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Developing the Appreciated Leader: Leader Development at a Teaching Hospital

Rebecca Phillips, with Jane Binger

Leadership in an academic healthcare setting often originates from deep expertise in a discipline such as radiology or cardiology. Discipline leaders are recognized for deserved reputations in research, clinical care, and education. They are, by academic standards, successful. This success is based on the quality and efficient delivery of systems of care, basic and clinical research, and services to develop the next generation of healthcare leaders in research, clinical care, and education. Yet, individually, these leaders wish for better preparation for their business and organizational responsibilities. Consequently, the learning and development function is responsible for supporting both business and academic success.

L&D’s expected role is to deliver training on requirements, initiatives, and a standard portfolio for workforce and leader development, as seen in business and industry. Leaders are responsible for focusing the staff and material resources. L&D teaches the organizational effectiveness and business systems in which leaders are expected to excel (allowing leaders to practice mastery of those systems so that employees will adopt them); and L&D teaches the leader behaviors or competencies (which constitute the leader profile) necessary to get work done through people. In an academic healthcare setting, the outcomes of learning’s role in leader development are defined as leader readiness and leader performance, demonstrated by improved systems thinking, adoption of best practices, translation of research to the bedside, and the best possible patient outcome and experience.

Knowledge of people and business systems results in an expanded view of the leaders’ full scope of responsibility, answering the question “What does it mean to be a manager and leader in this organization?” As in other fields, a strategic view is essential, and the effort to bridge the department and institutional strategies is an L&D role in leader development.

A variety of methods makes this happen. The advantages of classroom learning focusing on an institutional issue or a simulation to run a hospital creates a network and helps participants see how what they do affects others. More important, the classroom opportunity to meet the executives of business functions helps managers understand how they each contribute to fulfilling the mission and influencing effectiveness and compliance. Putting a “face to the necessary bureaucracy” enables large organizations to thrive while enhancing improvement efforts. Online training allows for greater consistency and can incorporate “live” messages from executives. It can also provide easy access to references when needed, draw on infrequently used systems, and refresh the training when many changes occur simultaneously. Online and in-person training occurs 24/7 in the hospital, with sessions conducted where people work.

Specific behaviors and competencies are required as leaders prepare strategic plans and then run the operations to achieve their strategic objectives and goals. To delineate leader profiles and expectations, many healthcare organizations draw on the leadership literature and the services of professional organizations such as Jim Kouzes and Barry Posner’s Leadership Challenge (www.leadershipchallenge.com) and the National Center for Healthcare Leadership. Effective executive development in healthcare reinforces alignment in these ways:

Expectations and profiles are decided in cooperation with organization executives. The definitions and examples should be theirs.

The resulting profile is measured against benchmarks in an assessment center.

The results from the assessment center are then used to establish individual strategic goals aligned with the institution’s strategic direction, with clear expectations. Individual learning plans are created with an internal coach, who helps the participants and their line managers identify and prepare resources for learning.

L&D offers training on competencies, during which participants specify the strategic initiative to which they will apply the new competency, aligned with their individual goals. This strategic area is meant to be worked on during a specified time period.

Following training on each competency, participants in learning and goal-setting events are supported by coaching, directed readings, and discussion sessions.

Participants speak with others about how they are applying the competencies to accomplish individual goals.

Business results are also tied to the competencies in business unit reports when executives comment on strategic and operational progress. Organization leaders are involved in development.

L&D is a common thread throughout talent management; for example, workforce and succession planning use the same competency sets; orientation functions as part of onboarding, teaching goal setting; tuition reimbursement is done as part of rewards, providing a system for individual learning plans; and education research and measurement are tied to outcomes and best education practices. Engagement comes from executive sponsorship and from applying competencies to achieve organizational and individual goals. Development is provided for leaders at various stages through these programs:

Leadership development for all includes formal open enrollment programs and performance feedback.

Emerging talent includes individual and organizational needs and interests and diversity strategy.

The Accelerated Development Program for high-potential staff is characterized by customized experience and learning, high resources, and high touch.

Succession development addresses both short and long horizons for specific positions.

The Honest Broker

L&D is the honest broker that convenes the organization’s leaders to ensure that the full system is functioning together. The launch of a new electronic medical record system is an example of this broker role. An incorrectly implemented EMR system could result in patient risk or even harm. A professional literature review found that the implementation of EMRs in some organizations resulted in more errors in patient care. This was deemed to be a “never event.” The launch of the new EMR was preceded by a review of clinical work flows, so high-quality improvement tools and skills were needed. Staff members learned both new processes and a new computer system.

