PRACTICE MANAGEMENTPeter F. Lawrence, MD, Section Editor

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Talent management and physician leadershiptraining is essential for preparing tomorrow’sphysician leadersBhagwan Satiani, MD, MBA, FACS,a John Sena, PhD,b Robert Ruberg, MD,a andE. Christopher Ellison, MD,a Columbus, Ohio

Talent management and leadership development is becoming a necessity for health care organizations. These leaders willbe needed to manage the change in the delivery of health care and payment systems. Appointment of clinically skilledphysicians as leaders without specific training in the areas described in our program could lead to failure. A comprehensiveprogram such as the one described is also needed for succession planning and retaining high-potential individuals in an eraof shortage of surgeons. (J Vasc Surg 2014;59:542-6.)

Talent management and leadership development isquickly becoming a major initiative in American medicalschools. Medical schools are increasingly expending timeand resources to developing physician-leaders, while physi-cians are revealing an interest in becoming leaders ofa department, medical college, hospital, or health careorganization. In 1993, for instance, there were six MD-MBA programs in the United States; in 2009, there were51; in 2012, there were 64.1,2

BACKGROUND

Physicians are in a unique position to lead health careorganizations because they are committed to treatment ofthe patient and prevention of illness. A study by McKinseyin the London School of Economics used interviews withmanagers and department heads in the United KingdomNationalHealth Service todeterminemanagement and lead-ership performance. They found that hospitals with themostclinician involvement in management affairs performed 50%higher on drivers of performance, such as effectiveness of

the Department of Surgery, Wexner Medical Center at The Ohioate University College of Medicinea; and the Department of English,he Ohio State University.b

or conflict of interest: none.ented at the Society of Surgical Chairs, Chicago, Ill, September 12, 2012.rint requests: Bhagwan Satiani, MD, MBA, FACS, Professor of Clinicalrgery, Division of Vascular Diseases and Surgery, Department ofrgery, Director, FAME Faculty Leadership Institute, Ste 700, 376 W.th Ave, Columbus, OH 43210 (e-mail: bhagwan.satiani@osumc.edu).editors and reviewers of this article have no relevant financial relationshipsdisclose per the JVS policy that requires reviewers to decline review of anyanuscript for which they may have a conflict of interest.-5214/$36.00yright � 2014 by the Society for Vascular Surgery.://dx.doi.org/10.1016/j.jvs.2013.10.074

overallmanagement, performancemanagement, and leader-ship compared with hospitals with little clinical leadership.3

While there is often a gulf and sometimes contentious rela-tionship between hospital administrators and clinical practi-tioners, the physician-leaders’ clinical background givesthem credibility with the medical staff, while their adminis-trative skills allow them to respond to health care reform,changes in reimbursement, and newly created integrateddelivery systems such as accountable care organizations,medical homes, and bundled payment models.4

Combining leadership skills and trainingwith their clinicalexpertise, they have the potential to become powerful andinfluential leaders capable of seeing new possibilities, inspiringothers, breakingdownsilos, creating anewvisionofhealth caredelivery, and transforming their vision into reality.

While some medical schools and health care organiza-tions provide comprehensive, coherent, and relevant lead-ership training programs, often what passes as leadershipdevelopment in some hospitals and medical schools isa hodge-podge of classes and lectures lacking coherence,logical progression, comprehensiveness, and relevance pre-sented on a variety of leadership and administrative topics.The episodic nature of the instruction is rarely successful indeveloping effective physician-leaders.

A typical career path for a physician who has become anadministrator of a department or leader of a health careorganization is that he or she was recognized as an excel-lent clinician, teacher, or researcher. While laudable, theseskills are not the competencies needed to lead departmentsor health care organizations at this time. The newlypromoted physician may lack financial, change manage-ment, communication, motivational, team building, riskmanagement, and leadership skills. Furthermore, many ofthe activities of the successful physician, from treatingpatients to conducting research, are often done as a sole

Table I. Topics and core knowledge covered in talent management and leader development program

Topic Core knowledge

Leadership competency Leadership skills and behavior, styles and technique; key barriers to effective leadership; establish and supportorganizational vision; promote commitment to the values; set personal example.

Strategic planning andvision

Organizational dynamics, political realities and culture; strategic planning processes development andimplementation; strategic business analysis; choosing an effective strategy, balancing risks and rewards.

