Learn how to capitalize on nonprofit board membership in today's podcast episode.

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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.

EXCLUSIVE: Get a daily dose of inspiration, information, news, training opportunities, and amusing stories by CLICKING HERE.

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

Download This Episode:

Right Click Here and “Save As” to download this podcast episode to your computer.

Podcast Editing & Production Services are provided by Oscar Hamilton

Today's PNC Podcast Transcript

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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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The opinions expressed here are mine and my guest’s. While the information provided on the podcast is true and accurate to the best of my knowledge, there is no express or implied guarantee that using the methods discussed here will lead to success in your career, life, or business.

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The post Capitalize on Nonprofit Board Membership and Strengthen Your Resumé – 255 appeared first on NonClinical Physicians.

In today's podcast, we learn how nonprofit board membership enables you to acquire management and leadership skills. 

Our Sponsor

We're proud to have the University of Tennessee Physician Executive MBA Program, offered by the Haslam College of Business, as the sponsor of this podcast.

The UT PEMBA is the longest-running, and most highly respected physician-only MBA in the country. It has over 700 graduates. And, the program only takes one year to complete. 

By joining the UT Physician Executive MBA, you will develop the business and management skills you need to find a career that you love. To find out more, contact Dr. Kate Atchley’s office at (865) 974-6526 or go to nonclinicalphysicians.com/physicianmba.

Nonprofit Board Membership and the 5 Business Management Domains

The list is in order from easiest to obtain to the most difficult. 

1. Financial Management Skills

   A healthcare manager must be to understand and read financial reports, especially profit and loss statements and a balance sheets. Also, knowing the difference between cash and accrual accounting is important. Finally, a very useful skill is being able to create, explain, and follow a budget.

2. Data Management Skills

   Typically the most common and easy for us to understand is quality improvement. Metrics such as mortality and complication rates, and length of stay are critical in healthcare.

   There are also patient satisfaction surveys. These are the Medicare-required patient satisfaction surveys, which can affect how much an institution is paid. In more general terms, being able to apply statistics and epidemiology, and understanding biases and confounding of data are also important. 

3. Business Management Skills

   Time management, productivity tools, and analytical skills are important. Negotiating and contracting are necessary skills. Sales and marketing and project planning are other essential skills for healthcare managers and leaders.

4. Leadership Skills

   There are specific types of skills that fall into the leadership category. These include thinking strategically, communicating well, and being persuasive. Leaders must place a strong emphasis on ethics and accountability. Nurturing personal growth, and knowing how to promote the vision, values, and mission of an organization are needed. Finally, developing and maintaining a positive culture in an organization is critical.

5. Talent Management Skills

   This is the most challenging area. It includes attracting and recruiting staff, onboarding, orientation, setting up compensation, understanding benefits, and managing direct reports day to day. Since much of that is taken care of by the HR department, it can be difficult for a still-practicing physician to develop expertise in these areas. 

Summary

When pursuing a nonclinical job, especially if it involves management responsibilities, skills from these five domains will be critical to acquire. This is especially true if the job involves upper management in a large corporate environment, such as a hospital, pharmaceutical company, or insurance company.

In the second part of this discussion (Episode 255), specific examples of expertise acquired while volunteering in nonprofit organizations will be described.

NOTE: Look below for a transcript of today's episode.

EXCLUSIVE: Get a daily dose of inspiration, information, news, training opportunities, and amusing stories by CLICKING HERE.

Links for Today's Episode:

• How to Quietly Build Leadership Skills As You Serve a Nonprofit – 016
• 5 Steps I Took to Be a Hospital Executive – 175
• How to Pursue a Nonclinical Career in Hospital Management – 080
• NewScr!pt

Download This Episode:

Right Click Here and “Save As” to download this podcast episode to your computer.

Podcast Editing & Production Services are provided by Oscar Hamilton

Today's PNC Podcast Transcript

Email Download New Tab

Transcription PNC Podcast Episode 254

How Nonprofit Board Membership Can Be the Key to Leadership Experience

John: Let's get to our main content today. Again, we're going to start with the end in mind. And so, if you're looking for some kind of a nonclinical career that involves management and executive position, even if it just has some leadership involved in it, but it's nonclinical, nontraditional, there are going to be some skills that you're going to have expected to have learned to apply in that kind of position.

The issue always is how do I get those kinds of experiences when I'm working clinically? Sometimes it can happen in your job. If you run your own office or if you're the chair of a committee at the hospital, you'll get some of those skills. But I'm going to talk about a way to get many of those skills that you can then talk about in your resume and your cover letter and so forth.

That's why we always start with the end in mind. The end of mind is you're trying to get that job that requires some management, some executive duties. And so, you have to be able to demonstrate in three major situations that you have those skills and that's going to be in your resume and you might allude to them in your cover letter, on your LinkedIn profile, and then also during your interviews. Think about that. "I have to demonstrate these. So, I have to be able to put something into my resume."

How does that work? Well, in the resume, they don't necessarily want to see a list of jobs you've had or volunteer positions or work that you've done on the side by your role. What they really want to see in that resume, and I talk about this in other settings, I've talked about resumes on the podcasts, I've interviewed Heather Fork. There are things you can look at to get into more detail on the actual definition and the content of a resume.

But the bottom line is they want to see examples where you demonstrate those skills. To say, "Well, I have a degree in such and such" it doesn't really matter if you haven't actually taken that degree and implemented the skills you learned by obtaining that degree or in other areas that can show that you can do the job that they are hiring you for. Keep that in mind.

Because we're looking at what we can show on a resume and in a LinkedIn profile, then we really need to get some hands-on experience. It's hard to do that when you're working clinically, you're not going to get a side job in a business or something to do those. But let me talk before we get into how to get those, and I may end up breaking this up into two episodes because it's a lot to cover in one 25-minute episode.

I'm going to spend the first half of this talking about what those skill sets are. Sometimes you can get those experiences in different ways. For example, maybe you have some experiences from before you went to medical school or nursing school if we're talking to other clinicians. So, keep that in mind. Or maybe there's some post residency experiences that you have, or sometimes you'll be able to use some of the skills that you've learned doing clinical medicine or practicing, and those are so called transferable skills. Let me talk about that for one minute.

Let's say that you want to demonstrate that you have a skill of being able to present something to a board of directors. Well, obviously presenting some kind of presentation to a community group or to a physician group would demonstrate definitely a transferable skill to now being able to do that in front of a board of directors. There's really not that much difference. That's kind of a no brainer.

Another example. Let's say that they want you to have some kind of project management skills. The job that they're asking you to do requires you from time to time to take on a new project, develop a new service or a new way of doing things. Well, maybe if you've developed a new clinical program at a hospital or in a medical group, that would be a demonstration of a transferable skill, again, developing a new service line.

Now, one thing I do want to mention is that obtaining and having a business degree is not the same thing as having management or leadership experience. Those are actually two separate things. One is knowledge base, and you can learn about things, the definition of things, and learn specifics about marketing and finance. Some of those things we're going to talk about today. But that's not the same as implementing those skills. And so, sometimes on the job training, even if it's a non-paid job is better than let's say an MBA or some kind of business instruction.

Let's really get into what are those five management or executive skill sets that many of these jobs are going to be looking for, whether it's in pharma, whether it's at a hospital or health system, whether you're an editor for a publishing company, you're going to need some of these management skills. And I'm going to take my lead from the American Association for Physician Leadership. That's where the model that I'm using today, these five areas of experience and expertise. And so, let's get started by defining those first. Let me list those. Here we go.

You have financial management skills, data management skills, business management skills, leadership skills, and then finally, the talent management skills. I put them in this order, not because there is really any set order, but I put them in this order from the number one as the easiest to obtain in a volunteer position to those that are more difficult to obtain. Again, financial, data management, business management, leadership, and then talent management, or HR, those kinds of things are the most difficult to get in general.

But let me give you little more detail on those five areas. Number one is financial management skills, or just simply knowledge and expertise in finances. What are some of the requirements or the examples of what you would need to know and how to do in that area? It's things like the following. Just being able to understand and read financial reports. That means do you know what a PNL is? And can you look at a PNL, compare different PNLs, understand the difference, which one's good, which one's bad, which one shows growth, which one doesn't? Then you have a balance sheet that usually goes with that. Those are the two primary financial reports.

