Healthcare Issues & Trends

Advice & Insights for healthcare's Leaders & HR Professionals

10 Successfully Designed Physician Leadership Academies

Posted on July 25, 2016 by James A. Rice, Ph.D., FACHE

 The move to clinical integration needs more than smart care management protocols. You need to find, develop, support, review, and reward a new generation of physician leaders. Physician leadership development, however, is easier to talk about than to accomplish. Ten examples of effective “Physician Leadership Academies” are profiled for your leaders to emulate in out own local planning and program refinements.

To secure the needed number and quality of physician leaders, hospital boards are authorizing increased investment into the formation and enhanced operation of physician leadership academies.

The scope and nature of physician leadership academies have expanded substantially during the past five years to support physician leaders in their successful achievement of three classic performance imperatives:

  • Align physicians’ time and talents to deliver a superior patient-care experience in a coordinated continuum of care system;
  • Encourage physician engagement for the design of new medical care protocols that yield enhanced clinical quality outcomes and cost effectiveness; and
  • Earn service volume gains from better designed and managed clinical service lines, referral support systems, and physician co-ventures in new high-tech and high-investment diagnostic and surgical centers. 

Successful designs for physician development programs can be studied in these 10 health systems:

1. Baylor Scott & White Health – STEEEP® Global Institute

2. Carilion Clinic

3. Cleveland Clinic – Samson Global Leadership Academy

4. Dignity Health

5. Florida Hospital

6. Legacy Health

7. Beaumont Health

8. Sanford Health

9. Sutter Health

10. UnityPoint Health

Physician leadership associations can also help1Through associations, physicians can strengthen their ability to effectively lead both clinical and nonclinical healthcare colleagues and advance as leaders in the healthcare delivery system.

The primary organizations that serve these purposes are the American Association for Physician Leadership (AAPL); the American College of Healthcare Executives (ACHE), in part through its Physician Executives Forum; and the American Hospital Association's Physician Leadership Forum.


5 Actions Boards Should Consider to Lessen the Disruptiveness of CEO Turnover

Posted on July 25, 2016 by James A. Rice, Ph.D., FACHE

Hospital CEO turnover rates continue to disrupt organizational stability. Boards should consider five actions for Leadership Continuity. 

“Elevated turnover among hospital CEOs seems to be a feature of the current healthcare environment,” says Deborah J. Bowen, FACHE, CAE, ACHE's president and CEO. 


Hospital CEO turnover in 2014 decreased to 18 percent, and remains among one of the highest rates reported in the last 15 years, according to a recent report by the American College of Healthcare Executives. The turnover rate in 2012 was 17 percent, and in 2011 and 2010 it was 16 percent. The annual rate has fluctuated between 14 and 18 percent in the decade prior to 2013.

Excellent management continuity is essential for organizational success, yet too many boards and C-Suite leaders fail to follow a disciplined roadmap to plan, prepare, and promulgate an organized process to replace a CEO or other senior C-Suite Executives.

A strategic thinking board benefits from a focused, forward-looking plan to help assure a good outcome for the organization, whether the new leader comes from the current management team or is recruited from outside.

Here are five actions for boards and leaders to discuss in the boardroom:


Action 1: Study Factors that Contribute to Turnover

Action 2: Document the Risks of Unplanned Executive Departures

Action 3: Map Departure Scenarios for C-Suite

Action 4: Build Simulation of Leadership Transition Plan

Action 5: Adopt an Emergency Continuity Policy


Action 1: Study Factors that Contribute to Turnover


It has become clear in the ACHE that key factors driving the turnover rates are:

o   The continuing trend of consolidation among organizations,

o   The increasing demands on chief executives to lead in a complex and rapidly changing environment, and

o   Retirement of leaders from the baby boomer era.


Their findings serve as a reminder for healthcare organizations to ensure they have appropriate strategies in place—including robust succession planning—to successfully manage senior leadership changes.