The executive team recognized that leaders were critical to the success of the EMR’s implementation, so the L&D professionals convened leaders from IT, HR, facilities, and various clinical areas for ongoing change management and problem escalation/resolution. A simulation or “playground” of the new system was made available so people could learn while “working,” see common errors, and make mistakes without causing harm. The L&D function demonstrated the integrated use of classroom and e-learning. The evaluation results showed comparable levels of learning and application on the job—all reinforced by leader messages, walk-arounds, and Q&A sessions and other in-person interactions. Patient errors did not increase during the implementation of the EMR, and targeted efficiencies were achieved.

The best evidence of L&D’s successful role in leader development can be found in responses from the participants themselves. Here’s a sample response. The learning experience “pointed out to me the importance of shared vision by leaders and the hospital. This has made me share more of myself, my vision, and model this more for others. It has given me a much larger view of my potential impact at this institution over my formal title and job responsibilities. Now I participate more in the leadership of this organization.”

The Same but Different

There are similarities in leader development between academic and nonacademic environments. And there are differences. Two features distinguish L&D in an academic healthcare setting. One is its unique role in providing deep education and training expertise to faculty and other professionals whose jobs include training others. The other is the use of evidence-based education practices.

Academic hospitals are critical for the preparation of healthcare professionals nationally and globally. Accrediting bodies specify competencies across trainee programs. Yet there often isn’t time in the health-care curriculum for the acquisition of the expertise to develop and deliver these trainee programs. At one academic hospital, L&D staff members partnered with the directors of fellowships to create the core curriculum required of all fellows. The benefits derived from this partnership included the elimination of redundant work; the opportunity for physicians to serve as subject matter experts and to have more time in their practices and to develop specialized training; the chance to have content delivered in many ways to suit learners and their schedules; and the spreading of the best content and practices across the institution.

How does L&D integrate with the clinical, research, and education missions of an academic health center?

We help define, obtain, and use knowledge of the institution’s priorities.

For large system rollouts, we make systems linkages explicit and support leader advocacy of the system. These rollouts require many training rooms and computers, so we partner with these facilities. Small and medium-sized enterprises know the content but not always how to share it, so we train them in facilitation skills or co-facilitate.

We identify skills and train based on them; these skills include change management, coaching, feedback, employee engagement, computer applications, work-flow process, technology changes, and improvement science.

We demonstrate proof of training’s impact using evidence in the form of evaluations of long-term patient outcomes and the impact on learners. We look at how much success is attributed to training and how confident the leaders are in their ability to perform.

We recognize and address areas of leader discomfort—potential errors, patient risk, changing people’s job roles (for example, for EMR work flow), and job descriptions (performance management system).

We offer more than training events. We use many types of media to reinforce learning and create opportunities for peer learning.

Evidence-based education practices are fundamental for academic healthcare L&D. During the performance management and fellowship core curriculum implementation, all facilitators received their evaluation feedback. If target evaluation scores were not achieved, then the facilitators and designers made changes to improve the results vis-à-vis learner satisfaction, the impact on patient outcome, new learning, application on the job, and the overall value to the organization.

These evaluation results and educator performance improvements were published and reported to the hospital’s executives and board members. Learner performance was further supported by providing online job aids and walk-in sessions based on evaluation results. Managers, applying new coaching and feedback skills, reported accelerated application of the new performance system and greater readiness for performance discussions.

At our teaching hospital, the learning and development function is essential because we create opportunity for individuals to set strategic and personal goals, we explicitly target learning to these goals and objectives, and we provide rigorous evidence of the impact on learners, on the organization, and on the results achieved with our young patients.

About the Author

Rebecca Phillips, PhD, is vice president for education and learning and an associate professor at Cincinnati Children’s Hospital and Medical Center. Previously, she was training director and deputy director, human resources, at Los Alamos National Laboratory and director of organizational research and associate director of the Center for Knowledge Management at Motorola University. Her research, teaching, publications, and international presentations include establishing organizational learning services, systems, and business plans (alignment with organization objectives); evidence-based adult education outcomes and financial assessment; applying improvement science to learning and development; educator and faculty development; and mentoring. She received a doctorate in curriculum and instruction and adult education (learning and development) from the University of New Mexico.

Jane Binger, executive director of leadership development and education at Lucile Packard Children’s Hospital at Stanford University Medical Center, also contributed to this chapter. She received her BS in nursing, MA in Education–Administration and Policy Analysis, and EdD in Education–Administration and Policy Analysis from Stanford University.