But then again, you need to know the difference between a cash and accrual-based accounting system. You're going to maybe need an understanding of healthcare finances, which are different, especially if it's a nonprofit than other businesses, pharma financial reports, when you look a lot different than a hospital financial report. For example, in hospitals, there's a lot of write-offs because of the way hospitals are paid. That can also apply to large groups.

And then the other big piece of that is understanding budgets. And to take it even a step further, understanding budgets is very important. But being able to create a budget is really a skill that most of us are not going to develop in even most of the jobs we're doing. But even as CMO, I reached the point where I had to really be able to explain my budgets, defend my budgets, and then adjust my budgets with the help of my directors on an annual basis. For most of us just understanding what a budget is and understanding the need for setting a budget well before the beginning of the next fiscal year is extremely important.

The other thing that comes up, that's pretty useful in a lot of organizations, and that's portfolio management. And even in the hospital I worked with, of course, we had investments and the finance committee at the hospital sometimes would have to make decisions and work with their brokers and how to invest those monies.

One thing that a hospital does and other large corporations do is have a number of days of cash on hand. That means if you were to stop receiving any payments whatsoever, your organization can continue to go and make its payroll and pay all its bills for so many days. But a lot of businesses have maybe 30, 60, 90 days. The average hospital has a little bit over a hundred days of cash on hand. The hospital I was at times had almost a year's worth of cash on hand, which is a very positive thing. I doubt that's true today after coming through two years of a pandemic.

Finance committee, knowing finances is something we don't learn in med school and residency, obviously, but it's an area that's important. And particularly those things that I talked about in the last couple of minutes. Now later, I'm going to tell you which of those things can be gained through volunteer work, and how you can gain knowledge of those things through volunteer work.

The second area is data management skills. Data management in healthcare, typically the most common and most easy for us to understand is quality improvement and patient safety data. That's everything from mortality rates, complication rates, that also includes length of stay, the risk adjusted usually in the healthcare environment, but that's not the only data that one needs to learn how to work with.

Besides that, there are things like patient surveys. That's the form of data. You get patient satisfaction surveys, that's HCAHPS or CAHPS. CAHPS is a generic term, HCAHPS is for hospitals. And then hospice has such things, nursing homes have such things. These are the Medicare required patient satisfaction surveys, which affect how you're paid. Again, another form of data management and data monitoring, understanding statistics and epidemiology, understanding biases and confounding and data. Those would be the big ones. Even the financials are a form of data that you need to understand which we've already talked about. There is overlap in these different five experience areas that you need to know about to be a good executive and get certain jobs.

The third one, this is more of a generic term - business management skill. What is unique to, let's say, running a business that we haven't already talked about? It does include financial report reading and understanding. It does include a little bit of quality and statistical analysis. But when we're talking about this group of business and management skills, we're talking about time management and understanding productivity tools, analytical skills, that's a little hard to measure. But how about negotiation? Techniques for negotiation, contract negotiation. That could be for an individual employment contract, which as physicians, a lot of times we don't get into, unless we own our own practice.

Contracting with a union. I was a volunteer for a board. I was the health board of the local county and it was one organization that I was in where the employees were unionized. I was the president of that board for several years. And as such, I was involved with the negotiations. And in fact, later on, even though I was no longer the president, because I had the experience negotiating and working with the union, I was put on the task force to help negotiate the subsequent ones. That's a skill you won't learn in med school or residency obviously, but it falls in that general rubric of a business or management skill.

Project planning. Now all of us know how to do project planning at some level. We're going to do a project at home. We're going to put in some landscaping. We're going to repair something. We're going to work with contractors to add an addition to our home. Those are all projects. But in business you get some big projects. And how do you learn if you're going to be working in a situation where those kinds of projects are happening on a regular basis? You need to know how to run those projects if it happens to fall in your department or your division. So, project planning is an important part of business and management skills.

And then usually sales and marketing fall under that. Again, something we rarely learn about while we're going through our medical education, but just about any business, including nonprofits, including hospitals, including hospices and nursing homes need to know how to do sales and how to market themselves. Because the secret to being successful in most cases is growing. Companies that remain stagnant, they're not growing, they tend to struggle quite a bit. There's always seems to be easier to be successful, have a bottom line by growing.

So, it's important that you do some sales and marketing to understand that in certain jobs, because it's going to be critical in almost any business. And even on something practical, like how to write a Gantt chart? A way to show how a project is planned out from step A through Z, and then over time, a Gantt chart.

And then another good thing to understand and know about is a SWOT analysis. Now it's not like a SWAT team and the police. A SWOT stands for Strength, Weaknesses, Opportunities, and Threats. It's a way to analyze your position in a market. Usually get a team together and you look at what your strengths are, what your weaknesses are, what opportunities are in that market and what threats are in that market. You put all that information together and it becomes very useful in doing strategic planning, which is long term planning, really, or even just management planning, which could be a six to 12 month planning cycle. And again, that all falls under business management skills.

The next one is leadership skills. It's really a set of skills that can be defined. It sounds rather vague. We all have our thoughts of what a leader is and what a leader does. A leader is usually someone who's very focused, who thinks strategically, who communicates well, and gets buy-in by all those around them. But there's some specific types of skills that fall into the leadership category. Focus on ethics and accountability. Leaders really are the ones that inspire others to follow. They usually have a lot more background and they spend a lot more time thinking about succession planning, both for themselves, and those around them.

A little bit more direct understanding, but this goes into business as well, and that's managing direct reports on a day-to-day basis. Particularly when you're the leader, let's say you're the CEO. And then you have 5 to 10 VP levels around you. You have to create a very strong united cohesive team that works together very effectively to run a large organization. We're talking hundreds of millions of dollars in health systems and hospitals, and even billions of dollars when you get into pharmaceutical companies.

So, if you want to be a leader in that setting, you have to work with your direct reports very effectively. There's a lot of performance management understanding how to recognize people, promote people and really an understanding in the executive role of an org chart. Usually when you go into a job as a medical director or a CMO or CMIO or something like that, you kind of handed the org chart and say, "Well, this is how it's going to be."

But the further up you get that chain to be the leader of the organization, then you're going to be asked to actually create the org chart and you're going to move things around. And it's not set in stone. This director may not always report to this VP. Maybe switch to another. That is especially true, as a CMO like myself came into an organization. Do I report to the COO? Do I report to the CEO?

Let's see some other ideas about leadership. You have to be very good at communication. Clinicians are usually good at communication, whether it's nurses or others on the team. But there's a different type of communication in leadership. Again, inspirational, understanding how to talk to different stakeholder groups. Is it a large group, a small group? Is it a board? Is it the community?

How to focus on nurturing growth, as I mentioned, as an important topic for an effective manager and leader. And how to promote the vision, the values, the mission, and develop a culture. That's much more important for a leader in one of the top-level positions. But even if you run a division or department, those skills can be very useful. And sometimes you have to actually create the mission and the vision and the values, either together with a team or with your board, depending on the structure. That's what I would say about leadership.

And by the way, the leadership skills are the most difficult to get early on because you're not starting as a leader. Even if you're doing some of the other things we talked about in terms of financial, the data, the business management skills, the leadership skills will come later, but you want to grab those as soon as you can. Get an opportunity to work on those. And a lot of that comes from running projects, which will help you learn management skills and that kind of thing.

All right, I do want to talk about the fifth one. And this is the most challenging. That's talent management skills. It includes HR, includes things like attracting and recruiting, onboarding and orientation, setting up compensation, understanding benefits, managing direct reports day to day. Performance management. What to do with a poor performer? How to encourage good performers? How to use recognition? I mentioned that a little bit under leadership. These are things that are tough to get into because even if you get a chance to be a medical director or you're on a board or even a subcommittee of a board, most of that stuff is taken care of by the HR department.

One of the things I recommend in any situation where you're eventually going to get to a nonclinical job is to try to have at least one or two people report directly to you. It's so many times that you can be in an office if you're in a large group and you have all these people working around you, working for you, but they don't actually work for you. They don't report to you. They report to their manager. The nurse reports to the nursing director. The MA's report to somebody else. And so, it can be a weird structure. It's common, but if you think about it as a physician, who are you reporting to? Do you have someone that you're directly responsible to? It's usually another physician. They like to have physicians manage physicians.

