Effective Physician Leadership Series
Learn how to capitalize on nonprofit board membership in today's podcast episode.
During clinical training and medical practice, it is difficult to develop basic business skills. However, there are ways to get those experiences through volunteer activities.
These are the 5 areas that were introduced last time:
1. Financial Management
2. Data Management
3. Business Management
4. Leadership
5. Talent Management
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Capitalize on Nonprofit Board Membership
Nonprofit boards need interested volunteers. They serve on the board itself, and on board-run committees.
Financial Management
Volunteer for the Finance Committee to learn those skills. Members learn to read a profit and loss statement (P&L) and balance sheet. Budgets are discussed and approved each year. And many nonprofits spend time devoted to fundraising.
Data Management
Data management skills are necessary when working in any large organization. Reviewing Quality Improvement and Patient Safety data is critical to improving performance. Quality Improvement Committee members learn how to collect, analyze, summarize and present data. Patient satisfaction reports and other measures of performance are also frequently presented and reviewed.
Business Management
These skills include running a SWOT (strengths, weaknesses, opportunities, threats) analysis, participating in annual management goal setting, applying Lean process improvement principles, understanding balanced scorecards, and marketing.
Other important skills in this domain include negotiation, contracting, and understanding healthcare law. Planning and running effective meetings is an important skill to learn.
Leadership
As Chair of a Committee or President of a Board, you will learn about corporate culture, succession planning, and promoting the vision, mission, and values of an organization. The board chair often oversees the evaluation of the Executive Director or CEO, and helps to redesign the organizational structure.
Talent Management
Most employees in a large organization will report to nonphysicians, allowing physicians to focus on clinical care. However, to move into management, clinicians need to manage human resources if they can. Large employers understand that this skill is the most underdeveloped in physician leaders. They expect physicians to master them on the job.
Advice
…the things I really had to learn on the job is how to work with direct reports, how to do the evaluations of my direct reports every year, how to motivate them, how to shift them around if I had to, how to consolidate departments and split up departments.
Summary
There are five major executive-level management skill sets: Financial, Data, Business, Leadership, and Talent. You can learn financial skills very quickly through a variety of committees and subcommittees in a nonprofit. You can learn data management in your regular clinical work, but there are opportunities within these nonprofits to learn much more.
Basic business management skills grow by participating in annual management planning, SWOT analysis, and developing new initiatives. Chairing subcommittees and the board itself instill leadership skills.
The toughest area to learn is talent management. Physicians spend little time on this. However, your employer will plan on providing the most support in this area.
NOTE: Look below for a transcript of today's episode.
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Links for Today's Episode:
- How Nonprofit Board Membership Can Be the Key to Executive Experience – 254
- How to Pursue a Nonclinical Career in Hospital Management – 080
- How to Become CMO in a Year – 052
- How to Quietly Build Leadership Skills As You Serve a Nonprofit – 016
- NewScr!pt
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Transcription PNC Podcast Episode 255
Capitalize on Nonprofit Board Membership and Strengthen Your Resumé
John: I started in part one by talking about what those five big areas of business management skills are so you truly understand those. And those are things you just typically don't get during your clinical medical education, but there are ways to get those experiences without having a side job or something.
And the way that I did it quite a bit was through working on nonprofit boards. Now don't get me wrong. I liked working on those boards. We were helping our clients, our patients, depending on what kind of organization it was. And I was contributing. I wasn't getting paid, but I was learning as I was going. It was actually a kind of free education.
Now this time I'm going to talk about each of those five areas and some of the specific skills and abilities and experiences we could have for each one and how those manifested themselves in the nonprofits that I was working for. Again, I'll be referring to some of my notes, but let's remind you again about what those five areas are. You've got financial management skills, data management skills, business management skills, leadership skills, and then talent management skills. And I'm using this model that comes from the AAPL, the American Association for Physician Leadership, which I've been a member of since about 1993, I believe. And I've been on their committees. I think it's a good way to break things down. And so, I'm going to explain how you can get experience in a nonprofit with each of those areas. And I'm starting with the easiest one and ending up with the most difficult, meaning the area, the talent management, where it's a bigger challenge to try to get some real hands-on experience, just because of the nature of what you're doing.
Let's go back to my list and talk about this. Now let's give you one example of what I worked on. I joined a hospice board many years ago. And on that board, you typically can just come to the board meetings, give your 2 cents, or you can get more involved. You can become the secretary, you can become the VP, you become the president of the board. And that board had different committees. It had committees like the board development committee. We had a quality committee, which I became the chair of and was, and still am the chair of what they call QAPI, if you go and look at any nonprofit hospice. It's overseen by Medicare and they usually have a committee called QAPI, which stands for Quality Assurance Performance Improvement.
Standard things I learned doing quality improvement at the hospital setting as a CMO later. I was on the hospice board. And after I got more experience at the hospital, I took that to the QAPI committee. And then that organization also had a finance committee and it had... You could call it a marketing committee. It was really like a public awareness committee where you're just trying to get the word out about hospice to the general population and to some extent to physicians and actually hold community events to help celebrate the lives of some of the clients for hospice or patients, I should say. Technically they're in the hospice environment. They are patients rather than clients, just like in the hospital. So, there's a lot there to work with in terms of learning new skills and doing things that you wouldn't normally do, let's say in your practice or in the hospital environment.
