Austin Littrell 0:17
Welcome to the special purported edition of Off the Chart, a business of medicine podcast featuring lively and informative conversations with healthcare experts, opinion leaders, and practicing physicians about the challenges facing doctors and medical practices. My name is Austin Latrell. I'm the associate editor of Medical Economics, and I'd like to thank you for joining us today. In today's special report, Megan Manzzano, senior custom content specialist at Physicians Practice, sat down with Kate Ashley, professor of practice at the University of Tennessee Knoxville's Haslam College of Business, where she directs both the Executive MBA in healthcare leadership and the Physician Executive MBA. Healthcare organizations keep promoting their best clinicians into leadership roles with little preparation for the business side of the job, and Ashley explains why the clinical expertise alone can't carry a leader through problems that are this interconnected. In today's episode, she lays out the five skills that she sees as essential, from systems thinking to curiosity, how organizations can start building leaders long before they land in the role, and her advice for physicians who want a bigger voice in how their organizations are run: get out of your lane. With all that said, Kate Ashley, thank you for joining us today, and now let's get into the episode.

Speaker 1 1:19
Hello, everyone. I'm Megan Manzzano, the Senior Custom Content Specialist of Physicians Practice, and we have a great episode for you about the leadership skills that are transforming healthcare. Today, I'm joined by Kate Ashley, Professor of Practice, Director of Executive MBA in Healthcare Leadership, and Director of Physician Executive MBA from the Hoslin College of Business. Thank you so much for joining me today, Kate.

Speaker 2 1:40
Thank you for having me this morning. I'm excited to join.

Speaker 1 1:44
Yes, definitely. And we have a really great episode because we are going to be talking about today's current landscape and how it affects healthcare leaders. Which we know today they face challenges that few expected a decade ago, including reimbursement pressures, workforce shortages, technological disruption, rising consumer expectations, and growing organizational complexity. So success now requires more than clinical expertise or operational excellence. It requires leaders who can navigate strategy, finance, organizational change, and cross-functional collaboration. So, Kate, before we even get into more of these changes, I just want to talk about specifically what has really changed about healthcare leadership within the last 10 years.

Speaker 2 2:21
So healthcare has always been complicated. What's different now is how interconnected the problems are. You can't pull one lever without three or four other levers changing. And so, if you think about, we need more access, but we need to reduce costs. We need to make sure our margins are met, but we have to reduce staffing expenses. Everything is in is in contrast to each other, and so leaders really have to find a way to navigate and thread between two issues that are both valid, but have to be handled in order to be successful in the healthcare market. That's really that's really the biggest thing. And so you know we could talk about oh it's AI that's part of it. We could talk about financial pressures that's part of it. But it's really that that interconnectedness that has changed, accelerated, and making the importance of change management, influence, and leadership skills even more critical than operational skills.

Speaker 1 3:25
Yeah, that's a really good point. I think about how you know these skills are not often just you can show up and you have them already good to go, especially on top of your other things. There's more that you have to learn and experience. So I just want to know, like, why is technical expertise not really enough anymore to navigate this landscape.

Speaker 2 3:42
Expertise in one domain doesn't automatically translate into the ability to lead across domains. I use the example with our physicians. You can be a really great engineer and individual contributor, and we see this in manufacturing firms all the time. And then you get promoted to a group leader while being technically expert, expert a technical expert doesn't mean that you have the the needed leadership skills or business understanding to actually be a good leader. It's important, but not it's necessary, but not sufficient, right? And so, a brilliant physician, you can have the best cardiologist on your staff, and to suddenly ask that individual to understand capital allocation, payer economics, operations, strategy, organizational behavior, change management, just because they're technically expert doesn't doesn't actually work. It doesn't work that way. It tells you what should happen. Leadership is about figuring out how to how it does happen in an organization? How to deal with those competing priorities and finite and finite resources? Physicians are trained to make extraordinarily complex decisions within a clinical framework, and then we promote them, ask them to do all these other things, right, and talk about. All these other issues that are in front of them, and we don't we don't give them any preparation for it.