Financial management Basic accounting, financial management and principles; financial statements; principles of operating, projectand capital budgeting, financial controls; revenue generation and capital funding; assessing financial rewardsand risk; time value of money; cost volume profit analysis.

Business planning Techniques for business plan development, implementation and assessment; defining problems/opportunities,forecasting and SWOT analysis; comparative analysis strategies; methods of evaluating alternatives.

Communication skills Principles of communication, public relations; communicate organizational mission, vision, objectives andpriorities, utilize human and technical resources, business communications, provide and receive constructivefeedback, present data analysis; build collaborative relationships, effective interpersonal relations (medicalstaff, suppliers, other stakeholders).

Change management Promote and manage change; identifying stakeholders early; explore opportunities for the growth anddevelopment of the organization on a continuous basis; promote contiguous organizational learning/improvement; anticipate and plan strategies for overcoming obstacles; overcoming resistance to change;tolerance for ambiguity.

Quality of care andpatient satisfaction

Benchmarking techniques; clinical pathways structure and function; national quality initiatives includingpatient safety; customer satisfaction principles and tools; patient communication systems; qualityimprovement framework; quality planning and management; publicly available outcomes; patientsatisfaction scores.

Team building Creating an organizational climate that encourages teamwork; assessing the organizational values and culture;the social style model.

Negotiation and problemsolving

Range of negotiations; types of negotiations; quantifying stakes for parties involved; facilitation/negotiations:mediation, negotiation and dispute resolution techniques, team-building techniques, labor relationstrategies, build effective physician and administrator leadership, facilitate conflict and alternative disputeresolution, facilitate group dynamics, process, meetings and discussion groups.

Stress/burnout andlifestyles issues

Physician concerns; satisfaction/unsatisfaction; causes of burnout; common gripes; management of time andinefficiencies; balance; tips to avoid burnout; develop and implement policies and procedures with physiciansto address physician behavioral and burnout issues.

Human resources andtalent management

Organizational policies and procedures; human resources laws and regulations; recruitment and retentionstrategies; selection techniques; compensation and benefit practices, conflict resolution and grievanceprocedures; defining staff roles, responsibilities and job descriptions; evaluate and manage employeeefficiency and productivity.

Diversity for health careleaders

Working definitions of diversity and meanings in organizations; what it is not; why diversity; strategies tosupport and increase diversity; individual level: address cultural competence and countertransference; issuesof power and privilege.

Health care law Basic contracts, federal and state court system, legal procedures and litigation; Stark, anti-kickback law andfalse claims act; restrictive covenants; physician employment models; impact of health reform.

Medical ethics Organizational culture and behavior; organizational ethics; duties and obligations in health careadministration; contractual obligations of health professionals; patient rights; corporate complianceprograms; conflicts of interest; HIPAA; substance abuse.

Final case study

HIPAA, Health Insurance Portability and Accountability Act; SWOT, strengths, weaknesses, opportunities, and threats.Adapted from American College of Healthcare Executives Competency Assessment Tool 2013.

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and autonomous professional. Consensus building, leadinggroup activities, developing a shared vision, and forgingpartnerships are often not a part of his or her training orexperience. The unfortunate result is that the physician’sperformance in his or her new role is often mediocre orworse.5,6 The demands, complexity, and responsibilitiesof a modern health care organization are too importantto be left to “accidental leaders.”1

PROGRAM DESCRIPTION

To overcome this traditional pattern and to createphysician leaders, the Department of Surgery at The OhioState University Wexner Medical Center developed aTalent Management and Leader Development Academy(TMALDA) to provide a coherent, comprehensive, and rele-vant development program for physicianswhowish to assume

administrative or leadership roles in their departments,medical colleges, hospitals, or health care organizations (eg,HMOs, medical insurance companies, life sciences industry,medical device manufacturers, and pharmaceutical firms).The success of the surgically oriented program has led theCollege ofMedicine to offer a second iteration, which startedin 2013, called the Faculty Leadership Institute (FLI), whichis open to all faculties in the college of medicine.

