The Limits of Clinical Executive Leadership

There is little-published data documenting how many senior hospital executive leaders (COO, CEO, CFO) are clinicians while also holding significant clinical leadership portfolios (CMO, CNO, Department Chair, etc) in large healthcare organizations. My sense is, not many as a percent of all organizations. And I suspect that fewer yet hold those senior executive positions and still practice or hold significant clinical leadership positions (Department Chairs, Practice Leads, etc.).

Yet this is a time that calls for substantial clinical delivery system innovation. Health care reform is nigh. The first wave of “Accountable Care Organizations” and “Medical Home” demonstrations already call for new and close partnerships between the delivery of professional and support services, the acquisition and use of technology, and the critical participation of health care finance and operations experts. Aren’t physicians and nurses best positioned (as are Ito, Jobs, and Lazaridis) to align the delivery of care and the business of care?

So should we expect to see – or should we intentionally place – more clinicians in executive leadership positions in order to have knowledgeable innovators at the highest organizational levels? Instead of the prevailing model where CEO, COO, and CFO executives “partner with” CMOs and CNOs as necessary to balance business with clinical care, does the future require it be the other way around? If so, what are the ramifications for better preparing clinician leaders in terms if formal education (business and management curricula) and “on the job” training (mentoring, coaching, and experiential training)? And for preparing erstwhile senior executives to take different roles vis a vis clinical leaders?

Sustainable Innovation?

And if clinicians do assume more executive roles, can they maintain their clinical currency sufficiently to be guardians of the business and of the quality and appropriateness of care? Will the need to combine skill sets at the top be temporary – until a new order is established – or permanent because new equilibrium is not likely to be achieved?

Ito apparently recognizes that for him, at least, the dual role can’t last very long:

“Although he’s certainly had experience on both the business and design fronts, Ito makes clear that he’s aware that wearing two hats will be challenging. He told BusinessWeek that the strategy behind the dual appointment might be temporary. That is, once he gets Honda back on track financially, he might pass the R&D; post onto someone else.”

If clinicians follow the same route will they, in the end, give up medicine or management? Which role will clinicians in leadership ultimately decide provides them with the best opportunities to improve care? Is it possible to go back?