those with experience on the front lines? It is imperative, however, that leaders have a common language and the necessary skills and training. Competencies in change management, a strong understanding of the economics of health care, team building and communication skills will be in high demand for all leaders and will comprise many physician leadership educational programs. Navigating the rapidly changing health care landscape requires engaged physician leaders who can take charge of initiatives such as medical home development, care coordination, chronic disease management, practice management, information systems implementation and strategic planning. Physicians who possess the right mix of leadership competencies will serve as effective partners with hospitals and health systems to move toward a more accountable and efficient health delivery system.

John R. Combes, MD,
is AHA senior vice president and president and chief operating officer of the AHA’s Center for Healthcare Governance.

Characteristics of an effective hospital medicine group

This post originally appeared on The Hospital Leader.

By Burke Kealey, MD

It’s here. Today in the Journal of Hospital Medicine, SHM is publishing The Key Principles and Characteristics of an Effective Hospital Medicine Group: An Assessment Guide for Hospitals and Hospitalists.

That’s a mouthful of a title but really a simple document.

The main thrust of the paper is to be a guide and a tool for reflection for our nation’s hospital medicine groups (and maybe the C-suite too!). We are still a young specialty populated with young hospital medicine groups. The oldest groups we have are only 20-25 years old, many are less than five years. With that broad range of clinical experience comes a broad range of business and leadership experience, too. The Society asked itself, how could it put a tool in the hands of those leaders that showed them some of the key characteristics of our more experienced and successful groups. Over 200 leaders in the field of hospital medicine and even throughout the healthcare industry gave input, ideas, and refinements over an 18-month period.

The eight esteemed authors, all experts and leaders in practice management, helped shepherd the process and whittled down the many ideas captured into the document you see today. It is now 47 characteristics grouped under 10 major principles. Not every characteristic or principle applies to every kind of practice, for example an academic inner city practice may not share every characteristic for success with a rural small group in a community hospital, nevertheless every practice should be able to see themselves in this document and see things that they can aspire to.

As I hinted at above, this document is also meant to be read and used by those in the hospital C-suite. Just like we see a variety of hospital medicine practices, we also see a variety of understanding of how hospital medicine practices can best be supported by hospital leadership. Is there dedicated space for the hospitalists? Do the hospitalists have adequate support staff? Our hope is that this paper — which is also being promoted by other leadership groups, like the American Hospital Association, the Healthcare Financial Management Association, the Medical Group Management Association and the American College of Physician Executives — will reach the eyes of those who can better help our hospital medicine groups succeed and improve care for hospitalized patients.

In addition to creating this paper, the authors and the society will be taking further steps to validate and refine it. After publication, the group will be identifying 20 representative hospital medicine groups and asking them to review their own characteristics and processes in relation to the paper and then look at both applicability and ease of validation. This information will be brought back and analyzed to see if the characteristics as published are hitting the mark and if so how effective are they at being a guidepost for hospital medicine groups. What refinements will be needed to help even more groups going forward?

This is an exciting day for those of us who have been watching this paper unfold over the last few years. We look forward to hearing from hospitalists and hospital medicine leaders to make sure it is meeting their needs, so please share with your colleagues in the hospital.

Burke Kealey, MD, SFHM is the Associate Medical Director for Hospital Specialties at Park Nicollet HealthPartners Medical Group in Bloomington, Minnesota. Dr. Kealey serves on SHM’s board of directors, and SHM’s President-elect. He will take office in March 2014.