Why Physicians Must Lead Change: All Physicians Are Leaders

This transcript has been edited for clarity and length.

Increasingly, healthcare organizations are hiring physicians to fill executive and other leadership roles. Given their clinical knowledge and focus on patient care, physicians understand healthcare processes, organizational needs, and challenges differently than administrators.

Cheryl Toth: Our guest today is nationally recognized physician leader Peter Angood, president and CEO of the American Association for Physician Leadership. Welcome, Peter. We're so glad to have you on SoundPractice today.

Peter Angood: Thank you for the opportunity. I'm looking forward to the conversation.

Toth: Today we're talking about physician leadership, and we couldn't ask for a better guest than you, Peter, because not only have you been in leadership roles for decades, you also head the nation's premier organization for developing physicians into leaders. Why don't you give us a quick overview of the AAPL and the work the organization does.

Angood: You're very kind, thank you so much for that. AAPL is a wonderful organization in so many ways. We take on the philosophy that at some level, all physicians are leaders. That is the same way in which we approach all of our programs, products, and services. How do we help physicians and their teams assume some of those responsibilities around leadership?

We have a whole host of educational programs, a wide variety of professional development initiatives, a strong wellness initiative, a whole cadre and cache of information, resources — a strong community. And all of this is nicely glued together with a technical platform that we've custom built and implemented ourselves. It's a robust and thriving organization that fits nicely into the current healthcare industry's complexity.

Mike Sacopulos: I'm excited to learn more about that, but I think it would be helpful sequentially for our listeners to know a little bit about your background. Dr. Peter Angood has been a senior executive leader in healthcare for decades. Since 2011, he's held the role of CEO and president of AAPL. And prior to that, Peter was vice president with the Joint Commission, where he was the first chief patient safety officer and oversaw the national patient safety goals, as well as other enterprise-wide international patient safety initiatives.

Toth: And Peter, you've also held senior advisor for patient safety roles for both the National Quality Forum and National Priorities Partnership. You've been the chief medical officer with the patient safety organization of GE Healthcare. And through all these engagements, you've worked intermittently with the World Health Organization too. That included your involvement in the early stages of the WHO Collaborating Center for Patient Safety Solutions.

I'd love to hear the story about your journey from the exam room to the conference room, as it were. How did it all unfold for you to move through this body of work to where you are today as a physician executive?

Angood: Again, you're very kind with your words, and thank you so much. Career development is a fascinating journey for all of us. Sometimes, it comes through by being well prepared and other times it's luck in circumstances.

I started my life in surgery and followed the clinical discipline of trauma surgery and surgical critical care. Both of those are very multi-discipline-oriented, and very much systems-oriented.

For a healthy trauma center to work, you have to really be thinking through from the pre-hospital environments all the way out to long-term rehab and long-term care environments. And similarly, in the ICU environments, the flow of an organization's patient care oftentimes is dependent on what's going on in the ICU. How do you move those patients in and through?

While I thoroughly enjoyed all of my clinical time and the patients whom I was privileged to look after, what I found myself thinking about more as I got into mid-career was how to create smoother, more efficient systems that are of better quality and more safety oriented. Those two clinical disciplines really kind of drove me into that type of mindset.

As I got into that mid-career, I then, in part through my academic involvement, had become engaged with a variety of professional societies and my recognition on the national scene gradually had increased. I was very fortunate to be asked to become the first chief patient safety officer at the Joint Commission. And that was one of those very enlightening career shifts that really opened my eyes to complexities of healthcare on a national and international level.

It was also reassuring in that globally, healthcare is somewhat similar. It's obviously different in different countries and different regions of the world, but people are people and diseases are diseases. So, we tend to react similarly, but the culture of international arena versus the resources available is what makes the difference between our U.S. domestic-based healthcare and how other countries are dealing with it.

That involvement both nationally and internationally through the Joint Commission and in those other entities that you described really opened my eyes, and it further consolidated my sense of the complexity of our industry and how difficult it will be and still is to continue creating change.

While it was very satisfying to be in that policy development and implementation arena, I also recognized that there truly is this gap between the policy levels in the front line of healthcare. So, I was really more intrigued about how to work in that gap zone. And as things moved along for me, and this opportunity came forward, this organization really moves comfortably in that gap zone.

