Summary Notes (PDF) - AAMC

Meeting Notes: 2013 Joint Gathering of the COD, COTH, CMOG, and GFP
Saturday, April 6, 2013
Background Information
Session Title: Doing the Tough Stuff: The Future Role of Chairs
Session Facilitator: Joanne Conroy, AAMC
Delos M. Cosgrove, M.D., Chief Executive Officer, Cleveland Clinic Health System
James E. Keeton, M.D., Vice Chancellor for Health Affairs & Dean, School of Medicine, University of Mississippi School of Medicine
Session Time: 2:00-3:15, 3:30-4:45
Session Objective:
Discuss the characteristics of effective chairs of the future
How will roles and responsibilities change?
Are departments extinct?
Review proven strategies to “ get the right people on the bus”
Questions to be Addressed at Session:
1. What changes are intuitions making to role of chair?
2. How do you make it happen?
3. Is there a process?
4.
5.
6.
Page 1 of 6

Notes
Topic Brought Up by
Speaker
Key Observations from Facilitator/Panel and
Differing Opinions (Bullet per Item)
recruiting Chairs role is changing – requires different
skills
Unanswered Questions
How to avoid current
undermining of recruitment
requires organizational will
How to make this happen, power
source impacts ability to change
structure Leader can’t have all chairs reporting to
them need to create streamlined process
Recruitment process Need to have one so not constantly
reinventing the wheel
Transparency Accountability will come with transparency
Possible Next Steps that AAMC Might
Consider on this Topic
What are key elements to recruit
process
How to help organizations feeling
held hostage by chairs
Summary
(To be Completed at Conclusion of Session)
Key Observations: 1. Recruitment about leaders not CV
2. Structure should be patient centric model not as guild
3. Need a process for recruitment
4. Transparency important
5.
6.
Critical Follow-Ups: 1. Provide examples and key elements to create a recruitment process
2.
3.
4.
5.
6.
Next Steps: 1. Provide webinar to more broadly share practices that will develop chairs for the future
2.
3.
Page 2 of 6

4.
5.
6.
Delos M. Cosgrove, M.D., Chief Executive Officer, Cleveland Clinic Health System
About Cleveland Clinic:
Tripartite nonprofit group practice, physician lead, salaried, annual review take seriously that go to the board of governors, salary adjusted based on
contribution to organization. Made it patient care centric.
How they are organized is to be patient centric first and not function as a guild –moved from departments to institutes that focus on patient problem or disease.
Started with Neurology, Psychology, Neurosurgery. The change created so much anxiety they decided to do it all at once rather than dragging it out and it was
very successful. No one has talked about going back.
Example of hiring mistake was when they hired a Nobel laureate who left after six weeks because he wasn’t hired for leadership skills.
RRC had trouble understanding what was happening – now all accredited
New model Improved collaboration – fostered innovation – (innovation takes place at the boarders of disciplines)
Recruiting and retaining good chairs/leaders requires recruiting for those skills. It is about leadership not just the CV
Skills to lead include – empathy, street credibility, communication.
Organization has adopted a team mindset – everyone is called CAREGIVER which had huge impact on how people perform their roles as well as interact.
Discussion:
Was it difficult to get transition? Not difficult
How do cross subsidies work in this model? All centralized then goes out (always had this)
Cost? Turnover? Physical arrangement? Moved the deck chairs, at the time just started a new building project moved Heart and Vascular first. Backfilled after
that. Lost almost nobody, no cost impact.
How do you do evaluations? Evaluations are done by institute leaders then sent to board of governors
How do you open up when looking for a leader – how do you identify traits you are looking for? Standard process – biggest failures have been personality not
competence
1 year contract with faculty – no tenure, Salary done based on contribution to clinic – The do not give academic appointments (Lerner fills that role)
Regular communication with all staff important with meetings, TV recording, electronic
Fact that group practice and docs lead is secret sauce – don’t have pockets of money it is all one to help make common decision
Page 3 of 6