Let's go through each one individually here. The finance committee. I didn't sit on the finance committee normally. However, I did often participate in the finance committee when I was on the board, particularly when I was the president of the board, because I really wanted to know how all the committees worked. And since I was the chair of the quality committee, well, I knew how that worked very well in great detail, but the finance I didn't. And so, the thing about the finance committee is what is it doing? Every month it's looking at the financial reports. A very sophisticated P&L profit and loss statement, balance statement every year. The other thing you're looking at are the budgets. You might be involved with the budget in the finance committee. Usually someone else is going to create the budget, but then they're going to have to present it to the committee.
Another thing I would like to say now, is that in anything that I'm talking about here, in terms of what you're learning on a committee, you learn 10 times more if you're the chair of the committee. And usually on a nonprofit, if you're a member of the committee, you could be the chair. And even though you might think, well, let's say there's a CFO or a VP for finance in, let's say a hospice or a hospital for that matter.
But the thing is, it's a board committee, so it has to be chaired by a board member. If you're on the board or if you're a member of the committee, or sometimes it doesn't have to be a board member, and as long as it's someone who's in the committee, well, then you can chair it. And if you chair it, that means you get to look at everything ahead of time. You get to ask questions, get clarification so that when you go to your meeting, because another skill of being the chair is running a meeting, which I didn't mention in part one of this program of this series here. And that is that running a meeting is an important business and management skill. And running it, effectively planning for it. And the thing is, you don't want surprises in your meeting, so you have to prep for it and you have to know what's going to happen and be prepared to answer questions.
And there's also a whole skill set in terms of how to engage everybody in the committee to participate. Chairing is always better than being a member, but you can learn a lot as a member. But you can really learn a ton by being the chair of any of these committees. And also, if you're on the board then become at least temporarily because they do rotate the president of the board or the chairman of the board, depending on whether you're a non-profit or for-profit.
I digress a little bit there, but I'm talking about the finance committee. So, now we've talked about budgets, we talked about the P&L. If you're in a huge organization, you might even learn about how to do a bond issue. Let's say you're trying to raise money and that's a skill that you can acquire when you're in a big organization that can be applied later. And then later you might become the head of a large academic institution and then you'll have to oversee the CFO about, "Okay, what does this mean to do a bond issue and to raise money for our organization?" Fundraising. If it's a nonprofit, oftentimes you're going to be involved in fundraising. That's a skill. Our hospital was a nonprofit and we had a separate foundation that would do fundraising so that we would sometimes be able to go to the community to invest in new technology.
So, these are all things that fall under the finance committee, all these things we don't learn about in medical school or residency for the most part, but this is a lot that you can learn when you're on the finance committee for one of these nonprofits. And I know just attending the meetings I learned a whole lot. And then of course the board meetings, we were looking at the financials every month. Well, we were meeting every two months on that board, but it's an area that's the most foreign to clinicians oftentimes, but at the same time, there's a lot you can do and learn and really get into as a volunteer that will translate directly to, when you're applying for a job, let's say, as a medical director or chief medical officer or something like that.
If you can understand all these financial aspects, you're going to be way ahead of the competition. It's enough for financial management skills.
The second one on our list was data management skills. And as I mentioned during the first part of this, most of us have some exposure to quality. Quality improvement and patient safety. And the thing about that is that's a pretty sophisticated kind of data management, but it's very applicable so that you can get in your clinical role if you get involved. Now, remember many of us are in a clinic, we're in a large group and we never look at other people's quality data, the hospital quality data, maybe we're in an outpatient only setting.
So, we may not have that much exposure, but it's very easy. If you're in the hospital and you go to the quality improvement meetings and you go to your department meetings, you're probably going to have quality data to look at, particularly your own data. And you're going to look at "Is it risk-adjusted?" That's a big thing. What is the P level that you are using? What is the statistical significance they're looking at for quality? A lot of times it's wider than the 0.05 P-value you would use for, let's say a clinical study because you're not that concerned about being certain of the effectiveness of a change in a protocol or something to improve the quality of care. You actually want to be more likely to capture the improvements than to miss the improvements. So, you might have a 10%, 15% or 25% P-value when you're using quality data. But you learn that as you're being involved.
And if you're on a nonprofit like I was, I was on the hospice board, but I was also the chair of the QAPI committee. So, we didn't have the kind of sophisticated tools for measuring quality. A lot of it was manual. A lot of it involved surveys, but there was data of another source, which again, you can learn about. When you're talking about business skills that involve the data skills rather of an executive, it could be the quality and safety, but then you've also got satisfaction surveys that need to be analyzed and discussed. And you have to make plans based on that analysis. Things like doing root cause analysis because of a sentinel event, something bad happens and that's a different type of quality improvement, but it's data. Of course, the financial is a form of data.
Anytime you are looking at some kind of data, taking the raw data, analyzing it, and converting it into graphical data is a big thing. We had done that a lot for quality improvement. Also, for the finance committee. You could look at marketing data, it's another type of data. Response to ads, response to Facebook ads, response to how many likes, how many forms of engagement are on some kind of online activity. With these things you do get a pretty good exposure to a nonprofit, again, as a chair.