But how do you get the experience in that job or in some other job, even a volunteer job, managing people? Well, most of the time, if you're volunteering, then there is no reporting. The other people are reporting to their boss who's not a volunteer. That's why I put the talent management as the last one. But I'm going to talk about how you can get a little bit of experience in there, but don't sweat it because everybody knows that. And unless you actually run a business, you're not going to have a lot of experience with talent management.

Really that's what I wanted to start with in part one of this presentation. Those are the five areas that a lot of nonclinical jobs, particularly if it involves working at a management or executive level, that you're going to need to obtain skills in and can be very challenging. But now here's where we're going to get into in part two, how to overcome that challenge and actually develop some real skills that you can leverage to get that first job. And I'm going to give you real examples of organizations I've worked in. Probably mostly one organization, but I've been on multiple of these nonprofits volunteer type organizations where I was able to get different skills, doing different jobs on a volunteer basis at different organizations. Let's get into that next time.

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The post How Nonprofit Board Membership Can Be the Key to Executive Experience – 254 appeared first on NonClinical Physicians.

A Book Review

As I’ve studied the issue of career transition, I’ve often encountered burnout as a reason to shift careers.

But there is an ignored cousin to burnout: physician suicide. The physician suicide rate is double that of the general population. And it appears, at least anecdotally, that the training of medical students contributes to the likelihood of suicide in both medical students themselves, and then later in practicing physicians.

Suicide is a tragedy, whenever it occurs. And in this age of physician shortages, the physicians lost each year to suicide affect thousands of spouses, children, parents and friends, and an estimated one million patients.

Rather than try to address this issue myself, I want to raise your awareness of this problem and of the work of Dr. Pamela Wible. Dr. Wible is a family physician who addressed her own frustration with modern medical practice by creating and promoting Ideal Medical Care.

Physician Suicide Expert

Along the way, she also became interested in physician and medical student suicide. She has now become an expert on the subject, and a resource for suicidal physicians and the families of suicide victims.

She speaks on the topic, hosts a retreat to help physicians establish a more holistic medical practice, and continues to provide support and encouragement to struggling medical students and physicians.

I recently read her book Physician Suicide Letters Answered. It is eye-opening and heart-rending to read. In addition to background on the topic, and some proposed solutions, it consists largely of private letters and last words from doctors who could no longer bear the pain of an abusive medical system.

It’s an important topic that should not be ignored, even as we each try to deal with our own burnout and pursuit of renewed joy. I strongly encourage you to read the book, support Dr. Wible’s vision, and reach out to your colleagues if you sense that they’re in pain.

Build Leadership Skills As You Serve a Nonprofit

In this episode, I’m going to talk about nonprofit boards. Specifically, I’ll describe:

• My experiences serving and leading nonprofit boards;
• How serving can help in your career transition, and your personal and work life; and,
• What not to do when serving on a board.

During my career, I’ve been a part of several nonprofit boards and committees. Although I didn’t appreciate it at the time, serving on these boards helped me tremendously to transition from clinician to full-time hospital executive.

I’ll explain exactly how later.

I believe those experiences would have helped me in pursuing other non-clinical careers.

I think my experiences are fairly common, but they probably only apply to other healthcare-related nonprofit boards of a certain size. These boards generate annual net revenues of between three million and 350 million dollars. And all of my experiences have been as an unpaid volunteer.

Therefor, my observations might differ from others who are involved with much larger nonprofit organizations, or for-profit companies.

Unlikely Volunteer

I’m an introvert. So, I’m more energized when I can take my time and work on problems alone, or in small groups. I’m not energized by large groups of people, or giving a speech.

In spite of that, I'm a joiner and a people pleaser. I like working on worthwhile projects and helping others in achieving their goals. So, I’m inclined to say yes when asked to help with an organization. And once I’m involved, I want to do a good job that benefits the organization and all of its constituents. Like you, I’m proud of myself when I do a good job.

As a result, over the years I became involved with several nonprofit organizations, serving on their boards, or on one of the committees of their boards. Here is a list of the boards and committees that I joined over the years:

• Hospital Board (member)
• Hospice Board (Committee Chair, VP, President)
• County Medical Society Board (All positions, including President)
• County Board of Health/Health Department Board (President)
• Private High School Annual Fundraiser Committee (Co-Chair with my wife, Kay)
• State Medical Society CME Accreditation Committee (Chair, this enabled me to attend quarterly board meetings)
• Accreditation Council for CME Accreditation Review Committee (member)

I’m currently still serving my Board of Health, my County Medical Society, and the local Hospice Board.

I assumed that being involved with these organizations would provide me the satisfaction of contributing to a good cause. I was committed to supporting the medical profession (through the county and state medical societies) or filling the need for services for terminally ill patients (through hospice).

But I discovered that there were many unanticipated benefits to my participation. In a moment, I’m going to describe some of those benefits.

What Nonprofit Boards Are Looking For

Let me describe the reasons that I was recruited by these boards. I discovered the reasons after serving and helping to recruit new members as board positions opened up.

New members are generally selected from recommendations by current members. Some boards are mandated to include physicians, while others seek out physicians for other reasons.

For example, health boards often require a specific number of physicians and dentists. Boards like to include members who have a certain reach in the community, often for purposes of fundraising.

Desired Attributes

But beyond those considerations, a board wants to involve members who:

• Are well-respected in the community;
• Have demonstrated a willingness to help when asked;
• Reliably show up and fulfill commitments; and,
• Always follow-through on assigned tasks.

There are some further points I want to make about these factors.

In anything that you do, including your efforts to pursue an alternate career, it is important that your reputation, integrity, and honesty are NEVER in question. Even if your current job makes you miserable or drives you crazy, your goal should be to perform it with dignity and integrity.

You may be counting the days until you can leave this job, but you must continue to be present until that day comes, and consistently perform at your highest level.

Even if you plan to leave clinical work behind completely, do not take shortcuts, skimp on your documentation, or be chronically behind on your schedule. A sloppy, unorganized and chronically tardy physician will not be an attractive candidate for a board position, or for a new nonclinical job.

The bottom line is this, your reputation should be PRISTINE if you want to be considered for that job in management, or as a physician advisor or medical director, and for that position on a nonprofit board.

Time Commitment

Second, you should not accept board position if you don’t believe that you can honestly take the time for the meetings and for the additional work that might be required.

Photo by Noor Younis on Unsplash

The work is generally not a heavy burden. However, as a board member, you should be prepared to:

• Complete an orientation;
• Prepare ahead of time for meetings by reviewing minutes and other written reports;
• Participate in, and possibly chair a committee; and,
• Attend community events.

If you cannot carve out the time to contribute, then don’t accept the appointment.

What Not to Do:

Here are three common ways I’ve seen some of my physician colleagues squander a board position:

• They miss most of the meetings;
• come late to every meeting; or,
• fail to follow-up on even minimal tasks they agreed to do (such as contacting someone or looking up some information).

Abusing your position in this way is worse than never joining a board. These behaviors indicate that you’re either disorganized or lack the integrity to fulfill your commitments.

5 Benefits of Serving a NonProfit

Now to our primary reason for discussion of this topic. What are the major benefits I discovered by serving and sometimes leading these organizations?

1. Learning New Skills
   • management skills
   • leadership skills
   • other skill unique to the organization
2. Networking
3. Building Confidence
4. Recognition and Reputation
5. Joy and Meaning

Learning Management, Leadership and Other Skills

This may be the most important reason relative to career change. The opportunities for learning are tremendous.

As you attend these types of meetings, you’re usually going to be exposed to management and leadership principles that you won’t learn running a medical practice, or participating in a hospital medical staff.

Management Skills

You’ll have an opportunity see how meetings are run. Board presidents are generally very successful businessmen and women who have experience running effective meetings. You’ll see them demonstrate a balance of tactful yet direct communication.

The State Medical Society meetings were the most formal I’ve witnessed. They were run by strictly following Robert's Rules of Order. That was quite interesting.

Most boards are not quite so formal. But they do require that meetings be orderly and productive.

Many boards include attorneys, whose perspective reminds us of the importance of following bylaws and policies and procedures.

As a board member, you’ll be involved in project planning, at least at an oversight level. And you’ll often be asked to participate in strategic planning. I was once asked to lead a SWOT analysis for the hospice directors and managers.