The TMALDA program created in the Department ofSurgery is 18 months in duration, consisting of 4-hour semi-nars offered once a month on topics designed to developphysician-leaders. The first group of participants started inSeptember 2011 and “graduated” in April 2013. The curric-ulum was based on the recommendations of faculty from theCollege of Medicine, the Ohio State Univeristy FisherCollege of Business, and the Humanities College at The

Table II. Participant departments and their roles

Department(No. of faculty)

Roles of participants upon starting theprogram

General Surgery (2) Director of fellowship, second participantpromoted in administrative role sinceprogram completion

Pediatric Surgery (2) Section ChiefsPlastic Surgery (2) Young faculty, no assigned

administrative role yetOtolaryngology (4) Young faculty, no assigned

administrative roles, picked by ChairObstetrics andGynecology (1)

Director of division

Orthopedics (2) Both section chiefs (trauma andoncology)

Neurosurgery (2) Subspecialty leadersCritical Care, Trauma,and Burns (1)

Section Chief

Ophthalmology (2) Young faculty, no assignedadministrative role but deemedpromising leaders by Chair

Oral and MaxillofacialSurgery (1)

No assigned role yet, picked byDivision Chief to participate

Urology (3) All three <10 years in practice, oneleading a section

CardiothoracicSurgery (1)

Administrative role planned by DivisionChief

Vascular Surgery (1) Endovascular program director

JOURNAL OF VASCULAR SURGERY544 Satiani et al February 2014

Ohio State University, as well as surveys and literatureaddressing physician leadership competencies.1,6,7 Thesessions cover the areas of leadership and talent developmentlisted in Table I. Seminars are taught equally by internalfaculty and nationally recognized experts from outside theUniversity, including speakers from the Mayo Clinic, BaylorCollege of Medicine, and prominent consulting firms.

Sessions are highly interactive. Attendees are enthusi-astic and receptive students: they are anxious to acquirenew skill sets, think in terms of new paradigms, adoptnew ways of viewing health care, and learn a new language.Participants were divided into teams, each with four to sixindividuals to work on projects throughout the year and in-class discussions. Teams also presented their projects andprizes were awarded based on scores by three judges(B.S., R.R., and J.S.).

The Program Director works with facilitators who aregiven specific instructions about the core knowledge to becovered for each module, which is 3.5 hours and includesabout a 20-minute break. The session on leading changeinvolves a six-stagemodelwhich addresses issues such as antic-ipating change, achieving buy-in from employees, construct-ing a change plan, overcoming resistance, implementationof a change program, and evaluation methods. Due to theimportance of quality management in fully integrated healthsystems of the future, two modules are devoted to quality ofcare and improving the patient experience. Sessions on ethicalissues, negotiation strategies, and conflict managementinvolve case studies based on the instructors’ experiences.

The program also includes several projects thatstudents undertake in teams. The three selected projecttopics reflect current issues facing health care leadership:“Creating an ACO”; “Leading a Hospital Merger”; and“Improving Healthcare Delivery Systems.” The assign-ments demand that physicians consult medical leaders,conduct their own research, and work in collaboration.Their oral presentations are attended by College of Medi-cine faculty and senior administrators.

Selection of the first 24 candidates for participation inthe program began by sending a detailed description ratio-nale of the program to surgical department chairsthroughout the College of Medicine. Goals, subjectmatter, expected outcomes, and a list of instructors withtheir areas of expertise were included. The program orga-nizers met with the chairs to further explain the program,answer questions, and get their support and commitmentto allow faculty to attend the program. The chairs wereasked to nominate physicians who were in the early-to-mid part of their careers and whom they felt had potentialto become effective leaders (Table II). Funding wasprovided by participant fees paid by each department.

The response from department chairs has been enthusi-astic. For the FLI, more than twice the number of physicianswas nominated than could be accommodated by the 30 slotsavailable. Both the TMALDA and the FLI program do notrequire physicians tomake abinarydecision: doIpursuea clin-ical career or an administrative career? Physicians in theTMALDA program have not given up their medical or

surgical practices. In fact, the program has enhanced theirleadership development, according to reviews by the depart-ment chairs after completion of the program. The leadershipprogram also addresses succession planning, a key tocontinued and effective leadership over time. The leadershipprogram addresses another significant issue facing healthcare: succession planning. Talentmanagement and successionplanning constitute a systematic process for preparing peopletomeet an organization’s needs for leadership and talent overtime. They are designed to ensure the continued effectiveperformance of an organization by developing the skills andcompetencies of high-potential individuals to assume leader-ship positions in the future.8 Failure to prioritize talentmanagement and succession planning often leads to a steadyattrition of high-potential individuals or to the retention ofpeoplewith outdated skills or both.With the current shortageof physicians and vascular surgeons, it is imperative to identifyfuture physician leaders and to create developmentalprograms to close thegapbetween their current skills and abil-ities and those needed for higher-level positions.9