Regional hospitals - The have expanded the Cleveland model to regional sites (FL, Abu Dhabi) now financially responsible to main organization for budget which
brings engagement across all sites. Invested $1B in IT using the EHR and hospital transfer system are what hold all this together – to carry patient centered focus
to all location
Address culture – 4 yrs ago established Quality Alliance – to get paid the same as the CC – use EHR, meet quality indicators and follow evidence based CC
pathways
How they Recruit Chairs:
Have a process for look for leadership skills rather than CV, Once hired they are provided a coach (outside consultants) and assign internal mentor for new
leaders. They are given business training (doc like talking with docs) – all backed up by admin. They are responsible for P& Ls across institutes
What is the relationship with SOM? they have traditional chair roles – their chairs are not CC chairs - students are taught by CC staff (really two schools CC and
Learner)
What is the role of the chair now? Clinical protocols, developing personnel, innovating across organization, recruiting and managing personnel
How to make nurse and doc leadership work together? Head nurse has relationship with institute. Usually based on geographic location
If research can’t support after three years they are out
Total transparency has been most powerful by ranking and posting performance – raises quality – no one wants to be last on the list
Joanne suggested: Assoc. of Academic Recruiters – do behavioral recruiting
Use AAMC salary data for benchmarking and McGladery at 90% ….close to community comp
Fixed increase each year no bonuses, no incentives
Describe most successful institutional leader: skills – bright, communicative, lead and organized well, committed to vision of larger organization, interpersonal
and communication most important –
Do again – be smart enough to know you need leaders to lead
Have flexibility to modify structure as you go
James E. Keeton, M.D., Vice Chancellor for Health Affairs & Dean, School of Medicine, University of Mississippi School of Medicine
Must understand own environment to understand larger environment
To know Medicaid you need to know Mississippi
Page 4 of 6

11% of budget supported by the state
Always recruiting – sometimes find leaders localyl ( don’t forget to look in your own backyard)
Removing chairs is tough – biggest mistake is waiting to long – we can’t save them so don’t drag it out
What are you looking for?
Must have behavior that allows communication (major point), sense of humor and ability to connect.
Looking for character, integrity, listening, flexible, can they change….?
Looking for different skill set run through chairs business skills
All three missions equal but clinical makes money – all boats rise together
Asking chair to come from academic world to run a 30M business – they don’t have those skills
Mississippi still traditional center with departments
Always thinking about diversity – Miss 30% African American – no AA chairs
Many chairs have an emotional attachment to chair role
Three years ago tried to create an individual committee to recruit each chair – failed almost everytime
New model:
Have permanent search committee –includes SOM, hosp, nursing part of the process…14 members – they are trained in interview skills, use psychological
testing, use behavioral tools, use search firm
Conduct SWOT of department. Info given to committee, search firm and interviewee
Candidate and bring spouse on first visit to see if they like it
Only see team on first visit –(candidates) liked the process and that Miss was trying to see if they fit with organization
Second visit with departmental leadership – this is when they articulate resource needs
Letter of intent – salary done in 15 min – chairs 75 percentile
Everyone on 1 year contract with state
All chairs do clinical work (avg 18% of their time)
Regular meetings with leadership starts weekly then monthly
Moving towards full consolidation – merging 17 physician groups and brining dental and NP, PT will be in one model
Fair market salary – use RVU
Merged model …. hospital will contribute “tax” ( like a JOA) – $ come to chancellor – one pot of money – will give chairs state money, clinical earned funds, -
allow chairs to divide money as they see fit…accountability and responsibility.
Mission driving program development – improve health of Mississippi
Chairs report to VC – practice plan reports to Hospital
Discussion:
How to get “my money” to be “our money”
Reducing reporting the VC and developing small team to manage missions is key. Also important for succession
Page 5 of 6

Do you incentivize behavior that is going to get us to the future? – Collaboration, cost savings?
Problem departments….– presented deficit to practice plan – made issue transparent
Is it the pace of change that is burning people out? Unknown
Miss – five chairs removed are still there in different roles – thriving – had them in the wrong place
The Future Role of Academic Chairs: AM article 2005 : good roadmap
All we talk about is quality because quality will make us money
Consistency and alignment in vision (don’t play the parent against each other)
`
Page 6 of 6