The IPC-UCSF Fellowship for Hospitalist Leaders is a custom leadership program developed for and with IPC The Hospitalist Company Inc. IPC is a leading national physician group practice focused on the delivery of hospital medicine and related facility-based services. IPC providers manage the care of patients in coordination with primary care physicians and specialists in over 900 facilities in 26 states across the U.S, providing care to over 1 million patients annually.
Robert M. Wachter, MD, Professor and Chief of the Division of Hospital Medicine at UCSF wrote about the emergence of the IPC program beginning with a meeting between Adam Singer (IPC’s CEO and Chairman), and Jeff Taylor (IPC’s president) – the practice leaders in the hospitalist industry, and himself in his blog (wachtersworld.com): http://community.the-hospitalist.org/2011/11/18/leaders-and-leadership-in-hospital-medicine-the-story-behind-the-ipc-ucsf-fellowship/ “Creating a true collaboration between a private hospitalist enterprise and our academic programs is an exciting and inspiring challenge, and we at UCSF are totally committed to its success.” Wachter coined the term ‘hospitalist’ in the New England Journal of Medicine in 1996 and is generally considered the academic leader of the hospitalist movement, the fastest growing specialty in the history of modern medicine. He co-directs the training program, along with fellow UCSF hospitalists Arpana Vidyarthi and Niraj Sehgal, and Center Director Ed O’Neil, an internationally respected figure in healthcare leadership training.
Dr. Wachter sums up the depth of the program as follows: “The fellowship went far beyond your typical Leadership 101 course. In addition to four 2-3 day on-site meetings, we also conducted twice-monthly distance learning sessions, mentored quality improvement projects, provided one-on-one executive coaching, and more. The goal was for the IPC physician leaders to develop a new set of competencies, including self-awareness of their strengths and gaps as leaders, in negotiation and conflict resolution, in running meetings and giving oral and written presentations, and in innovating. We also taught quality improvement, patient safety, and project management, along with the basics of health policy and health economics for the hospitalist leader.”
Niraj Sehgal, MD, MPH, himself an alumnus of the Center’s CHCF leadership program, has been integral in the initial development of the program in 2010 as well as its continuous revisions. The first cohort was to launch within three months of the contract initiation. He recalls many different conversations about the goals and structure of the program with IPC: What are you trying to accomplish? Who are the strategically important people? CEO Adam Singer identified practice group leaders as being in an essential leadership role, but only equipped with clinical training. They needed more leadership training to be true “hospitalists”.Change management and care improvement were vital parts of their roles and needed to be addressed through the program.
Greg Harlan, MD, Director of Medical Affairs at IPC, has been very much involved in the program development, even participating in the first cohort. He explains some of the motivating factors for IPC to collaborate with UCSF. “We saw that we had many practice group leaders (PGLs) with widely varying skillsets spread across the country. Meanwhile demands on hospitalists were increasing, so was the need and desire for greater alignment between PGLs and their facilities, the hospitals. We wanted them to be able to move beyond clinical leadership to hospital leadership and create a shared vision--for each practice, for PGLs and executive directors in each region and for PGLs with IPC nationwide”.
“The Center had the model and core curriculum to put a program together quickly,” Dr. Sehgal explains, “but we emphasized not developing a cookie cutter program. Because this was a rapid planning cycle for the first cohort, we were balancing what needed to be customized to hospitalists with IPC’s energy for wanting it to happen right away. We built, for example, new, hospital and hospitalist-specific role plays around issues such as “managing difficult conversations”. The process was very much a co-creation with the IPC team. The more we’ve learned about their needs, the better the program has become.”
A great deal of care was exerted defining the goal of the program so that the degree of success could be measured. Initially, simply moving the needle on some leadership skills was important; attendance served as a measure of engagement. But the IPC team also wanted to create space to let transformation happen. Some participants really had profound insights into what they required to become great leaders. Dr. Sehgal adds: “Considerable focus was also directed to deliverables in the projects. IPC is very data and performance driven with a great IT structure to measure results. They have a great desire that the projects not only let people learn skills, but actually have a measurable impact.”
Dr. Wachter reports in his blog about the Cohort 1 Graduation: “Sarada Sripada, a diminutive woman with an outsized passion for improvement, focused her project on patient satisfaction. When the fellowship began, her group’s patient satisfaction survey results were abysmal, in the bottom decile of Press Ganey’s national database. The fellowship taught her that she needed to set an improvement goal. To me, a goal of reaching the 50th percentile would have been fine, and a goal of the 75th percentile would have been highly ambitious. But Sarada thinks big—her audacious goal was to reach the 90th percentile. By working with her team, collaborating effectively with other departments at her hospital, and using the skills she learned in the fellowship, she achieved her goal, a jaw dropping achievement. The audience of about 100—Cohort I’s 40 participants, the 40 new participants in Cohort II, IPC’s executive leadership and several of its board members, and our UCSF faculty—overflowed with excitement and pride, and several of the presentations received standing ovations.” In fact, Sarada presented her project last month at the national Society for Hospital Medicine meeting.
Greg Harlan describes the results of the program so far: “The program has helped build a sense of community between the PGLs, a peer network. It created more engagement among the group. Participant feedback is continually positive. There is also anecdotal evidence of increased self-awareness and changes in leadership style being observed at multiple levels in the organization as “second generation” projects are starting to pop up.” As the program continues, Dr. Harlan is working on improved workflow and data capture methodologies to show quantitative outcomes of the program such as ROI, retention, and clinical outcomes improvement.
Dr. Sehgal also expresses appreciation for the process itself: “I selfishly gained a lot as well. I learned more about community hospital settings and gained new insight into my own field with IPC being a nationally successful hospitalist company.”
Dr. Harlan cites benefits beyond the impressive program results as well: “The program development process forced us to look internally and clarify our organizational structure and reporting relationships. In addition, there has been very good communication from the Center. The clarifying questions from the program directors helped us continually reevaluate and refine our goals for the program. The process has been truly collaborative, a co-creation. The Center also uses feedback to reevaluate content and teaching methods in a cycle of continuous improvement.”
For more information about the Center’s custom programs, please contact Jake Blackshear at jbleackshear@thecenter.ucsf.edu.