During a retreat a few years ago, the Northeast Georgia Health System medical staff discussed how to tackle the existing organizational challenges, including a lack of physician engagement. On the way home from that meeting, NGHS leadership decided to cancel all elective surgeries because of the increasing severity of the pandemic. Leadership went from having conversations about engagement survey results to discussing how to minimize patient deaths and keep staff safe.

As the pandemic continued, however, leadership knew that they needed to return to their concerns around the lack of physician leadership and engagement throughout the system. The organization's leaders believed that by empowering their physicians as leaders, they would be able to come together as a system to emerge stronger. Therefore, NGHS decided to partner with The Leadership Development Group, a consulting firm, to adopt a customized leadership development program that focuses on development in four leadership clusters over a period of six, 12, or 18 months.

Determine what's what

The program started with an organizational priority assessment (OPA), which included interviews with 10 organizational leaders—the CEO, chief operating officer, chief HR officer, and various senior physician leaders—to gain an understanding of the individual leaders, the organization, and their hopes and concerns surrounding the program. Interview questions included:

• What are NGHS's most important strategic priorities for the next one to five years?

• Which skills must physician leaders develop to meet those goals?

• What are the most important challenges NGHS must solve to enhance the relationship between physicians and administrators?

An analysis of the results informed the program content. The results fell into two main areas: the desired outcomes and barriers to success. Desired outcomes included physicians who can lead and grow future leaders, projects that are meaningful and make a difference, as well as improvements in key metrics such as physician and employee engagement. The potential barriers to success included time constraints, selecting the right cohort to participate in the program, the realities of the pandemic, and a jaded mentality on physician leadership development.

Specifically, the OPA revealed that a barrier to success was that physicians had low trust in NGHS as an organization. They didn't believe administrators would commit to giving them a true seat at the table and a say in system decision making. Further, there was a sense among physicians that the Applied Physician Leadership Academy (APLA) was a short-term way to placate them instead of a long-term, meaningful engagement strategy.

Engaging individuals and giving them a voice through participation in the OPA socialized key stakeholders to the program objectives and presented the opportunity for them to contribute to the program design.

Three strategic imperatives resulted from the OPA:

• Physician involvement in strategic system development goals, particularly as they relate to population health or service line development

• Physician engagement and leadership in day-to-day issues; goals relative to performance in the safety arena as well as in quality; how to deal with readmission issues; and relationships that physicians have with the nursing staff

• Organization-wide cohesion to drive positive change and organizational outcomes

Program implementation

The APLA uses the 70-20-10 framework in which 10 percent of learning incorporates interactive training courses that focus on specific leadership skills, 20 percent focuses on assessment and coaching, and 70 percent entails hands-on experiential learning to directly apply learning and develop leadership competencies to real business problems.

Thirty people participated in the APLA, including a mix of senior physician leaders and high-performing leaders, leaders with low engagement scores, and individuals serving key positions who had little management training.

The program kicked off in January 2021. For six months, the cohort participated in a wide range of assessments, courses, and activities. Each participant worked with a coach who conducted an in-depth interview and an emotional intelligence assessment with the individual. The coach and participant then completed seven one-to-one executive coaching sessions spread out over the program's duration.

Group learning

Individuals also participated in four monthly group learning sessions from January to April. The sessions were rooted in four leadership competencies: leading self, leading for results, leading change, and leading others. The sessions, led by the TLD Group team and faculty members, incorporated input from the OPA interviews to highlight focus areas in five didactic learning sessions.

Capitalizing on Emotional Intelligence to Effectively Lead at NGHS (leading self). Physician leaders learned about the connection between emotional intelligence and effective physician leadership, factors that affect interpersonal and intrapersonal intelligence, and ways to remove barriers that may affect one's ability to lead with emotional intelligence.

Building Acumen and Financial Literacy—How to Contribute to Operational Success (leading for results). This session covered basic business finance language and the logic of business while also touching on how NGHS generates profit and what it will need to grow in the future.

