Help Wanted: Strategies for Cardiologists Working with, or in, the C-suite

There’s plenty of room for clinicians in hospital C-suites. Start by appreciating nonclinical expertise, zeroing in on shared concerns and leveraging “soft power.” 

Hospitals that ranked high on U.S. News & World Report’s 2009 “Best Hospitals” list were more likely to be led by physician chief executive officers than non-physician CEOs, according to an empirical study published in Social Science & Medicine (2011;73[4]:535-9). The study has limitations that its author, Amanda Goodall, a researcher at the IZA Institute for the Study of Labor in Bonn, Germany, details in the article. Still, she writes, the finding suggests “a strong association between the ranked quality of a hospital and whether the CEO is a physician.”

One of the study’s data points—that hospitals run by physician-CEOs performed as much as 33 percent better than their non-physician peers—got traction on Twitter in March, after Pamela S. Douglas, MD, highlighted the finding at the American College of Cardiology (ACC) annual conference in Washington, D.C. What makes the finding more noteworthy is that less than 5 percent of U.S. hospital CEOs are physicians.

Douglas, professor of research in cardiovascular diseases at Duke University in Raleigh-Durham, N.C., and an ACC past president, outlined the advantages of having physicians in the C-suite. “It works,” she says. “There’s a lot of data that managers with technical experience establish more appropriate goals, more accurately assess the contributions of others and create a more protective workplace.”

Reframing the conversation

For the ACC.17 talk, Douglas was tasked with recommending how attendees could “negotiate the minefields” in C-suites. Simply retitling her presentation to “How to Collaborate Successfully” would allow her to sit down without another word, she joked. “The C-suite does not see you as the enemy, and we should not see the C-suite as the enemy but as a group of colleagues with whom we can share goals, vision [and] some activities,” she said.

While more clinicians are earning MBAs and enrolling in leadership training courses, a general guideline is for physicians to think of C-suite staff as dyad partners. “Where you have clinical skills and knowledge, [C-suite personnel] have operational skills and knowledge,” she said. “You are two halves of a whole. … Everybody’s expertise is required. Doctors can’t run hospitals unless they know how to manage the finance, operations, infrastructure and administrative component of it, not just the clinical part.”

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Joining the C-suite

Clinicians aspiring to join the C-suite, whether as a CEO or in a position “specifically designed for caregivers,” such as chief medical officer, chief quality officer or chief nursing officer, should start by recognizing what they contribute. “Your clinical expertise in cardiovascular medicine is critically important to the C-suite,” Douglas said. With that expertise comes “soft power—the authority you carry with you not because of your title but because you are … knowledgeable, an expert [who] can get things done.” Soft power is “at least equally, perhaps more important, than the hard power of being behind a podium, for example,” she said.

Learn to work on teams, think strategically, leverage emotional intelligence and balance patient outcomes with respect for the bottom line, Douglas advised. But the most important skill in “these turbulent times” is change management. “We’re all navigating the volume-to-value transition, and the people in the C-suite are the ones who are going to have to lead that change. Physicians in the C-suite have to bring the physicians along, make them aware of the need to change and how to change, and set an example. Change management is not a trivial skill.”

Recognizing shared concerns

Successful engagement comes down to respect for each other’s knowledge, appreciation of clinical and nonclinical skills, a shared vision, trust and collaborating as a team. It also helps to recognize how much clinical and C-suite staff have in common. Douglas zipped through a CEO’s top-10 list: “Financial challenges; government mandates; patient safety and quality … very dear to our hearts; personnel shortages … often physicians; patient satisfaction … dear to our hearts; access to care … important for us; physician–hospital relationships … absolutely; population health management ... we’re all learning together on this; technology … clearly that’s us; reorganizations, partnerships, networks.”

Most of these are challenges practicing clinicians tackle daily, Douglas said. “The CEOs have the same concerns you do. They’re just looking at them from “a slightly different viewpoint.”