Candidate Profile

Dr. Wesam BolkhirSameh Naseib, MD, FACP, FHM
Chairman, Department of Hospital Medicine
Beaver Medical Group
Redlands, CA

Leading Change, Vision First
By Nick Marzano

It is essential of good leadership to be able to identify opportunities, overcome problems, and adapt to trends. Leaders often grow excited by this process and assume others will see the intrinsic value in the solution. Yet there is a difference between seeing the end-point and knowing how to get there. In the hospital setting, that path runs through a myriad of administrators, academics, nurse practitioners, and physician assistants, just to name a few. Effective leaders know it's not enough to have the vision and see the goal. Authentic change means motivating others to walk the path with you. For Dr. Sameh Naseib, the goal is making sure patients are improving, overcoming disease, and experiencing a better quality of life. The path is quality improvement, and he is committed to convincing others that his passion can make a difference.

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And it has made a difference. In the past year and a half, Dr. Naseib served as Physician Champion on a Congestive Heart Failure project that effectively cut by forty percent the number of readmissions due to CHF. The team implemented a new order set, and developed patient teaching tools and standards that now include videos, booklets, and follow-up post discharges by case managers. Prior to this, he served on a committee charged with gaining accreditation as a stroke center. While not a QI project per se, Dr. Naseib nonetheless considers it another coup for patient safety, since patients can now receive treatment on-site instead of there being a rush to transfer them within the critical window for effective thrombolytic therapy. Now, as part of his Leadership Certification Project, Dr. Naseib has set aim on the next area for opportunity.
By applying the same leadership principles honed in his CHF and accreditation initiatives, he is looking to have a big impact on instances of venous thromboembolism (VTE). At Redlands Hospital in Redlands, CA, where Dr. Naseib is the Chairman of the Beaver Medical Group Hospital Medicine Department, VTE prophylaxis was present on some order sets but not in an organized or goal-oriented structure. Realizing there was not a comprehensive program in place to prevent VTE in the hospital, Dr. Naseib assembled a team in November to address the gap. The goal of the team is to formalize the structure and print a form with every order set as part of the admission protocol, thus ensuring every patient is getting a form of prophylaxis. It seems like a straightforward enough vision but one that requires communication and mutual understanding from all parties. Buy-in at the hospital administration level, creating the dashboard, and turnover within the original group have all been necessary hurdles to cross. The next hurdle, according to Dr. Naseib, is getting buy-in from general hospital staff. To do so, Naseib is speaking at the general medical staff meeting in the coming weeks about VTE prophylaxis. I asked him what he plans to say that can convince a staff with varying degrees of stake in the project and a variety of pulls on their time.

Dr. Naseib said the key is communication and specifics: “Over 2 million Americans suffer VTE every year, with over half of them developing VTE in the hospital or thirty days post-hospitalization. We want to give them the information on our local stats.” He hopes that communicating the problem in evidence-based, relevant numbers will help connect the initiative to everyone’s overall duty to patients. Subtly hidden within this is Dr. Naseib’s unstated leadership mantra: lead with the vision, not the plan. There is no doubt about his spoken mantra, reiterated on several occasions throughout our interview: “Our patients deserve the best care.”

Voice of Experience

Leonard Marcus, PhDJasen W. Gundersen, MD, MBA, CPE, SFHM
President & Chief Medical Officer
TeamHealth Hospital Medicine

What is the best piece of leadership advice you have ever received? If you are able, please provide an anecdote or elaborate briefly on how it has impacted your leadership style or career.

Succession planning is critical. It is something that young leaders have a tendency not to think about as much. True leadership allows the programs that you built to continue on with the same, or more, success after you move on to new roles. At first, it can feel threatening to new leaders to build succession early, but with time it is important to know that there is someone else to take your place when the next opportunity arises. I found myself in this very position a few years ago.  A new opportunity occurred within my organization that was a great fit. I was told the job was mine as soon as I had someone to replace my current role. This was a big learning point for me, and one that I have tried to build and grow with as my career has progressed.

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What is one piece of advice you would give to up-and-coming leaders?