If you're not familiar with that term, SWOT is an acronym for strengths, weaknesses, opportunities and threats. A SWOT analysis is often performed as part of a management or strategic plan to help identify important goals.

You’ll also have an opportunity to review financial reports. For most medical practices, cash-based accounting is utilized. Now you’ll learn about accrual accounting. And you’ll be asked to review and approve annual budgets.

You’ll also learn about marketing, branding and public relations.

Leadership Skills

As vice chair or chair of the board, you’ll learn leadership skills. You’ll learn to read people, communicate skillfully, and include everyone’s input into important decisions.

You may be charged with leading a review of the organizational mission. And, you’ll be asked to project the vision and values of the organization.

The local newspaper or radio station may seek you out for comment. Or you may need to join the executive director in meetings with other community leaders on important local issues.

You’ll likely get a crash course in fundraising.

And, you might find yourself leading a recruitment committee tasked to find a new executive director for the organization.

Organization-Specific Skills

In addition to general leadership and management skills, you’ll learn more about a specific field. As a hospice board member, I’ve become much more knowledgeable about palliative care, hospice care, the Medicare definitions of hospice services, and other issues related to end of life care.

Although I have a master's degree in public health, by serving on the board of health, I’ve greatly expanded my understanding of communicable disease outbreaks, environmental health, food safety, sanitation and public education.

Networking

Your network of colleagues and confidants will naturally develop. Instead of just one or two select mentors, you will develop a “tribe of mentors,” a term coined by Tim Ferris.

As a result of my board memberships, I have developed a network that includes attorneys, accountants, IT experts, bankers, investors, small business owners, entrepreneurs, philanthropists, mayors, state legislators, hospital executives, and other community leaders.

I can think of many times when I sought information or advice from one of these associates. You can imagine how these connections might be helpful in career transition.

And you'll serve as a mentor to others. As you provide advice and counsel to younger board members, your network will continue to grow.

My attorney and accountant both serve on one of the boards I mentioned earlier. My initial appointment as a hospital executive was certainly not hurt by the fact that I had been a hospital board member for several years before my employment.

Recognition and Reputation

As I noted earlier, reputation is of vital importance when developing new career options. On a nonprofit board, you will be contributing to your community on a grand scale.

Helping distribute meals at a soup kitchen is one way to serve. But leading a fundraising effort to raise thousands of dollars can potentially impact many more people. Setting the strategic direction of an organization will potentially affect hundreds or thousands of those in need.

Over time, your participation and contribution will become a source authority or gravitas. This provides opportunities to promote your favorite projects or enhance your career.

You’ll be seen as a community leader with direct benefits to your current career. It will help promote your medical group, build support for a new clinical service at your hospital, or attract partners for a joint venture. And this reputation will help when applying for a leadership position in a nearby hospital or medical group.

Building Confidence

Most physicians, after years of intense training, feel confident in treating patients. But we don’t always feel confident about trying new things, or interacting in a non-clinical setting.

However, after working on a team of other professionals in a board setting, you will naturally begin to feel more confident when working in larger teams. You’ll have an opportunity to learn from potential mentors with a diverse set of backgrounds.

I was somewhat surprised by the insights I developed as a result of being involved in these community organizations. They often solicit intelligence about local employment trends and planned company expansions, or local community college and university initiatives.

You can therefore develop a broader perspective on issues affecting your community. As a result, your opinion will be sought by other community leaders, and your physician colleagues.

Joy and Personal Satisfaction

Many of us want to leave medicine because we no longer experience the joy of helping individual patients. Contributing to a worthy cause through participation and leadership on a board is one way to recapture that joy.

And, by helping us to learn new skills, network with others, enhance our reputations, and build confidence, it can vastly improve our chances of finding a new career. And that will rekindle our joy as much as participation in the good cause itself.

Summing Up

Those are the FIVE benefits:

1. Learning New Skills
   • management skills
   • leadership skills
   • other skills unique to the organization
2. Networking
3. Building Confidence
4. Recognition and Reputation
5. Joy and Meaning

Let’s end today’s episode with a quote.

The best way to help me is to sign up right below for my newsletter so I can remind you about future podcasts and other happenings.

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Next week, I’ll have an interview in which my guest and I discuss how to prepare an awesome resume.

So join me next time on Physician Nonclinical Careers.

Resources

Resources are linked in the content above.

Right click here and “Save As” to download this podcast episode to your computer.

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If you'd like to listen to the premier episode and show notes, you can find it here: Getting Acquainted with Physician NonClinical Careers Podcast – 001

The post How to Quietly Build Leadership Skills As You Serve a Nonprofit – 016 appeared first on NonClinical Physicians.

A distinguished gentleman who looks to be in his 60s is asking the question. He and I are sitting across from each other at the end of a long, dark mahogany conference table.

I don’t remember how I came to be here. I probably look a bit confused.

“John. Tell me… How would you do that?”

Now I remember. I’m interviewing for the position of Chief Quality Officer (CQO). I’m ten minutes into an interview with the Chair of the Board of Directors. His name is Samuel.

That’s quite a broad question, Sam.

Clarify the question for me. You want me to describe how I would build an ideal quality improvement program? For a hospital like this? Are there any financial constraints?

“I’d just like to hear your opinion on what a really good program looks like. Let’s not worry too much about budgets. But keep it within the realm of possibility.”

A Great Hospital Quality Improvement Program

OK. I’ll tell you what I think. And I’ll try to keep it brief and fairly high level.

I’m making the following assumptions:

• We’re talking about the quality program at a stand alone general full-service hospital.
• I am going to include patient safety as part of overall quality program.
• I’m assuming that this program will need to meet all of the required reporting demands of CMS and other regulatory bodies.

“That sounds good,” Sam replies.

OK, then let me start with the basics.

First, I’ll define what I mean by quality improvement.

We’re talking about a program designed to support the hospital’s efforts to deliver medical care to patients that is:

• Undeniably effective and evidence-based,
• Timely, and
• Error free.

I’ll describe my design of a basic quality program. However, in the real world, the design process would be collaborative. It would involve multiple conversations with stakeholders from the local community, and possibly some outside experts.

Culture

The underpinnings of the program will start with the culture of the organization. Quality and safety must be built into the fabric of the culture of the hospital.

That means that the hospital mission addresses quality and safety. And the values of the organization will also include a commitment to quality.

Furthermore, the QI program itself would have its mission, values and vision. They would be defined by the hospital leadership, with input from all stakeholders, including patient representatives.

The Board of Directors will approve them. And everyone working at the hospital will need to acknowledge and sign off on the mission, vision and values. That includes the employees and non-employed medical staff members and independent contractors working at the facility.

The cultural aspects must include evidence that teamwork and effective communication are valued. We will implement the list of Safe Practices from the National Quality Forum.

Credentialing

Next, we will ensure that team members believe in quality and continuous learning. Hiring will involve an assessment of the commitment of potential hires to quality and safety.

Of course, all necessary licensing and credentialing will be followed.  An excellent quality program starts by involving motivated and engaged team members. Whether it's environmental services, phlebotomists, CNAs, lab and imaging technologists, nurses, pharmacists, or physicians, we will ensure that they all have the best credentials and a demonstrated ability to provide excellent care.

That sets the stage for building a great program.

Metrics

A great hospital quality improvement program has the ability to measure, report and improve important measures of quality and safety. So, next, I would define for the organization how quality is going to be quantified. 

We will need to implement tools to monitor our performance. In order to clearly define the tools we need, the expertise we need, and the structure to put this program in place, we need to define the metrics that will demonstrate our success or failure.

Ideally, we will track every outcome and process measure that experts agree define quality in the hospital setting. Off the top of my head, the following are generally recognized as important outcomes to track and report:

• Overall mortality rate, expressed as mortality index.
• Mortality rate for high volume conditions like heart failure, COPD and pneumonia. The top 20 by volume would be a good start.
• Complication rates for the top 20 procedures (by volume), such as total joints and other inpatient procedures.
• 30-day readmission rates for the top 20 medical, and top 20 surgical, diagnoses.
• Compliance rates for process measures (such as CMS core measures and other important lead measures).
• Selected patient safety measures (including Sentinel Events and Never Events).
• Selected AHRQ Inpatient Quality Measures.
• Length of Stay (overall, and for specific high volume diagnoses).
• Medication Errors.
• Additional measures, as indicated by comparing the Leapfrog National Measures Crosswalk and other published guidelines to what is already in place.

