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HEALTH CARE EDUCATORS:

NEW DIRECTIONS IN LEADERSHIP
DEVELOPMENT
CARYL HESS
Fortune 500 companies have a competitive advantage in leadership development, whereas health
care has lagged far behind. Physician leadership development, in particular, is a game changer for
a closed staff, group practice that relies on a pipeline of physician leaderssuch as the Cleveland
Clinic. To address this leadership development gap in health care, the Cleveland Clinic Academy
(CCA) was established in 2006. The academy is predicated on developing health care leaders with
specific emphasis on physician leadership education using a competency-based curriculum
with value-added components, including continuing medical education (CME) and masters of business administration (MBA) transfer credits. In the pioneering spirit of Dr. F. Mason Sones, the novel
curriculum includes didactic learning, experiential immersion, and executive coaching, designed to
promote physician career development, leadership potential, productivity and job satisfaction, and
business acumen. The unique programs54 stand-alone courses, and customized programs such as
Leading in Health Care, Staff Leadership Rotation, Samson Global Leadership Academy, Healthcare
Finance and Accounting, and othershave affected individuals and patient care by reaching over
6,000 health care providers, including physicians from Cleveland Clinic, Bulgaria, France, Ireland,
Japan, Qatar, UAE, India, Belgium, Saudi Arabia, Nigeria, Turkey, Dominican Republic, and throughout the United States. CCA provides a new direction in leadership development with an integrated
competency-based curriculum for physicians, nurses, and administrators.

Introduction
Leadership development is a competitive advantage
for the U.S. Army, General Electric, PepsiCo, Federal
Express, Johnson & Johnson, and other Fortune 500
companies whereas health care has lagged far behind.
Physician leadership development, in particular, is a

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JOURNAL OF LEADERSHIP STUDIES, Volume 6, Number 4, 2013

2013 University of Phoenix
View this article online at wileyonlinelibrary.com DOI:10.1002/jls.21269

game changer for a closed staff, group practice that

relies on a pipeline of physician leaders to be the organizational decision makers, serving leaders, and inspiring
role models.
To address this leadership development gap in health
care at Cleveland Clinic, Cleveland Clinic Academy

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(CCA) was established in 2006. The academy is predicated on developing health care leaders with specific
emphasis on physician leadership education using a
competency-based curriculum with value-added components, including CME and MBA transfer credits.
Since inception, the academy has implemented a new
and multifaceted approach to curriculum that includes
didactic learning, experiential opportunities, and executive coaching. This combination of instruction and
methodology effectively prepares aspiring physician
leaders for new opportunities and is automatically
linked to each physicians annual professional review.
In an organization where physicians are hired based on
a 1-year contract and performance includes clinical as
well as nonclinical achievements, leadership development is a value-added component of the clinics culture
and learning environment.

Instructional Challenges
Many physicians who are currently in leadership position are doctors over 50 years old, typically males,
who were trained in an era when (a) autonomy was
rewarded; (b) quality was an individual standard; and
(c) costs were ignored in favor of patient care. These
physicians are now functioning in a decentralized, fragmented, chaotic system of ever increasing costs, tests,
and devices.
In order to bring calm to the chaos, we need a new
kind of health care leader in every system and at every
level of the organization. These new leaders must
organize physicians into teams with nurses and other
providers, practice serving leadership, measure performance by patient outcomes, reward with financial and
behavioral incentives, adopt continuous improvement,
embrace lean techniques, and communicate effectively.
Creating a new kind of health care leader requires
institutional support at the highest levels. Teaching and
learning must become part of the regular workday
and not an early morning, lunch hour, or after-work
event. Pedagogy and instruction must be customized for
the individual, culturally sensitive, and driven by internal faculty. Internal practitioners and respected leaders
must be invited to teach and share their knowledge
with colleagues and encouraged to develop their own
faculty skills. The curriculum must be a combination

of competency-based, experiential, and patient-focused

approaches, with an academic rigor appropriate to the
learner.
N E W, I N N OVAT I V E , A N D E F F E C T I V E
P E D AG O G Y

The U.S. health care system is ill. The symptoms of its

illness include high costs, dissatisfied patients and families, waste, lack of qualified caregivers, and inefficient
processes. One cure is innovation and innovative leaders who are trained to challenge the process and implement innovative solutions to improve patient care.
As Kouzes and Posner (2007) have documented
in The Leadership Challenge, there are five exemplary practices of personal-best leadership behaviors that mobilize others to get extraordinary things
done: (a) model the way; (b) inspire a shared vision;
(c) challenge the process; (d) enable others to act; and
(e) encourage the heart. Since 1983, Kouzes and Posner
have analyzed thousands of personal-best leadership
practices across gender, cultures, geography, and industries to uncover similar patterns of behavior and these
five common practices among dynamic leaders.
The exemplary behavior of challenge the process is
an innovative practice for health care leaders that can
be taught and learned by physicians, as well as other
caregivers. Arguably, effective pedagogy to teach challenge the process must seek to include the following
components:
Highly engaging and cognitively challenging
instructional methods
Faculty dyads of clinical leaders and academic
scholars who will marry practice and theory to create a dynamic learning environment
A clinical expert to provide the live vignettes or
problems involving real-time health care issues to
demonstrate challenges to the process and activities
to practice risk taking
Leaders who challenge the process are not satisfied
with the status quo. Physicians in particular must be
empowered to venture and take risks. Because their
medical school training was based on individual effort,
conformity to acceptable standards, and competition,
physician leaders must learn to innovate, grow, and

