The dyads that are less effective are characterized by partners who take more of a divide-and-conquer approach, he says. “Sometimes the nonphysician executive will say, ‘I know the administrative side and how to run an enterprise, so I’ll do that,’ and the physician half of the dyad will say, ‘I’m the expert in patient care, so I’ll look after that.’ That’s not an integrated dyad, and some organizations are falling into that trap.”
Individual clinicians can also be plagued by a host of “barriers and baggage” that can thwart their effectiveness, according to Massingale, whose company oversees more than 19,000 physicians. Qualities that can create challenges include resistance to change and a preference for autonomy over teamwork.
“Doctors are also used to being pretty autocratic,” he adds. “We write an order, and we expect someone to take that order off the chart and do it, whereas there’s a lot more consensus building in leadership roles.”
In addition, a widespread dilemma physician and nurse leaders face is forgoing some degree of one-on-one patient care to make time for administrative activities.
The right bedside-to-boardroom ratio varies by organizational policy and clinician preferences. Clinical leaders at AHN, for example, are almost all required to maintain some clinical practice, Hundorfean says.
Rubino says he has gradually reduced his clinical load over the years as his career encompassed greater and greater administrative responsibilities. As president of AHN’s 315-staffed-bed Forbes Hospital, he spends about 20% of his time seeing established patients of his 30-year-old OB-GYN practice and 80% on administrative responsibilities.
“I feel my level of clinical activity allows me to continue performing at the highest level. I impose a high standard on myself and would cease to operate or maintain clinical responsibilities if I or others witness anything less,” he says.
Moreover, the close relationship Rubino shares with his patients makes them comfortable sharing both good feedback and bad, he says. “They do not hesitate to tell me about their experiences at the hospital or their interactions with our caregivers.”
In addition, “I still operate, which I think gives me a certain level of credibility among my fellow caregivers because whatever clinical issues they’re facing, I’m facing as well,” Rubino says.
The Mayo Clinic espouses a similar philosophy, Noseworthy notes, which helps ensure clinical leaders are “walking the walk.”
Some leaders, on the other hand, eventually arrive at a difficult crossroads where they must choose one path, says Cracolici. “A very wise mentor of mine once warned, ‘You’re going to reach a point where you can’t work as a staff nurse on weekends and then work all week as an executive. To avoid burning out, you’re going to have to decide which one you’re going to give 150%.’ It was a challenging decision I think a lot of individuals face.”
Distefano no longer works as a nurse while serving as a hospital CEO, but has made peace with the transition. “You kind of move from being a steward or focusing on one patient or a small group of patients to affecting a larger group,” she says. “It’s admittedly a different approach. I’m not physically laying hands on patients, but I feel like I’m still improving patient care because I’m working on policy and decisions that have a broader impact. I still feel like I’m close to the patients.”
Debra Shute is the Senior Physicians Editor for HealthLeaders Media.