Measurement Tools

Given the list of measures that we must monitor, I will lead a team to identify the best measurement tools. If there are tools that can integrate with our EMR, I will focus on those. Otherwise, I will find tools(s) that will provide as much of the needed data as possible. The tools will need to provide risk-adjusted outcomes and rates for process measures. It will need to be as affordable as possible.

Such tools might include those provided by The Advisory Board, Premier, Quantros and others. Without automation of these measurements, they become very difficult to follow and compare to benchmarks.

People

In addition to leadership by the CMO or CQO, we will need an experienced, knowledgeable, clinical expert to lead the quality and safety department or division. He or she will have the appropriate attitude, experience and training to ensure success in this position.

Other expertise needed within the department will include:

• Regulatory (CMS, TJC or DNV, and state regulatory departments);
• Quality processes, including process improvement, quality improvement, and patient safety;
• Sentinel events and root cause analysis;
• Infection prevention;
• Medication safety;
• Data analysis, decision support and statistical analysis;
• Continuing medical education;
• Super-user for any measurement tools installed; and,
• Coding and documentation as it relates to quality and safety reporting.

Structure

We will need to assign the activities to the appropriate teams and create a REPORTING structure. We can start with a structure that looks like this, and adjust it to suit our needs:

In a small facility, one person might handle multiple duties. As the organization gets larger, the duties will need to be managed by a larger team.

I will place management of continuing medical education as part of the QI division. In this way, the majority of educational content for physicians will be designed to address gaps in care or patient safety.

Process

The Quality Committee, which is a subcommittee of the Board, will oversee all of the activities. So, there will need to be several scorecards that the board can review in order to easily monitor our performance.

The membership of the committee will include select board members, the CEO, COO, CQO, CMO, QI & PS Director, Pharmacy Director, Nursing Director, representatives from CME and  Infection Prevention, and members of the medical staff from each of the large departments (e.g., medicine, surgery, etc.).

Several subcommittees will report directly to the QI Committee:

• CME
• P & T/Medication Safety
• Readmissions
• Quality Team (tracking mortality, complications, core measures)
• Patient Safety
• Infection Prevention
• Code of Conduct

Each of these subcommittees will be monitoring outcomes and creating teams to address specific gaps in performance. The subcommittees might need specific teams for certain projects or for certain high risk units.

Here is how the COMMITTEE structure might look:

Reporting

Each SUBCOMMITTEE and TEAM will develop its own scorecards for reporting the ongoing performance being addressed. Minutes of each meeting and scorecards for each TEAM will be sent to its SUBCOMMITTEE. Each SUBCOMMITTEE, in turn, will report to the Quality and Safety Committee.

The CQO will present quarterly quality and safety reports to the senior executive team and the Board of Directors.

That structure ensures accountability of the organization to the community, via the Board.

Peer Review

Notice, Sam, that this model has not addressed the formal physician peer review process. But that must be included as part of the re-credentialing process for physicians.

My recommendation is that medical staff peer review be done by a multidisciplinary committee, with members from each medical staff department appointed by the chair. Cases will be reviewed, based on screening criteria for each department. Also, cases can be referred to the peer review committee as needed.

Some of those cases will also be reviewed through the sentinel event or QI process as well. The physicians will be invited to participate when their case is being discussed.

So, Sam, that’s what I consider to be a starting point for a good program.

In addition to the what I've already mentioned, we will:

• address new opportunities as they arise,
• focus on continually improving the quality of the care,
• take a multidisciplinary approach,
• integrate education into the process, and
• evaluate the culture through regular cultural surveys.

Wrapping Up a Great Hospital Quality Improvement Program

Sam replies, “That sound like a really sound plan. Thanks for taking the time to describe it.

“I think we’re out of time, so I’ll bring you to your next interview. Best of luck and thanks for coming in to meet with us today.”

I'm walking toward the door when, suddenly, I hear a distant ringing. The ringing becomes louder and louder.

Where is it coming from?

I open my eyes. The alarm on my cell phone is ringing. And I’m in my pajamas, in bed. I'm so preoccupied with my upcoming job search that I was dreaming about an interview!

Some of those ideas about a quality program were pretty good, though.

I jump out of bed to find a pen and paper to jot the ideas down!

Next Steps

What have I forgotten in my dream-induced quality plan? Let me know in the Comments.

Please share this if you found it useful – just use the links below to share on Facebook, Twitter or LinkedIn.

The post Building a Great Hospital Quality Improvement Program appeared first on NonClinical Physicians.

A colleague reminded me about the upcoming Spring Institute and Annual Meeting of the American Association for Physician Leadership. I had just completed registering myself. And I volunteered to act as an ambassador, assisting with introducing speakers and helping to support the meeting.

Networking with colleagues and old friends will be fun. And I look forward to spending time in New York City with my wife, Kay, when I am not attending educational sessions.

As vice president of the local nonprofit hospice board, I had the privilege of chairing the board meeting because the president was out-of-town. It was interesting to observe how the board members, many of them leaders in their own organizations, communicate with one another and run some of the subcommittees to which they are assigned. It is a very effective team.

I also had the opportunity to present a lecture to the internal medicine residents at the hospital where I previously worked as chief medical officer.

When choosing the topic for the lecture, I consulted with the residency leadership but also reflected on the topics I had written about on this blog for the past nine months.

As I did so, two revelations occurred to me:

• Physicians are natural leaders.
• Most physicians will assume formal leadership roles during their careers.

I thought about all of the physicians I have known over the years. Very few spent 20 or 30 years practicing without assuming some management or leadership role.

They have been hospital committee or department chairs or president of the medical staff, medical directors, nonprofit board members or former hospital or medical group executives. Or they have become involved in their specialty society. I have other colleagues that serve as county and state medical society trustees or committee chairs.

Given this likelihood, it make sense that physicians, even those still in training, begin to think about the gaps that exist in their abilities as they learn to be a better physician leader.

So this post and the next are based on the lecture I gave to the residents this week.

Physicians Are Natural Leaders

You have met the challenges of a rigorous and challenging process. Many of the traits that have allowed you to complete your training successfully are those needed by leaders:

• Intellect
• Focus
• Accountability
• Ability to handle complexity
• Good communication skills
• Perseverance
• Commitment
• Altruism
• Desire to work with people

Most of these traits will serve you well as a future leader. Some, like accountability and communication skills, will need to be enhanced.

Most Physicians Will Lead

There is an ongoing and increasing demand for physician leaders. Physicians prefer to be led by other physicians. Engagement of physicians improves when physicians lead their organizations.

Better engagement creates better quality outcomes and patient satisfaction. Other team members are inspired when the physicians are passionate and engaged.

Hospitals are seeking more chief quality officers, chief medical officers and other physician executives with management training and experience.

Value based care, pay for performance and population health initiatives require the input of physician leaders that can integrate the clinical with the business aspects for large organizations.

This recognition has led to an explosion in need for physician executives.

But there are new attitudes and skills that must be improved or developed in order to be a better physician leader.

Preparing to Be a Better Physician Leader

Existing leadership characteristics and abilities must be enhanced and new ones must be learned. In Part 1 of this series, I am going to focus on just a few of the attitudes or perspectives that emerging physician leaders should adopt.

In Part 2, I will discuss some specific skills that should be learned or honed as these new roles are assumed.

Physician leaders, to be most effective, must evolve to being:

• Proactive rather than reactive;
• Planners rather than performers;
• Strategic rather than tactical;
• Delegators rather than deciders;
• Participative rather than independent; and,
• Organization focused rather than practice focused.

And  I believe that there are three special areas that we should try to enhance as leaders.

Accountability

The accountability inherent in individual patient care should evolve into accountability for the team or the organization. One sign that accountability is in place is the ability to admit mistakes. The young physician leader must be willing to own up to mistakes.

No one is infallible. We all make mistakes. But the sign of leadership is our ability to admit our mistakes, regroup and move on.

There is a process that leaders use to address individual accountability in an organization. I saw this most clearly described by Michael Hyatt. The process follows these steps:

• Admit that you did not prepare, communicate or manage properly to achieve the desired result;
• Restate your understanding of your responsibility;
• Explain how you’re going to rectify the problem;
• Commit to resolve the issue by a specific deadline.

