physician executive council hr advancement center

Physician Executive Council

HR Advancement Center

How health care leaders can

address the leadership gender gap

Veena Lanka, MD, MPH

Research Partner

© 2019 Advisory Board • All rights reserved • advisory.com

2

Women physician executives—few reach the top

Source: “Fixing the Gender Imbalance in Health Care Leadership”, Harvard

Business Review, https://hbr.org/2018/10/fixing-the-gender-imbalance-in-

health-care-leadership; Physician Executive Council interviews and analysis.

Percentage of women physicians by role

3% of CMOs are women

6% of department chairs are women

9% of division chiefs are women

http://www.advisory.com/

https://hbr.org/2018/10/fixing-the-gender-imbalance-in-health-care-leadership


3

Women physicians achieve better outcomes

Source: Kacik Alex, “Few Women Reach Health Care Leadership Roles”, Modern Healthcare,

https://www.modernhealthcare.com/operations/few-women-reach-healthcare-leadership-roles;

Tsugawa Y et. al, Comparison of Hospital Mortality and Readmissions Rates for Medicare

Patients Treated by Male vs Female Physicians”, JAMA Intern Med, 77, no. 2 (2017): 206-213;

Physician Executive Council interviews and analysis.

1) Based on data analysis of hospitalized Medicare beneficiaries.

Patient results were compared with those cared for by male

physicians within the same hospital.

2) In a survey of 200 hospital and health system executives.

3) Of hospital and health system executives.

Improved clinical outcomes

Women physicians have

5% lower readmission risk

than male physicians1.

Women physicians

have 4% lower mortality

risk than male physicians.

64%Believe3 turnover would

decrease at their

organization with

greater gender parity2.

59%

Believe3 their

organization would be

more profitable with

greater gender parity.

Improved business outcomes


https://www.modernhealthcare.com/operations/few-women-reach-healthcare-leadership-roles


4

Women physicians rarely considered for leadership

1) Of nearly 200 hospitals and health systems surveyed.

2) In a poll of 3,200 male and female executives.

Of executives said women have

been overlooked due to gender at

their organization2

55%

Of executives said women do not

self-promote as strongly as men

54%

Gender’s influence on

promotion trajectories

Source: Kacik Alex, “Few Women Reach Health Care Leadership Roles”, Modern

Healthcare, https://www.modernhealthcare.com/operations/few-women-reach-healthcare-

leadership-roles; Green Jeff, “Managers Pick Mini-Me’s of Same Race, Gender”, Bloomberg,

https://www.bloomberg.com/news/articles/2019-01-08/managers-pick-mini-me-proteges-of-

same-gender-race-in-new-study; Physician Executive Council interviews and analysis.

Percent of executives1 who say

they invest more in junior people

of the same race and gender

71%


https://www.modernhealthcare.com/operations/few-women-reach-healthcare-leadership-roles

https://www.bloomberg.com/news/articles/2019-01-08/managers-pick-mini-me-proteges-of-same-gender-race-in-new-study


5

Most women leave medicine too early in their tenure

Source: Paturel, A, et al., “Why Women Leave Medicine”, AAMC,

https://www.aamc.org/news-insights/why-women-leave-medicine;


“When you invest more

than a decade of your life

to learn a skill and you’re

willing to walk away from

that early in your career,

that’s more than a red flag.

It’s a burning fire.”

Sasha Shillcutt, MD,

University of Nebraska

Medical Center

Gender

harassment

Percentage of women exiting medicine or

going part-time within six years of residency

40%

Salary

inequity

Gender

bias

Work-family

conflict


https://www.aamc.org/news-insights/why-women-leave-medicine


6

Catchall term ‘work-life conflict’ masks the real drivers

Source: Physician Executive Council interviews and analysis.