Like I said, we had a marketing or a public awareness public education committee. And there was a lot of data that came out of that. And so, you can analyze that. Then when you go to, as we discussed in part one, how does this help you when you're applying? Well, again, you're going to put that in your resume. You're going to put that in your LinkedIn profile. And you're going to mention it during your interviews saying, "I worked with this data. We were responsible for collating, analyzing, presenting the data to the board or to other stakeholders." That's all a transferable skill.
If you can go to a pharma company and say, "Well, I did all that for, let's say the quality data at a hospice or at a hospital", and now you're in pharma, well, it could be quality data, it could be outcome data. It could be some other form of data, but you understand how to do that. You understand how to take a table and convert it to a graph or a line chart or some more sophisticated way of presenting the data. That is a valuable skill. You've got to put that on your resume and explain exactly what you did.
And by the way, I didn't mention this previously. You want to quantify all of that. The person that's hiring wants to see that you can solve a problem that they have. Let's say that you're hiring a physician who is a medical director for a certain service line. And one of the issues you have is you cannot get your complication rate below this level, or you can't reduce the use of a certain product, or let's say a medication or something, and it's too costly and you want to get it switched. So, what you want to see on that person's resume is did they do something similar to that? And what was the improvement they got?
In other words, on your resume and what you want to look at in somebody else's resume is "As the chair of such and such committee, I oversaw the implementation of a new process to reduce our use of this drug. And over a two-year period, we were able to reduce the use of the drug by 30%, reduce the cost of that drug to our formulary by 20% and maintain the exact same or improved patient care or client satisfaction." Those are all quantifiable. And someone who's looking to hire you can imagine, "Okay. Well, I have a project that I could give that person, and if they can do the same thing and get those kinds of results, I'm going to be very happy. Those are some of the things that we're talking about under data management.
Third is basic business management skills. And these are the things we did do. When we were on the hospice board, when I was on the board and on the QAPI, which I still am. But what I remember the experiences sometimes, like I once led a SWOT analysis for their yearly management goals. We sat down, all the managers, directors, the executive director, and me, because I had learned how to do this previously in another nonprofit, and I was on the board at the hospital and so forth. I said, well, I'll take you through a SWOT analysis. We're all going to go through. We're going to talk about our strengths. We're going to talk about our weaknesses. We're going to talk about the opportunities and the threats of our competition.
We're going to put that all together and we're going to look at different specific possible projects we're thinking about doing. Are we going to add another complimentary service? Are we going to expand to a different location? Are we going to buy a building? Are we going to build a building? And then we're going to do a SWOT analysis of each of those. And then we're going to look at the ones that seem to be the most likely to be successful. And whether it's going to have a significant return on the investment that might be involved. And so, that is a basic business skill, how to do a SWOT analysis and use that to develop management or strategic goals. Productivity tools, learning about lean thinking and the Toyota lean process improvement.
I was on the public health board, not really technically a nonprofit, but also not a for-profit. It's a pseudo-government body. And we had to negotiate a contract with our union every two or three years. Well, there you go, negotiation. That is an important business management skill. And so, we learned how to do that.
When we were hiring a new medical director for the hospice, we had to put together an employment contract. Okay, well, now we're getting into how to negotiate and how to understand healthcare law and contract it.
We talked about project planning. Okay, we're going to do one of these new projects. And again, I mentioned it as part of the SWOT analysis, but again, once you decide what you're going to do, there's going to be a team. And if you can share that team, which is really a subcommittee of another committee or of the board.
And what we had for example, in our hospice is we decided to build a grief center. Then we found a building, so we didn't have to build it. We had to take this building, and had to remodel it. And then we had to do all the programming for the grief center. 90% of which was new. We were doing some in the original building for the hospice itself, but it was way overcrowded. And we only had a little one or two offices to do the grief counseling, but now we had a whole building.
It was going to be multi-purpose, but also you had a library, more resources, more time, more room. And so, we had to put together a plan for that. And so, there was a planning committee. For me, I think I was the president at the time. I would sit on the committee, but I definitely wasn't running it. But if you were on the committee and you could be the chair, you could run it. And so, that was a great way to learn some skills that you wouldn't otherwise have learned.
You're going to learn about sales and marketing. The marketing committee that I talked about before was actually not a board committee or at least it was for a while, but then it turned out that it really shouldn't have a marketing committee of the board. So, it was really an organizational committee, but there were board members that could attend and join it as well.
And so, you could learn a lot about not just normal advertising sales and marketing and so forth, but you would actually learn about using Facebook and a website. And what are the statistics that you track on a website and how do you follow those and how do you grow those over time? Because more clicks mean more people seeing what you do, it means more referrals. Again, a great way to learn those business and management skills is to be involved on those subcommittees and do some project planning.
