Forum Focus – The skills doctors and nurses need to be effective executives

This article originally appeared on the Harvard Business Review (www.hbr.org) on April 7, 2015.

By Sachin H. Jain, MD

We are witnessing an unprecedented transformation of the health care industry. There has been a rapid growth in jobs and an explosion in the number of start-ups. There are new types of insurance companies such as Oscar; novel provider organizations such as OneMedical, IoraHealth, and ChenMed; and new health information technology companies such as Castlight, Vital, and WellFrame that aim to use technology to improve care and value. Physicians and nurses are being called upon to lead these new health care enterprises — and are assuming a higher level of influence in the business of health care than ever before.

Maximizing the effectiveness of physicians and nurses in these new positions, however, will require different skills than the ones they developed during their clinical training. Having managed or worked with clinical leaders in care-delivery organizations, the pharmaceutical industry, and government, I have observed three skills that are critical to the success of doctors and nurses as they make the transition to management:

Operations management and execution. Many physicians and nurses excel at operations management because it requires the same kind of detail and complexity that is required to effectively manage a large clinical load.  In clinical work, we must constantly triage patients and parse significant amounts of low and high-level detail. Many clinicians manage a small operation in the form of their own clinical practice or ward before shifting to leading larger operations.

Still, many clinicians struggle with operations management because they fail to appropriately distinguish between urgent tasks and important, non-urgent tasks — often letting the latter fall by the wayside in favor of the former. Just as a first-year resident physician or a fresh nursing graduate must learn to manage his or her own workflows and develop a plan of attack to manage a patient’s issues, so too must a new clinician executive learn to act with urgency and ownership to build an organization’s workflows and address its problems. Clinician leaders should recognize this potential gap in perspective and work actively to make sure that tasks are appropriately triaged by priority level.

People leadership. When thrust into a management or leadership position, many clinicians have never hired or fired anyone in their life. The instincts crucial to deciding whom to hire and how to hire them managing others’ performance are often underdeveloped in clinical leaders. For example, many clinicians, by nature and by training, are kind and compassionate. While these qualities help engender loyalty, they often make some of the difficult conversations associated with managing people especially challenging.

To accelerate the development of their people-management skills, clinicians should partner closely with fellow business leaders and HR professionals. These colleagues can be instrumental in helping them surface their needs and identify tactics to build and manage high-performance teams. These colleagues can also serve as sounding boards when they must make hard decisions and hold inevitable hard conversations.

Setting and defining strategy. Many clinician leaders are drawn to roles in which they can actively work to define organizational structure and strategy. While strategy roles often tap the strengths and deep frontline knowledge of clinicians, executives with clinician backgrounds often forget that creating a strategy involves making trade-offs. The decision to pursue one set of activities is often a decision not to pursue another. Strategy guru and Michael Porter of Harvard Business School elegantly articulated this when he wrote that strategy is both what we choose to do — and what we choose not to do. Clinicians must work to develop organizational strategies with this simple and important maxim constantly in mind.

One CEO with whom I have worked remarked that physicians and nurses run the risk of losing their clinical identities as they develop into executives. It would be a shame if they did. As they transition to careers in the business of health care, clinicians must hold on to the heart and practice of medicine as they continuously develop the core executive skills required to effectively lead and shape their organizations. Health care will be markedly better for it.

sachin_jain2
Sachin H. Jain, MD, is chief medical officer of the CareMore Health System, a division of Anthem, Inc., and a lecturer in health care policy at Harvard Medical School. Follow him on Twitter at @sacjai.

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