The University of Texas MD Anderson Cancer Center is one of 50 nationally designated centers devoted exclusively to cancer patient care, research, education, and prevention. Yearly, the center cares for 174,000 cancer patients, conducts thousands of clinical trials, and spends $1 billion on research. Located in the largest medical center in the world with a progressively competitive landscape, resulting in an increased focus on the patient experience, the center also provides uninsured or underinsured patients with more than $238 million in uncompensated care.
THE PROBLEM
Healthcare organizations are expanding to provide specialized cancer care, and patients are choosing care based on proximity and speed of access to services. This has resulted in an increased focus on improving patient experience through differentiators such as leadership development. Leadership development in healthcare is particularly important to successfully navigate complex academic medicine health systems, new payment models, advanced technologies, and changing care workflows.(1,2)
We learned through our exit and biennial engagement surveys that the most common reason for departure was a lack of career development opportunities. Significant resources would be needed to address this multifaceted issue systematically and effectively. To ensure a worthwhile investment, we would need to investigate not only participant perceptions, learning, and attitude change, but also the transfer of skills to the job and the impact on individual and organizational outcomes.
Beyond program availability, we would also need to ensure that the investment of resources in leadership development is aligned with our organization’s mission, that active participation would be supported by leadership and the organization’s culture, and that systems of accountability would ensure short-term and long-term gains.
LEADERSHIP INSTITUTE
The Leadership Institute at MD Anderson, launched in the fall of 2018, takes a defined, comprehensive approach to developing existing leaders and creating trained talent pathways for our organization. Our philosophy is that everyone is a leader, regardless of the formal title held across administrative, clinical, research, and education functions. Each day, we need to display leadership characteristics and competencies in all situations to serve one another and the MD Anderson community.(3)
Specifically, the Leadership Institute focuses on leadership and employee development, enveloping curricula, mentoring, coaching, selection, surveys and assessments, change enablement, and team development for faculty and employees at all levels (see Table 1). These programs support all leaders as they transform into relentless learners across the entirety of their career lifecycle.
Development at All Levels
There are four tracks of development: Core, Competency, Discover, and Accelerate. The Core curriculum develops the foundation of leadership skills and behaviors necessary to succeed at the individual’s current level of leadership. The Competency track is based on the learner’s particular competency needs. Discover and Accelerate tracks are designed to help individuals prepare for advancement before the opportunities arise.
1. Core Track. See Figure 1 for the target population for each Core level. We applied for and received Continuing Medical Education credit.
Leading Self. The first steps of leadership development begin with the individuals reflecting inward on who they are as leaders. Course topics include change, professionalism, emotional intelligence, difficult conversations, and awareness of bias.
Leading Others. This program is designed to help leaders manage performance, create an environment of trust, and reinforce the need to deal directly with challenging situations. Course topics include emotional intelligence, performance management, psychological safety, change leadership, and difficult conversations. This bundle of programming is certified by the American Association for Physician Leadership (AAPL).
Leading Teams. This program is designed to help leaders of other leaders identify and understand the critical issues they have in common, engage in candid discussions about the most challenging aspects of that work, and develop the skills needed to demonstrate strong and effective leadership. The cohort-based program includes didactic, simulation, and interactive learning, accompanied by coaching. This programming is also certified by AAPL.
Leading Leaders and Leading Institution. This program supports our senior leaders and executive leadership team in leading by example in their own growth, supporting the growth of others and the institution. Three full days each year are dedicated to these learning sessions. The topics for this program change every year; examples include change management and decision-making, safety and engagement cultures, wellness-centered leadership, and data literacy.
2. Competency Track: A deep dive into competencies needing further development allows for customization of the leader’s experience. Offerings following our competency model (see Figure 2) are available to support the leader’s journey. For example, we have courses designed to develop business acumen competency with a focus on financial skills.
3. Discover Track: Offered at the leading self, others, and team levels, this track is focused on opportunities for individuals motivated to grow in their own development with aspirations toward a different leadership level. The program is self-driven and can be flexed around the learner’s schedule. It offers 40 hours of online learning, mentoring, and self-guided activities over five months.
4. Accelerate Track: Similarly offered at the leading self, others, and team levels, this track is focused on opportunities for individuals who have demonstrated capabilities in leadership at a higher level, ready to take on development in preparation for future roles. The cohort-based programs offer more than 40 hours of leadership development, which includes in-class, self-study, mentoring, coaching, and sponsorship over 5–10 months.
Student Programs
We offer experiential learning programs for students and recent graduates with a focus on leadership development. Our Administrative Fellowship Program offers early careerists an opportunity to develop their leadership style and to use their skills and competencies in day-to-day operations.