Action 2: Document the Risks of Unplanned Executive Departures


The lack of a pre-planned leadership continuity strategy exposes the organization to some significant and disruptive risks:

1.     Confusion among community leaders about the strategic path for the organization

2.     Uncertainty and eroding morale among middle managers

3.     De-celebration among physicians to push for clinical integration initiatives

4.     Weakened negotiation influence with payors

5.     Unfocused compliance with billing and physician contracting oversight

6.     Loss of other senior executives in C-Suite

7.     Loss of momentum to earn market position against active competitors


Action 3: Map Departure Scenarios for C-Suite


Having a leadership transition process in place helps to relieve potential anxieties on the part of the Board, departing CEO and other senior executives, as well as physician leaders, staff, and the community at large. Invest a few hours with an experienced adviser to identify likely departure scenarios, and then map positive and negative implications of each. Common scenarios could be:

o   The CEO retires

o   The CEO becomes incapacitated by health or scandal issues

o   The CEO is recruited away to another organization

o   Multiple senior executives in the C-Suite announce planned moves to other systems

Seek input on the implications for such scenarios from such diverse stakeholders as board members, physicians, middle managers, payers, strategic alliance partners, and others.


Action 4: Build a Simulation of a Leadership Transition Plan


Boards can review the implications from alternative departure scenarios and develop a simulated process of how they would/should respond, before, during and after each of the potential departure scenarios. This simulation work, in advance of its need, helps minimize the risks and maximize the benefits of leadership team changes.


The obligation to have on your shelf or in your files a well-articulated continuity plan is clear:

o   You can know how your leadership team will assure a continuing sequence of qualified people to move up and take over when the current generation of managers and key people retire or move on.

o   Your governance leaders will more likely be able to continue to exercise good stewardship and to know that management excellence is not dependent on the good health or good behavior of any given individual.

o   You will be more likely to define how the organization can properly develop and nurture its human capital for organizational success


An effective Leadership Continuity Planning process should have these 10 steps:


1.     Initial fact-finding about the age, career plans and timing of possible change for each C-Suite member.

2.     Design board involvement in all scenarios and contingency situations

3.     Map the ideal competencies needed not just within the CEO position, but in all senior executive and physician leadership posts

4.     Interview & assess team members about needed personal and professional development requirements for the next 3-5 years

5.     Develop leadership team profiles and position descriptions that anticipate the needs of your strategic plan, competitor threats, and strategic alliance opportunities

6.     Update your annual leadership performance assessment and management processes

7.     Discuss alternate implications of changes in senior management on middle management, medical staff continuity, and the performance of the physician enterprises

8.     Model alternative executive compensation models

9.     Explore ways to strengthen your executive and board member onboarding processes

10.  Develop clear communication plans for each unique internal and external stakeholder that can be update easily when needed for various continuity situations and strategies


Action 5: Adopt an Emergency Continuity Policy


While designing a long range continuity process within certain scenarios is a healthy discipline for boards, it is also imperative to update your Emergency Continuity Policies and Process.

According to The Governance Institute, just 24 percent of hospitals and health systems keep their succession plans current—and some consultants say that’s a rosy figure. More than half of healthcare organizations admit they have no succession plan—20 percent higher than other industries—even though two out of five new corporate CEOs fail in the first 18 months. And just 15 percent of freestanding hospitals know who their next CEO will be, compared with 60 percent of businesses. 

A plan for the unplanned departure of a CEO covers, at a minimum, four actions:[1]


1. Who will step in to run the place right now? The board has three choices: an executive already on staff; an outsider who can serve as an interim CEO until the board can find a permanent leader, a search that usually lasts at least four months; or a management firm that can keep the hospital running.

2. How much authority will the interim CEO have? A plan for an unexpected CEO vacancy should outline performance expectations for the interim CEO and any limitations on the stand-in’s authority.

3. How will we choose the permanent CEO? Once the hospital or health system is in the capable hands of a trusted interim administrator, the board must quickly turn its attention to the months-long job of finding a new CEO. A good emergency plan outlines such first steps as: It identifies the executive search firm chosen by the board to handle the task, and it might name internal candidates whom the board can consider as possible candidates for the vacated position.

4. How will stakeholders be informed to minimize distractions and disruptions? Board leaders should have a crisis communication plan on the shelf that can be refined based on the current situation and context.[2]


Turbulent Waters. Uncharted Pathways. An Untested Compass.

