'Physician leader': An often poorly defined term

The number of physician leaders within an organization has expanded alongside healthcare's growing footprint and rising complexity, resulting in a vast patchwork of leaders with different job descriptions, expectations and standards. In the face of all this complexity emerges a simple question with no single, clear answer: What is a "physician leader"?

During a panel at Becker's Annual Meeting in Chicago, Naeem Ali, MD, asked the audience: How many of your hospitals or health systems define physician leadership in a clear way across the organization? 

The sprinkling of hands that went into the air did not surprise Dr. Ali, who serves as medical director of University Hospital, the flagship hospital of Ohio State University Wexner Medical Center in Columbus.

"There's a lot of baggage and history that comes with medical leadership," he told Becker's. Historically, hospitals have been organized around an independent medical staff, requiring organizations to navigate many rules and regulations about how to engage these leaders and structure their time and efforts, Dr. Ali said. 

What's more, the number of medical leaders at an organization can easily snowball based on an organization's local strategic and regulatory needs, creating an unstandardized and ever-expanding network of physician leaders.

"Particularly at academic medical centers, the number of leaders with oversight over those specific roles just multiplies," Dr. Ali said. "It becomes, over time, something that can get bigger than you envisioned in a single plan. And so it becomes a challenge to kind of create a single structure that applies to all of those."

A two-year process

Three years ago, University Hospital embarked on a journey to redefine its physician leadership model, starting with its inpatient units. Under the original model, a single physician leader acted as medical director of his or her specialty on each unit.  

"If you had a large unit with three or four different specialty services represented, we'd have three or four medical leaders who were involved in that space," Dr. Ali said. "And it created a lot of confusion."

Though the leaders were called medical directors, they really acted as service leaders. Many felt responsible only for the patients who fell under their specific specialty on the unit, and those leaders were not serving the nurse and administrative team, according to Dr. Ali. 

To eliminate confusion and create more effective leadership processes, University Hospital adopted a dyad and triad leadership model in which unit-based teams were overseen by leaders who had a scope of responsibility over an entire unit versus just sections of it. 

Hospital leadership created new, standardized position descriptions for those medical directors. The original job descriptions contained broad, generalized leadership expectations to account for the many different types of medical director roles throughout the hospital. The new job descriptions, however, clearly outlined leaders' main priorities, with one of the initial competencies being responsiveness to the needs and concerns of a patient on a service line that was different from the medical director's own, according to Dr. Ali. 

"The best role our medical directors can play is as a translator," he said. "They have to be able to articulate how their clinicians make individual patient treatment decisions based on an appropriate, locally determined risk-benefit discussion. But then also understand how that gets put together in the big scheme of things. … Ultimately they have to move to advocating as a system leader, not just an individual clinician support."

After rolling out the new leadership structure, Dr. Ali said physicians' responses varied. Few overtly resisted the new structure, though the hospital did see turnover of about 10 percent at two key stages of the change management process. The first round of departures came when the new job descriptions were shared with physician leaders and they had a clear understanding of what was expected of them. The second came one year later, when medical directors received crucial feedback during performance reviews, which became more focused under the new job description. The hospital saw another 10 percent turnover during this period.

"So it's generally a two-year process, I think, to remold those expectations," Dr. Ali said. 

Expansion to outpatient

University Hospital has since expanded the leadership model from the inpatient space. About a year and a half ago, the hospital revamped leadership structures and job descriptions for individuals who were integrated with inpatient operations but also had outpatient responsibilities, such as operating room, bronchoscopy and radiology directors. 

"Each year, we've added layers to the onion," Dr. Ali said. "The key is we've added different core areas, but we've stayed with the same structures and expectations."

He cited engagement and alignment across the hospital's C-suite team, administrative leaders and executive directors as a crucial component of the initiative, noting all stakeholders must agree on what they expect from medical leaders. This agreement creates a sense of camaraderie and ensures everyone is on the same page about the values and responsibilities they are looking for when cultivating a medical team. 

"At the end of the day, I feel like we've been able to move faster because we have broader endorsement across the entire leadership team of what we need to see for medical leaders," Dr. Ali said. 

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