Evaluation of this program is as important as it is diffi-cult. In the absence of national norms for measuringphysician-leader progress, we have taken a short-term andlongitudinal approach. Students are asked to evaluate theprogram and their progress. Their immediate supervisorsare also asked if they have observed administrative growth,increased skill levels, and changes in behavior. Longitudi-nally, the career paths and achievements of the participantsshall be tracked.

A successful physician leadership program must remainflexible and adaptive. Subject matter in future offerings may

Table III. Questions on final evaluation returned by participants and brief summary of responses

Question Response summary

Were you satisfied with the process, faculty, andeducational materials employed in the program?

Yes: 93%; one participant yes/no

Name two things you liked the most about the program. Faculty; varied topics, topics not covered in school, small group discussions,interact with peers, comprehensiveness, several participants mentionedspecific modules, seeing how medical center works

Name two things you liked the least about the program. Group projects, long program, long sessions, lot of work, final project,What things would you like to see changed or improved? Shorten program, shorten session by 1=2 hour; no dinner break, more

finance, module on retention/recruitment of faculty, fewer projects butmore in-class work, teams could pick their own projects,

Would you recommend this program to your peers? 100%; two commented that this program is better suited for faculty planningcareer in hospital administration

How has the program helped you in your current role?Be specific please.

Improved leadership skills; improved negotiation skills; more self-awareness ofleadership style, using team building in relationships and various roles,relationship with other faculty, more confidence in leadership roles,collaboration techniques, aware of emotional intelligence aspect now,networking with others would not have occurred otherwise, understandhealth care transformation/negotiations/health care law, etc

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be revised based on new challenges in health care, theeffects of health care reform, and changes in delivery andpayment systems. In the FLI, student evaluation includesa 360-degree assessment.

CHALLENGES FACED IN IMPLEMENTINGPROGRAM

Although a commitment from Chairs was obtained torelease faculty once a month for the various modules, indi-vidual surgeons felt obligated to deal with patients theyhad operated on and missed some sessions. We also hadparticipants sign statements that they would abide by theattendance requirement, but no penalty was enforced otherthan keeping their fees.With a 75% attendance requirement,one participant decided to withdraw after three consecutiveabsences early in the program. Another participant withdrewmore than halfway into the program for similar reasons.

Another challenge was to try and hit a “sweet spot” interms of asking facilitators to cover topics so the informa-tion would not be too basic or at too high a level. A surveydone halfway through the program indicated that therewere a couple of people who thought the content waseither too basic or too hard. The same feedback wasreceived about the length of the class (3.5 hours) and theextent of homework/reading given to participants.

Finally, all teams formed at the beginning remarked thatthey had difficulty getting together towork on their projects.Perhaps use of new technologic aids such as Google workgroups or Facetime, etc. would have solved this problem.

PROGRAM EVALUATION

Besides evaluating each facilitator and session, partici-pants were asked to evaluate the entire program, topics,content, amount of work, physical environment, whetherthey would recommend this program to others, and areasof satisfaction and dissatisfaction. This was done halfwayinto the program and at the conclusion of all sessions. Asummary of the final evaluation is shown in Table III.

CURRENT STATUS OF LEADERSHIPPROGRAMS

The emergence of physician-development programsmust be seen as part of a larger, system-wide change in healthcare that requires fundamental re-examination of the struc-tures, priorities, and professional relationships in hospitalsand health care organizations. Hospitals and health careorganizations, for instance, must revisit their governancestructures, physician recruitment and promotion criteria,and career paths for physicians. AnAdvisoryBoardCompanysurvey suggests that many hospitals have not prepared theground for physician-leaders: when physician-leaders wererecruited, 59%of the hospitals surveyed did not clearly defineroles, responsibilities, and performance objectives for them,and 78% did not evaluate physician-leaders’ performanceagainst established goals.4 Physician-hospital relations mustbe strengthened, trust between them renewed, leadershipopportunities made available, mutual expectations clarified,and a shared vision for the future created. Nonclinical exec-utives must view physician-leaders as partners in serving theneeds of patients, not as threats to their careers.10

