Program for health care leaders focuses on sustaining the academic mission

Complexity, disruption, culture, interprofessionalism, and vitality—these are just a few of the concepts that leaders in academic medicine are thinking about while working to create environments where teaching and safe clinical practice thrive in tandem. Sixty-one of these leaders gathered in Boston in June for the Harvard Macy Institute’s Program for Leaders in Health Care Education. A week of interactive discussions and team exercises were designed to help them navigate an environment undergoing change in virtually every aspect.

The major objective of the annual program is to help its participants—whether they chair departments in schools or hospitals, serve as academic deans, direct training programs, or create curricula—learn how to develop the strategies and skills required to create and sustain organizational change. As the breadth of the presentation topics demonstrated, these are not changes occurring in a vacuum, or merely the ideals of one bold leader with the potential to be shaped into innovation. A diversity of forces are impacting medical education and health care delivery—at both the organizational and individual level—and those charged with leadership are discovering that change is not a choice, it ’s a fact of life.

The program provides an opportunity for the participants to reflect, and connect what they are learning to the challenges ahead of them.

The program’s participants were invited to explore this state of flux during the first session, when Elizabeth Armstrong, PhD, who directs the Harvard Macy Institute, asked them to contemplate the picture of health care in 2010. “We began the program with an interesting discussion of a speculative case study of what one academic medical center might look like in the near future,” said Armstrong. “By examining the trends, both in medicine and society at large, that might have led to this future state of health care, and by imagining what new skills physicians will require in that milieu, we can begin to understand where we are today, and what we need to do as health care changes. This really sets the tone for the rest of the week ’s discussions.”

Clayton Christensen

Whether developing faculty or dueling for dollars, leaders in academic medicine are discovering that the solutions to problems and the practical experiences that can aid their decision-making can often be found outside of the academic medical center. Over the years, Armstrong has worked closely with Clayton Christensen, DBA, of Harvard Business School to develop a core of program faculty whose experiences and expertise cover the full spectrum of the challenges facing medical educators today, from the bottom lines of business to the fine points of teaching.

The organization as community
Thomas Viggiano, MD of the Mayo Medical School led a session on developing institutional professional development programs with the aim of enriching thecareers of faculty for the greater good of the institution. He discussed the best practices of recruiting, orienting, and developing faculty, using a life cycle model to demonstrate the dynamic contract between faculty as individuals and the institutions where they work, a relationship based on a shared set of needs and goals. “Faculty vitality means the ongoing realization of goals,” said Viggiano. “This is a career-long journey, not a destination.”

Dr. Thomas Viggiano: Faculty vitality is a “career-long journey, not a destination.”

A strong organizational culture, he said, is the biggest influence on vitality. It is this learned, shared, tacit belief system that nurtures a sense of community. “The role of leadership in promoting the culture is to create the environment for it by aligning values, resources, and processes,” he said.

Viggiano described three barriers to building such a culture: decentralization of the organization, individual self-interest, and the idea that needing and asking for help is a sign of weakness. “Our culture (in the medical education community) assumes that the faculty members with the ‘right stuff’ don’t need any help.”

Building a business case for teaching
One of the most difficult challenges facing academic medical centers is creating a balance between the different roles of the faculty. With research and clinical practice closely tied to the financial well-being of the institution, many physicians are hard pressed to carve out a niche for teaching that enables them to meet the educational goals of their institution. But as one session made clear, the answer to this dilemma lies not in isolating teaching from the rest of the academic medical center’s operations, but rather in taking a business approach to teaching.

Michael Epstein, MD, vice-president and chief operating officer of Beth Israel Deaconess Medical Center, challenged the program participants to build the business case for teaching by linking education outcomes to patient outcomes. “The connection between quality of care and education exists,” he said. “We just have to do the analysis.” He emphasized that department chairs should learn how to write business plans and develop annual reports that showed the results of their educational work. This makes sense, he pointed out, because when institutional budgets are developed, money isn’t the only resource that is allocated among the academic medical center’s many units; rooms for study and teaching, among other elements, are also highly valued.

A dynamic approach to change
The program’s participants finished the week with a large collection of strategies, insights, and practical experiences to draw from. For many of them, the challenges they face upon their return home are daunting—comprehensive reforms that will require them to change many minds and manage many competing agendas. But as Armstrong points out, the leadership program isn’t really about working harder to achieve these goals, but rather about altering their approach and working differently.

“The culture of academic medicine continually reinforces the idea of individual diligence, and asks that physicians build their knowledge through the efficient delivery of care,” said Armstrong. “But the modes of health care delivery are changing, and therefore through this program we are working to promote the concept of teamwork, and help these leaders become reflective in their approach to improvement, so that they are working with a systems approach that enables them apply what they learn in their daily practice and make improvement a proactive, rather than reactive, element of the process.”

Armstrong notes that a key element of the leadership program is to help the participants maintain autonomy while embracing a team approach. “One of the themes of this year’s program was interprofessionalism,” she said. “Going forward, the health care leaders and educators who are successful at creating and sustaining change will be those who are able and willing to work across disciplines. To that end, this year we included leaders of schools of nursing and pharmacy among the scholars, and hope to expand that network.”