Optimism

Healthcare can be challenging and frustrating. Payments are declining. Patients can be demanding. Personnel issues make us crazy.

Too many times I have been in conversations with physicians that are negative and defeatist. Apathy and resignation are rampant.

But leaders cannot withdraw. As a leader, you must inspire and encourage your team and remind them of the shared mission and vision, even when things are not going so well.

Humility

I can't count the number of times I heard one of my physician colleagues offer an opinion on a topic about which he knew very little. Some of my colleagues seem to think that their medical degree grants them insights into every field of endeavor.

Leaders are not self-righteous, or condescending. They're able to admit that they’re not the experts in every field. They hire and defer to people who are smarter than they are and welcome input and allow associates to accomplish goals in their own ways, without micro-managing.

Nobody wants to follow a leader that's a know-it-all.

In Summary

Observing attitudes in ourselves and our colleagues is a start to understanding how they affect managing and leading.

Next Steps

Watch how others lead. See how they express their accountability, optimism and humility through their body language, and verbal and written communication. Observe how others respond to their leadership style and personality.

Then reflect on your own approach to these issues. Ask a few close friends how your own personality and leadership style are perceived. You may receive some interesting insights.

I encourage you to attend the upcoming meeting of the American Association for Physician Leadership. The speakers are excellent, the content is very useful, and the conference offers great value to the new or established physician leader.

In the next post, I will continue with a discussion of the skills new physician leaders should begin to understand and acquire.

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The post Preparing to Be a Better Physician Leader – Part 1 appeared first on NonClinical Physicians.

The CEO and the Board of Trustees (or Directors) definitely want to see meaningful reports about hospital performance. They truly want to see that performance is improving. Along with positive financial results, nothing will make the CEO and board happier than seeing that quality can be measured, is at an acceptable level, and is improving.

There are many ways to collect, analyze and present such data. I am going to show you how to prepare quality reports that my board found useful and interesting. Several of my board members told me that they really looked forward to seeing these reports.

First, Some Basics

Anyone who works in the quality arena will take the following caveats as a “given.” But for those who are just starting, here are some things to keep in mind.

It is not easy to reliably measure quality. And for hospitals, we generally do not measure “chart-level” outcomes. Our quality measurements are limited by the fact that we use billing data to collect mortality, complications, length of stay and other quality outcome measures.

UB-04 Billing Form

However, there is more than two decades of work by universities and quality vendors validating the use of billing information to measure outcomes. These researchers have produced an approach to quantify outcomes and apply statistical methods to the process. This enables us to compare the performance of facilities across the country. These methodologies are the same as those used by CMS and private quality reporting organizations such as Truven Health Analytics and HealthGrades.

You should verify that the following requirements are in place before you try to create reports like the ones I describe:

1. Your organization has a quality measurement tool that is interfaced to all of the necessary hospital systems.
2. The tool accurately draws data such as date of admission, date of discharge or death, source of the patient, destination on discharge, length of stay, etc.
3. The system(s) have the ability to distinguish between medical conditions that were present on admission (POA) from those that arose during a hospital stay.
4. Your hospital has robust medical records, coding and billing departments that accurately assign CPT codes, ICD-10 codes, and DRGs. You must be confident that those codes comply with the definitions from CMS and other quality agencies.
5. You have staff in the quality department that is knowledgable and can pull the outcome reports you need.

Other Considerations

The systems that I’m describing perform risk-adjustment of the data. It is therefore valid to compare outcomes to other organizations. In addition to reporting risk-adjusted rates, the outcomes are also expressed in one of two ways:

1. As an index, defined as the ratio of the observed rate over expected rate. If the observed and expected rates are the same, then this ratio is 1.0. A higher ratio indicates a rate worse than expected. A lower ratio than 1.0 indicates a better than expected rate.
2. As the difference between the actual and expected rates. If the difference is a positive number, the actual rate is worse than expected. If it is less that zero (a negative number) the rate is lower/better than expected.

Finally, most systems will also indicate whether the difference or ratio is statistically significant, and at what level of significance. When considering quality comparisons, we want to know differences at the 75th and 90th percentile. In research studies a significance level of 95% is desired. But we want to err on the side of identifying opportunities for improving quality. And we ignore opportunities with a significance of less than the 75th percentile, because they are more likely a result of chance alone.

Bringing It All Together to Prepare Quality Reports

As complicated as all of that sounds, the majority of hospitals have systems that meet those requirements. They can produce risk-adjusted outcomes and deviations from expected. And they can apply statistical testing for any of the high volume diagnoses. This allows us to prepare quality reports for our medical staff, our executive team and our board.

Using these systems, the quality department can create a report for the high volume diagnoses that lists the mortality, morbidity (complications), readmissions and length of stay.

I usually break these reports into two main categories. I produce one report that focuses on the mortality and length of stay for serious medical conditions. In this way, I can show the CEO and board a report that addresses pure quality (mortality) and a combination of quality and utilization (LOS).

For the high volume surgical or procedural admissions, since the mortality rates are very low, I find it more useful to present the morbidity (complication) rates and LOS data.

Start With a Spreadsheet

I use Microsoft Excel to create the data table and the graphs. But most spreadsheet software should work as well. I copy them to Microsoft PowerPoint for my presentation. I keep the slides as simple as possible. Usually, I include a minimum of labels so the information is clear. Yet I try to be parsimonious: showing everything that is needed, but nothing that is not needed.

Creating the bar graphs is simple: just highlight two columns (the list of diagnoses and the outcomes) and select the type of bar graph from the drop down menu. I generally use 2-D graphs for simplicity. Then, I save the charts on a separate page so that I can easily copy them to my slides.

The “bubble graph” is created by highlighting the three columns to be included (LOS, mortality and volume columns in this case), then choosing the prefered style from the “Scatter or Bubble Chart” option.

An example of a table that includes all of the information needed for these graphs follows. Note that these are completely fictional data that I generated for demonstration purposes only. But the information I present will look very much like this table, but for a larger number of conditions (20 or 25).

Using the information from the table, I create a bar graph to show the spread of outcomes from best to worst (in this case, lowest to highest mortality and LOS indexes). To do so requires sorting the data (lowest to highest) before creating each chart. Here is how those graphs would look:

Preparing the Bubble Graph

Finally, in order to bring it all together when I prepare quality reports, I combine all of the information into a single graph. This graph displays a grid showing the mortality index, the LOS index and the volume of cases. That graph is shown below.

I usually add small labels for each bubble indicating which diagnosis it represents. [Those must be added manually using individual text boxes. I did not do it for this post to save time. – VPE] I should also note that most of this work was delegated to a capable quality improvement nurse once I had created the first few iterations of these reports.

When I was presenting these data regularly for our board (twice a year), I would show the previous results and the current results. And I would skip through the bar graphs quickly, since all of that information was also incorporated into the bubble graph. But I wanted the board to understand where the bubble graph information came from.

Then I would just leave that bubble graph up on the screen while I discussed the great results of conditions sitting in the bottom left quadrant. And I would point out that it is possible to have great outcomes and a short length of stay (contrary to the opinions of some of my medical staff colleagues).

I would then describe the challenges of the conditions in the top right quadrant. And I would outline the procedures we had instituted to address the excess mortality and/or LOS. I might also comment on how we would prioritize working on the largest bubbles in the top right quadrant because they represented more cases.

Other Steps

It is best to preview these presentations with your CEO and senior executive team. That way, you can better anticipate questions the board may ask. And it gives you an opportunity to engage other team members in your quality improvement efforts.

You can combine any two variables (plus the volumes) to create similar slides. In addition to mortality and LOS, I would present a bubble graph of morbidity and LOS as noted above, or incorporate readmission rates. You may want to apply this method of analysis to metrics from patient safety or infection control. Even the finance team can find a use for these types of graphics.

Next Steps

Get creative and come up with some other combinations. Once you create some charts, why don’t you include a picture in the COMMENTS below, or just describe what you have created.

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He had been on the board for several years, and had an intimate knowledge of the performance of the hospital. He knew many of the local medical staff. His wife had once worked for the hospital.

At one point in our brief conversation he said, “ You know, John, I really look forward to your quality reports. We all do. The board members like to know that things are going well. We also want to know when there are potential problems, and the steps taken to address them.”