Decreasing career potential coupled with increasing stressors create natural exit points

Resident Early Career Motherhood Mid-Career Broken Rung Tenured

• Shorter

rec letters

• Fewer Grants

Medical

Student

• Salary Inequity

• Fewer

conference

invites, research

citations, funding

• Disparaging

Treatment

• Sexual

harassment

• Primary caregivership

• 8.5hrs more

housework/week

• Breastfeeding/

Pumping

discrimination

• Motherhood Penalty

• Inflexible hours,

location

• 71% report burnout

• Sexual harassment

• Fewer Mentors

• Salary Gap

Widens

• Fewer leadership

opportunities

• Greater burnout

• Gender

Discrimination

• Tapped for

‘supportive

leadership’ roles

• Not included in

CEO Pipeline

• Fewer P&L

responsibilities

• Fewer industry

event invitations

• Fewer media

features

• Leadership

Bias

• Settle into

Non-CXO

roles

• Round two

primary

caregivership



7

How health system leaders can flip the script


• Give women physicians

exposure to early career

leadership development

• Establish unbiased

succession management

• Identify and address culture

and incivility issues among

medical staff

• Understand women physicians’

individual career goals—and

uncover any barriers to

achieving them

Retain them past

early career hurdles

Create a path to

leadership pipeline

Early career women physicians1 Tenured women physicians2



8

Begin with identifying and measuring drivers of turnover

1) Staff respond with “yes” or “no” to the question: Are you likely to

retire, move out of your current region, or go back to school full

time in the next three years?

Source: Advisory Board Survey Solutions’ National Employee Engagement Database; Branham L, The Seven

Hidden Reasons Employees Leave, New York: Amacom, 2005, 3; “Global Generations, A Global Study on

Work-Life Challenges Across Generations,” EY (2015): 12-13; Talent Development research and analysis;


Interpersonal relationships 1Poor team dynamics may create

distrust and a feeling of disconnection

Career growth and development 2Lack of real or perceived opportunities for growth

or promotion undermines attachment to role

Job content 3A poor fit between responsibilities and skills

leads to frustration and dissatisfaction

Workload and stress 4Demands and insufficient support lead

to burnout and departure

Where we often have control

15%Of staff say they will likely retire,

move, or go back to school full

time in the next three years1

12%Of staff leave for financial reasons

Limited number plan to

leave for personal reasons

Compensation rarely

the deciding factor

Where we have less control



9

Start with feedback from women physicians

Source: HR Advancement Center interviews and analysis;


Focus group road map:

Introduction

(10 minutes)1

Get feedback on root causes

(25 Minutes)2

Discuss solutions

(25 minutes)3

Closing and next steps

(2 minutes)4

Root cause flipchart:

• Pre-write the problem and the goal.

• Pre-write one of your root causes at the

top of each page. Throughout the

discussion, document comments from the

group below each root cause. If the group

surfaces a strong root cause that you

hadn’t previously considered, document it

on a separate page.

Solutions flipchart:

• Pre-write ground rules for the session.

• Create a “parking lot” for ideas that

are out of scope for your discussion,

have this page visible during the root

cause discussion.

• Use the subsequent pages

to document solutions.



10

Deploy stay interviews to uncover career goals

and unique barriers

Source: Talent Development research and analysis;

Physician Executive Center interviews and analysis.

Learn what they

value the most

• Are there any

responsibilities they don’t

want to let go of?

• What skills do they

consider most critical to

their development over the

next year?

• Is there something you can

do to make this job feel

more fulfilling to them?

1

Understand the different

frustrations they

are facing

• What frustrations do they

have that they would

not put up with in the

long term?

• What’s one thing that

might make them not

want to work here?

• How can you better meet

their needs or fix existing

problems with their

current job?

2

Surface tension between

key life events and their

future goals

• Where do they see their

life going in the next

three years?

• What challenges might

that create for them in

their current role?

• How can you

best support their

progress toward their

future goals?

3

Three key aspects of the stay interview



11

After stay interviews, address top concerns

If they say: You might:


Physician Executive Council interviews and analysis..

“I’m passionate about

improving patient experience

but not sure how the business

side works.”

