The Effects of Physician Leadership and Collaboration on Patient Care and Quality Outcomes

Publication Name: May, 2007

SEARCH TERMS USED: Physician leadership, collaboration, quality care, patient outcomes;

BRIEF SUMMARY OF FINDINGS:
As the challenges of leading in healthcare become more complex, healthcare institutions have increasingly emphasized the importance of leadership training for physicians. These articles provide information on the programs offered and their effects on physicians and patients.

INDEX:

How physicians can change the future of health care.
Increasing physician engagement. Using norms of physician culture to improve relationships with medical staff.
Physician management and leadership education at the Cleveland Clinic Foundation: program impact and experience over 14 years.
Musings on the nature of academic medical leaders.
Special report: quality of care survey. Challenges in patient safety and quality: replacing discouragement with hope.
Formation of a leader.
Doctoring as leadership: the power to heal.
The CMIO--a new leader for health systems.
Imparting wisdom to evolving leaders. New leadership program at Geisinger focuses on case-based discussions mixed with personal experience.
Leadership characteristics and business management in modern academic surgery.
Physician leadership: a new model for a new generation.
The applicability of Bass's model of transformational, transactional, and laissez-faire leadership in the hospital administrative environment.
Focus on physician satisfaction to improve quality, boost patient satisfaction, contribute to bottom line.
Developing effective physician leaders: changing cultures and transforming organizations.
Physician leadership styles and effectiveness: an empirical study.
Leadership trends in academic pediatric departments.
Developing effective physician leaders: changing cultures and transforming organizations.
Physician leadership and the common good.
"Acting" leadership roles: lessons learned.
Leadership education for physicians. Refine your focus and communicate your goals when developing physician leadership programs.
Development of physician leadership competencies: perceptions of physician leaders, physician educators and medical students.
Leadership insights of Xenophon.
Physician leadership: a roadmap for health-system change.
The importance of leadership in the development of an integrated team.
Transformational, transactional, and laissez-faire leadership styles: a meta-analysis comparing women and men.
Physician-led: good idea or not?
The physician leader in health care. What qualities does a doctor need to be an effective organizational leader?
What skills do physician leaders need now and in the future?
Programs for the development of physician leaders: a curricular process in its infancy.
Mayo leadership programs for physicians.
Survey of physician leadership and management education.
Developing physician leaders in academic medical centers. Part 1: Their changing role.

JAMA. 2007 Mar 14;297(10):1103-11.
How physicians can change the future of health care. Porter ME, Teisberg EO.
Harvard University, Cambridge, Mass, USA. mporter@hbs.edu

Today's preoccupation with cost shifting and cost reduction undermines physicians and patients. Instead, health care reform must focus on improving health and health care value for patients. We propose a strategy for reform that is market based but physician led. Physician leadership is essential. Improving the value of health care is something only medical teams can do. The right kind of competition--competition to improve results--will drive dramatic improvement. With such positive-sum competition, patients will receive better care, physicians will be rewarded for excellence, and costs will be contained. Physicians can lead this change and return the practice of medicine to its appropriate focus: enabling health and effective care. Three principles should guide this change: (1) the goal is value for patients, (2) medical practice should be organized around medical conditions and care cycles, and (3) results--risk-adjusted outcomes and costs--must be measured. Following these principles, professional satisfaction will increase and current pressures on physicians will decrease. If physicians fail to lead these changes, they will inevitably face ever-increasing administrative control of medicine. Improving health and health care value for patients is the only real solution. Value-based competition on results provides a path for reform that recognizes the role of health professionals at the heart of the system.

Physician Exec. 2007 May-Jun;33(3):38-45
Increasing physician engagement. Using norms of physician culture to improve relationships with medical staff. O'Hare D, Kudrle V.
Mercy & Unity Hospital, Coon Rapids, Minnesota, USA.

Comments on the 2004 survey identified that physicians thought it was too early to judge whether the new structure itself was successful. This year, the survey will be repeated to measure the effectiveness of the new structure and to help administrators set goals to further improve physician engagement levels. Meanwhile, Mercy & Unity is using the tenets of the physician compact, elements of physician culture, and elements of administrative culture to inform new process-improvement activities. More study is needed to identify whether Mercy & Unity's techniques of reorganization contributed to the higher rates of physician satisfaction and engagement, but it is our belief that incorporating physician cultural norms into the process helped prevent the change process from turning the horse into the proverbial camel.