I thanked him and promised that I would continue to keep the board informed, and he went on his way. Over the years, other board members mentioned similar sentiments. They were very interested in how the organization was addressing quality and safety.

Historical Perspective

Thirty years ago, hospital boards spent most of their time reviewing financial reports, statistics about patient volumes, new programs, and capital investments in equipment or the physical plant.

But over the past few decades, there has been an increasing emphasis in healthcare on measuring and improving quality and safety. Hospital and health system boards are well aware of this evolution. They are interested in assuring that their organization is meeting its mission to provide safe, high quality care to its patients.

Simultaneously, quality, safety, infection control, risk management and decision support departments have grown in size and sophistication. The number of reports describing outcome and process measures has also grown. Many of these are of great interest to your board of directors. And physician executives, like the chief quality officer and the chief medical officer, have stepped up to lead that process.

The 7 Hospital Board Reports

The following is a list of some of the reports I have personally provided to our board. These always generated discussion and good questions.

1. Review of Hospital Compare Data

These reports include an overall star rating, core measure performance, complications, readmissions and mortality. Hospital Consumer Assessment of Healthcare Providers and Systems Survey (HCAHPS) is also posted on the Hospital Compare website.

There is probably too much information to present at one sitting. Note that some of the information is presented annually, while some is available quarterly. Since this information is available to the public, it is very important for the board to be aware of current rankings and trends.

2. Annual HealthGrades Summary

HealthGrades applies its own risk adjustment and analysis to publicly available data and generates an annual comparison of the hospitals and physicians each year. It analyzes the data to generate one- three- and five-star ratings (below average, average and above average, respectively) for several clinical conditions.

My board found it useful to review a grid that I developed to summarize the star rating for each item each year. The grid included a row for each measure. Each column included the star rating for that measure in a given year. I also included a total for each column of the number of five-star and one-star ratings.

3. Annual or Quarterly Quality Review

Using a quality improvement tool that extracts information from the coding and billing information, most hospitals can generate risk adjusted outcomes for its most common discharge diagnoses. We would generally review risk-adjusted length of stay, complication rates and mortality rates for our top 20 (by volume) diagnoses.

I would summarize these data by creating a bar graph that presented the observed over expected ratios, from highest (worse performance) to lowest (best performance) for the measures noted above. I might then compare year the results from the previous year to the current year.

4. Sentinel Event Summary

Every hospital and health system experiences sentinel events. Large systems probably count more than a dozen or so, if they are honest with themselves. In addition to the events that meet the CMS definition, there are also near misses that deserve a root cause analysis (RCA). In a hospital setting, these sentinel events may include the administration of the wrong medication, an unexpected death, wrong site surgery, patient suicide or a fire in the operating room.

During the root cause analysis of an error that threatened the life or limb of a patient, the RCA team will identify the proximate causes, the contributing factors and the root causes of the untoward event. For the board's purposes, it can be useful to summarize each year's RCAs. Place each event into a specific category and review the root causes that were identified and the plans for addressing each.

5. Patient Safety Update

I discussed the patient safety indicators when I discussed how to deliver patient safety. These events consist of uncommon occurrences, especially during or following surgery. Because their rates are so low, be prepared to answer questions about why they occurred and what steps are being taken to prevent them in the future.

These are best shown in tabular format, which includes historical information by year for each PSI and the national averages. The goal for most PSIs is for none to occur, unlike quality indicators in which is generally some baseline rate due to unavoidable patient factors.

6. Annual Review of Behavioral Issues

Due to the widespread recognition that so-called “disruptive behaviors” by physicians threaten good patient care, many hospitals have developed a plan for reducing such incidents. This includes the adoption of a universal code of conduct (or code of behavior) and creating escalating consequences for violating the code. There is usually a committee to oversee the process and investigate the validity of alleged violations of the code by physicians.

Our organization created a physician-led multidisciplinary team that reported to the Medical Executive Committee (MEC). It investigated allegations of inappropriate behaviors. The team was able to interview and provide education to those with minor violations of the code of conduct. When serious violations were confirmed, they were sent to the MEC for action.

Once each year, I presented a summary to the board that listed the nature of the confirmed violations and the actions taken. I also presented a graph depicting the number of annual investigations, which showed the declining rate of occurrences after the program was put in place.

7. Infection Control Updates

You should be producing a monthly report that describes the incidence of serious hospital acquired infections. This is usually reported in the form of a dashboard. This can be rolled up to an annual summary and then trended over several years for review by the board.

In Summary

Health system and hospital board members want to see more than just financial reports. They genuinely want to know that the care being provided is good, and that it is improving. These seven reports will provide your board with a good sense of the quality and patient safety being delivered at your institution.

I would really like to hear your additions. What reports have you presented, or seen presented? Which of them seemed to produce the greatest discussion and questions? Please share in the COMMENTS.

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There is more need today than ever for skilled physician leaders. There are several specific steps that hopeful executives can take to enhance their competencies. But each physician will need to determine his or her own path based on his or her circumstances.

When trying to acquire these skills, it is best to follow Steven Covey’s admonition: “Start with the end in mind.”

Resources for the Emerging Physician Leader

Here are some resources that I found very helpful while I pursued my dream to become a physician hospital executive.

Join Pertinent Associations

Join organizations that provide support, education and networking. While I was actively working as a hospital CMO, I was a member of the American College of Healthcare Executives (ACHE). It provided some very good resources, including an annual conference to attend.

Since my hospital belonged to the American Hospital Association, I had access to its resources.

The dominant physician-led organization is the American Association for Physician Leadership (AAPL). I joined the organization in 1994 and have been a member ever since. In addition to conferences, workshops, and on-line activities, it publishes a monthly journal and hosts a job board.

Consider an Advanced Degree

Obtaining an advanced degree such as an MHA, MMM or MBA is not required. But it can be quite helpful for developing new management and leadership skills. In 1993, I completed a master's degree in public health, with a focus on occupational medicine. At the time, I was working as part-time medical director for an occupational health clinic.

Had I joined the AAPL before starting the MPH, and fully considered my long-term goals, I may have chosen to pursue an executive MBA or MHA. The MPH has been useful, nonetheless, in my work in quality, safety and population health initiatives.

Although it is not an advanced degree, the Certified Physician Executive (CPE) designation is evidence of competence in many physician leadership skills. It can be obtained by those with or without an advanced business degree through the Certifying Commission in Medical Management.

Get Training in Business and Management

Formal training relevant to the physician leader can be obtained through workshops, conferences and on-line programs. The organizations mentioned above all provide extensive education in business and management topics. If you are on staff at a hospital, you should be able to access some of the AHA programs. If employed, even part-time, by a hospital or other healthcare organization, you can probably access the ACHE conferences and workshops.

I attended many conferences organized by the AHA and ACHE over the years.

I also recall attending training provided by the Advisory Board, the Studor Group, Press Ganey, and the Greeley Company. Also, specialty societies, state medical associations and the American Medical Association offer additional learning opportunities for the emerging physician leader.

The additional benefit of attending AAPL courses and workshops, including on-line courses, is that many of them count toward CPE certification.

Read Books, Journals and Blogs

There are many good books to read on the subject. Some are written by physicians such as Atule Gewande, some are about physicians leadership (by Mark Hertling). Most of them address general business and leadership topics (by experts like Jim Collins, Peter Lencioni, Susan Scott and Sean Covey).

The AAPL publishes the Physician Leadership Journal monthly. Modern Healthcare is useful, as is Medical Economics.

There are several blogs devoted to leadership. This is a resource that was not available to me when I began my career journey into the executive realm.

I like blogs because they are contemporaneous, and often more focused and brief than a journal article. Also, they often allow for interaction with the blog author or other readers through the Comments section.

There are some great blogs devoted to leadership that provide free content and engagement with others interested in leadership, like MichaelHyatt.com, JohnMaxwell.com and SkipPrichard.com. I have been unable to find any blogs written for the physician leader that don't require membership in a parent organization like the AHA or ACHE.

Volunteer Your Services

A good way to get experience is to lead hospital based teams, and participate in professional society committees and nonprofit boards. At my hospital, I volunteered to work on the CME Committee. That led to being asked to join the Illinois State Medical Society's Committee on CME Accreditation. I later served as chair for that committee for five years. In that role, I attended the ISMS Board meetings.