The MHA/MBA summer internship integrates knowledge and theory learned in the classroom with practical application and skills development in a professional healthcare setting. Our Human Resources Externship Program provides an opportunity for undergraduate students to enhance their academic preparation by working side by side with human resource professionals. Lastly, Learn2LEAD targets underserved high school students, providing knowledge and skills related to leadership and interpersonal skills.
Coaching
Coaching is a key development tool within the Leadership Institute, supported by a blend of International Coaching Federation (ICF) certified internal and external coaches. We developed the CoachFINDER, an online searchable database of internal coaches where any employee can review profiles and request a meeting with their desired coach. We have multiple coaching programs, including 1:1 coaching, onboarding coaching, and team coaching, as well as coaching training through CoachRICE and Coach2Lead.
Coaching 1:1. Traditional one-on-one coaching involves a series of sessions between an internal or external coach and the leader. The coaching is customized to the leader and lasts 6–18 months.
Onboarding Coaching. Newly hired executives or faculty leaders and current employees recently promoted into a position of higher leadership are automatically assigned an onboarding coach to support them in their first 9–12 months in their new role. They receive 15 hours of coaching, including three triad meetings with their one-up.
Team Coaching. An internal or external coach works with an existing team to achieve a common goal. The length and focus of the coaching are customized based on the team’s goal.
CoachRICE. In partnership with Rice University’s Doerr Institute for New Leaders, this program prepares a cohort of leaders to become International Coaching Federation-certified coaches. Certified coaches are then expected to serve as coaches for our cohort-based programs, including Leading Self Accelerate, Leading Others Accelerate, and Leading Teams Core. They also are available through CoachFINDER for any employee who is interested in coaching.
Coach2Lead. This program develops leaders’ interpersonal competencies to promote a coaching culture within their teams. Sessions focus on skills related to coaching stars, emerging talent, disengaged talent, and teams.
Mentoring
The mentoring program provides many opportunities for leaders to become effective mentors and mentees. Through 1:1 mentoring, engagement circles, onboarding mentoring, champions, and mentoring up, there are programs to meet all employees’ diverse needs.
1:1 Mentoring. Employees leverage an online platform to match with one another to better navigate their career path. Relationships can vary in duration; employees are encouraged to engage in multiple relationships as both mentee and mentor.
Engagement Circles. Engagement circles are peer-mentoring activities that help leaders create organizational relationships and networks, drive career development goals, build key skill sets, expand organizational knowledge, and increase functional expertise. Each circle is facilitated by two co-leads from senior leadership, with approximately 12 employees per circle.
Onboarding Mentoring. In collaboration with the recruitment department, the onboarding mentoring program supports new employees by matching them with a mentor for the first six months of employment, thereby helping new employees acclimate to the organizational culture and make connections across the institution.
Champions. A mentoring champion represents their division and serves as a mentoring advocate within the institution. The champion disseminates information about mentoring programs and helps their areas’ mentoring efforts with the mentoring team’s guidance.
Mentoring Up. In this reverse-mentoring program, roles are flipped as employees serve as mentors to executive leaders to give a different perspective and share experiences from the front lines. Executives and employees meet throughout a 12-month period; a shadowing experience is included for the executive leader to round in the front-line employee’s work environment.
Change enABLEment
Internal change experts created our change enABLEment model through a literature review, stakeholder engagement, and a multidisciplinary workgroup. The model showcases the activities, behaviors, and actions that allow change agents to successfully lead their teams through change (see Figure 3). Courses build skills in change leadership; leaders learn how to navigate the four phases and leverage the associated tools.
Align: Identify and communicate the opportunity and make the case for change for various impacted stakeholders. We work with the leaders of the change using tools such as a change readiness assessment, a business case, and a change vision statement.
Build: Understand how the change will impact stakeholder groups and develop detailed plans to prepare them for success in a future state. During this phase, we work with leaders using tools such as stakeholder analysis, learning needs analysis, strategy plan, RACI, and a communications plan.
Lead: Understand the change plan and begin to execute the change, working to meet stakeholder needs and bring them along the change curve. We work with the leaders to recognize factors that can affect how they lead through change and execute the integrated strategy plan using key performance indicators and a skill-will assessment.
Embrace: We work with leaders to create long-term and sustainable adoption, monitoring and adjusting the strategy and plan as needed using tools such as lessons learned and risk and issue logs.
Team Development
Using our team-science-based framework (see Figure 4), we developed a diagnostic that helps a team understand its current level of team effectiveness.(4) Below are several services we facilitate to support teams in achieving their optimal effectiveness.
Customized Team Consulting. Based on a series of diagnostic tools and debriefs, a Leadership Institute practitioner diagnoses the specific problems facing the team, makes recommendations for team process and team dynamics, and helps facilitate in-person or synchronous virtual interventions with the entire team.
Team Coaching. Intact team coaching can be provided as a part of the customized team consulting process. Team coaching involves direct coaching to the team, both in their group interactions and individually with each leader to help with group-level change and transitions.