J Med Pract Manage. 2007 Jan-Feb;22(4):237-42.
Physician management and leadership education at the Cleveland Clinic Foundation: program impact and experience over 14 years. Stoller JK, Berkowitz E, Bailin PL.
Division of Medicine, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 55195, USA. stollej@ccf.org

As the challenges of leading in healthcare become more complex, healthcare institutions have increasingly emphasized the importance of leadership training for physicians. Several institutions have offered in-house training programs. This paper describes the 14-year experience and evolution of physician leadership development training at the Cleveland Clinic. We describe the curriculum, organization, and goals of the Leading in Health Care course, which is offered to high-potential physician leaders. As a metric of the success of this physician leadership effort, we report the number and types of business plans developed in the course that have been either implemented at the Cleveland Clinic or have directly affected plans for program implementation.

Physician Exec. 2007 Mar-Apr;33(2):32-4.
Musings on the nature of academic medical leaders. Schidlow DV. Department of Pediatrics at Drexel University College of Medicine, Philadelphia, PA, USA. Daniel.schidlow@drexelmed.edu

No Abstract Provided

Physician Exec. 2007 May-Jun;33(3):16-7.
Special report: quality of care survey. Challenges in patient safety and quality: replacing discouragement with hope. Shannon D.

No Abstract Provided.

Physician Exec. 2007 Mar-Apr;33(2):14-8. Links
Formation of a leader. Bartelme T.

No Abstract Provided

Perspect Biol Med. 2006 Summer;49(3):393-406.
Doctoring as leadership: the power to heal. Schei E.

Section for General Practice, Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway. Edvin.Schei@isf.uib.no
Physician power has been attacked, and tabooed, in legitimate efforts to strengthen patients' rights. Yet the structural and symbolic power wielded by doctors is what makes good and right healing actions possible. Avoiding the power issue contributes to a confusing state, where patient trust is faltering and physicians are uncertain about how to fulfill the doctor's role with the intellectual tools of mere science and technology. I argue that constitutive characteristics of health, illness, and the clinical encounter necessitate a prescriptive and responsible healing agent who is more than a technocrat, an information broker, or a seller. The article proposes clinical leadership as a concept offering practical and ethical direction to clinicians, education, research, and health policy. Leadership presupposes reflective awareness of physicians' structural and symbolic power, and is displayed as discerning, empowering improvisations in critical situations, based on empathy and willingness to learn from patients. The notion of clinical leadership highlights patient vulnerability, medicine's ethical core, and the importance of character development in medical education.

J Am Med Inform Assoc. 2006 Sep-Oct;13(5):573-8. Epub 2006 Jun 23.
The CMIO--a new leader for health systems. Leviss J, Kremsdorf R, Mohaideen MF.
Sentillion, Inc., Andover, MA 01810, USA. jonathan.leviss@sentillion.com

Physician leadership is a critical success factor for health information technology initiatives, but best practices for structuring the role and skills required for such leadership remain undefined. The authors conducted structured interviews with five physician information technology leaders, or Chief Medical Information Officers (CMIOs), at health systems that broadly used health information technology. The study aimed to identify the individual skills and organizational structure necessary for a CMIO to be effective. The interviews found that the CMIOs had significant management experience prior to serving as a CMIO and were positioned and supported within each health system similar to other executive leaders; only one of the five CMIOs had formal informatics training. A review of the findings advocates for the CMIO to have a strong background and role as a physician executive supported by knowledge in informatics, as opposed to being a highly trained informaticist with secondary management expertise or support.

PMID: 16799119 [PubMed - indexed for MEDLINE]

Physician Exec. 2006 May-Jun;32(3):24-9.
Imparting wisdom to evolving leaders. New leadership program at Geisinger focuses on case-based discussions mixed with personal experience.
Gruver W, Spahr RC.
Geisinger Health System Foundation, Danville, PA, USA. gruver@bucknell.edu

PMID: 16736628 [PubMed - indexed for MEDLINE]

Langenbecks Arch Surg. 2006 Apr;391(2):149-56. Epub 2006 Mar 30.
Leadership characteristics and business management in modern academic surgery.
Büchler P, Martin D, Knaebel HP, Büchler MW.
Department of General Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany. markus.buechler@med.uni-heidelberg.de