All right. Number four, leadership. Little more obtuse in a way because how are you going to learn about strategic planning skills on a committee or even on the board? Because there's not a lot of time spent on that, but some is. And particularly if you're the president of the board of the chairman, you're going to be involved in all of those discussions. So, you at least get some exposure depending on where you are on this cycle about are we going to revisit our mission? Are we going to come up with new values or stick with the old values? And then what is our culture? How do we measure our culture? And then how do we develop a culture if we don't like the culture that we have? And we say, well, we're a culture of compassion, but it seems like when we do a survey of our organization, we're more about getting the job done or a culture of not spending too much money or that kind of thing. Those are leadership skills now that are specific to some of that executive or leadership level.
Let me think of others. How do you engender cohesiveness in an organization and how do you promote the vision and mission and culture? And you can get some of that exposure on a large subcommittee. If you're in a huge $100 million - $200 million organization, and even though the subcommittee or one of the committees is small, it doesn't entail the entire organization. When you're in an organization that big, that committee has enough work to do that you might actually get into those even within a committee itself rather than on the board.
I always thought it was interesting because I did learn when I was way at the beginning of my career, when I was on the hospital board for a while, I really got to a chance to get involved on hospice and recruiting a new executive director or at the hospital it was the CEO, and talk about succession planning. I learned a little bit about that at both of those levels, on those boards.
Again, we had some turnover in the executive director over the time I was there. We had a CEO of the hospital leave while I was on that board. And so, we got to be involved. We got to be involved in what's the job description? Let's get involved in recruiting. How do you hire a recruiter? How do you use a recruiter? And then how do you actually interview people looking for that kind of high-level job?
Those are definite skills. And again, you would translate that onto your resume or your LinkedIn profile. You would say "Led this search for a new executive director" or maybe you didn't lead it. Maybe you participated. It's always best if you're leading it. Resulting in within six months, replacing the ED that was leaving. The new ED fully oriented in three months. Concrete, what actually did you do? And what did you learn and what skills have you acquired as a result of doing that? The person looking at your resume can say, "Oh, I can use that in this job that I'm posting at this time."
Another thing we did on the hospice, which was interesting, and I think what's very useful is converting basically a very subjective evaluation, annual evaluation. And again, this comes at the leadership level because we're evaluating the ED. How do we make that more quantitative? Rather than just saying, well, what was your subjective assessment? Because the board it's difficult. But we say, okay, we set goals at the beginning of the year for growth. We set goals for financial results. We set goals for quality measurement. From the beginning to the end, did it improve? Concrete hard goals.
And we actually got to the point where we were using almost only fully measurable concrete goals. And really you need to have some room in there for talking about communication style and feedback. Were there any complaints? So, you do a mix of these things, but I learned a lot in that process that I could use at other jobs.
The other thing is understanding an org chart. And moving an org chart around, or being creative with the org chart and understanding a matrix relationship as opposed to a direct reporting. Solid line versus a dotted line. And you can learn all those things working on one of these committees or on the board for a nonprofit. I think those are the main ones under leadership.
The fifth, talent manager is the most difficult to demonstrate because as physicians, a lot of times they keep the staff away from us in terms of a direct report. "You work with nurses, you work with them." I think I mentioned this in part one. But you don't have direct responsibility for them. They're not part of your budget. And so, it's difficult. I always remind my mentees, my coaches, people that I'm talking to in presentations, anytime you can get someone directly reporting to you, go for it. It might seem like a headache. You might have to orient them.
I'll give you an example. When I was a CMO, I had a CMIO. Well, he was the medical director for informatics, at least initially. And I was trying to get him trained up to pull him a little bit out of clinical and get more into management. And so, I knew it would be really helpful if he could learn to manage people. We didn't have an informatics department. The pharmacy was doing a little bit of informatics and information systems and the nursing did a little bit of theirs. And then we had the information management department. It was all split up.
At one point when we were going to develop our EMR and implement it, we needed a nursing informaticist to teach the other clinical people and to show physicians how to use the system. And so, when I hired this part-time internist to be our medical director for informatics, I said, "Well, we have this new nurse informaticist, let's have them report directly to him." A little bit of a hassle. He's going to have to do their evaluations. He's going to have to supervise them. He's going to have to review them, but it gave him that experience. So, when he went to his next job as a CMO, he could say, "Yes, I managed these people. I had those management experiences. I had that HR experience. I had that talent management experience."
Some of the things, again, that I mentioned in part one under talent management is finding the skill sets needed, recruiting effectively, onboarding, orientation, compensation and benefits, succession planning, again, it's a supplement to the leadership. Learning how to manage the direct reports day to day, like manager to supervisor, supervisor to team leader, team leader to frontline. That's hard to get. And it's hard to get obviously in a situation I'm talking about too, where you're using a nonprofit to get some of these because as the chairman of the board, I'm not doing any of those. I'm not directly responsible for the staff. I'm working with the ED. I'm working with the VPs and then everything else gets taken care of by them.
I'm going to say it's going to be limited. I think you can get involved in things like recognition, planning the employee recognition dinner, because that's a transferable skill to another job where, "Okay, how do you recognize employees? Okay. I was on that team. I was on that committee or subcommittee to help plan that every year." And that would fall under talent management. There you go. Talent management recruiting, and encouraging, doing little contracting, maybe doing some evaluations, the most difficult to find. But generally, if you're a physician moving up into one of these roles, that's something that they aren't going to expect you to have a lot of experience with and they are going to expect you to learn on the job, which is what I did.
