21st Century Healthcare Executive
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Leadership in an Era of Accountable Care
Just after the turn of the century, we published “Creating the Healthy Hospital”, a whitepaper on physician leadership co-authored with William J. Fulkerson Jr., MD, who is now senior vice president for clinical affairs of Duke University Health System.
Dr. Fulkerson’s prior position as the top leader of his hospital, and his transition from “hospital” to “system” leadership, says everything about what has changed - and what will continue to evolve - in the delivery of health care. Then, our focus was “technology and clinical connectivity.” Today, our focus for the 21st Century Health Care Executive is on how those two concepts have set the stage for “accountable care” - the linchpin of health care reform which will engender a new level of “system-ness.”
In such a revolutionary time, indentifying and cultivating candidates for leadership - including physician and nurse leaders - who fit well and will drive the success of your organization remain paramount.
We’ve outlined several fundamental requirements below which can guide you in this process.
High-level technological decision-process leadership skills
Tomorrow’s top health care executives will have to manage technological assessment and decision-making at a very rapid pace in order to keep their organizations current and competitive. Today’s technology menu for both clinical applications and management is vast. Tomorrow’s technology options will be many times greater, with new technologies impacting the marketplace faster than ever before.
Leaders will need the highest-level skills in asking the right questions of both external and internal experts to elicit the knowledge needed to evaluate and select technologies that represent the best investments for their organizations. As is true today, technological decision-making processes will need to encompass competitive analysis of nearby health care entities’ product lines and planned initiatives. They also will need to consider retention of affiliated physicians, the organization’s mission and a variety of other factors and concerns.
What will be different is that the complexity of identifying the right technologies to fit an organization’s strategic direction via the ever-expanding market of technological products. And decision-making processes will need to be completed with greater-than-ever urgency to ensure an organization’s competitiveness.
Clinical connectivity
Due to increasing depth of physician involvement in management decision-making, tomorrow’s non-medical senior executives will have to connect well with clinical management. Far beyond understanding clinical issues and how they are impacted by management, he or she will have to include physicians’ perspectives and effectively integrate them into decision-making.
In order to elicit effective contributions from physicians, leaders will need to do more than become skilled at understanding clinical perspectives. They will need to engage physicians in business decisions and foster physician understanding of business issues facing their organizations. Many health care CEOs today tell us that effective physician relationship development is among the top three core competencies for rising leaders.
Ability to integrate teams and align incentives
As articulated by the American Medical Group Association, Accountable Care Organizations (ACOs) “are clinically accountable to the communities they serve, coordinate care, have invested in use of electronic health records, and embody ideas of continuous quality improvement.” Such systems - in which accountability, risks and rewards are shared - must be built on the foundation of credibility and trust.
The industry’s maturation toward accountable care creates the absolute necessity for leaders with the track record and reputation that prove their skills in integrating teams and aligning incentives.
Leadership of diverse management teams
As health care organizations succeed in developing more diverse management teams, the most senior executives will need to be effective at leading diverse groups and using each member’s expertise to advance the organization toward becoming an ACO. Beyond racial, cultural and gender diversity, tomorrow’s health care management teams also will include members with very different professional and educational backgrounds, forms of expertise and knowledge bases.
The richer the diversity of viewpoints, the more effective the idea generation process will be, with better outcomes the likely result. It takes courage, open-mindedness and competence for a leader to hire senior managers who are not in the leader’s image. It will be increasingly critical to the success of an organization, however, not only to hire such people but to listen to them. ACOs will approach management decisions from multiple perspectives.
Fostering of innovative thinking and problem-solving
The ACO leader must encourage a culture of innovation throughout the organization. The culture must begin with the leadership team and flow through the entire organization. Leaders set the direction for innovation by first identifying a vision for the organization that reflects a true marketplace assessment and the support of its important stakeholders.
As buy-in to the organizational vision evolves, the leader can then encourage development of solutions and ideas that will help support the vision. Creation of a culture in which people feel that their ideas will be valued will result in effective, often creative problem-solving and innovations that can make an organization more competitive and cutting-edge.
Determining your leadership development strategy
Developing a strong pool of leadership talent within today’s health care management ranks is a critical need of the industry as a whole. As a health care executive leading your organization toward a system of accountable care, ask yourself questions such as:
- Does the leadership team need an infusion of new talent with different skills or capabilities?
- Do current leaders need to undergo intensive assessments to identify their skill and knowledge gaps in delivering accountable care?
- How can training resources best be utilized to maximize the potential of mid-level managers and build bench strength within the organization?
- Do we need skilled assistance in objectively identifying talent from within and outside our organization who will share our vision, understand our culture and fit our team?
Whatever the answers to these questions, addressing them proactively will help you build the leadership team of an ACO.