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Leading in
Health Care

nt
me

me
lop
hip
De
ve

lop

Lea
de
rs

eve

Staff
Leadership
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em

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Staff
Mentoring

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Figure 1. Integrated competency-based curriculum

Ma

improve health care. Physicians must be taught to listen

more to the patient or customer, because most innovations tend to come from the people on the front line
or patients actively engaged in the process (Endsley,
2010).
It is quite possible that the physician leader will not
be the innovator. However, all leaders must create a
climate that will encourage innovation, acknowledge
good ideas, and challenge the system in order to implement new programs, processes, procedures, and products. Because life is the leaders laboratory, one way to
deal with the potential impact of mistakes, failure, and
risk is to approach change through pilot programs
incremental steps and small wins. Role-play, simulations, shadowing experiences, storytelling, and other
experiential learning opportunities must be structured
to allow physician leaders to challenge the process. These
laboratory opportunities are included throughout the
Cleveland Clinic Academy curriculum and programs.
Academy curriculum and programs span an organization of 43,000 employees, including 3,000 physicians,
in Ohio, Nevada, Florida, Canada, and Abu Dhabi.
The geographical dispersion creates opportunities for
distributed learning and ongoing collaboration among
physicians, nurses, and administrative caregivers. As
Figure 1 demonstrates, curriculum and programs for
leadership, management, and professional development
are integrated and complementary.
Since 2006, 5,654 Cleveland Clinic physicians,
nurses, and administrators with at least a masters degree
or 3 years of supervisory experience have attended 53
didactic courses in the Cleveland Clinic Academy (the
foundation of the pyramid in Figure 1). In 2012, one
third of the attendees were from regional facilities.
Of the 53 didactic courses offered in 2012, attendees
rated their level of course satisfaction a 4.8 on a 5-point
Likert scale with 5 being the highest score. The average
course size was 27 in 2012, purposely small in order
to promote engagement, interaction, and networking.
The curriculum is supported by 87 volunteer teaching
faculty, 7 executive coaches, and 89 volunteer mentors.
In 2012, 3,171 CME credits were claimed by attendees
and 40 clinic employees transferred academy course
credits to MBA programs at partner universities.
Regarding other programs in Figure 1, Leading
in Health Care (LHC) is a 10-month program for

Cleveland Clinic
Academy
Professional Development

35 nominated physicians and research scientists that

focuses on team building, innovation, emotional
intelligence, mission, vision, values, and business acumen. The outcome of the LHC program is an innovative business plan that was developed by a team and
ready for enterprise implementation. Recent survey
results revealed that 61% of the business plan projects
in Leading in Health Care have been implemented.
With respect to the Staff Leadership Rotation course,
this 6-month program for 15 nominated physicians and
research scientists focuses on leadership and career development and the creation of a personal leadership plan.
In 2012, 100% of the 3-year personal leadership development plans in the Staff Rotation course were submitted, career coaches were engaged, and shadowing
experiences completed. Staff Mentoring moved from a
pilot project in Internal Medicine and Pediatrics to an
automated, enterprise program in 2011. Participation
in the formal Staff Mentoring Program includes physicians new to the clinic through senior leaders from 19
of our 26 institutes.
The curriculum for all of the programs in Figure 1 is
research and competency based. The competencies are
listed in Table 1.
Designed similar to a university, the curriculum is
subdivided into tracks: leadership, management, communication, and quality. The tracks function as a guide

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Table 1. Cleveland Clinic Competencies

Leadership Competency

Denition According to the Cleveland Clinic

Emotional intelligence

Self-awareness; self-management; social awareness; relationship management

Professionalism

How we conduct ourselves as caregivers in our interactions with patients and society

Change management

Readiness, models, avidity

Communication

Active listening, conict resolution, and giving feedback

Commitment to lifelong learning

Open to new ideas and practices

Deliver observable results

Actively plan, discuss, and implement

Finance, marketing, and IT

Business acumen

Regulatory environment

Joint Commission on Accreditation of Healthcare Organizations (JCAHO), Centers for

Medicare and Medicaid Services (CMS), . . . and high-quality resources

Recruiting and hiring

Aware of resources, legal, and sensitive to diversity

Process assessment and management

Knowledge of resources and strategies

Philanthropy and development

Skills to solicit and cultivate donors

Medicolegal issues

Aware of legal issues and policies (contracts, malpractice)

Managing physicians

Mentor and coach others

Clinic awareness

Leadership structures, cultural climate, opportunities, privileges

for physicians and other caregivers who strive to link

their learning and leadership development with their
annual performance review while earning free CME
credits and accumulating transfer credits toward a masters degree in business or education at an area university. For example, a physician who desires to improve
his or her communication skills with patients can participate in a series of courses taught by other physicians
whose patient satisfaction scores are higher. Coursework
is CME certified and eligible for transfer to an area university toward a masters degree.

