An interview with Dr. Douglas E. Henley, M.D., FAAFP, Executive VP and CEO of the American Academy of Family Physicians on what it takes for a new CEO to successfully take the helm of an advocacy organization. The American Academy of Family Physicians and its chapters represent more than 115,900 family physician, resident, and medical student members.
Douglas E. Henley, M.D., FAAFP, serves as executive vice president and chief executive officer for the American Academy of Family Physicians. The AAFP is the medical specialty organization representing 105,900 family physicians and medical students nationwide.
Change management and Health Human resources (HHR) in Health Care Organizations
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Arcus: Could you please identify 3 of the biggest challenges a new CEO might face in deploying a strategic plan at a medical organization.
Dr. Henley: I think the skill set of the CEO has to have an internal and external focus. Internally, you need to mobilize staff to understand the strategic direction and the key areas of focus so that they have a sense of priority for their work and how it fits into the organization as a whole. Externally, you have a board of members that you need to engage and you also need to consider the politics of medicine in Canada, dealing with the government or with other medical associations, to move that strategic direction forward. So there needs to be a balanced skill set with someone who can manage those internal and external requirements and still be able to move the agency’s agenda forward.
Arcus: For an organization like yours, do you believe the CEO needs to come from within the ranks or is external experience in a related field sufficient?
Dr. Henley: Well I guess I am biased. I am a family doctor and in today’s environment and when you have a large physician membership to speak to and represent, such as my own, I do think the CEO needs to be an integral part of the profession.
Arcus: It can be a polarizing discussion. Some people say it is important for the CEO to have a proven record in the field for credibility. Others say there is a balance of skill sets. Or that all things being equal, the position should go to the best manager. That is not to say that someone who is a physician could not also be a good manager. What three things would you say are the most persuasive points to go with industry experience over managerial skills? Do you think it is important to understand the complexity around medicine, for example? To have firsthand experience with it?
Dr. Henley: Yes I think both are important. I do understand the comment that you made about a good manager but let us not forget that in an organization like AAFP, you can create other senior staff positions such as a COO, who can be a non physician with excellent managerial experience and an ability to run the internal management. That allows the CEO, preferably in this case a physician, to be the external face of the organization while not divorcing him or herself from being the leader of the staff. The primary agenda of the organization will be serving the needs of members and representing them, particularly to the government and to other medical associations. Having someone who is a physician with that background, and who has that capability to represent well in the external environment, that is very important.
Political acumen is important – the ability to be patient, to surround yourself with people who are sometimes smarter than you are and be comfortable in that environment and to also be a good listener.
Arcus: If you had to list three skills essential for the incoming CEO to succeed, in context with the new kind of challenges they are going to face over the next 5 or 10 years, what would they be?
Dr. Henley: I think having some previous executive experience would be very helpful. For example, for a medical organization it could be a physician who has run a large physician group, or someone who has been a CEO of a health care system, or a director of a hospital or whatever. So, some degree of having some knowledge of how you interact and motivate staff is related to that. Political acumen is important – the ability to be patient, to surround yourself with people who are sometimes smarter than you are and be comfortable in that environment and to also be a good listener.
Arcus: How many years experience do you think would be optimal to take on the CEO role of an organization like AAFP? Some have said the ideal candidate should be a practicing physician and have been in an administrative position for the past 10 years. Is that a reasonable tenure, level of experience?
Dr. Henley: I think the management experience needs to be at least 5 years in duration, maybe 10, but I think it still could be someone who has spent that time in private practice. Some practicing physicians manage a group of doctors so the experience can accumulate simultaneously. One doesn’t have to follow the other.
Arcus: Do you have an opinion on how long the optimal tenure of a CEO would be? 10 years? 5 years? Is that something that should be considered or not?
Dr. Henley: I don’t think so. The board may want to have a contract limit, like the first contract may be for 3 to 5 years or something like that. To me, though, that should be a renewable contract, assuming that the CEO is doing his or her work well as judged by the board. Continuity of these positions is critical in terms of the relationships that you build with people over time. So the academic model, of you being a department chair for 5 years and then you step down, that may be a model that works well in academia but I don’t think that is a model to follow with these types of positions. I think as long as the board deems that the CEO is doing the job well and that the organization is moving forward, I don’t think there should be any limit on that.
The contract may be 2 year evergreen contract. It could be a 2 year contract that is evaluated every year. So if, for example, my board decides at some point in time that they want to go in a different direction, I will complete the last year of my contract and then be gone. But every year when we do the performance assessment, if I am doing a good job and they want to keep me, then I get a brand new 2 year contract, and so it rolls over in that manner. It has worked well for the academy. Now several other CEO colleagues they have 3 year contracts at a time that are renewable and some even have 5 year contracts that are renewable. So limiting the number of years that one can serve and then you have to step down – I don’t see that as a good policy.
Arcus: Could we talk about two or three strategic challenges that medical organizations facing in Canada, and maybe I could get your comments on each one, based on your experience in the US. With regard to membership engagement, what would be three things that in your experience have really driven engagement? I will give you one example. One of the things we have heard in our research with member funded organizations is that members who don’t have a good understanding of the strategic priorities of their organization tend to not see as much value in their membership as others. Can you share some insight into membership engagement and what drives it?
