The Physician Leadership Institute Bridges the Gap in Physician Leader Development

Nearly 50 percent of senior leaders at healthcare organizations nationwide are approaching retirement age within the next 10 years.(1) This impending vacancy in leadership, together with a rapidly changing landscape of healthcare delivery and academia, has accelerated the need for succession planning with appropriately prepared physician leaders.(2)

With the larger part of medical education, residency training, and early career promotion practices centered on scientific achievement and clinical and educational excellence, it is not surprising that the majority of current physician leaders ascended into executive positions based on the same criteria.(3) However, this career selection process renders accomplished physicians initially ill-equipped to handle the administrative and leadership responsibilities required of the office.

To function effectively in the profoundly complex healthcare enterprise, future leadership must not only understand the intricacies of clinical medicine and academic scholarship, but also be educated in management, strategy, policy, and operations of healthcare delivery. Furthermore, the evolution from a paternalistic healthcare model to a collaborative team-based, patient-centered approach calls for rising physician leaders to develop superior communication skills and emotional intelligence.(4)

In response to the foreseeable void in physician leaders and the dearth of formal leadership training, in 2010, the Physician Leadership Institute (PLI) was founded at Henry Ford to identify early to mid-career physicians with inherent leadership strengths and to cultivate their development into adept physician leaders capable of navigating the unique culture, challenges, and opportunities within Henry Ford Health System (HFHS) and the Henry Ford Medical Group (HFMG). The primary aims of the PLI are to:

1. Establish basic leadership competencies — including technical knowledge, industry knowledge, problem-solving skills, communication, commitment to lifelong learning, and emotional intelligence — and provide training tools to cultivate physician leaders.

2. Strengthen and evolve a unique culture that engenders diversity and inclusion and broad connectivity across the enterprise and aligns with institutional mission and goals.

3. Facilitate opportunities for career advancement to keep competent physician leaders within the organization.

The mission of HFHS and HFMG is to provide clinical care, medical education, and research. As such, the term physician leaders used here also refers to the research scientists who participated in the PLI.

The current study aimed to evaluate the outcomes of the PLI curriculum with special focus on physicians’ internal advancement and career development.

Methods

PLI Curriculum

Selected participants include 12–20 staff physicians and post-doctoral PhD faculty who are nominated annually by departmental chairs for their innate aptitude and desire to lead. The final selection is made by the executive committee of the PLI, consisting of four to six physician and administrative leaders. Selection is made to ensure the diversity of the class in terms of specialty physicians/primary care physicians, gender, ethnicity, and practice site (Henry Ford Hospital/satellite/affiliated hospital). Because research is an integral part of the mission of HFHS, each class includes a scientist. As the PLI is designed to prepare the next generation of leaders within HFHS, general (but not absolute) guidelines include those who had been with HFHS for at least five years and are early- to mid-career and hence typically younger than 45.

The PLI curriculum includes eight monthly education sessions and requires the completion of a capstone project. Each of the education sessions lasts a full day and features reflection exercises, small-group activities, large-group discussions, and interactive didactics led by senior leaders across many disciplines, including finance, business strategy, patient safety, healthcare management and leadership, health system operations, and talent management. Figure 1 details an overview of the PLI curriculum. Teams were also paired with advisors to facilitate the design and completion of the capstone projects. As appropriate, selected invited non-HFHS faculty were also included.

Figure 1: PLI Curriculum overview

Influencer Model

PLI participants are encouraged to identify and leverage their individualized leadership strengths and taught to practice the influencer model as a means to change behaviors to achieve measurable results. The influencer model focuses on clarifying measurable results, identifying vital behaviors, and analyzing six sources of influence.

The first step of the influencer model asks participants to create a measurable result that quantitatively describes the desired outcome in time-bound manner. Second, participants are challenged to identify crucial moments and vital behaviors that will lead directly to results. Vital behaviors are actions that explain exactly what to do and how to do it. For example, a crucial moment may be “I want to sleep an additional 30 minutes in the morning.” The vital behavior would then entail “write one paragraph each weekday morning” which would ultimately lead to the result: “complete the manuscript by the end of the month.”

