It Takes Two: Can Dyad Leadership Provide a Durable Pathway in Healthcare's Brave New World?

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 - doctor and woman

When three cardiovascular practices joined forces nine years ago to become Piedmont Heart Institute, leaders knew their success would lie in getting the structure right. “We realized we wanted to be a physician-led organization,” recalls Katie Lund, RN, MBA, senior director of clinical integration for Piedmont Healthcare, which includes seven hospitals and 26 cardiology offices across metro-Atlanta and North Georgia. “But we also knew that being a good physician doesn’t necessarily make you a good administrator. So we groomed our physician-leaders and paired them with administrators, and now we have more and more physicians moving into leadership roles within our dyads.”

Piedmont is hardly an outlier. As hospitals and other medical organizations are being redefined by integrated provider networks and the movement from volume to value, they are realizing that entrenched leadership models are sorely outdated. The days of easing physicians with the most years of practice into top-tier posts of authority are over; temperament, training and vision will be essential to bringing positive change to the entire organization. By pairing clinical and administrative leaders whose skills, expertise and credentials complement each other, dyads are carving a pathway into a new era of quality-based, team-driven care. “I believe they’re essential today to survival,” declares Cathie Biga, RN, MSN, president and CEO of Cardiovascular Management of Illinois and a former hospital CEO. “Leadership responsibilities are bigger than any one individual, and dyads allow you to pull together the best of both worlds and help ensure that people are operating at the top of their license.”

While no firm numbers exist on the number of dyads across the country, the Advisory Board Company cites a 2015 survey that found 46 percent of service line leaders and 32 percent of medical directors in hospitals are involved in dyads. The movement is clearly spreading as hospital systems adapt them to clinical service lines, such as cardiology, orthopedics and oncology; to improvement initiatives in areas like quality, finance and patient outcomes; and to regional or national networks of providers. Catholic Health Initiatives (CHI), for one, has moved to service line dyads at many of its 105 hospitals across the country as well as at its clinical practices. “I’m hearing of dyads popping up everywhere as people come to realize that what we’ve been doing in healthcare hasn’t worked,” asserts Kathleen Sanford, DBA, RN, senior vice president and chief nursing officer for CHI, and co-author of the book Dyad Leadership in Healthcare (2015). “We have tribes of people out there who have worked for years in parallel thinking they know each other, but really don’t. Now they need to cross over and become one big tribe centered around what is best for the people they care for.”

Challenges Abound

But, Sanford hastens to add, converting to a dyadic structure can be a daunting task. “Many clinicians who get involved are astonished at how much hard work it is,” she acknowledges, while adding none of the dyad partners she interviewed for her book said they would ever go back. For a dyad to succeed, according to participants in the field, hospitals must be committed to redrawing many of the traditional lines of power and control and be willing to openly welcome a new culture where shared decision-making and accountability are paramount. Physicians, for their part, must be willing to unload any biases they hold (be they gender, race, cultural or assorted others) and relinquish some of the autonomy they’ve enjoyed in the past to a team-based approach. They also must have a passion for communicating (and, when necessary, for sharpening their communication skills), particularly with their administrative partners. Therein lies one of the biggest challenges facing any nascent dyad: ensuring their clinical and administrative heads are respectful of each other’s background and skill sets and able to work seamlessly together—the antithesis of a shotgun wedding.

“You can’t just throw two people together and call it a dyad,” emphasizes Sanford, who is a partner, along with the chief medical officer of CHI, in a dyad responsible for medicine and nursing practice across the entire CHI system. “They must understand it’s going to change their perceptions of power and that they need to have the right conversations if they’re going to work well together. That’s the only way a true dyad can work