Connect them to a mentor or shadowing

opportunity with an administrative leader

or involve them in an ongoing effort.

“As a single parent and/or the

primary caregiver to an aging

relative I need to be home on

weekends and nights.”

Explore part-time or flexible work options for

work schedules—and/or help find a new role

in the organization that fits their schedule

“I’m concerned I’ll never get

the opportunities I need to

prove myself as a leader.”

Solicit them to lead new performance

improvement initiatives or give them

ownership over part of the rollout

for a new technology or process

“My infant has complex

medical needs and my eight

week maternity leave is not

enough to return to work.”

Understand their needs and help explore

leave and disability benefits that might

apply. Consider starting a volunteer time

bank program for employees to fund each

other’s leave.



12

A supportive culture benefits business too

Source: Medical Group Strategy Council Interviews & analysis;


Examples:

• Patients with high risk of

readmissions and utilization

• Patients with multiple chronic

co-morbidities

Dual purpose of primary care segmentation

Provide the best place for

physicians to practice medicine

Provide the best place for

patients to receive care

Immediate care

Traditional primary care

Virtual and digital care

Complex care

Examples:

• Women’s health

• Executive health

• Concierge medicine

Examples:

• Retail segments

• Embedded within

medical group practices

Examples:

• Video and e-visits

• AI platforms

NorthShore allows physicians to self select into primary care specialties



13

Tips for facilitating a stay interview

Block your calendar for 15

minutes after each stay interview

to identify one to two action steps;

share clear next steps with the physician

Check-in again with the physician

three weeks from the interview to

review your action steps—and tweak

if necessary

Practice active listening

during the check-in

Follow up in one month to confirm your

actions steps were put into practice and

are making a difference



Schedule time with your own leader,

peers in your network, or HR to

brainstorm ways to make the role more

appealing and clear away obstacles

Tee up the conversation in

advance and send the questions

you’ll ask ahead of the meeting

Schedule another stay interview

conversation in six months to make

sure you stay up to date on what’s

important to them

Don’t try to problem-solve in the

moment; instead, use the time to

ask questions and learn about the

physician’s priorities, frustrations,

and hopes for the future

Before and during the interview: After the interview:



14

Examining your own culture: Difficult yet necessary

Source: Advisory Board Survey Solution Database, 2017;

HR Advancement Center interviews and analysis; Physician

Executive Council interviews and analysis.

1) Based on an employee’s agreement with the statement “I am likely to

be working for this organization three years from now.”

2) Tend to Disagree, Disagree, or Strongly Disagree.

Percentage of first-year staff who strongly agree

with the statement: “I am likely to be working for this

organization three years from now.”1

18% 18%

46%

First-year staff who

disagree they have

good personal

relationships with

coworkers

First-year staff who

disagree they receive

the necessary support

from employees to

succeed in their work

2 2

First-year

staff overall

Benefitting from an

outside perspective

“It can be the canary in the mine—

people working in the environment

that are not aware of the negative

culture. Sometimes it takes someone

from the outside to see there is

a problem.”

Debbie Wilson, VP/ Chief Nursing Officer

Saint Luke’s Hospital of Kansas City



15

Survey clinicians to identify unsupportive environments

Source: Saint Luke’s Hospital of Kansas City, Kansas City, MO; Nursing Executive

Center interviews and analysis; Physician Executive Council interviews and analysis.

1) The Heavenly Seven is copyrighted by Dr. Cole Edmonson, DNP, RN, FACHE, NEA-

BC, FAAN and Joyce Lee, MSN, RN at Texas Health Presbyterian Hospital Dallas.