Subsequently, participants are called upon to analyze six sources of influence that impact the vital behavior and, therefore, the measurable result. The first source of influence analyzes personal motivation and asks what might be painful, frightening, boring, or uncomfortable about the vital behavior; the second source of influence evaluates personal ability and what gaps in knowledge, understanding, physicality, or social skills may interfere with the vital behavior.

The third and fourth sources of influence call for analysis of social motivation and social ability. This involves assessing whether peers are encouraging the vital behavior and if they are providing the help, information, and resources required.

The fifth and sixth sources of influence look at structural motivation and ability to determine whether pay, promotions, performance reviews, or costs are encouraging the vital behavior and if there are adequate tools, facilities, proximity to others, and policies to facilitate the vital behavior. Through adoption and application of the influencer model, PLI participants are capable of changing their attitudes and behaviors to produce measurable and sustainable results.

Emotional Intelligence

Throughout the PLI curriculum, particular emphasis is placed on emotional intelligence, the core leadership competency. Originally coined by Salovey and Mayer in 1990, emotional intelligence describes the capacity for recognizing one’s own feelings and those of others, and for the effective regulation of emotion in oneself and in relationships.(5)

Participants are challenged to enhance their emotional intelligence through the development and application of its four key elements: self-awareness, social awareness, self-management, and relationship management. In becoming self-aware, participants learn to anticipate how they are perceived, which in turn fosters their social awareness as they are better able to recognize, respect, and relate to the emotional cues of others. Subsequently, participants are taught to channel this personal and social awareness into becoming superior self-managers who exercise control, adaptability, and optimism, as well as strong relationship managers, capable of inspiring and influencing others to enhance the execution of their vision.

Appreciative Inquiry

The concept of appreciative inquiry is taught and accentuated as an approach for generating positive transformation. The concepts of positive core and the 4-D cycle are presented as tools to aid in the development of an appreciative inquiry, which evokes positive imagery that leads to positive action.(6)

To establish a positive core, participants are asked to reflect on strengths, peak experiences, best practices, past successes, and key learnings. This positive core serves as the framework for construction of a 4-D cycle that circulates through 1) Discovery: appreciating the best of what is working well; 2) Dream: envisioning what might be; 3) Design: discussing what should be; and 4) Destiny: innovating what will be.

Integration of the positive core within a 4-D cycle facilitates participants’ ability to appreciate, envision, and co-construct positive change within themselves, their departments, and the greater HFHS community.

At the inaugural session, participants are divided into three teams with which they execute the capstone project. Together, team members work to develop and submit three project proposals that aim to improve the HFHS system, are capable of implementation within 12 months, and impart some measurable, meaningful, or sustainable deliverables.

PLI facilitators, in discussion with senior leadership, then review and select one of the three proposed projects from each team. Over the next eight months, teams work to develop a business plan, which consists of a report that defines the project’s intent, identifies necessary resources, organizes the development, outlines measurements of success, and projects the return (financial or other). At the final session, each team presents its business plan to the HFH budget oversight committee, at which point they may establish funding to execute their capstone project.

In its final stage, the projects are presented on day of graduation to senior leadership (including CEO, COO, hospital director, CMO, department chairs), and faculty as a final presentation with open feedback.

Participants and Sampling

Staff physicians were considered eligible for the current study if they: (1) graduated from the PLI; (2) were active employees at HFHS; and (3) entered the SurveyMonkey website through a provided link and answered the questionnaire. The questionnaire was sent via email through the link produced at the SurveyMonkey website (https://www.surveymonkey.com/r/RNSFWV7 ).

