Hospital Impact—Putting team-based leadership into action at your organization

Scott Kashman headshot
Scott Kashman

Last month, a panel discussion that I attended during the Health Forum and American Hospital Association Leadership Summit got me thinking about team-based leadership models—and how my own organization is making them a reality. 

During the event, John Combes, M.D., the AHA's senior vice president and chief medical officer, outlined the six integrated leadership principles for success that have been approved by the boards of both the AHA and the American Medical Association. 

As detailed in an article from Hospitals & Health Networks, these principles include ideas such as integrating leadership at all levels and creating an interdisciplinary structure that supports collaboration in decision-making.

While most health systems have administrators, nurse executives and physician executives, our hospitals are trying something a little more unique—and in line with what Dr. Combes described. Over the next few weeks, we are implementing our dyad leadership model across all our hospitals. This will include vice president of patient care services and the acute care medical officer. Two of the five dyads are already in place, with the next three set to roll out over the coming weeks.

Our physician and nurse executive will each work in partnership, and will be responsible for the total operations within the hospital. This team-based leadership structure will foster collaboration, alignment and where appropriate, standardization. 

Not only will these leaders have day-to-day accountability within their hospital, we are also working together across all our hospitals and ancillary services to learn best practices from one another. This applies in our approach to quality, safety, patient experience and financial performance. Of course, these learnings and collaboration will extend across our full care continuum.

When it comes to finances, though, it can be easier said than done to apply the principles of standardization. With more than $1.74 billion in net revenue at my health system, it’s not uncommon for our departments, hospitals, ancillary areas, clinics to spend where they see a need—for their respective areas. The challenge comes when you share what that cost looks like as you apply a consistent standard across the board. We have examples of tools and resources that may cost $100,000 to $200,000 when applied to one hospital and $600,000 to $1 million if applied across all facilities. 

My advice to organizations with similar concerns: Start reviewing your system's collective contract costs, purchased services and overhead costs. Then have a dialogue where you want to spend your money.

Here are some suggestions to spend your system's money like it is your own:

  • Determine your most critical long- and short-term strategies.
  • Ensure you know and achieve the operating margin you need to continue to support your mission.
  • Apply the necessary operating dollars to support the "must haves or non-negotiables" (such as core staffing levels to ensure compliance, safety and high-quality care). These costs should also include the "stakes in the ground" or "big bets” your organization is banking on for success. Everyone needs to know about these and rally in support.
  • Review the "nice to haves" and prioritize based on what money is left. These remaining funds should help you optimize quality, safety, service and financial performance. They should also support your team. The only way to run your company is through the engagement of your employees, medical staff, volunteers and board of directors; they are the ones directly taking care of your patients or supporting those who take care of your patients.

Ultimately, when you are part of a collaborative leadership team, it is your job to challenge each other to achieve your organization's goals. It is also critically important for leaders to clarify priorities and trust their team. How you choose to optimize exceptional care delivery, will be determined to a large degree by the way you leverage your resources and collaborate.

I look forward to hearing stories about how you are using team-based leadership models.

Scott Kashman is the chief acute care officer for Lee Health, a health system based in southwest Florida.