Rising to the Top: Clinicians Taking on More Leadership Roles

By Jennifer Larson, contributor

April 15, 2012 - Kevin Roberts, RN, remembers his first day at his current job at Glendale Adventist Medical Center in Glendale, Calif. He donned a set of scrubs and headed to the operating room to watch surgery.

That, in itself, isn’t unusual for a nurse…except that Roberts is actually the president and chief executive officer of the hospital. “None of the (OR staff) could remember a CEO in scrubs before,” said Roberts, who was a student nurse at the same hospital more than 30 years ago.

Roberts is one of a growing number of clinicians who have risen through the ranks to claim top leadership slots in healthcare organizations around the country.

A recent article in The Atlantic magazine described the phenomenon, noting that as new care models are emerging, many organizations are looking for leaders with clinical backgrounds to guide them into the future. According to the article’s statistics, quoted from the healthcare search firm of Witt/Kieffe, there are 64 physicians occupying the chief executive officer position, “with thousands more in the talent pipeline.” And even more nurses are occupying the big office; approximately 2 percent of the American Organization of Nurse Executives’ (AONE’s) 8,500 members report that they’re serving as CEOs of healthcare organizations, with still more serving as chief operating officers and in other executive positions.

Many experts expect the trend to not only continue but to expand.

“I think boards of healthcare organizations are wanting leadership at the helm that understands the core business,” said Donna Griffith, MSN, RN, senior vice president and chief nursing officer at Martin Memorial Health Systems in Stuart, Fla.

And Susan Kosman, MS, BSN, RN, chief nursing officer of Aetna, agreed. “I just see opportunity all over,” she said.

Proponents say clinicians bring an insider’s understanding of patient care to the decision-making table.

“They’ve a very valuable voice,” said Michelle Janney, Ph.D., RN, president-elect of AONE. “They’re trained to be clinical thinkers and problem solvers, which are definitely attributes of a successful leader.”

And nurses especially are accustomed to working in teams, she added. That’s a useful approach for leadership to have because no one can advance care in a silo.

Health reform has been a significant driver in this clinician-to-leader trend. Although the status of the Affordable Care Act has yet to be finalized, following last month’s arguments before the Supreme Court, the health reform law has already had a significant impact on the changing landscape of healthcare. It has driven the creation of models that attempt to align quality patient care with cost-effectiveness, most notably the accountable care organization (ACO).

For example, the Centers for Medicare and Medicaid Services (CMS) recently announced it has entered into agreements with 27 ACOs through the Medicare Shared Savings Program, joining 32 Pioneer Model ACOs announced last December, and six Physician Group Practice Transition Demonstration organizations that started in early 2011. And a majority of the new ACOs are physician-led, according to the American Medical Association.

According to Peter Angood, MD, CEO of the American College of Physician Executives (ACPE), physicians who pursue leadership positions are typically driven by two major factors: the altruistic desire to help people and the desire to shape the changes they want to see.

“The passion clinicians have to improve patient care is deep,” noted Angood, himself an example of a physician inspired to pursue a leadership path.

But clinical experience by itself is not enough to make someone a successful leader of an organization.

Leaders need to have an understanding of the business side of healthcare and develop the relevant competencies, Griffith noted.  While many acquire that knowledge on the job, to some extent, increasingly clinicians are turning to other options to learn more about finances, strategic planning, philanthropy, health policy and advocacy.

To gain those additional skills and competencies, individuals should assess their needs to see what’s missing and then figure out ways to fill in the holes. “You always have to be thinking, ‘What else should I be looking at?’” said Kosman.

Added Roberts, “You’ve got to be willing to take some risks and make some mistakes and learn from every single one of them.”

Many clinicians on the leadership path choose to return to school to pursue graduate degrees in administration, finance or other relevant fields to broaden their knowledge and experience beyond their existing clinical knowledge and skills.  For example, Kosman, Griffith and Roberts all returned to school for graduate education that has helped them secure the positions they currently hold.

In recognition of the potential opportunities for their members, many professional organizations have begun offering programs to groom physicians and nurses for leadership roles. The ACPE offers a program called the Physician Leadership Development Program, and the AONE offers the Aspiring Nurse Leader Program and the Nurse Manager Academy. The American Association of Critical-Care Nurses (ACCN) has created a program called CSI Academy to teach innovation, project management and leadership development to hospital-based nurses.

The American Nurses Association (ANA) is planning to launch a program called Leadership Academy later this year to nurture nurse leaders so they’ll be equipped to integrate their clinical experience into boardroom competencies. It will help them build the personal and professional strengths they’ll need to be effective organizational leaders, including financial literacy and business strategy and decision-making.

“The program provides a deliberate means to raise the visibility of nursing’s leadership potential and enhance individual nurses’ leadership abilities,” explained Terri Gaffney, MPA, RN, senior director, new product development for ANA.

And Gaffney hopes that such programs will ensure a steady pipeline of future nurse leaders.

“There are nurses in leadership roles across the U.S.,” she said. “However, we remain largely overlooked in the highest levels of organizational leadership.”

Susan Lacey, Ph.D., RN, the program director for AACN CSI Academy, believes there are great opportunities ahead for clinicians who are willing to take the step into leadership.

“Clearly the clinician--and most assuredly, the nurse--is the heartbeat of the hospital,” said Lacey, director of the nursing innovation center at Children's Mercy Hospitals and Clinics in Kansas City, Mo.


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