Based on your last shift, rate your agreement

with the following statements:

1. I felt welcome on the unit

2. Someone offered help when I needed it

3. If floated again, I would enjoy returning to

this unit

4. I had the resources I needed to complete

my assignment

5. I witnessed someone expressing

appreciation to another for good work

6. Staff showed concern for my well-being

7. I received appreciation for my work

Saint Luke’s Hospital of Kansas City’s

“Heavenly Seven” Survey¹

Incivility Survey Sample interventions on units

with unsafe learning environments

Add additional

FTEs

Conduct focus

groups with staff

Sponsor team-

building retreat

Coach

ineffective leaders



16

Retaining early career women physicians

Discussion Questions for Leaders and Changemakers


• Do you know the top reasons why women physicians at your organization are

turning over or going part-time?

• Do you have conversations in place for routinely uncovering these reasons?

• How does your organization currently identify sources of incivility and

toxic culture?

• When sources of incivility or toxic culture are identified, how does your

organization typically respond? Are there ways to hold people accountable?

• If you were a female physician experiencing harassment, bias, work-family

conflict, etc., would you know who or where to go for support?



17










medical staff




achieving them

Retain them past


Create a path to

leadership pipeline




18

Actively connect women to leadership opportunities

Source: “Women Leaders of the Future”, Korn Ferry,

https://www.kornferry.com/perspective-women-leaders-of-the-future;


Three barriers to leadership development

Few opportunities to

hone leadership skills

You can have the most capable women…but if they don’t have the right experience they will always

be on the list for CEO but never get the job.”

Jane Stevenson, Vice Chair, Korn Ferry

Limited exposure to

executive leaders

Physician Leadership

Experience Forums

Lack of relationships

with current leaders

Strategic Leadership

Coaching Partnerships

Physician

Sounding Boards


https://www.kornferry.com/perspective-women-leaders-of-the-future


19

Honing leadership skills with hands-on experience

LVHN targets one-on-one coaching to individual skill gaps

Strategic Leadership Coaching Partnerships

Source: Lehigh Valley Health Network, Allentown, PA;


1) Specific Measurable Action-Oriented Realistic Timely.

Three key components of physician leader mentorship process

• Physicians identify 1-3

SMART1 learning goals

• Goals based on

self development,

organizational learning

• Physicians create action

plan for recording

criteria for success,

measurements,

goal milestones

• Physician, mentor meet

individually each month

• Mentor reviews goal

progress, offers

recommendations

Action plan

creation

Monthly

check-Ins

Learning goal

definition

Case in Brief: Lehigh Valley Health Network

• 988-bed, two-hospital system based in Allentown, Pennsylvania; employs 500

physicians

• High potential physician leaders eligible to participate in the Institute for Physician

Leadership, an internal leadership development and mentoring program; Institute

led by CMO and directed by internal OD consultant

• 40 physician fellows nominated for Institute by senior leadership every three years



20

Fellows select own coaches for compatibility

Seeking matches with common interests, expertise

Source: Lehigh Valley Health Network,

Allentown, PA; Physician Executive Council

interviews and analysis.

LVHN physician leader mentorship pairing process

Official

mentoring

partnership

lasts two

years

Participants create

mentorship

agreement

outlining terms,

committing to

productive

relationship

Fellows review

questionnaires,

identify top five

potential mentors

based on

interests,

learning goals

Mentors

complete

questionnaire

describing

leadership

experience,

strengths

CMO and OD

consultant match

physicians with

mentors based

on selections



21

Providing practical context rather than theoretical

Cleveland Clinic forums illustrate real-world application of skills

Source: Cleveland Clinic, Cleveland, OH; Physician

Executive Council interviews and analysis.

Participants

14 new and emerging

physician leaders,

scientists selected

based on department

director or

institute nomination

Content

Presenting leader

explains current role

in organization,

leadership journey,

day-to-day

responsibilities

Timeline

Group convenes one

full Friday each month

for six months; meets

with two or three

existing hospital

leaders each session

Lessons learned

At program conclusion,

each participant

creates leader

development plan and

has opportunity for

career coaching

Physician Leadership Experience Forums

Cleveland Clinic

• 3,119-bed, physician-led health system based in Cleveland, Ohio; employs 2,700 full-time physician

staff, 1,100 trainees

• Implemented Leadership Rotation Program to expose new and emerging physician leaders to

existing hospital leadership and leadership challenges, foster collaboration

• Each cohort meets with 20 physician and non-physician leaders across 6-month program

