Research Guides Programs to Build Stronger Leaders

Since the COVID-19 pandemic, the steep challenges of running a successful healthcare organization have only become more acute. Increased pressures in finance, supply chain and employee hiring and retention affect every aspect of running a hospital.

All of this makes strong leadership more important than ever. But do leadership training approaches traditionally used in business always work well when applied to experts in healthcare?

That’s a key question for Gina Thoebes, an organizational development consultant at the Jack, Joseph and Morton Mandel Global Leadership and Learning Institute (GLLI) at Cleveland Clinic. Thoebes specializes in organizational research and measuring the impact of leadership and learning programs for GLLI, which presents programs to help clinical and non-clinical professionals hone their leadership skills.

Thoebes recently published research examining these issues. “Examining the Differences Between Physician and Administrative Leaders at Cleveland Clinic and the Implications for Leadership Development Programming” was published inBJM Leader. “Physicians as Leaders: A Systematic Review Through the Lens of Expert Leadership” was published in July in Leadership Health Services.

Consult QD interviewed Thoebes about how Cleveland Clinic is using research to ensure that leadership training is as effective as it can be, and to better understand the ways that physicians may differ in their approach to leadership. Here’s an edited excerpt of the interview.

Rigor in the research

Please explain the goal behind your research.

Sure. It’s twofold. First, we want to measure and evaluate our leadership development work, as well as some of the other organizational development work, that we do for Cleveland Clinic. The clinical world is very evidence-based. We want to match that rigor in what GLLI provides so we can continuously improve and provide the highest impact possible.

Second, we want to advance the literature in organizational development and healthcare. Academic journals in leadership are really for academics, not for those with boots on the ground leading hospitals.
In partnership with Dr. Timothy Crone, Vice President of Cleveland Clinic Mercy Hospital, and Tracy Porter and Jessica Peck, faculty at Cleveland State University, we designed a study to learn more about the hospital integration process, with an emphasis on the caregiver experience. We interviewed caregivers to understand their experience of change. We want to help identify their current, ongoing needs and understand how we as an organization can better implement integration efforts going forward. We already utilized our findings internally during a recent systems integration effort. We plan to publish our findings so that leaders in other hospital systems can learn from it and the healthcare field can grow from what we’re doing.

What prompts your interest in the differences between administrators and physicians in this arena?

Sometimes leadership development programs use off-the-shelf tools with the hope that they work for everyone. We know that that is not exactly how adult learning works. People have different motivations; they have different inclinations. Some people really enjoy experiential learning, some people do not.

We want to look at our programs and understand whether participants have personality differences in their motivations around being a leader. How confident are they in their own ability to lead? This is important because you might want to sculpt programs for people based on those differences.

We have looked at some programs for administrative leaders and some for clinical leaders and compared them to see if there were differences in those populations that might merit changes. Maybe we would want to keep the programs separate. Or maybe we don’t want to, because we’re also exploring the benefits of getting these groups in the same classes to see how they can learn from each other.

Different disciplines, different styles

And what did you find out?

The key takeaways were that administrative and clinical leaders have differences that might indicate they would benefit from tailored programming. For example, rigorous medical education does not always make room to build in leadership development theory or time to practice certain leadership skills. So clinicians’ leadership self-efficacy in several domains was lower even though they had, on average, more years of tenure in leadership than our administrative leaders.

That tells me that it may be worthwhile to invest in fundamentals that we might have assumed physician leaders felt comfortable with because they’ve been leading for a while.

There also were some qualities where they were ahead of the administrators, such as leading a section-sized team. Our research shows that they felt comfortable and confident, in that they can own their area of expertise. So that might suggest we invest more in sharing skills that will help physicians more comfortably step into that grander scale and direct a larger team.

What has surprised you from the results of your research?
One thing that surprised me a little bit has to do with who we are as Cleveland Clinic.

We looked at motivation to lead, which is a trait-based evaluation of what motivates you to be a leader. It looks at why someone is interested in leading. There are a couple different components to that. One of those is affective identity: How strongly do you feel like a leader yourself? What is your sense of leadership identity? And we found that our physician leaders in this study were higher in this trait-based motivation to lead.

This is contrary to what we have seen in other literature. Physician leaders sometimes struggle with the duality of their role. They see themselves as a physician first, not a leader first.

But at Cleveland Clinic, we really position all physicians as leaders. And so we think that might be a cultural component that is showing up in our study.

We also found something else a little bit surprising. Our administrative leaders scored a little bit higher in openness. Openness is very highly correlated with cognitive ability. Physicians are incredibly high in cognitive ability, so I wouldn’t have expected them to have lower scores than the administrative leaders in openness. There wasn’t much difference, but it was still a significant difference, about half a point.

Is there an assumption that because physicians are such high performing individuals, that they are natural leaders, too?

Yes. There are so many traits about physicians that make them completely qualified to lead. And there are some things that they may not be familiar with that can help them become more effective leaders.

One of the biggest questions is how to switch contexts. Leading in the operating room is more directional; it’s hierarchy-based. If you are leading a bigger organization, now it’s more about delegation, collaboration, creating psychological safety, and creating a clear vision. Those are not the same skills. So you need to be able to be flexible and agile and change your leadership style based on the context that you’re in.

What’s the next practical step to be taken with what you have learned?

We are using the research to inform how GLLI invests in physician leadership, and discussing how we help support foundational skills.

Lead Every Day is a new program for physicians who have been with Cleveland Clinic for three years. It allows them to become more comfortable building their communication style and working on their emotional intelligence.

I am also working on designing further research on how to support physicians early in their career in developing leadership identity. In partnership with Dr. Minh-Tri Nguyen and Dr. James Stoller, my colleague Montana Drawbaugh and I are designing a leadership coaching intervention to supportChief Residents because this is actually one of the first places that physicians get to step into a leadership role.

We want to support them from day one to build the best and most effective physician leadership base that we can.