Workshops. Team effectiveness workshops are designed with group discussion, exercises, and key takeaways to be applied in the workplace. Workshops include Introduction to Team Science, Building Psychological Safety in Teams, Creating a Healthy Conflict Culture, and Introduction to Team Decision Making.
Team Building. This less-structured approach provides teams with strategies, information, and activities they themselves can lead to address their development needs.
Assessments and Surveys
The Leadership Institute uses assessments and surveys to gather data, gain insights, and guide further action. Broadly, we use these tools in the following three ways:
Development and Feedback. Assessments are often used as a baseline learning measure for our programs. As an example, the LEAD 360 is an internally developed, validated multi-source feedback instrument aligned with our competency model and used only for development purposes. It compares the leader’s perspective with their direct reports, peers, manager, and other colleagues to give them a more holistic view of their leadership style.
Selection. Only validated selection instruments are used during the hiring process for key roles. These assessments compare applicant profiles to success profiles developed for similar roles. Behavioral assessments are used as part of the application pre-screening process for front-line service, individual contributor, and administrative roles. For administrative and faculty leaders, a personality assessment and emotional intelligence assessment are used as data points in the selection process for final candidates and later help in the onboarding coaching for the new leader.
Organizational Surveys. Organization-wide surveys around key MD Anderson metrics such as safety, employee engagement, and perceptions of leadership are also used. We use information gathered by these surveys to enhance the employee experience by focusing on ways for leaders to act on issues of concern and create meaningful change. Examples include our employee engagement survey and exit survey.
OUTCOMES
Overall Participation
More than 15,000 employees and leaders have participated in our programming since the fall of 2018, and more than 115,000 hours have been dedicated to development since 2022. Our evaluations follow a quasi-experimental research design methodology and employ multiple methods to increase rigor and confidence in our evaluation, such as:
Online pre- and post-program surveys are distributed to participants and others who have sufficient opportunity to detect changes in participants’ leadership behaviors (their supervisors, peers, direct reports, instructors, and coaches). We include published measures of constructs of interest and create customized measures of knowledge gain.
We distribute time-lagged follow-up surveys to participants and others to measure the application of learning and the impacts on relationships and teams.
Confidential or de-identified information stored in human resources systems, employee-wide engagement survey response databases, and other specific performance metrics databases (e.g., Press Ganey) are matched with program participation records to investigate individual and organizational outcomes.
We utilize matched control samples to compare program participants’ outcomes with employees/leaders’ outcomes who are eligible to participate in a program but who have not yet participated.
A full example of a strategic evaluation is the following results from the Leading Teams Core cohort program.
Participation: Five cohorts have completed our Leading Teams Core program over the last five years. Of the 535 eligible leaders at this level, 417 (78%) have graduated. We are on track to train every leader at this level within the next two years.
Experience: Through post-program surveys, 100% of participants report that the program meets objectives, and 94% report that their participation is a valuable use of their time.
Training Outcomes: As measured on post-program surveys, 98% of participants report displaying servant leadership through actions; 73% of participants’ coaches and 70% of participants’ supervisors report that the program had a positive impact on their leadership behaviors.
Individual and Organizational Outcomes: We have found that higher program engagement leads to greater impacts on direct reports’ engagement survey favorability, indicating the benefits of the program can be perceived by others. These impacts are possible only because the participants are fully engaged in the learning process.
Individual and Organizational Outcomes
We regularly conduct research investigating the impact of program participation on several important outcomes and share these findings in many ways, including through publications in peer-reviewed research outlets. A few outcomes are summarized below:
Improved patient experience: Care provider participation in competency track courses is associated with 2% more favorable patient satisfaction scores, as measured by Press Ganey Provider Experience surveys.
Decreased burnout: Participation in mentoring is associated with a reduced likelihood of reporting burnout by 10%.
Higher rates of promotion: Participation in Leading Self Accelerate is associated with an 80% higher promotion rate, participation in Leading Self Discover is associated with a 133% higher promotion rate, and participation in coaching is associated with an 8% higher promotion rate.
Lower rate of turnover: Participation in Leading Self Discover is associated with an 81% reduced likelihood of turnover, and participation in coaching is associated with a 50% lower turnover rate.
Higher annual manager-rated performance evaluation ratings: Participation in coaching is associated with a 3% higher performance rating.
Stakeholder Engagement
Advisory Boards. Two advisory boards play a role in guiding the Leadership Institute. The Leadership Development Council is a group of dedicated internal leaders across the institution who meet monthly to give input into and evaluate plans for leadership programs and serve as a connection point with stakeholders in the institution.
The External Advisory Board consists of thought leaders, MD Anderson Board of Visitors members, and industry leaders external to the institution. It meets biannually with the Leadership Institute to discuss ongoing programs and share their high-level insights and experiences. The purpose of this board is to ensure program alignment with current industry trends, evaluate the investment in leadership development, and share best practices.