We have incredible membership and involvement with a whole variety of healthcare systems at that front line, but we're also very well-recognized on the policy level and at that development level. We have a reach inside of both aspects of the gap zone — the policy side and the front line. And that's what makes this organization just so fascinating, not only to work within, but also to continue to gradually exert its influence and expand its influences within the industry. Thank you for the question.

Sacopulos: Your answer's fascinating, and it shows your path and how things have changed in your career, but at the same time, things are changing elsewhere. I'd like to focus the next question on how hospitals, healthcare organizations, health tech companies, are putting physicians into executive positions. What's your take on this, and can you speak to general trends in this area?

Angood: It's interesting how the industry is in some ways going full circle and engaging and involving physicians in leadership roles. For decades, even arguably centuries, the healthcare industry was focused on the physician-patient relationship and how everything moves in and around that.

In the relatively recent past, physicians wound up being a little bit marginalized in some of the ongoing evolution and development of the complexity of today's healthcare, although not by any purposeful intent of any portion of the industry. It was just a sequence of events that gradually occurred.

As we've been trying to improve the industry over the last decade, decade and a half, there's been this recognition that if you have the physicians engaged more tightly, better integrated into the systems of delivery, then those organizations tend to behave a little bit better. When you add on the layer of formal education and experiences in terms of leadership and management, then those organizations improve even further over and above others. Some studies have gone so far as to demonstrate that when a physician is a CEO of a healthcare delivery system, some of the quality metrics that are well recognized are as high as 25% and 33% better than other comparable institutions.

Why does that occur? Well, if you think about it, the physicians inside all of the clinical disciplines are those who are educated and trained to the highest academic level in terms of understanding people and diseases and management. They're now getting better exposures into the management of health and population health as well, but that detailed understanding of people and disease management, health management, and how to improve the quality of care is fairly unique to physicians.

So, when you layer on that leadership and management component, that really brings added value into any healthcare delivery system in terms of being able to perform better.

Non-clinical administrators and leaders certainly get good training and expertise, but most will readily admit they can't compete on the direct patient care aspects that physicians are so comfortable with. It's an added advantage.

Some of the other clinical disciplines, certainly nursing and pharmacists, also experience some of those added benefits if they choose to go into leadership and management roles. But it still seems that the physicians have the most added advantage and, therefore, the greatest contribution to the improving the quality, efficiency, and safety of organizations as well as their overall business operational successes.

Toth: You mentioned the gap zone between front line and policy, and you always want to have the physician’s input on every step of that process. Because of their training, they've got to be an integral part. You mentioned in your intro as well, that all physicians are leaders. Can you expand on that in terms of how they can fit into this gap zone and how they participate in these organizations?

Angood: When the general public is surveyed and polled on which types of professions and which industries they trust the most and which ones they trust the least, the health industry often times comes up on the top of the list of most trusted. And within that, the physicians and the nurses — but usually the physicians — wind up being the most trusted. Our society continues to expect the medical profession as a whole to be a leadership profession.

I think that's in part because of how healthcare has evolved, with that patient-physician relationship being the pivotal aspect. But it's also so intimate and personal that people need and want to trust the medical profession and certainly their physicians. So that inherent trust and belief in the physicians in the healthcare industry is why I say, at some level, all physicians are leaders because that's expected of them.

Toth: When it comes to this feeling that the public has of physicians being leaders, what are some of the characteristics beyond them just being physicians that make the public see them as successful and what are the characteristics you find make physicians successful leaders?

Angood: Part of it's just the baseline kind of personality that goes into healthcare. Physicians are highly intelligent, they're altruistic, they're idealistic, and they have this drive to want to care for other people. And that oftentimes comes across not only when they're dealing with the patients in their practices, but it also comes across in their beliefs as they're trying to help create change inside the system they're working in, whether it's their individual practice, a hospital, a larger-scale delivery system, or even outside the formal clinical delivery side.

You'll often hear those physicians referring to what's best for the patient, what's going to give the best results, what's optimal care, etcetera. And people who are receiving care will pick up on that the vast majority of the time.

Are physicians perfect people? Absolutely not. Are we perfect in the delivery of all of our care all of the time? Absolutely not. But that interpersonal relationship is picked up by patients and their families. And there's an expectation that the high quality of professional can help them in a time of need. Whether it's a devastating illness or just a general wellness checkup, they want to be reassured. So, there's that inherent trust that we need to continue to build on.