Work on the Committee on CME Accreditation led to working as a CME surveyor and appointment to one of the Accreditation Council for CME's subcommittees.

In later years, I joined the local hospice board of directors, where I now serve as Vice President and President Elect. I have also served as a member and chair of our local health department board.

All of these experiences have given me an opportunity to set agendas, lead meetings, participate in strategic planning and review financial statements.

All of these experiences have helped me to hone my business and management skills over the years.

Take the Plunge

Once you have some education and experience, you will be ready to seek that full- or part-time job as a physician executive and leader. You will never be fully prepared. It is like marriage, the only preparation for being a physician leader, is to become a physician leader.

Now, take a deep breath and jump in. Our profession and our patients need you.

Have you found any blogs devoted to physician leadership? If so, please mention them in the Comments Section.

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And feel free to contact me directly at john.jurica.md@gmail.com

The post Resources for the Emerging Physician Leader appeared first on NonClinical Physicians.

A Touching Letter

About fifteen of us were sitting around the conference room table. The hospice executive director was reading a letter from a client's daughter.

The daughter wrote about how thankful she was for all of the support that had been provided for her family during the days leading up to her mother's death. The family had grown quite attached to the hospice staff, and they to her. The daughter explained how they had become like family. Her mother was at peace during her final days and they were comforted by this.

As a member of the hospice board of directors, I was touched by the sincere gratitude expressed by the daughter. I was impressed and proud by how committed the staff were. And I was thankful to be a part of this team.

It's a Business, Too

As I reflect on my involvement on this board, it occurs to me that I have learned many lessons that helped me as a physician leader and executive. Like other hospice organizations, it is a very successful business. Many nonprofit organizations (NPOs) provide an opportunity to learn leadership skills while providing a valuable community service.

Some of the nonprofits that physicians typically get involved with include:

• Hospitals
• Charitable support organizations such as the American Lung Association and Arthritis Foundation
• Research and education foundations such as the ALS Association and the March of Dimes
• Advocacy organizations like the National Council on Aging
• Other local community foundations
• Local or state health departments (technically, many of these are governmental, but function like an NPO)

They each have a clear mission, vision and values. They have the same financial, marketing, financial, legal and HR issues as other corporations. And the same leadership principles apply. There is a lot to learn when working on such boards.

As a board member, we don't get involved in the day-to-day running of the agency, but we do get involved in many significant decisions, not the least of which is recruiting and hiring the executive director and participating in strategic planning.

Getting Involved

Getting involved is not as simple as just asking to join a board, however. Generally, there is a formal process for identifying and appointing new members.

Show an interest in working with local agencies and a willingness to donate your time. Get to know the directors of these organizations and their current board members. Let them know that you are interested in participating. You will certainly be asked to assist on certain projects. Provide meaningful assistance and, eventually, you will be approached about serving on the board.

Five Skills for the Emerging Physician Leader

Here is a list of skills that a physician can learn by volunteering on such boards.

1. Reading Financial Reports

Most boards will be reviewing regular financial reports (at least quarterly and annually). Like most large corporations, NPOs typically produce income statements (also called profit and loss statements) and balance sheets on an accrual basis. This differs from financials for a small practice, which are often based on cash accounting. They are quite similar to financials produced by hospitals and other corporations.

2. Marketing

Many NPOs will do market analysis, create marketing plans, utilize public relations techniques, operate web sites, hold promotional fund-raisers and purchase advertising. These are all topics that a physician manager or leader needs to learn more about.

3. Understand Legal Issues

It is not  unusual for an NPO board to be involved with discussions about compliance, intellectual property, HIPAA and other legal issues. Many of the topics discussed at our hospice board meetings, for example, were similar to those discussed at our hospital senior executive meetings.

4. Practice Project Planning and Meeting Management

These two issues overlap so much that I put them together. It is common for a board member to chair a subcommittee of the board. In that role, the physician will be able to apply time management, running of meetings, setting agendas and involving everyone on the committee. Hopefully, all of the issues discussed in Nine Maxims for Masterful Meetings can be put to use.

5. Improve Communication Skills

The same listening skills and ability to probe and question that I described in Effective Teams Crave Conflict will be developed on an NPO board.

These are five skills that every physician leader needs. By studying the financials, discussing the marketing and legal issues, and chairing subcommittees, these skills will be developed.

Two More Reasons to Participate

6. Exposure to Other Community Leaders

An NPO board is a great way to network with local community leaders. You might even find future collaborators, partners or employees.

7. Contribute to the Community

It should be obvious that this is a great way to support your community and promote important services. This can provide a sense of purpose that only comes with giving to meaningful causes.

A Few Final Thoughts

There are probably more good reasons to participate on a nonprofit board. Aside from the time commitment, there are really no downsides to doing so.

In the comments, please list some of the nonprofit boards you have joined. And tell us about the best experiences you had on your board.

As always, please Subscribe Here.

On an unrelated note: check out my recent guest post on Future Proof MD where I provide a short overview of the use of relative value units (RVUs) in physician compensation plans.

Other questions, thoughts or suggestions? Email me at john.jurica.md@gmail.com.

The post How to Serve Your Community And Learn Business Skills appeared first on NonClinical Physicians.

One of the tools used by business leaders to do such an assessment is a SWOT analysis. SWOT is an acronym for Strengths, Weaknesses, Opportunities and Threats.

The  development of the SWOT Analysis (or Matrix) has been attributed to Albert S. Humphrey, although he disavowed having invented it. It is a conceptual tool that has been used by countless business leaders to assist in planning. As a physician manager, you should become very comfortable using it.

What Are the Components?

The strengths and weaknesses generally refer to internal  characteristics of an organization. This includes financial resources and performance, human resources, branding, and loyalty of customers. It also might include cultural issues, such as whether your organization or division is nimble or slow-moving.

The opportunities and threats describe external considerations. How is the local economy doing? Is the market growing or shrinking? What are the demographics of your clients? Is your competition strong or weak? What is the regulatory environment like? Are there major legal hurdles to entering a new market?

When to Use a SWOT Analysis

They are commonly used when making a major business decision. For example, they may be used to flesh out a decision about:

• Adding a new service line (e.g., open heart program, neurosurgical program, hospitalist coverage)
• Expanding into a new geographic market (e.g., new clinic, freestanding emergency room or ambulatory surgery center)
• Merging or acquiring another entity (e.g., hospital or medical group)
• Implementing a new electronic medical record

Example

Rather than try to explain each of the components in detail, let's examine an example of a hospital system's imaginary plan to open a new urgent care clinic.

SWOT Analysis – Fast and Furious Urgent Care Start-up

Strengths

• Strong brand recognition of the hospital system
• Financial strength – good reserves and cash flow
• Strong interest by medical group primary care department to staff the clinic
• Strong management team with expertise in opening new clinics in retail settings

Weaknesses

• No expertise in urgent care
• Multiple competing strategic initiatives already in place
• Recent difficulty in recruiting support staff
• Current gap in medical group leadership position (due to a retirement)

Opportunities

• Underserved population – there is a demonstrated need for primary care services
• Several of the medical group live in the area of the proposed clinic
• There is vacant rental space available at low cost
• Large number of employers in the area would support workers compensation business
• The community is supportive of a new clinic and job creation

Threats

• Large percentage of uninsured in the market
• Competitor may be looking to establish a clinic in the same market
• Some of the hospital medical staff (not employed) may be threatened by opening a hospital based clinic in their backyard

Next steps include addressing the weaknesses and threats by:

• hiring a new medical group leader that has experience in the urgent care business
• developing a written plan for staffing the urgent care center
• updating the market analysis to see if the insurance coverage has improved
• discussing with local physicians how an urgent care center might impact their practices
• creating a pro forma with monthly projections for the first year and a five year projected budget (by the CFO)

This example is abbreviated, but you can see how the SWOT analysis can drive further study and preparation. Ultimately, it will help clarify the decision to move ahead with a large project or not.

Two Final Thoughts

1. You will impress your CEO and enhance your indispensability if you present a SWOT analysis in anticipation of annual goal setting or a proposal for a new service line.
2. You will be a much better executive team member by preparing for strategic planning sessions by thinking about the SWOT categories and identifying specific questions to explore.

Have you used a SWOT analysis to assess a proposal? What were the results?

The post When to Use a SWOT Analysis appeared first on NonClinical Physicians.