All those things, the things I really had to learn on the job is how to work with direct reports, how to do the evaluations of my direct reports every year, how to motivate them, how to shift them around if I had to, how to consolidate departments and split up departments, sometimes you can put UM quality together. Sometimes you can't. So, you can do it. It's just going to take time and use mentorship and coaching from the other people around you.
What I wanted to point out is there are five major executive level management type skills - Financial, data, business, leadership, and talent. You can learn the financial very quickly through a variety of committees and subcommittees on a not-for-profit. You can learn data management somewhat in your regular clinical work, but there's opportunities within these nonprofits to learn a lot about data management, because you see a lot of reports and you're going to be doing a lot of interpretation and then implementing things based on that.
The business management skills, again, you can get involved in management planning and SWOT analysis and Gantt charts and project planning because they'll want your input. Getting into the leadership is a little more difficult. But try and get involved, try to chair those committees, start at one, do another one. Eventually get yourself on the board. Eventually become the president of the board. It's usually a limited time, maybe two to four years at the most.
And then the talent management is the toughest. Do what you can, take every opportunity that might show up where you can actually supervise individual employees who report directly to you. But don't worry if you can't do that because that's the one that usually those hiring you will overlook and plan on teaching you how to do that. So that's all I wanted to say today. That's it for this week's presentation.
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Transcription PNC Podcast Episode 255
Capitalize on Nonprofit Board Membership and Strengthen Your Resumé
John: I started in part one by talking about what those five big areas of business management skills are so you truly understand those. And those are things you just typically don't get during your clinical medical education, but there are ways to get those experiences without having a side job or something.
And the way that I did it quite a bit was through working on nonprofit boards. Now don't get me wrong. I liked working on those boards. We were helping our clients, our patients, depending on what kind of organization it was. And I was contributing. I wasn't getting paid, but I was learning as I was going. It was actually a kind of free education.
Now this time I'm going to talk about each of those five areas and some of the specific skills and abilities and experiences we could have for each one and how those manifested themselves in the nonprofits that I was working for. Again, I'll be referring to some of my notes, but let's remind you again about what those five areas are. You've got financial management skills, data management skills, business management skills, leadership skills, and then talent management skills. And I'm using this model that comes from the AAPL, the American Association for Physician Leadership, which I've been a member of since about 1993, I believe. And I've been on their committees. I think it's a good way to break things down. And so, I'm going to explain how you can get experience in a nonprofit with each of those areas. And I'm starting with the easiest one and ending up with the most difficult, meaning the area, the talent management, where it's a bigger challenge to try to get some real hands-on experience, just because of the nature of what you're doing.
Let's go back to my list and talk about this. Now let's give you one example of what I worked on. I joined a hospice board many years ago. And on that board, you typically can just come to the board meetings, give your 2 cents, or you can get more involved. You can become the secretary, you can become the VP, you become the president of the board. And that board had different committees. It had committees like the board development committee. We had a quality committee, which I became the chair of and was, and still am the chair of what they call QAPI, if you go and look at any nonprofit hospice. It's overseen by Medicare and they usually have a committee called QAPI, which stands for Quality Assurance Performance Improvement.
Standard things I learned doing quality improvement at the hospital setting as a CMO later. I was on the hospice board. And after I got more experience at the hospital, I took that to the QAPI committee. And then that organization also had a finance committee and it had... You could call it a marketing committee. It was really like a public awareness committee where you're just trying to get the word out about hospice to the general population and to some extent to physicians and actually hold community events to help celebrate the lives of some of the clients for hospice or patients, I should say. Technically they're in the hospice environment. They are patients rather than clients, just like in the hospital. So, there's a lot there to work with in terms of learning new skills and doing things that you wouldn't normally do, let's say in your practice or in the hospital environment.
Let's go through each one individually here. The finance committee. I didn't sit on the finance committee normally. However, I did often participate in the finance committee when I was on the board, particularly when I was the president of the board, because I really wanted to know how all the committees worked. And since I was the chair of the quality committee, well, I knew how that worked very well in great detail, but the finance I didn't. And so, the thing about the finance committee is what is it doing? Every month it's looking at the financial reports. A very sophisticated P&L profit and loss statement, balance statement every year. The other thing you're looking at are the budgets. You might be involved with the budget in the finance committee. Usually someone else is going to create the budget, but then they're going to have to present it to the committee.
Another thing I would like to say now, is that in anything that I'm talking about here, in terms of what you're learning on a committee, you learn 10 times more if you're the chair of the committee. And usually on a nonprofit, if you're a member of the committee, you could be the chair. And even though you might think, well, let's say there's a CFO or a VP for finance in, let's say a hospice or a hospital for that matter.
But the thing is, it's a board committee, so it has to be chaired by a board member. If you're on the board or if you're a member of the committee, or sometimes it doesn't have to be a board member, and as long as it's someone who's in the committee, well, then you can chair it. And if you chair it, that means you get to look at everything ahead of time. You get to ask questions, get clarification so that when you go to your meeting, because another skill of being the chair is running a meeting, which I didn't mention in part one of this program of this series here. And that is that running a meeting is an important business and management skill. And running it, effectively planning for it. And the thing is, you don't want surprises in your meeting, so you have to prep for it and you have to know what's going to happen and be prepared to answer questions.