CASE EXAMPLE



23

Expanding your lens past the usual suspects

Source: Kettering Health Network, Kettering, OH;


Kettering’s Physician Sounding Board

Meet with the CMO to discuss

specific initiatives relevant to

their specialty

Average time commitment

5-30 minutes, no more

than once a month

Informal group of 25-30

influential physicians who

occasionally provide input

to the CMO

The Physician Sounding Board should

represent the diversity of the medical

staff and include physicians across

specialties and sites of care

!

Physician Sounding Boards



24

Finding the non-usual suspects

Source: Kettering Health Network, Kettering, OH;


Key questions to identify candidates

for physician sounding boards

• Who recently turned down a formal

leadership role that was offered to them?

• Whose opinions do physicians pay

attention to during meetings?

• Who is a consistent performer, but doesn’t

often have an opportunity to contribute?

• Who handles matters so well that they’re

rarely on your radar?

• Who is different from you, but

complements the team well?

• Who offers constructive process

improvement ideas?

Dr. David Doucette, Chief Medical Officer,

Kettering Physician Network

“I noticed in meetings that there were

some physicians who seemed to have a

lot of influence with their peers but who,

for one reason or another—maybe they

felt disenfranchised, didn’t have

enough time, or didn’t seem as

aligned—weren’t formal leaders.”



26

Common bias keeping women physicians off the list

Source: Grossman R, “The Care and Feeding of High-Potentials,” Society for Human Resource

Management, August 1, 2011; “Corporate Performance at Risk as Today’s Rising Talent Prepares to Jump

Ship,” Corporate Executive Board, June 1, 2010; HR Advancement Center interviews and analysis;


Leader biases when selecting high-potential talent

Common

biases:

Potential

consequences:

“Mini-Me”

Younger version of current

leaders; similar qualities

and experiences

Staff distrust in

selection process

“Old Faithful”

Reinforcement

of status quo

Long-time employee; loyal

to leaders; has deep

institutional knowledge

“Ivy League”

Poor performance

in position

Highly intelligent; may hold

several degrees; performs

well in academia



27

Use succession planning to reduce promotion bias

Source: Garman AN, Tyler JL, “CEO Succession Planning in Freestanding U.S.

Hospitals: Final Report,” prepared for the American College of Healthcare

Executives, October 27, 2004; HR Advancement Center interviews and analysis;

2019 CMO Role Survey; Physician Executive Council interviews and analysis.

1) As defined by the American College of Health Care Executives

2) Of nearly 200 hospitals and health systems surveyed.

30%

“A structured process involving

the identification and preparation

of a successor for a given

organizational role that occurs

while that role is still filled.”

Definition of

succession planning1

Percent of CMOs2 have

not identified a successor

or succession plan

60%

Four key steps for implementing high-impact succession plans….

Identify

top talent

Customize

high-

potential

development

Personalize

onboarding

for new hires

Pinpoint

future

leadership

gaps



28

Standardize screenings to identify potential talent



Vet top selectionsIdentify high-

performing staff

Final pool of potential

successors

Two screens to identify and vet leadership talent

Leadership

Potential Diagnostic:

Identify the top 25% of high-

potential leaders by assessing

a standardized set of behaviors

Group Hi-Po

Discussion Guide:

Narrow the list of physician

succession candidates to

the top 5%-10%


https://www.advisory.com/-/media/Advisory-com/Research/PEC/Tools/2019/Leadership%20Potential%20Diagnostic916.pdf

https://www.advisory.com/-/media/Advisory-com/Research/PEC/Tools/2019/High%20Calibration%20Discussion%20Guide916.pdf


29

Identify high-performing physicians

Leadership Potential Diagnostic

Excerpt of Leadership Potential Diagnostic Questionnaire

Talent Questions Responses

1. Does this individual propose sound, defensible solutions to a

problem?

