Laying the Foundations for Building a Clinical Program: A Tactical Step-By-Step Approach.

From Vision to Execution

Building a clinical program in a hospital, clinic, or any health system requires a meticulous plan and strategic execution. Whether you're an early career physician just stepping into practice, or a seasoned medical professional, the journey from envisioning a program to seeing tangible results can be fraught with challenges. This article outlines a step-by-step guide from inception to implementation, tailored especially for physicians, medical students, residents, and fellows.

1. Understanding the Terrain: Know the Main Players

Before laying the first brick, one needs to survey the land. The complex ecosystem of a healthcare setup is divided into numerous divisions and departments. Your first task? Identify the pivotal players in each. This doesn’t necessarily mean the person with the highest rank. Instead, find a "Point of Contact" POC who has two of the following three characteristics: influential, competent, and accessible individuals.

Pro-tip: Create a list of contacts within each division. For instance, while the Emergency Room is vast, identifying an accessible physician and a nurse who can be your primary contacts will be invaluable. Similarly, departments like Pharmacy, Radiology, and Surgery should each have a designated point of contact.

You do not need POC in every division: You may not need a point of contact in geriatrics if you are building an Interventional Pulmonology Program.

2. The Art of Networking: Developing Points of Contact

As a leader, one of your primary tools is communication. Developing a roster of these primary contacts allows swift execution once your strategic planning is complete. To forge these connections:

- Approach heads of departments or divisions.

- Express your intent clearly, and request for a dedicated point of contact.

- Demonstrate the importance and value of having a representative from each section.

You should accomplish this task of having a POC list, within the first 3-4 months of taking over the role. If you do this slowly, you will build your program in 5 years, rather than 2-3 years. Practically speaking, to build a reputable, multi-million dollar revenue program that is making an impact on patient care, it takes at least two years.

3. The Dynamics of Doctor-Administration Relationships

The bond between physicians and administrative leads often goes unrecognized. Whether you're operating in a large practice group, a private clinic, a hospital, or a nursing home, the challenges remain strikingly similar. Hospital administration typically emphasizes revenue and compliance metrics, driven by business needs and external healthcare governance forces, such as Medicare and Medicaid in the US and provincial health bodies in Canada, the UK, and Australia. As a physician leader, the task at hand is multi-fold:

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(1) Ensuring the well-being of your clinical team, preventing burnout.

(2) If in an academic setting, make sure your trainees are satisfied with their learning environment.

(3) Monitoring your personal work-life balance and financial equilibrium.

(4) Most crucially, ensuring patients receive timely, expert, and respectful care.

Most physicians struggle to advocate for these tasks. Instead, they are obsessed with building a program they have been assigned to develop.

There is such a large divide between the physician perspectives and hospital administrative perspectives that unless you spend time in chalking down the metrics at play here, you may not be able to deliver the results. Once you have a list of outcomes/metrics/points that may be useful for both clinicians and administration, your biggest hurdle is over. Often, parallel alignment rather than singular alignment is often a pragmatic approach. Meaning, that hospital administration does not need to walk the line that physicians have to walk, as long as both are progressing and advancing forward. Singular alignment would be ideal, but it really depends on who your operations lead is. I have been lucky to have exceptional administrative leaders as partners who lobby for research funding for faculty without even having any selfish agendas. But luck aside, you will have great success if you try to act as a bridge and advocate for either sides as you balance the ideological forces with different agendas.

4. Mastering Multilingual Leadership

To be an effective physician leader means to be multilingual in the realm of healthcare. This involves:

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- Revenue Language (Admin Language): Grasping the financial mechanics that keep the hospital or clinic running efficiently.?

- Caregiver Language (TLC Language): Engaging productively with pharmacy, nursing, and tech leadership, understanding their challenges, motivations, and aspirations.

- Ego-pampering: This is a secret language that you will have to learn if you want to keep your doctors behaving. There will be egos that you will have to pamper to keep some strong-headed people aligned. For some people, this comes naturally. For others, not so. Irrespective, for leadership in healthcare, it is an incredibly useful tool to have.

Armed with these languages, the true test of leadership is to orchestrate an environment where patients have seamless access to quality care without being burdened by excessive costs. It's about creating a sustainable model that ensures the financial health of the institution while upholding the oath of patient care.

5. Carving Out the Path: Creating a Clear Journey Pathway

Now, with a team in place and influence established, sketch out your program’s journey. For instance, if building a high-functioning comprehensive stroke program, outline each step, from patient intake, diagnosis, and treatment protocols, to post-care follow-up.

Remember: Consistency in promoting your program's agenda helps solidify your goals within the team. Regular reminders ensure everyone stays aligned.

6. Charting Your Leadership: The Leadership Map

A visual representation can often speak louder than words. Sketch out your leadership chart:

- Mark out points of contact.

- Identify your superiors.

- Highlight individuals who fall within your sphere of influence.

7. The Financial Blueprint: Understanding Profitability

One of the primary drivers for any program's sustainability is its financial viability. To ensure your program thrives:

- Engage with finance and data teams. Understand their expectations and concerns.

- Familiarize yourself with the operational, quality, and revenue dynamics of your specialty.

- Outline how your program will be financially beneficial to the hospital. A program that consistently bleeds money will rarely find favor with the administration.

This point #7 is the last critical backbone for any emerging leader. Healthcare is not built in a way where accessing, reviewing, and getting familiar with your program's economics, cash flow, funding models, direct and indirect revenue streams, and impact of quality metrics on funding are parameters you must start reviewing and learning.

8. Data & Dashboard: Understanding Numbers

The most impactful leaders will advocate for data-driven programs. In healthcare, either there is no data, scarce data or sluggish data that flows in a few months later. Spending the first year of your leadership role in creating, and advocating for a data-driven backbone is the best decision you will ever make. In most situations: order-to-appointment timelines, readmission rates, length of stays, infection rate, OR turnaround times are some examples of these variables that may be relevant for your measurables. By reviewing these at least monthly, along with financial numbers, you will be able to ahead of the crowd. You will be able to align both the clinical and administrative side of the practice to align towards achieving your goals.

In conclusion, building a clinical program demands more than just medical expertise. It requires leadership, communication, financial savvy, and most importantly, an unwavering commitment to patient care. Embrace these facets, and the journey from vision to reality will be fulfilling, both for you and the community you serve. Negotiations, impact, influencing, and branding are other areas you will need to master, but I will cover that in future.

Send me a message on LinedIn if you are struggling as a clinician leader and/or feel stuck. Happy to help!