BACKGROUND: Management skills are necessary to successfully lead a surgical department in future. OBJECTIVE: This article focuses on practical aspects of surgical management, leadership and training. It demonstrates how the implementation of business management concepts changes workflow management and surgical training. METHODS: A systematic Medline search was performed and business management publications were analysed. RESULTS: Neither management nor leadership skills are inborn but acquired. Management is about planning, controlling and putting appropriate structures in place. Leadership is anticipating and coping with change and people, and adopting a visionary stance. More change requires more leadership. Changes in surgery occur with unprecedented speed because of a growing demand for surgical procedures with limited financial resources. Modern leadership and management theories have to be tailored to surgery. It is clear that not all of them are applicable but some of them are essential for surgeons. In business management, common traits of successful leaders include team orientation and communication skills. As the most important character, however, appears to be the emotional intelligence. Novel training concepts for surgeons include on-the-job training and introduction of improved workflow management systems, e.g. the central case management. CONCLUSION: The need for surgeons with advanced skills in business, finance and organisational management is evident and will require systematic and tailored training.

PMID: 16572328 [PubMed - indexed for MEDLINE]

Fam Pract Manag. 2006 Feb;13(2):51-4.
Physician leadership: a new model for a new generation. Serio CD, Epperly T. Family Medicine Residency of Idaho, USA.

No Abstract Provided

PMID: 16512590 [PubMed - indexed for MEDLINE]

Hosp Top. 2006 Spring;84(2):11-8. Links
The applicability of Bass's model of transformational, transactional, and laissez-faire leadership in the hospital administrative environment. Spinelli RJ.
Department of Health Administration and Human Resources, University of Scranton, Scranton, Pennsylvania, USA.

The purpose of this study is to evaluate empirically in the hospital administrative environment the relationship of leadership behaviors to subordinate manager's perceived outcomes, through examination of B. M. Bass's (1985) model of transformational, transactional, and laissez-faire leadership. The author measured leadership orientation and outcome factors through subordinate managers' ratings of hospital CEOs using a questionnaire, which asked: Is there a relationship between the leadership styles of hospital CEOs and subordinate managers' self-reported willingness to exert extra effort, perception of leader effectiveness and satisfaction with their leader? Findings revealed that the relationship between transformational leadership and the outcome factors were stronger and more positive than were the transactional and laissez-faire styles. These findings are consistent with the hierarchal patterns reported and support the universality of the model.

Health Care Strateg Manage. 2006 Apr;24(4):11-2.
Focus on physician satisfaction to improve quality, boost patient satisfaction, contribute to bottom line.

No Abstract Provided.

Hosp Top. 2005 Spring;83(2):11-8.
Developing effective physician leaders: changing cultures and transforming organizations. McAlearney AS, Fisher D, Heiser K, Robbins D, Kelleher K.
Division of Health Services Management and Policy in the School of Public Health and the Department of Pediatrics at The Ohio State University, Columbus, USA.

In this article, the authors discuss the problematic issue of transformational change in the face of cultural conflict between the worlds of clinical care and organizational leadership, and describe a case study of organizational cultural change facilitated through a physician leadership development program. A locally developed physician leadership program can be extremely effective at both improving physicians' leadership skills and increasing understanding of the strategic goals and direction of the organization. The transformational change required for physicians to develop and appreciate business and leadership skills can be supported and encouraged in a leadership development program that includes the components of careful curriculum design, program monitoring, and opportunities to apply new skills in practice. For Columbus Children's Hospital, Columbus, Ohio, this organizational transformational change effort was successfully achieved when a new medical leadership development program helped academic and community physicians to become involved in organizational leadership. The authors describe the background and development of this program and provide results of their evaluation of the program, with discussion of future extensions to the program.

Med Care Res Rev. 2005 Dec;62(6):720-40.
Physician leadership styles and effectiveness: an empirical study.
Xirasagar S, Samuels ME, Stoskopf CH.
University of South Carolina, USA. sxirasagar@sc.edu

The authors study the association between physician leadership styles and leadership effectiveness. Executive directors of community health centers were surveyed (269 respondents; response rate = 40.9 percent) for their perceptions of the medical director's leadership behaviors and effectiveness, using an adapted Multifactor Leadership Questionnaire (43 items on a 0-4 point Likert-type scale), with additional questions on demographics and the center's clinical goals and achievements. The authors hypothesize that transformational leadership would be more positively associated with executive directors' ratings of effectiveness, satisfaction with the leader, and subordinate extra effort, as well as the center's clinical goal achievement, than transactional or laissez-faire leadership. Separate ordinary least squares regressions were used to model each of the effectiveness measures, and general linear model regression was used to model clinical goal achievement. Results support the hypothesis and suggest that physician leadership development using the transformational leadership model may result in improved health care quality and cost control.

