Healthcare reform: Leadership at the local level…a case study

The context

The head of The family Medicine Department, University of Minnesota has a long history of developing physicians who have been influential in the field. He is committed to developing a self-sustainable program that will continue despite the external challenges. But the latest round of challenges before him is immense. Family Medicine lies at the cornerstone of healthcare reform. Yet state budgets to support Family Medicine resident education have been slashed by two-thirds. Hospitals and other healthcare systems that utilize and support resident training are unable to fill the void. Faculty have not received pay increases in several years, despite being asked to do far more. Indeed the business model of simultaneously providing care to the indigent and developing the next generation physicians is in jeopardy.

The intervention

The head of the department of Family Medicine decided he needs greater leadership support from his people. He provided three days of Strategic Leadership Tools™ training from The Leader’s Toolbox, Inc. followed by the formation of Toolbox teams who are expected to utilize the learning to address some of the department and clinics most pressing issues. These teams receive coaching support to ensure they use the tools correctly and focus on the right issues. The first teams addressed were tasked to develop plans and recommendations around the question: How do we building strong local leadership teams that can more quickly and effectively implement change. A second group will focus on the challenges of creating advanced family medicine practices given the new healthcare environment. The resultsThe return on this investment has already been significant…despite the fact that the training and subsequent Toolbox team work has just begun:

1. During the training portion of the program the local clinic leaders told the head of the department that they would shoulder more of the management responsibilities in order to help him devote more time to address the pressing strategic challenges. Local and senior department leadership have started to change their agendas and refocusing their work.
2. The head of the department brought together the leaders of several external organizations and used the learning to resuscitate one of the residency programs that was about to be dismantled
3. There is greater realization of the similarity and differences between the clinics…and the advantages of working more closely. There are instances of one clinic leader providing supportive advice for another clinic leader.
4. One of the clinic physicians called a meeting with her program director and the head of the department to announce her resignation from the program because she had been unsuccessful in her attempts to institute a new program within the department. Her program director used some of the learning from the Strategic Leadership Tools program to help her understand why her attempts had been unsuccessful and promised to provide leadership coaching. The physician was grateful for the interaction and has decided to remain with the program.
5. The tools are starting to be integrated with the residency education so that the residents will learn leadership and healthcare related skills
6. Leaders across clinic sites are starting to mentor one another. There is a greater sense of community among the leaders that is starting to emerge.
7. Tiger teams are addressing the challenge of building local cohesive and effective leadership teams at the clinic levels. Shortly they will address the issues around developing the programs and infrastructure necessary to create advanced family medicine.

Implication The resolution of the healthcare crisis cannot be solely borne by public policy. Instead it requires increased leadership capacity at all levels…including local physicians who become more easily adept at implementing change. We need to implement leadership development programs that are relevant, time-efficient, and yield results.