How to Create an Effective Dyad Model for Clinical and Administrative Leadership

Q&A with John Snyder, executive vice president and chief operating officer and Matthew Gibb, MD, executive vice president and system chief medical officer, Carle Foundation Hospital, Carle Physicians Group, and Health Alliance Medical Plans, Urbana, IL

HR: Since Carle has one of the “purest” and most successful dyad models in healthcare today, can you share a bit about how it’s organized?

MG: At every management level and in every department, we’ve established dyads—from John and me at the most senior level—to medical directors paired with administrative managers all the way down. Because the dyads are managed jointly on a real-time basis, each pair has access to all information. We also use team-based meetings, communications, and decision-making structures.

JS: While clinical decisions may be driven a little more by physician leaders and administrative decisions a little more by administrative leaders, the reality is that dyad pairs are in constant contact. I’m in Matt’s office 20 times a day!

HR: What kind of skills and training do you find are important for these physician leaders?

MG: We have definitely increased physician education, since most physicians typically don’t have management and business training. We’ve offered skill-building in core competencies like how to run a meeting, prioritize time, and deal with human resources issues so that physicians don’t leave the driving to others.

We’re also starting to see some significant traction in improving bi-directional communication since we implemented MyRounding with physician leaders on front-line physicians. And we have used a team- and project-based approach to educate on more strategic issues like what the market is doing, healthcare policy, and external pressures to the organization.

HR: How do you select the right physician leaders to serve in this type of role long-term?

MG: Because this is definitely a functional, accountable model over an extended time period, we’re looking for a commitment. Not every physician is well suited to this type of leadership. Our selection and interview processes have become much more oriented towards choosing individuals who will be accountable for getting real work done. It’s definitely a cultural shift in terms of how physicians are expected to integrate into operations. Communication and consistency is key.

HR: How do leaders bring complementary skill sets to the table in a dyad?

JS: Obviously, keeping the North Star on the patient and clinical focus is critical. Administrators don’t always appreciate the impact decisions will have on doctors in a “boots-on-the-ground” sort of way. Likewise, it’s critical that administrative leaders bring their physician counterparts up-to-speed on the business of medicine and good health for synergies in decision making.

The electronic medical record (EMR) is a great example. Implementation can be very disruptive to doctors, so a balanced perspective is important. This year, we finally implemented a formal optimization plan that considers the interface with the provider, physician, or nurse…to understand where we can get efficiencies and reduce the hassle factor for less time closing out visits. The EMR is oriented towards the provider interface.

MG: In the last couple of years, we’ve also worked hard to develop truly integrated service lines. It required a lot of work to break down silos and create a management architecture that works so that we have a product that allows us to grow. It’s been quite successful in terms of its ability to recruit new physicians and staff, add new technology, and expand our market share there. That’s tough to accomplish, and nearly impossible without a dyad.

HR: Any advice for organizations interested in exploring dyads themselves?

JS: You’ve got to be all in. You have to be willing to dedicate the time, money, and resources to truly involve physicians. For example, our medical director is 50 percent administrative time (as are all our assistant and associate medical directors), which is a huge commitment of organizational resources and their time. But how could he possibly do such a huge job without carving out significant time?

You’ve got to be willing to have a physician leadership structure that mirrors the administrative type of hierarchical structure and also be able to match and partner people. It’s just not effective if you have a traditional department head structure.

MG: You must also be very thoughtful about the types of people you select to do these jobs, especially on the physician side. Rather than choosing physician leaders because they are politically powerful or have constituencies that need to be recognized, it’s important to consider those who you may not be exposed to regularly. You need to tap those individuals on the shoulder, cultivate them actively, and include them in the succession plan process. Think proactively about where you are going to source physician leaders for your group.

And finally, don’t skimp on training! We’ve done a lot of accountability training and psychological assessments—like Meyers-Briggs and 360 evaluations—to understand how we can improve communication and interactions with each other. If you don’t invest in those things up front, you will pay the price later in conflicts that can be very time-consuming to sort through. Team building is important as you construct the model.

HR: You mentioned that medical directors are 50 percent administrative time at Carle. Can you justify that in terms of return on investment?

JS: I firmly believe that to be successful in healthcare going forward—to ensure good processes and decision making—you must have true physician integration as they drive so much of what goes on. At Carle, we’ve had outstanding financial performance since integration. We’ve experienced five percent growth annually the last five years and are also adding about 30 physicians a year because our model is very attractive to new physicians and those looking to relocate. Physician integration truly is the “secret sauce” of healthcare for becoming hugely successful.