And there's also a whole skill set in terms of how to engage everybody in the committee to participate. Chairing is always better than being a member, but you can learn a lot as a member. But you can really learn a ton by being the chair of any of these committees. And also, if you're on the board then become at least temporarily because they do rotate the president of the board or the chairman of the board, depending on whether you're a non-profit or for-profit.
I digress a little bit there, but I'm talking about the finance committee. So, now we've talked about budgets, we talked about the P&L. If you're in a huge organization, you might even learn about how to do a bond issue. Let's say you're trying to raise money and that's a skill that you can acquire when you're in a big organization that can be applied later. And then later you might become the head of a large academic institution and then you'll have to oversee the CFO about, "Okay, what does this mean to do a bond issue and to raise money for our organization?" Fundraising. If it's a nonprofit, oftentimes you're going to be involved in fundraising. That's a skill. Our hospital was a nonprofit and we had a separate foundation that would do fundraising so that we would sometimes be able to go to the community to invest in new technology.
So, these are all things that fall under the finance committee, all these things we don't learn about in medical school or residency for the most part, but this is a lot that you can learn when you're on the finance committee for one of these nonprofits. And I know just attending the meetings I learned a whole lot. And then of course the board meetings, we were looking at the financials every month. Well, we were meeting every two months on that board, but it's an area that's the most foreign to clinicians oftentimes, but at the same time, there's a lot you can do and learn and really get into as a volunteer that will translate directly to, when you're applying for a job, let's say, as a medical director or chief medical officer or something like that.
If you can understand all these financial aspects, you're going to be way ahead of the competition. It's enough for financial management skills.
The second one on our list was data management skills. And as I mentioned during the first part of this, most of us have some exposure to quality. Quality improvement and patient safety. And the thing about that is that's a pretty sophisticated kind of data management, but it's very applicable so that you can get in your clinical role if you get involved. Now, remember many of us are in a clinic, we're in a large group and we never look at other people's quality data, the hospital quality data, maybe we're in an outpatient only setting.
So, we may not have that much exposure, but it's very easy. If you're in the hospital and you go to the quality improvement meetings and you go to your department meetings, you're probably going to have quality data to look at, particularly your own data. And you're going to look at "Is it risk-adjusted?" That's a big thing. What is the P level that you are using? What is the statistical significance they're looking at for quality? A lot of times it's wider than the 0.05 P-value you would use for, let's say a clinical study because you're not that concerned about being certain of the effectiveness of a change in a protocol or something to improve the quality of care. You actually want to be more likely to capture the improvements than to miss the improvements. So, you might have a 10%, 15% or 25% P-value when you're using quality data. But you learn that as you're being involved.
And if you're on a nonprofit like I was, I was on the hospice board, but I was also the chair of the QAPI committee. So, we didn't have the kind of sophisticated tools for measuring quality. A lot of it was manual. A lot of it involved surveys, but there was data of another source, which again, you can learn about. When you're talking about business skills that involve the data skills rather of an executive, it could be the quality and safety, but then you've also got satisfaction surveys that need to be analyzed and discussed. And you have to make plans based on that analysis. Things like doing root cause analysis because of a sentinel event, something bad happens and that's a different type of quality improvement, but it's data. Of course, the financial is a form of data.
Anytime you are looking at some kind of data, taking the raw data, analyzing it, and converting it into graphical data is a big thing. We had done that a lot for quality improvement. Also, for the finance committee. You could look at marketing data, it's another type of data. Response to ads, response to Facebook ads, response to how many likes, how many forms of engagement are on some kind of online activity. With these things you do get a pretty good exposure to a nonprofit, again, as a chair.
Like I said, we had a marketing or a public awareness public education committee. And there was a lot of data that came out of that. And so, you can analyze that. Then when you go to, as we discussed in part one, how does this help you when you're applying? Well, again, you're going to put that in your resume. You're going to put that in your LinkedIn profile. And you're going to mention it during your interviews saying, "I worked with this data. We were responsible for collating, analyzing, presenting the data to the board or to other stakeholders." That's all a transferable skill.
If you can go to a pharma company and say, "Well, I did all that for, let's say the quality data at a hospice or at a hospital", and now you're in pharma, well, it could be quality data, it could be outcome data. It could be some other form of data, but you understand how to do that. You understand how to take a table and convert it to a graph or a line chart or some more sophisticated way of presenting the data. That is a valuable skill. You've got to put that on your resume and explain exactly what you did.
And by the way, I didn't mention this previously. You want to quantify all of that. The person that's hiring wants to see that you can solve a problem that they have. Let's say that you're hiring a physician who is a medical director for a certain service line. And one of the issues you have is you cannot get your complication rate below this level, or you can't reduce the use of a certain product, or let's say a medication or something, and it's too costly and you want to get it switched. So, what you want to see on that person's resume is did they do something similar to that? And what was the improvement they got?