Leadership Institute Ambassador Group. The Institutional Mentoring Council consists of leaders from across the institution. The members are responsible for representing their individual divisions, serving as mentoring advocates throughout the institution, and providing updates to the Leadership Institute staff regarding the needs of the organization.
Change Network. A change network is deployed for all major institutional initiatives to coordinate the cascade of information and engage stakeholders in the process. The network consists of champions, who are empowered leaders for each senior executive leader who can assist in navigating resistance in their areas, and advocates, who are employees from impacted areas who can be a point of contact for two-way communication.
Coaching Community. Every year, we graduate more than 40 leaders from the CoachRICE program, forming a coaching community of internally certified coaches. This group meets once every six weeks to network, share best practices, seek advice for challenging coaching situations, discuss advances within the coaching field, receive updates on the coaching programs within the institution, and encourage each other to further their personal and professional development as internal coaches.
Group mentor coaching sessions are held quarterly to allow internal coaches to deepen their knowledge and understanding of the ICF core coaching competencies and code of ethics, practice their coaching skills in interactive exercises, and receive targeted feedback from a mentor coach and each other.
LESSONS LEARNED
Many lessons have been learned along the journey. The first is that a comprehensive and effective leadership development strategy must support level-appropriate development for every member of the organization, demonstrating a cohesive and consistent alignment with the organization’s overall mission and strategic outcomes.
Leadership development must achieve a delicate balance between standardization of shared experiences and customization to individual role needs and preferences. Multiple modalities should be available to appeal to various learning styles and work environments.
It is also important to benchmark and leverage best practices from other successful organizations, those both similar and distinct from one’s own industry. Listening to different employee constituencies yields valuable feedback to refine and evolve programs as individual and organizational needs change, and it is important to analyze and share data that measure the key indicators that are important to the organization.
Finally, there is no such thing as over-communication of the available development options and their impact on both the individual and the organization. Continuous focus and reinforcement are necessary to create and sustain high levels of engagement and impact.
THE FUTURE
Leaders must be agile and comfortable with challenging the status quo. This requires them to actively direct and pace change within their organizations and to ensure that their teams are equipped and ready.
We are establishing a structural foundation to ensure seamless execution and effective governance of change initiatives through a change advisory and governance strategy and model, resource staffing, change portfolio management, and standardization of processes, tools, and techniques for change.
We continue to invest in tools and technology to upskill our employees, finding ways to involve and motivate employees of all generations to take control of their own career development. For example, collaborating with our partners in the wellness and benefits space, we are developing a legacy coaching program to provide support for those leaders considering retirement. Expanding our mentoring programs, where organic groups of employees are united by a common theme, such as navigating career transitions, becoming new parents, etc., allows employees to build robust networks of their choosing.
Finally, the future of leadership development is in creating customizable learning environments to personalize content to the learners’ roles and the organization’s needs through an ever-increasing array of online resources, interactive platforms, and digital tools that form “personal learning clouds.”(5)
We will need to help our leaders acquire new skills to leverage and manage the development of automation and artificial intelligence. Augmenting our leadership development programs with the necessary technology for these “personal learning clouds” will be essential for our continued success.
CONCLUSION
MD Anderson Cancer Center’s Leadership Institute is an example of transformation within the complex landscape of healthcare. Our comprehensive approach reflects a commitment to cultivating a culture of continuous learning and growth. Emphasizing the belief that everyone is a leader, irrespective of formal titles, we strive to empower individuals at all levels to become relentless learners, contributing to the betterment of the MD Anderson community.
The emphasis on competencies, coaching, mentoring, and team development not only strengthens individual leaders but also fosters collaboration and resiliency across team members. With a focus on adaptability to navigate change, we ensure that leaders are prepared to lead by example and drive positive outcomes for their teams and the institution as a whole as we work together to end cancer.
Acknowledgments: We would like to acknowledge MD Anderson Cancer Center president Peter WT Pisters, MD, and senior vice president Shibu Varghese for their continued support and personal examples of leadership both inside and outside our institution. We also want to thank the incredible team within the MD Anderson Leadership Institute for their dedication to quality and service in support of our leaders.
References
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Wolters Kluwer. (2023, December 20). Navigating the Future of Healthcare: A Glimpse into 2024 with Wolters Kluwer Health. Wolters Kluwer. December 20, 2023. https://www.wolterskluwer.com/en/expert-insights/navigating-the-future-of-healthcare-a-glimpse-into-2024-with-wolters-kluwer-health
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Moldoveanu M, Narayandas D. The Future of Leadership Development: Gaps in Traditional Executive Education Are Creating Room for Approaches That Are More Tailored and Democratic. Harvard Business Review. March–April 2019.