Dr. Henley: Anybody in the association business would be extremely happy with a high penetration of market share. The point is, every association, every CEO that I talk to, in every medical association in the United States – they are all having the same concerns. Every board has the frustration that when they go out and meet the troops, the membership is frustrated because they don’t know what the organization (or in our case the academy) is doing despite the fact that we bombard them with newsletters and everything else.
The fact is that they are busy people. So if I was a new CEO of a Canadian medical organization, what I would probably do is to get an external communication audit and learn what we are doing well and what can we do better. I imagine that one of the areas that could be improved is the use of social media; I know we have been guilty of that. In the last year and a half, we did an external audit and they helped us a great deal in terms of our communication, in terms of giving a bit more voice to the member and better promoting the organization rather than just informing members of the organization. There is a fine line difference between the two. How you word articles and headlines is important in terms of how to get people’s attention.
So again, with those numbers you just described, I would be smiling and celebrating but I would also be thinking of engaging social media more aggressively, adopting the role of a chief listening officer. If you are engaging people in different modes of communication, how are you listing them and picking out the common things in the middle of the bell curve that you need to be listening to versus the extreme left to the right.
Arcus: That is an interesting comment around membership. One of the concerns we hear from members of professional organizations is that these organizations have grown rapidly and with size comes fragmentation of member priorities. And as a result, the formation of diverse interest groups with potentially conflicting priorities. Do you think that should be an area of concern for professional organizations?
Dr. Henley: Professional organizations have certainly gone down a distinct pathway in the recent past- of what is referred to by some as special interest groups. I have been enamoured with that in one way but I am concerned that the trend may result in too many of those types of groups. It is one thing to create some online communities where a certain number of docs of a given level of interest, say emergency medicine, or rural practice, or maybe HIV care, things like that, are able to connect electronically with other doctors of like mind and share experiences, thoughts and ideas through online communities.
It is an entirely different thing to create a governance structure that gives governance voice to those groups. Some of them are large enough that they need voice. For example, emergency medicine in Canada is obviously large enough that they need that. But I am not sure that it is wise to complicate a governance structure of a professional organization so much. You add that additional administrative burden to your organization without significant return. I am not sure what the answer is. There likely is a need to pause and reassess the direction where they are going; that is an area that needs continued thought and discussion before expansion.
Arcus: One of the challenges we have heard is that rural physicians do not seem to be as much in the fold as those at teaching hospitals or urban locations in Europe and North America. Can you comment on the challenge around the engagement of rural members?
Dr. Henley: This is definitely an issue we face in the US; medicine is changing in both countries. It is clear that consolidation is afoot in terms of the efficiency scale. In rural practice, obviously that is much more difficult to accomplish. Using the internet and electronic health records and other technological advances will likely bring several rural practices together under a new legal umbrella. Kind of like a practice without walls where you have a central administrative unit located somewhere but all of the practices are out doing their usual daily work in their communities while the central administration helps to achieve some efficiency.
Arcus: How have you addressed that challenge in the US?
Dr. Henley: We have an online community where folks in rural practice can communicate with each other. We are also working now through our membership group to segment members so we can assess what are the key segments of membership that we need to focus on, and how do we modify the metrics to those groups on an ongoing basis. Things like male versus female, new physician versus those who have been in practice for a number of years, etc. If you can end up with the identification of 10 or 12 segments of your active membership that are most important, they would certainly have some different needs but they will also have some common needs which they would have communicated with each other.
Arcus: What would be other polarizing areas? You talked about male versus female, new physicians versus older, international versus local. Are there any others that come to mind?
Dr. Henley: Those who do a lot of procedures versus those who don’t, those who still do OB, those who don’t. Things like that.
Arcus: In closing, we talked about some of the contentious issues with special interest groups and rural membership. If there was one more thing that seems to be a hot button issue, what might that be? Is there another issue on the radar?
Dr. Henley: The rural issue has become more prominent in the last couple of years. A number of years ago somewhere, I am not sure if it was New Zealand…but the rural group got so strong that they actually separated from their mother academy. That created quite a rift. There is a risk of that happening in Canada. So I think their attention to that will be very important in the coming years in terms of how they better listen and learn in terms of what the needs are of their rural membership in Canada. To me, that is a larger concern than the necessity to have all these special interest groups.
Arcus: In closing, if there were 3 pieces of advice you have for the new CEO getting into a new position at a medical organization, what would they be?
Dr. Henley: One would be that once that person has been there 5 or 6 months, bring in an external consulting firm to do an external assessment to “see the lay of the land”, so to speak. This is what we did, to look at the organization from an internal perspective, to evaluate how can the staff be more efficient and better organized, to assess communication and use of information technology and what are those needs going forward. This would be a complete evaluation where you throw your doors open, be transparent and see what you can learn. That was very effective for us. Number two, I think would be addressing membership issues.
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