Toth: Can you think of an example or story where a physician demonstrated that ability to build trust with a patient in some sort of a difficult time?

Angood: It happens every day in our clinical environment. You’ve looked at the roster of patients that you're going to see that day, and you think, "Well, okay, it's blood pressure checks, it's diabetes control or it's injury management." But out of the blue, many times in the course of an afternoon's clinic, one or two patients will help you pause in your care and say, "I'd just like to talk to you about something else." And it's that inherent trust that they cue on that gives them the feeling they can and want to share some more intimate aspects of their life that they need or want some help with.

That's in the routine kinds of daily care, but it happens as well in the acute emergency settings, when you don't have any choice as a patient. Somebody's just hit you with their car and now you're hurting all over or your disease is making you have a stroke or a heart attack, etcetera. You show up for urgent and emergent care and you are giving yourself up to that care provider and that system. And again, the patients are sharing in such intimate ways that that trust and that bond is really just inherently there.

The care providers and physicians in particular are very respectful and often feel very privileged at being able to participate in those types of exchanges. I'll go one step further: If you ask any physician, more often than not, in the course of a day or a week, their neighbors or their friends, or somebody at the health club stops them and asks their opinion about some element of healthcare because they're viewed as trusted resources. It's a part of how physicians live their lives.

Toth: I love this theme of trust, empathy, drive, all those great characteristics. Peter, we're going to talk with you a little more about the advice you have for physicians and how you leverage some of those innate traits and develop their skills as physician leaders.

Sacopulos: Peter, what advice do you have for those physicians who want to augment their career or transition in some way into management or leadership roles? They want to move at least in part from exclusively the exam room to the conference room.

Angood: If we continue on this theme that at some level, all physicians are leaders, there isn't unfortunately that much exposure inside of the medical school training or their specialty training around leadership or management. Increasingly, the younger trainees are recognizing they need and want that. But the curricula change inside of medical schools and residency programs is slow to change.

So, there is this need that physicians often recognize. It's a diminishing number, but those in a solo, private practice, still have to run their office. They still have to have their staff helping them. They still have to look after paying their bills and all those other sorts of things.

As a physician starts to think about leadership, it's incumbent initially to recognize, "I may not have the actual skillsets to really and truly succeed." So, a first step after that awareness is to try to get engaged in committees or different types of task forces or an initiative that's trying to launch some type of new activity in their environment. And then just get a feel for how comfortable that type of engagement is or is not.

Some folks really don't want to pay any attention to administrative work and others begin to really thrive on it. And if someone starts to recognize, "I want to thrive and do well, and I've got an important voice to contribute," then I think it's incumbent to get some true added skills.

There's a whole variety of management topics out there: basic finance, accounting, HR, those kinds of topics. And then there are leadership aspects that really need to be moved along from core baseline personality. There’s a whole variety of leadership competencies out there that people should think about in terms of proactively trying to address.

AAPL actually offers some psychometric assessment strategies for folks so they can get a better sense of what their skills are and where their strengths are. And then how do they build off of those and really leverage what their capabilities are. But as folks get a better sense of their skills, their interests, and their aptitudes, then they can gradually go beyond that committee engagement and seek out those opportunities.

Physicians historically have been trained to be autonomous, independent minded, thinking people. So, increasing their personal awareness and then seeking input from others and trusted resources like mentors is critically important, but sometimes is a step for a physician to think through, "How am I going to do this?"

And the last stage for some is, "Well, maybe I should have some executive coaching as well to sort of help me move along." If their drive to create significant change and participate in leadership roles is strong enough, then for some, that executive coaching piece is that added benefit that really helps them shine.

Sacopulos: That fascinating description of how one goes about preparing themselves. Do you find that it is age or experience dependent? Or would you recommend that depending upon the physician's inclination that they may begin down this path toward leadership and developing these skills at any point in their career?

Angood: It's part of the age-old question: Are leadership's born or are they educated and trained. The answer is a bit of both. There clearly are individuals who have innate leadership skills and talents, and they'll progress through fast. But if you think about it, medical education and training, and then getting an early career off the ground is a long process. People aren't entering into their real jobs until their early 30s. And then they are also trying to get a relationship going, they've taken on debt, they may or may not have kids going, etcetera. So, 20s and 30s is a complex time in their lives.