Questionnaire — Physician Leadership Institute Graduate Survey

The English version of the questionnaire, “Physician Leadership Institute Graduate Survey,” was emailed to all PLI graduates actively employed by HFHS. The questionnaire items were designed to identify the PLI’s influence on staff physicians’ personal and professional growth. Sub-groups of items objectively evaluated career advancement (e.g., year of graduation, current position, promotions since graduation, election to the Board of Governors), while others assessed attitudes and beliefs about individuals’ leadership journey, impact of the PLI, and interest in future opportunities. Additional comments were accepted as the last item on the questionnaire. Detailed information regarding the questionnaire or the full version can be obtained from the authors upon request.

Data Analysis

Descriptive statistics were provided to report the respondents’ year of graduation from the PLI, current position at HFHS, promotion(s) since graduation, and election to the HFMG Board of Governors.

Free text responses to the question “Since graduating, how would you describe your leadership journey?” were read, categorized as either “positive” or “negative,” and reported. Free text responses to the question “What impacted you most about your PLI experience?” were read and categorized according to the following themes: (1) connections and networking; (2) communication and crucial conversations; (3) coaching from senior leadership; (4) emotional intelligence; (5) identifying strengths, weaknesses, and areas for improvement; (6) building and leading a team; (7) institutional and operational knowledge; (8) finances of medicine and execution of the capstone project. Nearly every respondent listed more than one impactful component of the PLI program, and their response(s) were recorded in all applicable categories and reported.

Multiple choice responses to the question “Are you interested in any of the following with other PLI graduates?” included: (1) networking opportunities; (2) social events; (3) educational opportunities; (4) all of the above. Responses were recorded and reported.

Results

From the years 2011 to 2018, a total of 123 staff physicians graduated from the PLI, and of these, 110 (89.43 percent) are still active employees at HFHS. The survey was emailed to the retained PLI graduates in April 2019 and the response rate from the collected data was 65.45 percent (72/110 individuals). Respondents represented all eight graduating classes, with the majority having graduated in more recent years. Figure 2 details the percentage of respondents stratified by PLI graduating class.

Figure 2: Percentage of respondents by year of graduation

Twenty-eight (38.89 percent) physicians/scientists reported having received a promotion and 11 (15.28 percent) endorsed serving on the HFMG Board of Governors, an elected body of physicians/scientists, since graduation. Table 1 stratifies the number of promotions received and election to the Board of Governors by year of graduation from the PLI.

Seventy-one (98.61 percent) respondents provided free text responses to the question “Since graduating, how would you describe your leadership journey?” Sixty-three (88.73 percent) responses were categorized as “positive,” describing their journey as continuous, evolving, or progressive, while 8 (11.27 percent) responses were categorized as “negative,” chronicling their journey as stagnant, unchanged, or regressive.

Sixty-nine (95.83 percent) respondents provided free text responses to the question “What impacted you most about your PLI experience?” The majority of responses reported developing connections and networking (44.92 percent), cultivating emotional intelligence (20.29 percent), strengthening communication skills (17.39 percent), and receiving coaching from senior leadership (17.39 percent) as impactful. In addition, several responses reported gaining institutional and operational knowledge (15.94 percent), learning finance concepts and executing the capstone project (11.59 percent), developing team-building skills (13.04 percent), and identifying and maximizing strengths (8.70 percent) have impacted their development. Detailed information regarding the most impactful portion of the PLI curriculum is provided in Figure 3.

Figure 3: Most impactful components of PLI curriculum

Sixty-two (86.11 percent) respondents answered the multiple-choice question “Are you interested in any of the following with other PLI graduates?” The majority (66.13 percent) were interested in networking opportunities, social events, and educational opportunities. Of the remaining respondents, 17.74 percent were exclusively interested in educational opportunities, 12.90 percent were exclusively interested in networking opportunities, and 3.23 percent were exclusively interested in social events.

Discussion

The PLI has successfully trained competent physician leaders who embody the culture of HFHS and HFMG and are well-acquainted with the organization’s infrastructure and senior management. An emphasis on core leadership competencies, a formal didactic and interactive curriculum, and the PLI capstone project have contributed to the growth of both personal and team-oriented skills.

