A Homegrown Approach to Physician Leadership

Physician leadership expertise doesn't have to come from a consulting firm. A large nonprofit health system in the Pacific Northwest has developed its own leadership academy, which is saving money and providing physicians with problem-solving tools and skills.

Like many other health systems and hospitals, Legacy Health, one of the largest health systems in metropolitan Portland, OR, looked to outside help provide leadership development opportunities for its employed physicians. With six hospitals, a medical group, hospice, and other health clinics, the large system needed a robust program that could handle volume with ease.

After weighing the benefits and costs, Legacy Health decided instead to launch its own leadership initiative in 2009, called the Physician Leadership Academy.

After five years, Lisa Goren, co-director of the academy and program director for physician alignment & engagement, says Legacy Health has saved money and provided physicians with crucial training they don't get in medical school by building its leadership program internally.

"We estimate savings of at least $500,000 by offering it in-house," says Goren. "When I look at doctors, most don't have a first job until 26, then they get so much medical training in residency that by the time they're in their early 30s, patients ask, 'Why are they like that?' We have to take it into our own hands to mold the rest of their professional development. It was an obligation, but now it's a necessity."

Legacy's Physician Leadership Academy offers physicians free continuing medical education credits to its physicians as a way to encourage participation in leadership classes.

Goren says physicians, by nature, are eager students, and by offering free, traditional CME classes, she and Physician Leadership Academy co-director, Melinda Muller, MD, clinical vice president for primary care, tap into what the doctors want to learn through the formal evaluations that physicians must fill out to earn CME credit.

That philosophy reminds me of the childrearing advice known as Grandma's Rule: Do what you need to do first, then you get to do what you want.

Muller says that initially, the leadership classes were based on the programs she attended through various societies, organizations, and conferences. At first, the classes were basic. For example, early healthcare finance classes were along the lines of "how-to-read-a-spreadsheet."

But those classes have since evolved, because physicians are telling Muller and Goren that they want to learn more. "Now we talk about capitalization, and it is one of the highest-rated classes," says Muller.

3 Levels of Leadership Courses
The first level of Legacy's Physician Leadership Academy is sort of like a starter course for leaders, and helps identify potential leaders for the future.

There are also two other levels within Legacy's Physician Leadership Academy. There is what Muller and Goren call an "emerging leadership" class, a one-day event offered only to employed physicians at Legacy. It's a big picture overview of how to lead at Legacy. It's offered twice a year, and is geared toward a smaller group class, with room for about 10 physicians.

Muller says within primary care, she's seen physicians go through the emerging leadership class go on to become medical directors.

"I can see the growth in how they lead, as their supervisor," says Muller. "The number of people I'm getting notified about getting nominated to [this class] is also increasing. In our system all of our physician leaders are paired with an administrator and interactions are much more fruitful and constructive. I can see culture changing."

The third level of classes is the deepest dive, called Leadership Foundations. It's a two-and-a-half day program, and the participants have to be in a formal leadership position at Legacy Health. This is the class where physicians leadership skills are put to the test, says Muller.

"One of our leaders who just went through the Foundations course is responsible for surgical site infections, and was struggling to push things to the next level," says Muller. "He felt that the skills he learned helped him look at the problem differently. He looked at the process of patient flow and staff… made changes in both, which increased throughput. We've seen an improvement in quality. Is it all physician leadership? No, but it is part of it."

Muller and Goren both use anecdotes from physicians who attend the leadership academy to show improvement. It's difficult to empirically tie outputs to the soft, but important skill of physician leadership. A 2011 study attempted to show the relationship, but the quality indicators the study relied on were U.S. News & World Report rankings, which are not widely accepted as healthcare industry standard for quality.

Expansion
However, Muller believes that Legacy's readiness to become certified as an NCQA patient-centered medical home would not have happened without Legacy's Physician Leadership Academy. Legacy has applied for, and believes it will attain this year, PCMH status for all 23 of its primary care clinics. It piloted the medical home model at five sites from 2007–2010. That number quickly grew to 18 by 2011.

"Once we got the model down, figured out what it was, we were able to roll it out to other sites," she says. "As we've opened new clinics, we've opened them in the model. Part of the reason we've been able to push it quickly is because of the training and coaching.

A key ingredient to Legacy Health's Physician Leadership Academy is that the classes are taught by leaders of the organization. The CEO teaches, but more than that, he leads by example, which underscores the value an organization places on leadership attributes. Developing physician leaders, or any leader, is more than throwing a few buzzwords around in a memo or meeting. Real leadership skills are learned over time, and by example.