Pediatrics. 2005 Aug;116(2):342-4
Leadership trends in academic pediatric departments. Stapleton FB, Jones D, Fiser DH.
Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA. bruder.stapleton@seattlechildrens.org

OBJECTIVE: To examine recent turnover trends among chairs of academic pediatric departments. METHODS: Membership data for the 150 institutions represented by the Association of Medical School Pediatric Department Chairs in the United States, Canada, and Puerto Rico were reviewed for the time period of 1993-2003. RESULTS: From 1993 to 2003, 278 individuals (250 men and 28 women) held the position of chair. The mean time of service was 5.58 +/- 3.2 years (median: 5 years). Twenty-nine individuals served continuously as chairs during the 11-year period. Seventy-two individuals served as interim chairs. Twenty-eight women were appointed either chairs or interim chairs during the 11 years. The number of female chairs decreased from 13 in 1993 to 11 in 2003. Female chairs were in office 3.42 +/- 2.72 years. A total of 123 departments had a change in leadership, with a mean annual turnover rate of 17% (range: 4.6-24%). Three departments had 5 different leaders as either interim chair or chair and 6 departments had 4 different leaders during this time period. Neonatology was the most common subspecialty represented by recent pediatric chairs, although nephrology was the subspecialty with the greatest proportional representation. CONCLUSIONS: Departments of pediatrics have high turnover of leadership. Women, in particular, serve for relatively short periods and appear to be under-represented within the leadership of pediatrics. Efforts should be made to ascertain personal qualities that allow sustained leadership and to attract more women into leadership positions.

PMID: 16190516 [PubMed - indexed for MEDLINE]

Physician leadership and the common good. Bone GH.

No Abstract Provided

PMID: 16334008 [PubMed - indexed for MEDLINE]

Physician Exec. 2005 Sep-Oct;31(5):40-4.
"Acting" leadership roles: lessons learned. Spahr R.Geisinger Health System, Danville, Pa, USA. RSPAHR@geisinger.edu

No Abstract Provided

PMID: 16224906 [PubMed - indexed for MEDLINE]

Healthc Exec. 2005 Jan-Feb;20(1):49-51
Leadership education for physicians. Refine your focus and communicate your goals when developing physician leadership programs. Babitch LA, Chinsky DJ.
Wayne State University, Ann Adams Department of Pediatrics, Detroit, MI 48201-2119, USA. lbabitch@dmc.org

PMID: 15656230 [PubMed - indexed for MEDLINE]

J Health Adm Educ. 2004 Summer;21(3):343-54.
Development of physician leadership competencies: perceptions of physician leaders, physician educators and medical students. McKenna MK, Gartland MP, Pugno PA.
Health Care Leadership MBA Program, Rockhurst University, 1100 Rockhurst Road, Kansas City, Missouri 64110, USA. mindi.mckenna@rockhurst.edu

Research regarding the development of healthcare leadership competencies is widely available. However, minimal research has been published regarding the development of physician leadership competencies, despite growing recognition in recent years of the important need for effective physician leadership. Usingdata from an electronically distributed, self-administered survey, the authors examined the perceptions held by 110 physician leaders, physician educators, and medical students regarding the extent to which nine competencies are important for effective physician leadership, ten activities are indicative of physician leadership, and seven methods are effective for the development of physician leadership competencies. Results indicated that "interpersonal and communication skills" and "professional ethics and social responsibility" are perceived as the most important competencies for effective physician leadership. Furthermore, respondents believe "influencing peers to adopt new approaches in medicine" and "administrative responsibility in a healthcare organization" are the activities most indicative of effective physician leadership. Finally, respondents perceive"coaching or mentoring from an experienced leader" and "on-job experience (e.g., a management position)" as the most effective methods for developing physician leadership competencies. The implications of these findings for the education and development of physician leaders are discussed.

Physician Exec. 2004 Jul-Aug;30(4):34-7.
Leadership insights of Xenophon. Enzenauer RW.
Department of Ophthalmology, University of Tennessee College of Medicine, Chattanooga, USA. rwenzenauer@pol.net

Over two centuries ago, the Greek military historian Xenophon wrote the first systematic book on leadership, Anabasis, or March Up Country. According to management guru Peter Drucker, it is still the best book on the subject. Physician executives can learn timeless lessons from Xenophon.