In other words, on your resume and what you want to look at in somebody else's resume is "As the chair of such and such committee, I oversaw the implementation of a new process to reduce our use of this drug. And over a two-year period, we were able to reduce the use of the drug by 30%, reduce the cost of that drug to our formulary by 20% and maintain the exact same or improved patient care or client satisfaction." Those are all quantifiable. And someone who's looking to hire you can imagine, "Okay. Well, I have a project that I could give that person, and if they can do the same thing and get those kinds of results, I'm going to be very happy. Those are some of the things that we're talking about under data management.
Third is basic business management skills. And these are the things we did do. When we were on the hospice board, when I was on the board and on the QAPI, which I still am. But what I remember the experiences sometimes, like I once led a SWOT analysis for their yearly management goals. We sat down, all the managers, directors, the executive director, and me, because I had learned how to do this previously in another nonprofit, and I was on the board at the hospital and so forth. I said, well, I'll take you through a SWOT analysis. We're all going to go through. We're going to talk about our strengths. We're going to talk about our weaknesses. We're going to talk about the opportunities and the threats of our competition.
We're going to put that all together and we're going to look at different specific possible projects we're thinking about doing. Are we going to add another complimentary service? Are we going to expand to a different location? Are we going to buy a building? Are we going to build a building? And then we're going to do a SWOT analysis of each of those. And then we're going to look at the ones that seem to be the most likely to be successful. And whether it's going to have a significant return on the investment that might be involved. And so, that is a basic business skill, how to do a SWOT analysis and use that to develop management or strategic goals. Productivity tools, learning about lean thinking and the Toyota lean process improvement.
I was on the public health board, not really technically a nonprofit, but also not a for-profit. It's a pseudo-government body. And we had to negotiate a contract with our union every two or three years. Well, there you go, negotiation. That is an important business management skill. And so, we learned how to do that.
When we were hiring a new medical director for the hospice, we had to put together an employment contract. Okay, well, now we're getting into how to negotiate and how to understand healthcare law and contract it.
We talked about project planning. Okay, we're going to do one of these new projects. And again, I mentioned it as part of the SWOT analysis, but again, once you decide what you're going to do, there's going to be a team. And if you can share that team, which is really a subcommittee of another committee or of the board.
And what we had for example, in our hospice is we decided to build a grief center. Then we found a building, so we didn't have to build it. We had to take this building, and had to remodel it. And then we had to do all the programming for the grief center. 90% of which was new. We were doing some in the original building for the hospice itself, but it was way overcrowded. And we only had a little one or two offices to do the grief counseling, but now we had a whole building.
It was going to be multi-purpose, but also you had a library, more resources, more time, more room. And so, we had to put together a plan for that. And so, there was a planning committee. For me, I think I was the president at the time. I would sit on the committee, but I definitely wasn't running it. But if you were on the committee and you could be the chair, you could run it. And so, that was a great way to learn some skills that you wouldn't otherwise have learned.
You're going to learn about sales and marketing. The marketing committee that I talked about before was actually not a board committee or at least it was for a while, but then it turned out that it really shouldn't have a marketing committee of the board. So, it was really an organizational committee, but there were board members that could attend and join it as well.
And so, you could learn a lot about not just normal advertising sales and marketing and so forth, but you would actually learn about using Facebook and a website. And what are the statistics that you track on a website and how do you follow those and how do you grow those over time? Because more clicks mean more people seeing what you do, it means more referrals. Again, a great way to learn those business and management skills is to be involved on those subcommittees and do some project planning.
All right. Number four, leadership. Little more obtuse in a way because how are you going to learn about strategic planning skills on a committee or even on the board? Because there's not a lot of time spent on that, but some is. And particularly if you're the president of the board of the chairman, you're going to be involved in all of those discussions. So, you at least get some exposure depending on where you are on this cycle about are we going to revisit our mission? Are we going to come up with new values or stick with the old values? And then what is our culture? How do we measure our culture? And then how do we develop a culture if we don't like the culture that we have? And we say, well, we're a culture of compassion, but it seems like when we do a survey of our organization, we're more about getting the job done or a culture of not spending too much money or that kind of thing. Those are leadership skills now that are specific to some of that executive or leadership level.
Let me think of others. How do you engender cohesiveness in an organization and how do you promote the vision and mission and culture? And you can get some of that exposure on a large subcommittee. If you're in a huge $100 million - $200 million organization, and even though the subcommittee or one of the committees is small, it doesn't entail the entire organization. When you're in an organization that big, that committee has enough work to do that you might actually get into those even within a committee itself rather than on the board.
I always thought it was interesting because I did learn when I was way at the beginning of my career, when I was on the hospital board for a while, I really got to a chance to get involved on hospice and recruiting a new executive director or at the hospital it was the CEO, and talk about succession planning. I learned a little bit about that at both of those levels, on those boards.
Again, we had some turnover in the executive director over the time I was there. We had a CEO of the hospital leave while I was on that board. And so, we got to be involved. We got to be involved in what's the job description? Let's get involved in recruiting. How do you hire a recruiter? How do you use a recruiter? And then how do you actually interview people looking for that kind of high-level job?
