By Marta Betancourt, MSc, CHCP, Educational Planning and Outcomes, Cedars-Sinai Medical Center; Megan Swartz, CHCP, Associate Director, Cedars-Sinai; Rebecca Kolb, MA, Cincinnati Children’s Hospital Medical Center
Healthcare reform presents many opportunities for stakeholders to devise workable solutions that address potential weaknesses in the healthcare system. To properly and effectively take advantage of these opportunities, physicians need to be fully aware of the tools, skills and resources needed to successfully lead, develop and implement quality or performance improvement initiatives within their organization or practice settings. In response to these opportunities, Cedars-Sinai and Cincinnati Children’s both developed continuing medical educational programs designed to leverage leadership and quality improvement (QI) from different vantage points and achieved similar improved outcomes.
Cedars-Sinai Quality Improvement Program
Recognizing that physician leadership requires leveraging the skills and experience of the entire team and organizational structure to bridge internal priorities and interests to achieve common goals, Cedars-Sinai (C-S) created an annual Leadership Development Retreat with a supporting Regularly Scheduled Series (RSS) to help emerging physician leaders enhance their skills and utilize resources within the academic medical center to effect change1. As an integral part of this program, participants managed a Performance Improvement (PI) project, specific to Cedars-Sinai, which allowed hands-on use of the tools and concepts learned in the program.
For the 2016/2017 academic year, three Leadership Development Program alumni served as course co-directors for the activity. The content for the activities were developed by the course directors in collaboration with the Office of CME and the Medical Staff Office. Recruitment for the program took place in the summer of 2016 by nomination and invitation via Cedars-Sinai’s Medical Executive Committee. Criteria for nomination included clinical expertise, interest level, attitude and alignment with strategic goals.
In September 2016, the monthly RSS sessions provided content designed to provide a fundamental framework for understanding performance improvement principles and tools, human-centered design concepts, self-awareness concepts, emotional intelligence and conflict resolution strategies, and relevant medical and legal issues. In November 2016, nominated physicians participated in a multi-day weekend retreat. The retreat curriculum consisted of a series of sessions focusing on Cedars-Sinai Medical Staff governance, organizational structure and operations, population health, information technology/health innovation, committee participation, team building and leadership skills. Participants presented their QI/PI project in abstract format, and received feedback from the C-suite and other senior executives and leadership. Post presentation collaborative opportunities with other disciplines were discovered. The combined course and RSS provided participants with 30 AMA PRA Category 1 Credit(s)™ credit hours over a 12-month period.
Following participation at the retreat, the emerging physician leaders actively worked on their declared QI/PI project, incorporating feedback or recommendations received. RSS sessions were utilized to share project progress and obtain input from physician project champions and peers about execution, data collection/analysis, collaboration and other aspects of the initiative. In early summer of 2017, the emerging physician leaders presented the outcomes of their QI/PI projects. (See Image 1.)
Evaluation methods utilized a standard online survey that asked learners to rate achievement of learning objectives and select from a menu of commitment-to-change statements. Learners had the option of writing in any other commitment-to-change statements and were encouraged to identify any outcome execution barriers. Seventy-one percent reported overall confidence in the application of basic PI principles, and another 70% reported the program increased interprofessional communication and conflict management skills.
Post-program outcomes measurement identified 18 QI/PI projects developed and launched by program participants. Eighty-six percent of participants completed their QI/PI project with established guidelines or protocols. This educational intervention achieved substantial positive change within various Cedars-Sinai departments based on the QI/PI projects identified by the Leadership Development program participants. Examples of 2017 completed QI/PI projects that have been integrated into the Cedars-Sinai enterprise include improvements in transgender care (Internal Medicine); antibiotic stewardship in the neonatal ICU (Pediatrics); advance care planning in patients with heart failure (Supportive Care); reducing readmission and length of stay for high-utilizing chronic pain patients (Anesthesiology); introduction of a robotic curriculum to residency program (OB/Gyn); and physician efficiency training [electronic health record] (EIS/Informatics).
Cincinnati Children’s Leadership Program
In 2010, Cincinnati Children’s executive suite recognized physician career advancement had previously based on academic or clinical achievements rather than on distinctive competencies needed to lead in a complex healthcare organization2. They identified the need to address the many challenges faced by faculty to grow within the organization and develop the necessary skills to become impactful leaders3.
The Core Leadership Program (CLP) planning team consisted of members from the Office of Academic Affairs and Career Development, the Department of Learning and Development and the Department of Continuing Medical Education. This team worked together to design a program that would develop outstanding faculty leaders, foster peer mentorship and create a culture of service4.
Learners were nominated by their division director to participate in the program because they had supervisory responsibilities and demonstrated leadership potential. In addition to submitting nominations, sponsoring divisions paid $1,200 per learner registration fee. In an effort to create an educational environment conducive to achieve learner objectives, planners used a mixed-model educational format that included pre-test, post-test, lectures, small group discussions, panels, case-based discussions, interactive workshops and self-assessment for a maximum of 25 learners per annual cohort.
CLP’s educational content gave learners the resources to demonstrate two global learning objectives: Develop self-awareness and confidence in leadership capabilities and expand core leadership skills, such as strategic planning, financial management, diversity appreciation and leading change. The program was structured to provide 68.5 live AMA PRA Category 1 Credit(s)™ over a 10-month timeline. Faculty led participants through Bill George’s book, Discover your True North, and the companion field book5. This process led the learners to conduct a series of personal reflection exercises that would guide the development of their own leadership profile (see Image 2). Individual leadership profiles were presented to peers on the last course date.
A mixed-methods program evaluation was used to assess performance, competence, declarative learning, satisfaction and participation. Both learners and their sponsoring division directors completed pre- and post-program surveys to assess impact. Outcome data indicated improvements in leadership confidence, leadership self-awareness, and strategic, operation and leadership skills. CLP graduates reported they improved (a) ability to articulate values and principles, (b) emotional intelligence, (c) social awareness, (d) relational management, (e) interdisciplinary collaboration, (f) peer support networks and (g) team member appreciation. CLP provides a replicable medical education program design that can be used by other healthcare organizations to leverage leadership to achieve change.
Leadership development programs benefit healthcare organizations and are a catalyst for change. Medical education programs with a QI/PI component should be designed to align within an organization’s unique goals, strategic objectives and financial commitment. By investing in leadership development, you create champions who are able to execute strategic and operational goals. They become self-aware and confident leaders capable to implement strategic planning, financial management, appreciate diversity and lead change.
- Leadership Development in Medicine | NEJM. New England Journal of Medicine. https://www.nejm.org/doi/full/10.1056/NEJMp1801610.
- Stoller JK. Developing Physician-Leaders: A Call to Action. Journal of General Internal Medicine. 2009;24(7):876-878. doi:10.1007/s11606-009-1007-8.
- Emans SJ, Goldberg CT, Milstein ME, Dobriner J. Creating a Faculty Development Office in an Academic Pediatric Hospital: Challenges and Successes. Pediatrics. 2008;121(2):390-401. doi:10.1542/peds.2007-1176.
- Hackworth J, Steel S, Cooksey E, Depalma M, Kahn JA. Faculty Members Self-Awareness, Leadership Confidence, and Leadership Skills Improve after an Evidence-Based Leadership Training Program. The Journal of Pediatrics. 2018;199. doi:10.1016/j.jpeds.2018.05.007.
- Bill George. Bill George. https://www.billgeorge.org/.