2. Does this individual collect information from all available

constituencies and sources prior to drawing conclusions?

3. Does this individual quickly learn complex concepts and then

apply them to his or her work?

4. Can this individual be an effective and inspirational manager,

even with

difficult employees?

5. Does this individual remain calm even in stressful situations?

Ambition Questions Responses

6. Is it important to this individual to be promoted to a senior

leadership position at this or another organization?

7. Is this individual motivated by being evaluated against his or her

accomplishments, rather than shying away from accountability?

Audience: Distribute to

service line, facility, and

department leaders

Purpose: Identify the

top 25% of leaders with

the talent, ambition, and

engagement to succeed

in senior positions




https://www.advisory.com/-/media/Advisory-com/Research/PEC/Tools/2019/Leadership%20Potential%20Diagnostic916.pdf


30

Vet top selections with a representative group

Group High-Potential Discussion Guide

Source: Bank of America, Charlotte, NC; HR Advancement Center interviews

and analysis; Physician Executive Council interviews and analysis.

Job Complexity

• How complex is the individual’s job relative to others at the same level or in

comparable functions?

Goal Complexity

• To what degree are the established goals more or less difficult or complex than

other similarly situated individuals?

Collaboration

• Does the individual collaborate with others and build mutual respect beneficial to

the hospital?

Skill Versatility

• Does the individual use skills and abilities beyond those commonly held by people in

similar roles?

Rare Talent or Expertise

• Does the individual possess skills or talent that are rare or uniquely valuable to

the hospital?

Reflects Leadership Values

• Does the individual model the hospital’s values?

• Does the individual value diversity and manage a diverse workforce?

• Does the individual enable others to contribute to their full potential?

Excerpt of Group Hi-Po Calibration Discussion Guide

Audience: Service line,

facility, and department

leaders should attend

these sessions

Purpose: Narrow the

list of succession

candidates to the top

5%-10%


https://www.advisory.com/-/media/Advisory-com/Research/PEC/Tools/2019/High%20Calibration%20Discussion%20Guide916.pdf


31

Developing physician leaders

• How do you currently choose individuals to participate in your leadership

development and advancement programs? How do you reduce bias in selection?

• What’s the current ratio of males to females in your development programs?

• Are there experiences you wish you had earlier in your career, or experiences

you think are critical for emerging physician leaders to have today?

Discussion questions for physician leaders


Succession management

Leadership development

• What were the formal and informal aspects that were at play when you were

chosen for your role?

• How can you limit bias in choosing your own successor?



32










medical staff




achieving them

Retain them past


Create a path to

leadership pipeline




33

Conduct a unit civility index survey

to uncover toxic workplace culture

Audit your parental leave policy

Identify high-potential women physicians

for succession management efforts

Audit and expand opportunities for

women physicians to access leadership

development opportunities

Have one-on-one stay interviews

with key women physicians

Identify and test flexible scheduling

models to improve work life balance

Where do we go from here?

Source: Physician Executive Center interviews and analysis.

1) Contact your relationship manager to access resources

included in your membership.

Possible next steps1



34

Physician Executive Council membership


• Care team ROI

• Care variation reduction at scale

• Future of the physician workforce

• Next generation primary care

• Patient access, medical group referrals

• Physician engagement and burnout

• Population health ROI

Perennial research topics

• Integrated medical group benchmarks

• Data-driven roadmap for

physician engagement

• Tools to make the most of your APPs

• Population health resources library

• Create care standards frontline

physicians will embrace

Popular resources

96%Health systems with a

system-level physician

executive role

System-level

83%Physician execs

with expanding

cross-continuum

responsibilities

Cross-continuum

81%Of health system

executives cite

physicians as the most

important stakeholder

for change

Strategically vital

Today’s physician executive roles

2. Mobilize the physician

enterprise to drive

lasting impact

1. Prioritize tactics to tackle your

system-wide priorities

How we partner with physician executives


physician executive council hr advancement center

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