Population Health: Collaborating and Building Partnerships (leading change). Leaders discussed the critical elements of value-based care for physician leaders, including how to effectively communicate value, the key tenets of population health, and how to collaborate to enable NGHS's population health success.

Adaptive Leadership—Leading Effectively in Groups and Teams (leading others). This session focused on adaptivity in leadership and implications of adaptivity for strategy and culture.

Resilience in Healthcare Leadership (leading self). In the final session, participants learned about incorporating a research-based, practical model of mindfulness, short reflections, strategic breaks, realistic boundaries between work and personal lives, as well as healthy sleep habits.

In the Leading for Results session, the cohort split into eight teams to participate in a competitive business simulation. Each team had to run a fictitious healthcare organization over the course of three years, balancing between short-term profits and long-term results as well as defining meaningful success factors for the fictitious healthcare system. They made decisions about how to respond to real-world business challenges, including staffing pressures, increasing regulations, more demanding consumers, and suboptimization of the revenue cycle.

Participants noted that, as clinicians without financial backgrounds, the session helped them understand why hospital administration can't just buy equipment or make other seemingly simple purchases. Now, the physicians find themselves asking how one purchase can have a domino effect on other areas of the hospital.

Adjustments to the learning sessions reflected the new needs and concerns that came up throughout the program. TLD Group representatives met weekly with a design team that included NGHS executives and senior physician leaders to take and implement feedback on the didactic learning sessions.

Action learning

The third portion of the APLA was a facilitated action learning process. The cohort split into four teams, each of which took on a project that linked to strategic organizational priorities—such as enhancing dyad partnerships to drive engagement and performance metrics—while developing leadership skills. At the end of the process, each project team presented their recommendations to executive leadership, enabling participants to both strengthen their leadership skills and contribute to systemwide solutions.

The criteria for the action learning projects included that they should cross boundaries and functions and address a complex problem with no obvious solution. Most importantly, the projects needed to empower participants to propose a solution as a team.

John Clifton Hastings, recent past chief of staff of NGHS, compared the process to learning how to swim. "In other leadership exercises, I've heard lectures about how to swim," he explains. "In this particular exercise, they put us in the pool—and at one point, they put us in the deep end, and we sputtered around a little bit. Ultimately, we helped each other and learned how to lead and come up with solutions together."

Results

Data collected via pre- and post-assessments and evaluation surveys reveal that participants had significant improvements across all four leadership competencies—ranging from a 5.9 percent increase for leading change to a 9.9 percent increase for leading others.

Leaders noted the significant improvement seen in the category "My commitment to NGHS has improved as a result of my involvement in the APLA program." The improved commitment to NGHS illustrates the impact a leadership development program can have on cohorts of physician leaders, particularly at a time of crisis like the pandemic. The program provided a way for participants to stay focused on strategy and to move forward through the crisis.

The APLA likewise enabled participants to understand that, in both the day-to-day stresses of working in healthcare and in emergency situations, they're able to receive and give support to their teammates. The facilitated action learning process helped them practice those skills and taught participants to lean on each other and work together.

After the program, leadership saw physicians become more willing to speak up and step up to take on work at the system level. Physicians also started volunteering more and demonstrated a strong commitment to making the dyad structure work.

Looking forward

The organization continued to invest in physician leaders in numerous ways after the APLA. For example, the first cohort of participants received the option to continue their executive coaching for an additional six months.

At the request of medical staff members, NGHS has run a second and third cohort, with former participants recommending other potential leaders and becoming mentors for the next group.

Before the program, when NGHS leadership looked at the medical staff to see who could serve in leadership roles, leadership struggled to identify potential leaders. As a result of the APLA, leadership realized that there are many great leaders in the health system who can serve in leadership roles—if given the right tools.

Northeast Georgia Health System

Industry:

Healthcare

Workforce Size:

10,000

L&D Staff Size:

5

HQ Location:

Gainesville, Georgia