Dyad leadership moves to the C-suite

A dyad leadership model — which often pairs a clinician with a non-clinical administrative leader for strategic and operational responsibility — is not new in healthcare. However, the model continues to evolve and is used in various ways at organizations today. 

This is the consensus of experts who spoke with Becker's about who is using the model and how it has changed since before the COVID-19 pandemic. 

Who is using the model and how? 

While difficult to pinpoint recent reliable data in terms of how extensive dyads are, it's safe to say that more health systems are adopting them and exploring how to use them more broadly than in the past. 

A poster from MD Anderson Cancer Center in Houston indicates the organization testing the idea in 2020-21 and the use of the dyad leadership model increasing at the organization.

Sacramento, Calif.-based Sutter Health hired Todd Smith, MD, to serve in the newly created role of senior vice president and chief physician executive. Dr. Smith and Mark Sevco, senior vice president and COO, will oversee the system's acute, clinic and ambulatory operations under a dyad leadership model.

And Chesterfield, Mo.-based St. Luke's named Tammy Lett, RN, senior vice president of its physician network. Ms. Lett will work in a dyad with Chief Medical Officer Darren Haskell, MD.

Additionally, Milwaukee-based Froedtert Health is among the healthcare organizations increasing their use of the model.

"We use them throughout our enterprise," Susan Campbell, RN, senior vice president of service lines at the health system, said. "Typically, they consist of an administrative leader, such as a vice president, director or manager, and then a physician counterpart."

One example could be the heart and vascular service line, where there is a dyad partnership of a vice president paired with a physician leader. 

Ms. Campbell said the goal of the partnership is to ensure that from a strategic and operational perspective, "We have someone who understands the operations, financial components of the business, and then you marry that with someone who has the clinical understanding."

"And so you make sure that the decisions you're making are not devoid of the other side. And what I mean by that is … you want to make sure any decisions you would make are actually what's best for the patients, but at the same time, you're using your resources effectively. This is why the partnership works well, because they can talk through the operations side of it. How do you make sure it runs smoothly? How do you make sure it's financially viable? And then at the same time, do we actually meet the needs of the patient and meet the needs of the family or caregivers?"

At Froedtert Health, there is a vice president of the musculoskeletal service line who's paired with an orthopedic surgeon in a dyad partnership. 

Ms. Campbell said the vice president and surgeon work together to look at, from a patient perspective, where musculoskeletal or orthopedics and spine cases should occur, whether that's a hospital or ambulatory surgical center site.

They also look at how to ensure care quality is maintained, she said. 

"The administrative person is able to say, 'What are the things we're going to need from an expense perspective?' Then from an operating perspective, working with the ambulatory surgery center to say, 'If we're going to move our cases over here, these are the things we need from a staffing perspective. These are the things we need from an equipment perspective. These are the things we need from a supply perspective.' And so they're able to kind of come at it from an administrative side, but marry those decision-making qualities with the surgeon who's coming at it from a clinical side." 

Ms. Campbell said that this type of partnership has helped ensure cases aren't moved to other healthcare settings solely for the sake of moving cases, but are being moved because a particular site is the best choice for that case.

The pandemic and the importance of partnerships

As more health systems explore how to use the dyad leadership model, the model itself has also evolved.

More specifically, the dyad leadership model has evolved from more of a collaboration to more of a partnership, said Ms. Campbell, with Froedtert Health.

"I think that has evolved over time, and I think, as you truly make these two individuals partners, I think the decision-making has definitely evolved and definitely benefited the patient and healthcare in general," she said.

Particularly post-pandemic, she also sees dyad leadership as a way to ensure comprehensive discussions as healthcare organizations are navigating resource challenges, whether it's supplies or people.

"You're figuring out different options to address the problems in front of you and then ideally ending with the best solution given the environment with which you live," Ms. Campbell said.

Linda Komnick is managing partner and leader of the physician integration and leadership practice at WittKieffer, an executive search and advisory firm. Earlier in her career, she served in leadership roles at Mercy Hospital & Medical Center in Chicago, including the roles of director of ambulatory care and as associate vice president of administration.

Ms. Komnick said she's observed the dyad model become more prevalent over time. While she recalls a time when medical directors and nursing directors were a large part of dyad leadership, she is now seeing this alignment amongst C-suite roles. 

"We've seen this expand over the number of years, in terms of the partnership between the chief clinical officer role and the chief operations officer, as the physician leader has become much more involved in strategic leadership," Ms. Komnick said. "But I have to qualify that to say, too, in many organizations it is a triad model with the chief nursing officer."

She noted that she has seen these partnerships involving C-suite members in service lines at health systems, but also at medical practices that are integrated within a health system.

"Healthcare is highly matrixed, and that hierarchical shift to more matrices has been a significant change breaking down barriers in creating these [dyads]," Ms. Komnick added. 

Shelly Carolan, who heads up WittKieffer's commercial healthcare (i.e., for-profit) practice, told Becker's she has also seen the evolution of the dyad leadership model as roles become more synergistic and work more closely together.

"To set this leadership model up for success it is critical that the organization aligns their strategic goals and KPIs and recruits talent that has the right leadership characteristics and competencies for the role," Ms. Carolan said.  

It's difficult to quantify the number of medical groups or healthcare organizations using the dyad leadership model. However, Ms. Carolan said she's seen a tremendous amount of interest in the model and inquiries about it from independent medical groups — for example, inquiring about potentially adding a COO to their practice.

This is "so they can either better align with the integrated hospital system or better compete in their marketplace in today's challenging environment," Ms. Carolan said.

Patrice Weiss, MD, a physician executive consultant for WittKieffer, is a professor of clinical OB-GYN  at Nashville, Tenn.-based Vanderbilt University Medical Center and previously served as executive vice president and chief medical officer at Roanoke, Va.-based Carilion Clinic.

Dr. Weiss said the pandemic showed that "healthcare is really a team sport and we need all participants on the team doing their jobs, taking responsibility, but also having an appreciation and recognizing what others are doing."

She particularly sees the benefits of dyad leadership in terms of bringing together clinical and administrative perspectives to move initiatives forward. This could include staffing, particularly during the COVID-19 pandemic.

"How do you take care of the ICU unit when you have more patients than beds? And every day, it feels like you had a decreasing medical workforce," Dr. Weiss said. "It's one thing for the clinicians to say, 'We need to do X,Y or Z with these patients. They need this bed, they need this unit, they need this clinical care. But somebody has to work to make that happen. And I think that's where you need both the clinical expertise and the administrative savvy to pull together the whole package."

She also gave the example of tackling a goal like decreased readmissions. 

"There's a whole clinical piece that needs to happen in making sure that the patient's being discharged has the right follow-up," she said. "But administratively, you need to make sure that there are all the right resources in place. So, for example, are there the office and day-to-day functions in place that when that patient calls the office, they get that follow-up appointment in 72 hours? Who makes sure the patient with congestive heart failure gets the scale and checks their weight? That's an example where you need both operations and the clinical judgment pulling together." 

The dyad leadership model will likely continue showing up at healthcare organizations, experts agree. It remains to be seen how the model will continue to evolve.

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