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Dyad Leadership Model Improves Communication, Cooperation

 |  By Jennifer Thew RN  
   April 07, 2015

To better adapt to changes in the healthcare industry, Lakewood Health System adopted a dyad leadership structure pairing administrative and clinical leaders.

Teresa Fisher, RN, MA, BSN

If you think farm fields, cows, red barns, and silos are synonymous with the Midwest, a conversation with Teresa Fisher, RN, MA, BSN, will change your mind. Since joining Lakewood Health System in Staples, MN, a year ago, Fisher has been committed to getting rid of silos—the organizational kind, that is—through use of a dyad leadership structure.

A siloed organizational structure—defined in this case as clinical leaders heading up clinical operations—"works very well in traditional healthcare models, but it does not work when you're trying to move as a system and be system-thinking," says Fisher, COO/CNO at Lakewood, a small, independent health system comprising a 25-bed critical access hospital and five clinics.

To be successful in today's fast-changing healthcare landscape, healthcare organizations must embrace a culture of cooperation and move away the insular and narrow perspective that silos foster.

"You can't do it on your own," she says of tackling the challenges presented by healthcare reform, changing payer expectations, and new quality requirements.

Instead, an organization's executive leaders, physician partners, and other stakeholders must follow a unified vision and strategic plan. The dyad leadership structure, which pairs an administrative leader with a clinical leader, can help facilitate the partnership and cooperation needed to achieve shared goals.

A modest proposal: moving to the dyad structure

Before coming to Lakewood in March 2014, Fisher worked at Centura Health in Denver where a dyad leadership structure had been in place for three to five years. She had seen how this leadership model could help an organization adapt to the cascade of changes brought on, in part, by healthcare reform, and she thought Lakewood could benefit from implementing a similar leadership structure.

"The dyad model really allows that administrative team, along with the physician team, to be equally represented in decision-making," she says.

"My experience was that [with a dyad model] we might have better and more deliberate traction without all of the uproar, dysfunction, and debacles that can happen when you have your traditional administration leadership not partnered with the physicians," Fisher says.

Though the dyad model would be an adjustment for everyone at Lakewood, its use would actually make it easier to cope with changes in the future.

After a few months as CNO, Fisher proposed that a dyad model be implemented at Lakewood, and President/CEO Tim Rice agreed. As part of the restructuring, Fisher's original role of CNO was expanded to a dual position of CNO/COO, and she was paired with CMO John Halfen, MD, to form the "system dyad." The pair have been working together to run day-to-day operations at Lakewood since August. The other dyad teams of "clinical services" and "growth and development" were rolled out last month.

Opening the channels of communication

Even though she previously had worked in a dyad structure at Centura, Fisher faced some new challenges when implementing the model at Lakewood. One major difference was the fact that Lakewood does not employee its physicians. This means that physicians working in Lakewood's system are basically independent vendors.

"You can imagine all the things we need to do as a system … will be much more challenging if we do not have a partnership between the physicians and the administration," says Fisher. "We have to get us all together on the same page with the same common goals and align as system so we're working together and not resisting change."

Change is always difficult but in an employed model, leadership has more leverage to get physicians to comply with organizational standards and initiatives. At Lakewood, mandates like that aren't an option. Instead, leaders there must rely on building trust and creating relationships, both internally and externally, in order to achieve their goals and mission.

That's not necessarily a bad thing.

"The biggest benefit is that we're openly communicating. We're building trust all around the organization," says Fisher. "Having aligned, common goals is critical and the dyad model helps us get there."

The cohesive problem-solving fostered by the dyad model has enabled Lakewood to tackle big changes such as joining an ACO and implementing Epic's EMR. Another example is the creation of an 18-month strategic plan aimed at maintaining Lakewood as a successful independent facility that meets the needs of patients and the community. The plan was posted online for anyone to view.

"The benefits [of the dyad approach] outweigh the traditional model of 'us, them, we, they,' " says Fisher.  "We talk about everything and I meet daily with my partner. We don't make decisions independent of each other."

Jennifer Thew, RN, is the senior nursing editor at HealthLeaders.

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