J Med Pract Manage. 2004 Jul-Aug;20(1):36-40.
Physician leadership: a roadmap for health-system change. Solomon RJ.
Graduate School of Business, The College of William & Mary, 627 Nansemond Street, Portsmouth, VA 23707, USA. Robert.Solomon@cox.net

Physician involvement in health-system decision making and their support of health-system initiatives can be critical to a health system's success. Many physicians, however, do not have the business skills or perspective to be effective contributors. This paper identifies three levels of physician leader development: awareness and head knowledge; creating an "us" culture; and taking ownership of the marketplace. It also identifies three physician leader-development methods that health systems can use to reach these points: integrated executive education; project-based learning; and facilitating ownership. Based on health-system objectives, top management should choose an appropriate level of physician leader development and then implement an appropriate change plan by using the proposed physician leader-development methods.

J Nurs Manag. 2003 Nov;11(6):371-6.
The importance of leadership in the development of an integrated team. Outhwaite S.
Team Leader, Fareham and Gosport Community Learning Disability Team, Fareham, Hampshire, UK. southwaite@supanet.com

AIM: To provide a personal perspective on the role of leadership within the development of an integrated team. BACKGROUND: The government white paper Valuing People recently proposed that collaborative working is essential in service delivery for people with a learning disability. This has led to the development of the integrated team to respond the often complex needs of people with a learning disability. METHOD: A situational analysis is used to outline the history, and the changes within learning disability services. The role of self, team development and leadership are then explored in achieving future change and objectives. CONCLUSION: Transformational skills are essential in the development of team working, however, understanding and commitment to the process of collaboration is required by all agencies and at all levels in order to implement change. Nurses are placed in influential positions within the change process.

Psychol Bull. 2003 Jul;129(4):569-91.
Transformational, transactional, and laissez-faire leadership styles: a meta-analysis comparing women and men. Eagly AH, Johannesen-Schmidt MC, van Engen ML.
Department of Psychology, Northwestern University, Evanston, Illinois 60208, USA. eagly@northwestern.edu

A meta-analysis of 45 studies of transformational, transactional, and laissez-faire leadership styles found that female leaders were more transformational than male leaders and also engaged in more of the contingent reward behaviors that are a component of transactional leadership. Male leaders were generally more likely to manifest the other aspects of transactional leadership (active and passive management by exception) and laissez-faire leadership. Although these differences between male and female leaders were small, the implications of these findings are encouraging for female leadership because other research has established that all of the aspects of leadership style on which women exceeded men relate positively to leaders' effectiveness whereas all of the aspects on which men exceeded women have negative or null relations to effectiveness.

PMID: 12848221 [PubMed - indexed for MEDLINE]

Physician Exec. 2002 Sep-Oct;28(5):20-3.
Physician-led: good idea or not? Zismer DK, Flygenring B, Campion B. Minneapolis Heart Institute, Abbott Northwestern Hospital, USA. zismer.daniel@dorseylaw.com

Whether physicians or not, leaders must possess certain skills and qualities to achieve success. Take a look at what's required to be an effective leader.

Health Prog. 2002 Nov-Dec;83(6):27-30.
The physician leader in health care. What qualities does a doctor need to be an effective organizational leader? Birrer RB. St. Joseph's Regional Medical Center, Paterson, NJ, USA.

No Abstract Provided

Physician Exec. 2001 May-Jun;27(3):46-8.
What skills do physician leaders need now and in the future? Williams SJ.
Division of Health Services Administration, Graduate School of Public Health,San Diego State University, USA. swilliam@mail.sdsu.edu

The role of the physician leader is moving beyond traditional medical staff issues. A recent national survey of physician leaders shows a growing need for education on specific technical, leadership, and practical skills. The results reveal the medical leadership skills that physician executives consider important today, and provide a window to the future about the skills that will be important tomorrow. Physicians say they need training now in quality assurance, clinical benchmarking, decision-making, and strategic planning. And when they gaze into the future and see the rapid changes throughout health care, they say they'll need more training in communication, organizational change, effective listening, and systems thinking.