Based on “practice management,” the prototypical physician leader development model, pioneered and implemented at the Cleveland Clinic in 1990, the PLI ensures core leadership competencies — technical knowledge, industry knowledge, problem-solving skills, communication, commitment to lifelong learning, and emotional intelligence — are taught, exercised, and reinforced throughout the curriculum with diverse methodologies.(8)

Additionally, formal didactics in finance, strategic planning, and operations are interspersed with reflection time and small-group discussions to encourage physician self-awareness and mindfulness. During this time, physicians are encouraged to reflect on how to leverage their strengths, express compassion, offer gratitude, and exhibit psychological flexibility in the context of a team. Principles of the influencer model and appreciative inquiry are incorporated and emphasized throughout the curriculum to promote a growth mindset and foster the development of aspirational, yet achievable, goals.

Finally, the PLI capstone project provides a practical on-the-job opportunity for physicians to apply their newfound financial, analytical, managerial, and marketing skills in the creation of a business plan. The process of working as a team to navigate through various administrative channels and secure resources builds camaraderie among participants from different departments as well as regional and statewide HFHS locales, and allows physicians to better understand the project-approval process at a hospital level.

Even in cases where a project does not receive the requisite funding, the completion of a capstone project has been shown to ingrain newly learned competencies and improve each physician-leader’s probability of future success.(5) Examples of successful PLI capstone projects include the development of a virtual wound care program, an initiative to reduce transfers/referrals to non-HFHS providers and hospitals, implementation of best practice standardization of IV fluids, and creation of a comprehensive venous disease program.

The majority of PLI graduates characterized the trajectory of their leadership journey as positive, citing the development of meaningful connections, continuous networking, insightful communications, senior leadership coaching, strength optimization, skillful team-building, enhanced emotional intelligence, and broad institutional, operational, and financial knowledge as most impactful in their careers.

Furthermore, there is a high retention rate among PLI graduates (89.43 percent from 2011–2018) with 38.89 percent having received a promotion since graduation. In recognizing talented physicians with innate leadership abilities and equipping them with the unique tools required for administrative success within the infrastructure of our institution, the PLI produces a pool of candidates for senior leadership succession spanning many departments. By hiring from within these candidates, the PLI has addressed the challenge of finding and recruiting leaders who embody the experience, skillset, and outlook to best succeed at HFHS.

Despite the strengths of the PLI reported in this study, there are limitations that should be acknowledged. First, the PLI selection process represents an inherent bias in that participants are nominated and chosen because of their evinced leadership abilities; therefore, it is possible the graduates’ career success is attributed to the initial selection process, rather than completion of the PLI. Second, there is a response bias associated with the employed survey methodology, as those who are satisfied with the PLI education were more likely to reply. Finally, this study presents mostly descriptive statistics, which are of limited predictive value.

Conclusion

The successes of the PLI may serve as a model for other institutions interested in cultivating and retaining physician leaders. The development of similar initiatives that emphasize leadership competencies, core institutional values, business planning, operational practices, and completion of a capstone project may aid other hospital systems in creating a self-sustaining pool of candidates for senior leadership who are capable of both innovation and implementation. Ultimately, this self-sustaining pool may help to minimize the need for outside leadership training programs, recruiting agencies, and consulting firms.

References

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3. Lobas JG. Leadership in Academic Medicine: Capabilities and Conditions for Organizational Success. Am J Med. 2006;119:617–21.

4. Serio CD, Epperly T. Physician Leadership: A New Model for a New Generation. Fam Pract Manag. 2006;13(2):51–4.

5. Salovey P, Mayer JD. Emotional Intelligence. Imagination, Cognition and Personality. 1990;9:185–211.

6. Cooperrider DL, Srivastva S. Appreciative Inquiry in Organizational Life. Research in Organizational Change and Development. 1987;1:129–169.

7. Sonnino RE. Health care leadership development and training: progress and pitfalls. J Healthc Leadersh. 2016;8:19–29

8. Stoller JK. Developing Physician Leaders: A Perspective on Rationale, Current Experience, and Needs. Chest. 2018;154(1):16–20.