Posted on July 25, 2016 by James A. Rice, Ph.D., FACHE


Just as these factors can frustrate a successful expedition in a strange land, so will they cause health system boards to uncover difficult risks in their transition from volume to value situations. Our work with boards across the US finds a baker’s dozen of 13 key risks facing the work of hospital and health system boards.

The Conference Board understands that any business is exposed to risks that can threaten its ability to execute its strategy. For this reason, strategy and risk oversight are inherently connected. Today, more than ever, the board of directors is expected to thoroughly assess key business risks and ensure that the enterprise is equipped to mitigate them.1

At Gallagher Integrated, we have identified these 13 risks:2

1.     Physician Contracting

2.     Relationships among board, medical staff and administrative leaders

3.     Accreditation

4.     Philanthropy and donor relations

5.     Population health management

6.     Tax-exemption

7.     Stakeholder engagement

8.     Executive oversight

9.     Quality of care oversight

10.   Payer contracting

11.   Capital financing

12.   Talent erosion

13.   Strategic Alliances


Practical dimension of these risks and how to remove or reduce them can be found in this downloadable resource:

How prepared is your board to manage and mitigate these risks? Which risks are the most important for your context in the coming year?

Contact our advisers to explore how to develop a customized Risk Mitigation Plan for your organization by emailing


Effective Boards Embrace "Agenda Innovation"

Posted on July 5, 2016 by James A. Rice, Ph.D., FACHE

Wise Boards break through the complacency of boring reports on finance and patient care volumes; but it is not easy!  Perhaps these three actions can help enliven and enrich the quality of your board meeting conversations:

1.     Break Through 1: Agenda Flip: move the conversation part of the agenda to the first 20 minutes, rather than at the end after the review of standard reports from CEO, CFO, Quality and staffing issues.

2.     Break Through 2: A Patient’s Story: once a quarter remind the board (in a 5 minute recap from a patient at the meeting) that the purpose of all of their good work must map back to improving the lives and health of real people. How does your health programming really impact good or bad a real patient/family?

3.     Break Through 3: Mission Lift: Once a year, elevate the meeting’s focus away from patient care to population health, especially a 20 minute conversation about the implications of the new “UN Sustainable Development Goals” in your community/region. See:

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A Season of Sound Bites

Posted on March 1, 2016 by James A. Rice, Ph.D., FACHE


The run up to elections, and the run up to population health management.

Both journeys subject us to deceptive and frustrating sound bites that suggest there are easy answers to complex challenges.

Both journeys make Boards naively hunger for short, easy answers to tough questions. But board work today is far from easy.

How are board members supposed to make sense out of our rapidly changing political, social, clinical, and financial landscapes?

Can we find any easy answers about how to govern in an age of more transparent decision making, more complicated, integrated clinical care management systems, and more difficult performance score cards?

I don’t think we will unless we recruit and support civic leaders who are passionate about “Governance Innovation.”

We need to be hungrier to continuously enhance and improve the processes, people, practices and information for governing; not only governing our own organization, but governing across the many other health related organizations in our region that we do not control or own.

For high performing governing bodies we need board leaders that continuously seek innovative governance that embraces creative, fresh, and cost-effective new ways to master five types of governance:

  1. Collaborative Governance
  2. Competency Based Governance
  3. Generative Governance
  4. Intentional Governance
  5. Transformational Governance

To encourage health sector executives and board members to examine their local board practices through the new eye-glasses of governance in different contexts, we are also publishing a series of three papers entitled “Dare to Compare,” which explores Great Governance in Canada, Great Governance in US Credit Unions, and Great Governance in the National Health Service of England.

Watch also for our studies this Spring into the challenges and best practices for governing bodies of Local Health Departments, Federally Qualified Health Centers, Long Term Care Facilities, Medical Groups, Academic Medical Centers, Accountable Care Organizations, Critical Access Hospitals, and Hospital Related Foundations.

No easy answers, but intriguing and provocative questions that stretch us out of our comfort zones into the challenging and unchartered waters of “continuous governance improvement for population health management and accountable care.”


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