Furthermore, increased attentionmust be given to iden-tifying high-potential clinicians, grooming them throughformal development programs, providing upward mobility,and including them in succession planning. This type ofprogram is materially different than most MBA programs(Table IV). Training and experience also requires attentionto emotional intelligence, consensus building, and conflictresolution. Success of the physician leader will of necessityrequire them to be engaged in clinical care, lest they bedeemed “out of touch.” This requires special organizationalskills and the ability to shift gears between varying responsi-bilities. Although some would argue that the time for thisintensity of training should be in medical school, we favortraining after completion of the residency and fellowshipand ideally after a few years of practice. This experiencenot only provides maturity but also a point of reference forthe “leader to be.” Our first year medical school class has

Table IV. Comparison of topics covered at Ohio StateFisher School of Business Masters in BusinessAdministration (MBA) program and Department ofSurgery’s Talent Management and Leader DevelopmentAcademy (TMALDA)

MBA core curriculum TMALDA topics

Common topicsAccounting Financial managementLeadership Leadership competencyStrategy Strategic planning and vision

Different topicsMarketing I Business planningOrganizational behavior Communication skillsOperations I Change managementFinance I Quality of care and patient

satisfactionManagerial economics Team buildingInternational business Negotiation and problem solvingOperations II Stress/burnout and lifestyles issuesFinance II Human resources and talent

managementMarketing II Diversity for health care leadersData Analysis Health care lawFlex core, major, andelective courses

Final case study

These are first-year MBA topics and vary from 1.5 to 2.5 credits. Most of thesecond year and a part of the first year has flexible core topics and electives.Source: http://fisher.osu.edu/ftmba/academics/curriculum/.

JOURNAL OF VASCULAR SURGERY546 Satiani et al February 2014

instituted a “business” cluster and invites speakers severaltimes a year. In addition, one of the authors (BS) has leda monthly Practice Management Seminar series for surgicalresidents, which is a credit course and encompassesa comprehensive curriculum over 24 months.

“Successful corporations,” according to John Kotter, oneof the founders of change management as an academic disci-pline, “don’t wait for leaders to come along. They activelyseek out people with leadership potential and expose themto career experiences designed to develop that potential.Indeed, with careful selection, nurturing, and encouragement,dozens of people can play important leadership roles..”11

Health care as we know it will never be the same.Changes and initiatives required by the Patient Protectionand Affordable Care Act, emerging technologies, newdelivery systems, changes in reimbursement models, therise of accountable care organizations and medical homes,demographic trends, the patient as consumer, andworkforcechallenges demand that hospitals and health care organiza-tions become more inclusive in their leadership structure.

ROLE OF THE SOCIETY FOR VASCULARSURGERY

Physician-leaders, including vascular surgeons, arean extraordinary leadership resource, combining soundmanagement with high medical standards, and they willplay an increasingly significant role in addressing the chal-lenges facing health care. The Society for Vascular Surgerymust be at the forefront in offering opportunities to itsmembers for developing management and leadership skills

as outlined. This initiative has recently been started by theincoming President Dr Freischlag by forming a newcommittee on leadership. Educational activities to developmembers as leaders may be a combination of cooperatingwith existing programs as well as a ground-up effort withan annual stand-alone meeting, which has a more intensivecurriculum. The American College of Surgeons and theAmerican Surgical Association co-sponsor a health policyand management scholarship for surgeons to attend theHeller School of Management at Brandeis University.12

Cooperative arrangements could also be made with theAmerican College of Physician Executives to offer scholar-ships to selected members to complete a formal CertifiedPhysician Executive CPE program, for instance.13

AUTHOR CONTRIBUTIONS

Conception and design: BS, JSAnalysis and interpretation: BS, JS, CE, RRData collection: Not applicableWriting the article: BS, JSCritical revision of the article: BS, CE, RRFinal approval of the article: BS, JS, CE, RRStatistical analysis: Not applicableObtained funding: Not applicableOverall responsibility: BS

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Submitted Jul 8, 2013; accepted Oct 11, 2013.