Balance your personal lives and your careers. It is very exciting to be in new roles with added responsibility, and it is very easy to get swallowed up in it. Take a break from email and work to recharge. Everyone hits a burn out point. It is important to set the expectation with those you work with about your availability and coverage. Set a strong example for hard work and time off. Mentor your direct reports to find the work-life balance. We talk about this a lot, but it is so often looked over. 

How does a leader of a growing hospitalist group balance quality and growth, which can sometimes feel at odds?

Growth is important, but you cannot just grow for growth’s sake. It is about strategic growth. Evaluate each opportunity to determine if the program is the right fit. We need to be sure that we plan for the programs and what the expectations are of each program. If we do a poor job and have poor quality, that pretty much limits any future growth. After the program is started, we must constantly evaluate the effectiveness and quality of the program.

How does your company invest and develop its leadership pipeline?

TeamHealth has been in the physician management business for over 30 years.  We have a robust leadership training and mentorship program that is tailored to each of our specific service lines. The academies occur several times a year. This past year we partnered with the Studer Group to add yet another layer of support and training for our leaders throughout the company. The breadth and depth of experience in the company is a tremendous resource for training and mentoring our leaders. 

Dr. Gundersen is President and Chief Medical Office for TeamHealth and a member of SHM’s Leadership Committee. He has also been a key member of strategic planning teams on a national level, such as chair of the National Task Force on Family Medicine Hospitalists on behalf of the Society of Hospital Medicine (SHM) and facilitator for special interest forums at national meetings.

Leadership Pearl of the Month

Navigating the Dyad Management Model

Sylvia C. McKean, MD, SFHM, FACPRussell Holman, MD, MHM
Chief Clinical Officer
Cogent HMG
Course Director, SHM Leadership Academies

The “dyad” model of management, referring to the partnership between a physician leader and a business/operational leader, has become a more prevalent and popular structure over the past several years in healthcare. The main drivers for creating the partnership are the unrelenting complexity of the healthcare industry heightened by the accelerating pressure to concurrently manage both quality and financial outcomes. While we in hospital medicine often refer to delivery of clinical patient care through inpatient teams, a growing value is being placed on practice and business management through teamwork of the physician/administrator partnership.

Attributes of a successful dyad team

  • Joint accountability for performance goals
  • Each member may take primary responsibility on an issue, but decisions are made collaboratively
  • Neither member reports to one another
  • Each member demonstrates and embraces mutual respect, recognizing that their partner brings valuable knowledge and skills to the team
  • Mutual interdependence
  • Team shares clear vision and understands mission and organizational goals
  • Constant communication with one another
  • In private may disagree; in public speaks with one voice

Potential division of labor

 

Barriers to effective teamwork

  • Lack of investment of time in developing the relationship
  • Poor communication, either in terms of amount or quality
  • Value placed on the individual rather than on the team
  • Undermining the authority of the dyad by communicating reluctance, blame, or victimhood to others
  • Lack of commitment, refusal to share information, or the lack of ability to give over control to the dyad
  • Lack of alignment with the rest of the organization

Recommendations for implementing and maintaining a dyad team

  1. Invest time in hiring dyad members who possess the capability to work well in teams
  2. Do not assume that two good people will work well together; create a dyad training program that includes:
    1. Informal venues to get to know each other personally
    2. Structured review of each other’s job descriptions and functional duties
    3. Set clear expectations about how the dyad is to function
    4. Set clear expectations about communication frequency and venues
    5. Consider personality profiles for each member of the dyad with open discussion about the findings
    6. Conduct a deliberate conversation about the concerns, fears, and apprehensions of each member working in such a model and/or working with the specific other individual
    7. Discuss and agree on how disagreements and decision making will be handled
    8. Identify resources for trouble-shooting
    9. Set a regular meeting schedule to revisit and reinvest in the dyad relationship
  3. Set shared goals
  4. Align incentives and rewards
  5. Do not assume this will be easy or that a single orientation meeting will be sufficient. It is not often easy or intuitive, but the synergistic power of the dyad model is unequaled.

Resources

The Physician/Administrator Team. MGMA Connexion. January 2002, pp. 54-59.
Examining the “Dyad” as a Management Model in Integrated Health Systems. Physician Executive Journal. January-February 2010, pp. 14-19.