A lot of folks wind up thinking about leadership and management roles beginning in their mid to late 30s, but more typically in the 40s and 50s. However, we also, in this philosophy of all physicians are leaders, try to make sure we've got offerings from early student days all the way through to whatever folks are doing later in life. So, it's not uncommon for someone who's in their 60s or even in their early 70s to say, "You know what? I'd like to give back into the system a little bit more. Let me get more engaged with that leadership and management stuff." I've also had the 30-year-old come up to me who says, "I'm halfway through my surgery training. I've already got my MBA and my startup is doing pretty good. What more can I do here?" And I look at that person and say, "Well, I think you're doing pretty darn good already."

They're all over the spectrum. We just don't know when they're going to plug in. A lot of it's their motivation to create change that helps them seek out these added skill sets that they don't get in their training.

Toth: I think this is a great segue to talk about the AAPL and what you offer at all these different points in the practice life cycle. Tell us a little bit about the mission and your vision for the AAPL. What do you offer physicians and how can physicians get involved?

Angood: At the end of the day, our true purpose is to create larger scale change in healthcare, and we're so privileged to have the platform of physician leadership in order to do that. As we said at the beginning, it's increasingly recognized that physician leadership is essential for better performing healthcare delivery.

As we think that through, for us, it's not all about what's best for the physician and the physician workforce environment. It's actually about how create change in healthcare? So, in order for physicians to better succeed, they do need more education, and we offer more than 100 different courses.

We do that in live events online and we do it on site, using delivery systems of all sorts of sizes and types. We have our host of what we call academies. These address special focus areas like the chief medical officer academy. We have our well-recognized Certified Physician Executive program. That's about 150 hours of coursework and then a really transformational capstone event that happens at the end. Uniformly, all of the participants say, "That just changed my life." And they have lifelong friends as a result of that experience.

We also recognize that some folks would like to have a master's degree, so we work with five university partners and have seven master's degrees that we offer as well. All of that's on the education side.

We have professional development services as well. For those who are inclined, we've got about a dozen different psychometric assessment tools that we use. Our education programs are competency based and they're geared toward novice to advanced and master levels of experience. Those competencies that I just mentioned are also embedded in some of these psychometric assessment tools so we can help people see and understand who they are, then direct them toward their education based on that.

Beyond psychometrics, we've got everything from simple educational counseling to career counseling — even the hardcore stuff of, "Hey, how do we do a better resume cover letter, LinkedIn profile? How do we do better interviewing?" And then there's a mentorship matching program, the executive coaching that I mentioned, and professional development.

So many people are feeling frustrated out there, so we have a whole suite of services around wellness. We take on a holistic wellness approach, but not everybody wants to be educated all the time. Not everybody's looking for a new job, etcetera. So, the third element is really the information resources. People want the information.

We've got a couple of different journals, a few different newsletters. We've got a whole cadre of books out there. And then we've got all of the social media activity as well.

So, the three elements of education, professional development, and information and resources are all there to help drive that sense of community around physician leadership.

As I mentioned in the beginning, we've built in a very robust technology. We call it our platform, but it really helps to integrate all aspects of an individual as well as a cohort of individuals together in terms of “How do you manage your profile? How do you target the career that you're wanting, how can we help you target and move along that career trajectory?” And then “What education do you need in there? What peer-to-peer interactions do you need in there? How do you find your jobs or your next jobs? And then what?”

All of that is right there at their fingertips. This is far more robust than any sort of social media community that's out there. It's certainly much, much different than an educational learning management system that you see in many of the universities. So, this technology platform really brings all three components together, drives the community, helps you find and network others who are like-minded, and you can do that anywhere across the country.

All of that together helps us service the physician workforce. But we are doing more and more in terms of helping the different organizations where physicians are working. How do we help those organizations better manage their medical staff? Whether that's a group practice, a hospital, or a healthcare delivery system, it's really a very robust offering in that fashion as well.

We also collaborate with a wide variety of other professional medical societies and we're doing a significant amount of work within the interprofessional arena and with nurses, pharmacists, other clinical disciplines, a variety of the hospital associations and medical societies at the state level and at the national level.

