Integrated leadership in healthcare usually refers to collaboration between an organization’s executive management team and its physicians, often referred to as dyad leadership. Dyad leadership surfaced as a necessary change from the days when health system administrators and physicians co-existed but did not truly collaborate. The mandate to begin moving from transactional, fee-based healthcare services to value-based services exposed the need for administrators and physicians to partner on the best ways to deliver optimal care without increasing costs.
Unsurprisingly, as physicians and healthcare executives began co-leading and forming strategies to improve patient care and remain competitive, they discovered a gap in their leadership teams – namely the nurses. Representing the consistent caregivers who monitor patients, administer medications, collect and report vital information, all while coordinating multiple people and processes to ensure that everything gets done, nursing leaders are essential to achieving organizational change and improvement.
However, even more important than the crucial knowledge that nurse leaders bring to the table, is achieving sincere and active engagement from all stakeholders in the delivery of patient care. And that kind of engagement is only possible when there is trust.
Without trust, there is no alignment, without alignment, there is no engagement, and without engagement, there can be no transformation. Functional trust-based partnerships between hospital executives, physicians, and nurses hinge upon the ability of each partner to work together, in service of shared clinical and business priorities.
The tasks that have to be accomplished in order to transform structure, standards, processes, and, ultimately, outcomes require a culture of collaboration and sincere trust. Unless and until that trust is established and physicians, nurses, and executives lead the way together, sharing a vision and values, the list of tasks-to-be-completed for healthcare transformation will never be completed.
Of course, establishing that trust may not be easy. A long history of silos in healthcare delivery has established some well-ingrained beliefs and issues that must be overcome.
Common Trust Issues and Solutions
| Trust Issue | Potential Solution |
| Risk Aversion: Due to the fragmentation of the healthcare industry, trust and collaboration are not natural among any of the various stakeholders, beginning with administrators, physicians, and nurses, but also including government, health plans, and payers. Risk is being shifted among participants and all are nervous about the future and hesitant to rely on others for their own security. | New Mindset: Integrated leaders come together and publicly commit to an organization-wide growth and abundance mindset to counteract and replace a culture of blame and mistrust. Physicians, administrators, and nurses should be purposeful in setting the collaborative tone for the desired culture and address their concerns about risk openly and then work to mutually acceptable solutions. |
| Physician Employment: A tendency for resentment amongst physicians who value their autonomy and do not like to be treated as “employees” is quite common. This creates a barrier between individual priorities and organizational objectives—usually further exacerbated by a lack of trust. | The Right People: Employ the deliberate selection and on-boarding of leadership partners – use behavioral based interviewing in the selection process. Select for cultural fit as much as technical skills. |
| Lack of Respect for Other Roles: Unfortunately, talking over one another rather than to one another has become commonplace between physicians and executives. And nurses all-too-frequently feel left out of the conversation entirely. Alignment between individuals and the goals of the organization remains a huge challenge for individuals accustomed to traditional roles in an industry that is conservative about making change that does not clearly and immediately benefit patients. | Right from the Start: A structured onboarding process makes it possible for new physicians, nurses, and administrators to start fresh together in a partnership from the start. Introduction to the roles and perspectives of others can be an eye-opening experience and makes the next step of participating in reciprocal business and clinical acumen training infinitely more productive. Developing shared goals between stakeholders through cooperative, trust-based exercises as early as possible will pay benefits far into the future. |
| Failing to Recognize Others: A consequence of the expert culture vs. collaborative culture in healthcare is the inability of physicians and administrators to appreciate the contribution of others in achieving success, which, in turn, makes it all the more difficult to take advantage of strengths and build collaborative teams. | Practice Together: Practice collaboration by working on strategic action projects where leaders build trust, band together to garner support elsewhere in the organization, establish collaborative goals, and share power. Also, time together working on leadership skills and strategies allows physicians, nurses, and administrators to get to know and appreciate one another’s talents. |
| Lack of Self-Awareness and low EQ: Neither medical schools, nursing schools, nor MBA programs focus on the value of self-awareness and emotional intelligence, both of which are essential to building relationships and trust. | A confidential 360 assessment immediately fosters better self-awareness and allows individuals to reveal vulnerabilities to colleagues, which builds trust. |
To develop productive partnerships, administrators, physicians, and nurses need a deliberate structure and experience to create the opportunities to build relationships, get to know one another, and build trust. An active engagement strategy and plan across all silos will go a long way in building that foundation of trust.