Speaker 1 5:07
Yeah, really well said there. Because you know, like we've been talking about, you can have all this expertise in one domain. You can be really good at something, and then you get thrown into a completely different world, and you're standing there like, what am I supposed to do? And I think about this too, even more narrowly. So, with challenges that healthcare leaders have to face across clinical and business functions, can you speak more to that?

Speaker 2 5:28
I'll return to that idea that decisions are interconnected, and you're in many times healthcare leaders are asked to decide between two valid situations. It's not usually a good option and a bad option. Those are the easier decisions. It usually involves two legitimate priorities that are in tension with each other, and so a big one is clinician autonomy versus standardization. You have to have clinical judgment. Nobody wants to get rid of clinical judgment, but health systems also need protocols and standards that improve quality, reduce unnecessary tests and variation, and control cost. So, which is it? Clinician autonomy or standardization? Right, both are valid. Both are needing to be tackled. How do you again thread the needle between those two things? Access versus clinician workload. We want to increase access. Patients need faster access. Clinicians are probably already stretched thin, if not overloaded. You can add more patients to the schedule every day, but how much is that going to increase burnout, turnover, and access for future days? So it's it's it's and we can we can talk about a whole bunch of other, you know, if this, then that, or is it this or that? When it's really both, and how do you figure out how to deal with both issues simultaneously while maintaining quality care and patient outcomes? It's tough.

Speaker 1 6:58
Yeah, it's a lot of it's a lot of pressure because, of course you want to be able to give patients the best care, but if you're focusing so much on what's going on with the business, what do you have to do to make certain things work, and then you also want to bring in more patients, you're spinning so many different wheels that just can't be sustainable. And I want to just know from your perspective, just what leadership skills do healthcare executives need to navigate the complexity that they're faced with.

Speaker 2 7:25
I this this is where I focus in my work. Systems thinking, I think, is the biggest idea that physician leaders can trans. It's easier for them to translate their systems thinking about the body into the systems thinking about an organization. They understand that the body systems are interconnected. Well, organization is interconnected. Seeing the organization as a system rather than optimizing one department or function. I think that's the first one. So systems thinkability, systems thinking. Excuse me. Systems thinking. Business fluency. We're not asking physicians to be experts in every discipline, but they need enough finance, strategy, operations, econ, behavioral understanding of people to understand the trade-offs and ask really good questions. So that that idea of business fluency, not business expertise, but business fluency, and then leading through influence. Healthcare is full of highly educated professionals who may not report directly to the leader. It's a very matrixed organization in most situations, and command and control leadership has serious limits. There's a place for command and control leadership, but running an organization that's not that's not where it it it it does it doesn't do as well in in long term success in an organization. So leading through influence takes longer, takes more skill, more nuance, but it's definitely needed. I spend a lot of time. My background is organizational and industrial psychology, and we spend a lot of time talking about change leadership. Announcing a change is not the same as implementing it. And leaders need to understand incentives, culture, resistance, what drives resistance? How to reduce resistance, and what it takes for a change to survive and be successful. It's probably one of the the hardest skill sets that physician leaders have to have to grow. And then this sounds simple, but man, with the pace of everyday life and the the stressors that physicians face. Curiosity. We I talk to my physicians about being able to ask great questions. You don't have to enter every room with the answers. You need to recognize who knows what in the room and ask really good questions. To elicit that information and to get to a better solution, so systems thinking, business fluency, leading through influence, change leadership, and curiosity-that that's that's where I would focus, and I think where capabilities are needed in physician leaders.

Speaker 1 10:23
Those are all really great points, and kind of leads me into what I'm thinking about next. When you take all of these together, how can organizations develop stronger leadership pipelines?

