Knowledge Expansion

5 success factors for physician-administrator partnerships

Insight Article

Governance

Denis A. Cortese MD
Robert K. Smoldt MBA

One of the latest buzzwords in healthcare is dyad leadership, a term that refers to physician/administrator teams that jointly lead healthcare organizations yet the concept dates back to 1908 when Will Mayo, MD, and Harry Harwick (one of the MGMA founders) put the theory into practice at Mayo Clinic, Rochester, Minn. Mayo recognized early on that truly integrated healthcare delivery has an administrative side and that joint leadership is more effective.

Many believe that the need for more integrated delivery of healthcare will encourage more of these dyad leadership arrangements. In “Examining the ‘Dyad’ as a Management Model in Integrated Health Systems,” the authors state that “… the nature of the integrated systems of care causes them to be better managed by the application of qualified physician and nonphysician teams.”

But simply putting a physician and administrator together in a joint leadership position does not guarantee organizational success. In fact, if not done correctly, it could lead to confusion, lack of consistent direction and divided organizational factions. This, in turn, begs the question: What factor(s) increase the likelihood of dyad leadership success?

The following thoughts on dyad leadership success factors come from our combined 62 years with team leadership at Mayo Clinic. We had various administrative and physician partnerships but near the end of our careers at Mayo, we shared the top leadership dyad. Reflecting on our experience, we believe there are five key success factors.

Common core value(s)

Perhaps the most important factor is that both members of the physician/administrator team have the same core value(s) for the organization in their hearts. For instance, at Mayo Clinic the core value of “the needs of the patient come first” is deeply imbedded. Although Mayo is an academic medical center with significant research and education, the highest quality patient care in a learning environment is the main thing and the main thing is always the main thing. If one of the dyad leaders at Mayo did not have this as a core value that team leadership would likely not be successful over the long term. We state that this core value should be ‘in their hearts’ for an important reason. The old management adage that “what I do is more important than what I say” is very true. It makes little difference what leaders say or write in their medical center communications if they turn around and behave differently. The staff of an organization will primarily deduce leadership core values from the daily actions they observe from those leaders. And in a dyad leadership situation, if the staff see different core values, it will lead to confusion and doubt about theory vs. practice about those core values.

Willingness to work together toward a common mission and vision

A clear mission and vision are critical for organizational success. In his book What It Takes: Seven Secrets of Success from the World’s Greatest Professional Firms, author Charles Ellis explains that it “is the big idea about why we are here and why we care so much and work so hard.” In a medical center, if the physician and administrative leadership team can work together on and toward that vision, the organization is much more likely to achieve it. And while it is important that each member of the leadership team has clearly defined individual responsibilities and accountabilities, it is also important that each is willing to be flexible and help the other accomplish those responsibilities. If the leadership team gets too territorial (e.g., this is my area, keep your nose out), the ideal of leveraging each other’s strengths will be lost. The best way to ensure that this does not happen brings us to our next success factor, namely, communication.

Clear and transparent communication with each other and the organization

To gain the most from dyad leadership, each member of the team should leverage and build on the strengths of the other. That cannot happen unless these two members engage in daily, open communication. The more time the individuals spend together as a leadership team, the more frequent and open the communication will be. If over time, communication frequency declines, it is probably a sign that the dyad has divided up responsibilities/authorities and is not really working jointly for overall success of the medical center. The leadership team also needs to have open and clear communication with the medical center as a whole. A part of this team communication that can be overlooked is communicating both the shared vision and shared reality. No organization is perfect. There will be a gap between the vision and where the medical center is now. But if the leadership team is open and honest about each, the likelihood of closing the gap between vision and reality increases.

Mutual respect

Delivering medical care is not an individual sport. It is based on the collective actions of many team members working for the patient. And a team works best if all team members operate in an atmosphere of mutual respect. As management gurus have stated for years: Leadership starts at the top. So in a dyad management approach, if the physician/administrator team do not share or show mutual respect for each other, mutual respect will likely also be lost among the healthcare delivery team. It is especially important for the physician/administrative leadership to remember that respect must be earned, and a big part of earning respect is to show respect for the views and positions of others. Neither member of the physician/administrative leadership team should assume that her/his view is always the correct one. Each needs to show respect and give thought to the other’s position. The ultimate goal, the main thing, is to do what is best for the patients in the medical center – not what is best for some members of the team.

Complementary competencies

No one organizational leader is good at everything that needs to be done in a medical center. Employing a dyad leadership approach can expand the level of competence in the top leadership. This is precisely why some organizations deliberately look for two individuals who will complement each other – one being strong in an area where the other is weak. Such an approach can indeed be helpful. At the same time, it is our view that this approach can be carried too far. For instance, in a physician/administer leadership team, it is not unusual for the administrator to have better financial skills than the physician, but it does not hurt (and actually helps) if the physician also has financial acumen. In this area, like most, judgment about what combination of characteristics for the physician/administrator team will work best for this particular organization. This requires both institutional, as well as individual self-awareness and understanding of:

  • What the organization needs
  • The strengths and weaknesses that each member of the potential dyad would bring to the table
     

Integrated delivery of care is an absolute must if we are to improve our health system. Establishing physician/administrator dyad leadership teams is a good step towards that goal.   

About the Authors

Denis A. Cortese
Denis A. Cortese MD
Foundation Professor and Director, Healthcare Delivery and Policy Program Arizona State University

Robert K. Smoldt
Robert K. Smoldt MBA
Associate Director, Healthcare Delivery and Policy Program Arizona State University
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