Physicians at the Helm: Executive Duo Adds a Physician's Perspective to Leadership

A rural healthcare organization makes a physician its CEO and partners her with a former CEO to add the credibility of a physician's voice to its conversations about quality of care and patient experience.

This is the second in an occasional series of conversations with physicians who also lead hospitals, health systems, and other provider organizations. In this installment, I talked with Deborah Agnew, MD, FAAP, and Kelley Evans, who will co-lead a new model of leadership at a rural organization in Montana.

Billings Clinic, one of the largest healthcare systems in Montana, recently appointed Deborah Agnew, MD, FAAP, to be one half of the new CEO/CAO dyad leadership model at two of its sites: Beartooth Billings Clinic and Stillwater Billings Clinic. Both sites of care are rural integrated healthcare organizations, which bring together physician offices, an emergency department, and a 10-bed critical access hospital under one roof.

Agnew's new role is CEO; Kelley Evans, who will be CAO (chief administrative officer), has served as CEO at one of the sites—Beartooth Billings Clinics—for more than two decades.

The new leadership model and partnership between Evans and Agnew is only one month old. They both told me they are committed to developing a strong relationship that will empower patients and strengthen rural healthcare.

HealthLeaders: What prompted the change in developing a leadership model that establishes a physician as CEO and co-partner of two Billings Clinic hospital sites?

Agnew: I think it was a long time coming to this level, but it has been foundational. Eight years ago, the clinic really stepped back and looked at our structure and strategy goals and recommended that if we wanted to have physicians at the table, we needed to give them dedicated administrative time and compensation.

They created the division chief council—a department manager and a department chair. I was chief of primary care, and my partner was a director of women and children's services. That was established with the goal of fortifying the dyad model. This opportunity came up in the spring when they decided they'd bring together a longstanding partner with experience, Kelley Evans, and partner her with me.

We are equal in terms of accountability for success. We also really needed to spread out the cost for two facilities. I would say that we've taken the lead from Mayo Clinic—they endorse this model, and we've learned a lot from them. It's another force.

Evans: I've been at Beartooth for 25 years. For the first 10 years, we were a nonaffiliated organization, but when things became more complex, more challenging, the board chose Billings Clinic because of its reputation for quality. [Editor's note: last month Trinity Health announced that it had signed a Letter of Intent between Trinity Health and the Billings Clinic RegionalCare Hospital Partners Joint Venture in which Trinity Health will become part of Billings Clinic RegionalCare.]

In 2010, we opened new replacement facility, and with the integrated model, we started looking at how to get it to be physician-led. We did an experiment, creating administrative time for a physician, but immediately the result was diminished revenues in the clinic. Billings Clinic became aware that Beartooth was struggling to find a balance. The opportunity came when the CEO of Stillwater made a decision to retire.

HealthLeaders: Dr. Agnew, what has been your approach to developing your skills as a physician leader?

Agnew: When I was chosen to be the chief of primary care eight years ago, foundational to that was the commitment by the organization to prepare me. During the first three to four years it meant getting a lot of extra training, and there is a lot available. I learned about finance, strategy, bargaining, physician recruitment, EMRs, and process improvement methodologies.

I'd go away for a week and come back and put it into practice. My willingness to take this job was entirely dependent on who my partner would be, and Kelly [Evans] was the clincher for me. I found someone equally willing to try. I also feel like I don't have full accountability. It's shared. We get to be experts together. That's a new thing, because all roads lead to one person. Sometimes I step forward, sometimes Kelly will step forward. I hope we can prove this is very successful. Having many, many lenses into how you tackle things is healthy. This was a unique opportunity to step into this role with the right partner.

HealthLeaders: Kelley, as a longtime CEO, what kind of progress do you feel has to be made in the next six months?

Evans: We need the credibility of a physician's voice when we are talking about quality and patient experience. It's an incredibly close relationship that physicians build with staff who are impressed and awed by a physician's presence. They are the leaders of your organization, with or without a title, and the temple of quality is set by the physicians. I've seen it.

For rural organizations, they are the silent leaders. They can create incredible moments of greatness when a life is saved in the rural ED. That's what I see as the two key things we will be looking at: patient experience and the relationship staff have with physicians.

HealthLeaders: What kind of structure are you setting up to determine how to co-lead at two different physical locations?

Agnew: We have accountability for these two organizations, but there are bridges being built with Billings Clinic. We are both affiliated with Billings Clinic, and they have a clear set of goals: quality and patient experience. All three organizations are in sync; our role, our job, and our goal is figuring out the best practice at the regional, system, and local levels. We have intentionally spent a fair amount of time together in both organizations. We want the leaders to see us together; we want to meet together. We've spent more time at Stillwater because they lost their leader. It's important for us to be there to reassure them that things will be okay.

There's no sense of loss at Beartooth at all. We've been putting out a lot of fires, and it's great because it gets you down in the weeds quickly, which is where you need to be. We are embarking on something very powerful, and we are deeply committed to culture being a driving force.

Evans: We both feel a lot of pressure in this first six months. Everyone is looking to see what will happen. Fortunately, we're both coming into this with both organizations doing well financially. One of the most important things for Deborah is for her to establish a relationship with both boards, and both of us adjust to the culture.

How to Jump-Start Culture Change

They are dramatically different cultures. To make good leadership decisions, that piece has to come together quickly. After 25 years, I don't want to be stale, I like new ideas, innovation, and change, and it seemed the right solution at the right time. I'm delighted.