TENSIONS IN THE FIELD

According to Goodalls study (2011), in the U.S. health

care industry, top-rated hospitals are more likely to be
headed by a physician instead of a professional manager. The study does not prove that physicians are more
effective health care leaders, only that top-ranked organizations tend to select more physicians to be the chief
executive officer (CEO).
Regardless of who is the health care CEO, leaders
are here to serve others and leadership development is
not about the person per se. Leadership development
is about the relationship between leaders and their followers and the leader as follower. It is about the intimate connection a leader has with a team of physicians,
nurses, and administrators in a health care setting. It is

the transparent communication a leader demonstrates

with members of the organizations board, neighborhood community, and donors. It is the emotional bond
that exists between a physician and the patient.
Tensions in the field of leadership development have
many sources. However, tensions can be reduced if leaders are taught to maximize their emotional intelligence.
Because the best leaders are the best learners (Kouzes &
Posner, 2010, p. 119), emphasis on developing emotionally intelligent leaders is critical in health care.
The phrase emotional intelligence (EI), or its casual
shorthand EQ, was first offered in 1990 by Mayer and
Salovey.
Because emotional intelligence is the ability to validly
reason with emotions and to use emotions to enhance
thought, the leaders challenge is to drive his or her
emotions and the emotions of others in a positive direction (Goleman, 1995). Part of the challenge of creating
and sustaining positive leadership is the need to recognize, manage, and direct ones own process of learning
and change. According to Boyatzis and McKee (2005),
people who manage their own development intentionally are poised to make good choices about what they
need to do to be more effective and satisfied leaders
(p. 86).
Cleveland Clinic Academys competency matrix and
interrelated programs provide caregivers, physicians in
particular, with an opportunity to manage their own

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leadership development. When coupled with the Clinic

Annual Professional Review (APR) for all 3,000 physicians and research scientists, the leader is invested with
the career resources needed to manage their own professional development with support from the department
and institute chairs, as well as the board of governors.
In addition to the APR, physicians and research scientists have access to an emotional intelligence assessment and executive coaches. Considered to be the single
most important competency that drives leadership performance (Goleman, 1995), EI can be measured and
developed. The clinic uses the Emotional Competency
Inventory (ECI), created in 1999, to assess the emotional intelligence of leaders, because it is highly reliable
and valid. The ECI 2.0 is a 360-degree tool designed to
assess the emotional and social competencies of individuals in organizations. Executive coaches certified in ECI
are available to help leaders interpret the assessment
results and develop an action plan. In order to ensure
confidentiality, the executive coaches are on retainer
with the clinic but are not employees.

Conclusion
As Bohmer (2011) contends, the only real hope for
improving health care delivery is for the old guard to
launch a revolution from within and redesign themselves. If health care educators desire to contribute to
the redesign, they must educate leaders to lead in a
time of chaos, risk, and uncertainty. Educators must
seek to develop a new breed of health care leaders who
are emotionally intelligent individuals and willing to
challenge the process in order to bring about change
and improved patient care.
Cleveland Clinic Academy is a best practice in leadership development. As a best practice, the academy
has been developing a new breed of leaders through
competency-based curriculum and integrated programs
focused on leadership, management, communication,

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and quality. The didactic courses, experiential learning,

and executive coaching have had an important impact
on leadership development at Cleveland Clinic and
throughout the world.
References
Bohmer, R. (2011). Fixing healthcare on the front lines. In Fixing
healthcare from inside & out (pp. 2948). Boston, MA: Harvard
Business Review Press.
Boyatzis, R., & McKee, A. (2005). Resonant leadership. Boston, MA:
Harvard Business School Press.
Cleveland Clinic Academy (2012). http://academy.cleveland
clinic.org/.
Endsley, S. (2010). Innovation in action: A practical guide for healthcare teams. Hoboken, NJ: Wiley-Blackwell BMJ Books.
Goleman, D. (1995). Emotional intelligence. New York, NY: Bantam.
Goodall, A. (2011, July). Physician leaders and hospital performance: Is there an association? Social Science and Medicine, 73,
535539.
Kouzes, J., & Posner, B. (2007). The leadership challenge. San
Francisco, CA: John Wiley & Sons, Inc.
Kouzes, J., & Posner, B. (2010). The truth about leadership. San
Francisco, CA: Jossey-Bass.
Salovey, P., & Mayer, J. D. (1990). Emotional intelligence. Imagination, Cognition, and Personality, 9, 185211.

Caryl Hess, PhD, is the director of the Cleveland Clinic

Academy at Cleveland Clinic and directs the leadership,
management, communication, and quality courses and programs for 3,000 clinic physicians, research scientists, nurses,
and administrators with an objective of creating a pipeline of
leaders. She has published and presented on the topics of leadership development, curriculum, mentoring, and technology
at national and international conferences, as well as received
numerous honors for her teaching abilities. Dr. Hess earned
her PhD from the University of Akron in 1993 and her MBA
from Baldwin Wallace University in 2000.

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