Acad Med. 2000 Feb;75(2):133-40.
Comment in:
Acad Med. 2000 Oct;75(10):958.
Programs for the development of physician leaders: a curricular process in its infancy. Schwartz RW, Pogge CR, Gillis SA, Holsinger JW.
Department of Surgery, University of Kentucky Chandler Medical Center, Lexington 40536-0298, USA. rschw01@pop.uky.edu

Physician leaders are crucial as never before to ensure the proper integration of good care and cost containment; such integration is both a reasonable expectation of patients and essential for the survival of health care delivery systems. In today's health care environment, a critical mass of physician leaders must be developed in a systematic fashion so that physicians may truly lead the health care enterprise. The authors (1) describe, with examples, the various types and levels of physician leadership training programs currently being offered; (2) explain the costs and benefits of each program type; and (3) offer a program rationale and model (using a program at their medical school), which they analyze using traditional management concepts such as strategic planning, net present value, and make-versus-buy. The authors emphasize that physician leadership training should be local, offer long-term instruction, and be led by physicians. They conclude by stating that the concept of physician leadership will not and should not be taken seriously by non-physician health care executives until the physician community becomes as serious about leadership and management training as it is about clinical training.

PMID: 10693843 [PubMed - indexed for MEDLINE]

Mayo Clin Proc. 1998 Mar;73(3):279-84
Mayo leadership programs for physicians. Tangalos EG, Blomberg RA, Hicks SS, Bender CE.
Division of Community Internal Medicine, Mayo Clinic Rochester, MN 55905, USA.

Health-care organizations have recognized the need to prepare physicians for various leadership and management positions within their own institutions. The demands of a dynamic health-care environment have created increased pressure for institutions to develop a larger cadre of physician leaders and managers among their staff, and this must be done cost-effectively and efficiently. In the past, physicians who wanted more education had to look beyond their practice to fulfill this need. Institutions have begun to create tailor-made programs for their physicians in order to meet the various needs of their staff regarding leadership and management. Herein we describe the educational initiatives undertaken in 1995 and 1996 to provide Mayo physicians with in-house leadership and management programming. A substantial number of institutions are answering the challenge for increased physician expertise in leadership and management through the development of their own in-house programs.

Mayo Clin Proc. 1997 Jul;72(7):659-62
Survey of physician leadership and management education. Scott HM, Tangalos EG, Blomberg RA, Bender CE.
Division of Community Internal Medicine, Mayo Clinic Rochester, MN 55905, USA.

Health-care organizations have recognized the need to prepare physicians for various leadership and management positions within their own institutions. In the past, those who desired further education had to search beyond the boundaries of their practice to fulfill this need. The demands of a dynamic and changing health-care environment have created increased pressure on organizations to develop a larger cadre of physician leaders and managers among their staff and to accomplish this outcome in a cost-effective, efficient manner. This article examines the results from a survey of leading medical institutions on the existence of in-house leadership and management educational programming. It also documents the approaches used by the responding organizations and the content of their course work. Numerous institutions are accepting the challenge for increased physician expertise in leadership and management by developing their own in-house programs. Future directions for Mayo initiatives in succession planning will be obtained from this benchmark survey.

Med Group Manage J. 1996 Nov-Dec;43(6):35-8, 40, 44 passim.
Developing physician leaders in academic medical centers. Part 1: Their changing role. Bachrach DJ.
University of Texas, MD Anderson Cancer Center, Houston 77030, USA.

While physicians have historically held positions of leadership in academic medical centers, there is an increasing trend that physicians will not only guide the clinical, curriculum and scientific direction of the institution, but its business direction as well. Physicians are assuming a greater role in business decision making and are found at the negotiating table with leaders from business, insurance and other integrated health care delivery systems. Physicians who lead "strategic business units" within the academic medical center are expected to acquire and demonstrate enhanced business acumen. There is an increasing demand for formal and informal training programs for physicians in academic medical centers in order to better prepare them for their evolving roles and responsibilities. These may include the pursuit of a second degree in business or health care management, intramurally conducted courses in leadership skill development; management, business and finance; or involvement in extramurally prepared and delivered training programs specifically geared toward physicians as conducted at major universities, often in their schools of business or public health. This article article was prepared by the author from research into and presentation of a thesis entitled. "The Importance of Leadership Training And Development For Physicians In Academic Medical Centers In An Increasingly Complex Healthcare Environment, " prepared for the Credentials Committee of the American College of Healthcare Executives in partial fulfillment of the requirements for Fellowship in the College (ACHE). Part 2 will appear in the next issue of the Journal.

The Effects of Physician Leadership and Collaboration on Patient Care and Quality Outcomes

Featured Resources