Now, rounding it all out is the fact that we do have membership in 40 or so different countries around the world. Healthcare is, as I said in the beginning, similar about 80% of the time, but leadership and management are very transferable into other countries. We're on the cusp of doing more internationally. We’ve completed several initiatives already, and we're very well recognized in the international arena as the go-to organization for this type of work.

Toth: The international sounds very exciting. I know Mike has a question to wrap things up, but I'm curious as a follow-up. You've got the live, you've got the onsite, you have the platform with all kinds of personalization and online learning, it sounds like. You mentioned wellness courses. And since that's such a hot topic right now for physicians and anyone in healthcare, but in particular physicians, tell us a little bit about the wellness programs.

Angood: As we know, it's not just the physicians; the healthcare workforce is struggling with a lot of these issues and it's in part because of the complexity of the systems that we use to deliver care. Around 50% of the physicians are feeling some element of burnout symptoms or are significantly depressed or even suicidal. And an unfortunate statistic is that about 400 physicians commit suicide every year.

We have to help the individuals who are struggling. This is not about becoming more resilient. It's not about just doing more yoga or patting the dog or going for a walk. There are other components here.

We're trying to take more of a holistic wellness strategy and say, "You're already an incredibly strong individual. Let's help you get stronger.” But also recognize that the systems you're working in are difficult, they're complicated, they need to be changed. Get engaged with trying to create change in the system, but manage your expectations for that change to occur rapidly. Change will occur slowly. And if you come at it in a more balanced contributory sort of fashion, you'll get better results in your change strategies, but you'll also feel better about it as you engage.

Obviously, looking after your personal health is important as is spending time outdoors and being able to contribute and participate with your family. Those are all important things. And the darn electronic health record that everybody focuses on isn't going away anytime soon, so how do you better manage your time around the EHR?

We’ve got a variety of educational offerings around wellness. We've got some great live courses. We do advising, as I said before. We help people with the psychometrics. We have online offerings, a toolkit, and a set of videos.

The platform really brings that sense of community and helps people share. Physicians are hesitant to share about this topic because they are worried about their reputation. They're worried about their peers. And if they can do this in a more peer-to-peer environment that's protected, then they'll open up and realize they're not all alone in the world.

All of that's working very well for us and we're getting a good amount of exposure in terms of the successes of that program.

Sacopulos: That is just tremendous. What you've just described in the last several answers is an organization of extraordinary depth. I'm interested as to where AAPL is headed in the next 12 months. Can you give us some insights?

Angood: We're trying to create larger-scale change in healthcare, so we will continue to consolidate and refine and mature all those programs, products, and services that I described. But more importantly, we are headed toward becoming more recognized as an influence group in healthcare, as a thought leader, and as an organization that really has an important voice so that we're able to influence that evolving healthcare industry.

It's a complicated industry, and it will always be complex, but we also talk about patient-centered care. We talk about value and value-based care. Those are terms that are easy to say, but very difficult to implement.

The patient-physician relationship is still what drives the vast majority of healthcare — 90% of healthcare is driven off that patient-physician relationship. So bringing patient-centered care and value-based approaches together is where the industry is headed, and we need to be there, helping create that thought leadership and that influence in order for it to become more successful and increase the pace of change that's required in the industry.

Sacopulos: I think that on that happy and insightful note, I will say thank you. Our guest has been Dr. Peter Angood, CEO and president of the American Association for Physician Leadership. Thank you very much.

Angood: Thank you so much for the opportunity. It's been a real privilege.

Toth: Appreciate your time today, Dr. Angood. Thank you.

Sacopulos: It was enlightening to hear Dr. Angood talk about some of the things that AAPL is doing and will be doing. But I was even more intrigued about the innovative projects that he's done over the years, and his focus on all physicians as leaders. Do you know what? He's right, and we need physicians at the head of our healthcare organizations now more than ever.

Toth: I agree. And it's the best way to achieve real change in our system and real change for patients. We need more physicians like Dr. Angood who will step in and be a powerful force for innovation and creative leadership.

Sacopulos: No doubt about it. SoundPractice will now be carrying that message too. I am honored to be part of supporting physicians in their leadership efforts. I'm honored to be working with you and the AAPL. So thanks for listening, everyone. If you enjoyed what you learned today, please tell your colleagues to listen and subscribe.

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