Those are definite skills. And again, you would translate that onto your resume or your LinkedIn profile. You would say "Led this search for a new executive director" or maybe you didn't lead it. Maybe you participated. It's always best if you're leading it. Resulting in within six months, replacing the ED that was leaving. The new ED fully oriented in three months. Concrete, what actually did you do? And what did you learn and what skills have you acquired as a result of doing that? The person looking at your resume can say, "Oh, I can use that in this job that I'm posting at this time."
Another thing we did on the hospice, which was interesting, and I think what's very useful is converting basically a very subjective evaluation, annual evaluation. And again, this comes at the leadership level because we're evaluating the ED. How do we make that more quantitative? Rather than just saying, well, what was your subjective assessment? Because the board it's difficult. But we say, okay, we set goals at the beginning of the year for growth. We set goals for financial results. We set goals for quality measurement. From the beginning to the end, did it improve? Concrete hard goals.
And we actually got to the point where we were using almost only fully measurable concrete goals. And really you need to have some room in there for talking about communication style and feedback. Were there any complaints? So, you do a mix of these things, but I learned a lot in that process that I could use at other jobs.
The other thing is understanding an org chart. And moving an org chart around, or being creative with the org chart and understanding a matrix relationship as opposed to a direct reporting. Solid line versus a dotted line. And you can learn all those things working on one of these committees or on the board for a nonprofit. I think those are the main ones under leadership.
The fifth, talent manager is the most difficult to demonstrate because as physicians, a lot of times they keep the staff away from us in terms of a direct report. "You work with nurses, you work with them." I think I mentioned this in part one. But you don't have direct responsibility for them. They're not part of your budget. And so, it's difficult. I always remind my mentees, my coaches, people that I'm talking to in presentations, anytime you can get someone directly reporting to you, go for it. It might seem like a headache. You might have to orient them.
I'll give you an example. When I was a CMO, I had a CMIO. Well, he was the medical director for informatics, at least initially. And I was trying to get him trained up to pull him a little bit out of clinical and get more into management. And so, I knew it would be really helpful if he could learn to manage people. We didn't have an informatics department. The pharmacy was doing a little bit of informatics and information systems and the nursing did a little bit of theirs. And then we had the information management department. It was all split up.
At one point when we were going to develop our EMR and implement it, we needed a nursing informaticist to teach the other clinical people and to show physicians how to use the system. And so, when I hired this part-time internist to be our medical director for informatics, I said, "Well, we have this new nurse informaticist, let's have them report directly to him." A little bit of a hassle. He's going to have to do their evaluations. He's going to have to supervise them. He's going to have to review them, but it gave him that experience. So, when he went to his next job as a CMO, he could say, "Yes, I managed these people. I had those management experiences. I had that HR experience. I had that talent management experience."
Some of the things, again, that I mentioned in part one under talent management is finding the skill sets needed, recruiting effectively, onboarding, orientation, compensation and benefits, succession planning, again, it's a supplement to the leadership. Learning how to manage the direct reports day to day, like manager to supervisor, supervisor to team leader, team leader to frontline. That's hard to get. And it's hard to get obviously in a situation I'm talking about too, where you're using a nonprofit to get some of these because as the chairman of the board, I'm not doing any of those. I'm not directly responsible for the staff. I'm working with the ED. I'm working with the VPs and then everything else gets taken care of by them.
I'm going to say it's going to be limited. I think you can get involved in things like recognition, planning the employee recognition dinner, because that's a transferable skill to another job where, "Okay, how do you recognize employees? Okay. I was on that team. I was on that committee or subcommittee to help plan that every year." And that would fall under talent management. There you go. Talent management recruiting, and encouraging, doing little contracting, maybe doing some evaluations, the most difficult to find. But generally, if you're a physician moving up into one of these roles, that's something that they aren't going to expect you to have a lot of experience with and they are going to expect you to learn on the job, which is what I did.
All those things, the things I really had to learn on the job is how to work with direct reports, how to do the evaluations of my direct reports every year, how to motivate them, how to shift them around if I had to, how to consolidate departments and split up departments, sometimes you can put UM quality together. Sometimes you can't. So, you can do it. It's just going to take time and use mentorship and coaching from the other people around you.
What I wanted to point out is there are five major executive level management type skills - Financial, data, business, leadership, and talent. You can learn the financial very quickly through a variety of committees and subcommittees on a not-for-profit. You can learn data management somewhat in your regular clinical work, but there's opportunities within these nonprofits to learn a lot about data management, because you see a lot of reports and you're going to be doing a lot of interpretation and then implementing things based on that.
The business management skills, again, you can get involved in management planning and SWOT analysis and Gantt charts and project planning because they'll want your input. Getting into the leadership is a little more difficult. But try and get involved, try to chair those committees, start at one, do another one. Eventually get yourself on the board. Eventually become the president of the board. It's usually a limited time, maybe two to four years at the most.
And then the talent management is the toughest. Do what you can, take every opportunity that might show up where you can actually supervise individual employees who report directly to you. But don't worry if you can't do that because that's the one that usually those hiring you will overlook and plan on teaching you how to do that. So that's all I wanted to say today. That's it for this week's presentation.
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