Speaker 2 10:33
Oh, that's a great question. I think, and this isn't just healthcare systems. This is organizations across different industries, they hire someone to be a leader, put them in a role, and then see how they do, and maybe send them some training. If there's something that they're lacking or something that they're not doing well, or they raise their hand and say, "I don't understand this, they'll send them training instead to get earlier in that pipeline, and when you see individuals that have some leadership capability or interested in making change happen, interested in doing things differently, start giving them gradually more difficult assignments, exposing them to different parts of an organization, so that by the time they get to a leadership role, they're already off and running. I think training people all along, instead of putting them in position, waiting to see if they if they naturally have the skills or if something is something is not right and trying to fix them is is not the best approach. It's a typical approach, but it doesn't. It does not breed success in long term long term outcomes. Does that make sense?

Speaker 1 11:49
Yeah, it does. Even as you were talking, my in my brain as you were explaining that you know they throw people in here without training and they expect you to just like figure it out. I was like, oh, tail as old as time, right? Because that's what happens, and then you're stuck there without knowing where to go, and then you know whose fault is it, right? Like you don't want that blame pushed back onto you for just not knowing exactly what to do in the moment. So yes, makes absolute sense. And thinking about more of like a future outlook, you know, because more change is going to come. I think that's sort of inevitable. What advice would you give for emerging health leaders,

Speaker 2 12:24
get out of your lane. I know that physicians are experts in their field, in their medical field, and we need that. We want that. If you want to be a leader of your department, your organization, your system, your group, get out of your lane. Learn enough finance to understand what the CFO is worried about. Learn enough operations to understand why processes work the way they do. Learn enough strategy to understand why the organization is making certain choices and not other choices. Spend time with nurses, finance, IT, patients, people outside administrators, people outside your own organization, facility maintenance, so that you understand how the organization works and who the different players are. So get out of your lane. The reason physicians need business knowledge isn't because we want physicians to leave medicine and become executives, it's because some of the people who understand patient care the best need to have a stronger voice in how healthcare organizations are run, and so we're you know we're we're I don't work to try to get physicians to leave medicine, I work with physicians to give them skills they need to make healthcare better, and so getting getting them out of their lane. Most doctors are naturally curious anyway. They like to learn, and so helping them frame those questions and see where the areas are that they could ask more questions and understand and deepen their knowledge. It it works well for for the people that I work with.

Speaker 1 14:01
I think that's incredible advice to end on. As you said, physicians are naturally curious, and I think it always works better to feed that curiosity and make people understand what everybody's doing, so you feel less like you're siloed off or just doing the same thing, but rather you could see what everybody's doing and how that can create a bigger picture. So, with that, I want to thank you so much, Kate, for joining me today.

Speaker 2 14:23
Thank you, Megan.

Speaker 1 14:25
This has been Megan Manzzano. Thank you, everyone, for listening.

Austin Littrell 14:33
Once again, that was a conversation between Megan Manzano, senior custom content specialist at Physicians Practice, and Kate Ashley, professor of practice and Director of the Executive MBA in Healthcare Leadership and the Physician Executive MBA at the University of Tennessee Knoxville's Haslam College of Business. My name is Austin Latrell, and on behalf of the whole Medical Economics and Physicians Practice Teams, I'd like to thank you for listening to the show and ask that you subscribe so you don't miss the next episode. As always, be sure to check back on Monday and Thursday mornings for the latest conversations with X. Sharing strategies, stories, and solutions for your practice, you can find us by searching "Off the Chart" wherever you get your podcasts. Also, if you like the best stories that Medical Economics and Physicians Practice publish, delivered straight to your email six days of the week, subscribe to our newsletters at medicaleconomics.com and physicianspractice.com. Off the Chart, a business of medicine podcast, is executive produced by Chris Mazzolini and Keith Reynolds, and produced by Austin Latrell. Medical economics and physicians practice are both members of the MJH Life Sciences family. Thank you.

Transcribed by https://otter.ai