The Mayo Clinic is a large multispecialty, multisite healthcare organization centered in Rochester, Minnesota. It has three large domestic destination medical center sites, located in Jacksonville, Florida; Scottsdale, Arizona; and Rochester, Minnesota, as well as multiple international destinations. Additionally, a substantial portion of the Mayo Clinic Enterprise is the Mayo Clinic Health System (MCHS), which has locations in 44 communities in Minnesota, Wisconsin, and Iowa, and is organized into four regions, two primarily in Minnesota and two primarily in Wisconsin. (The Iowa locations are divided into one of these four regions.) The MCHS is composed of 53 clinics, 16 hospitals, and a number of other facilities.
One of the MCHS regions is the Northwest Wisconsin (NWWI) region. The regional hub facility of MCHS NWWI, located in Eau Claire, Wisconsin, consists of 5 hospitals, 10 outpatient clinics, 5800 employees, and over 395 physicians and 262 advanced practice practitioners (i.e., nurse practitioners, certified registered nurse anesthetists, nurse midwives, and physician assistants).
The Mayo Clinic is organized as a physician-led organization, meaning that a physician is the lead (or chair) of most organizational functions and departments, partnering with administrative and nursing leaders to form a triad of leadership. Simply stated, a physician must be the chair, or named leader, of all clinical committees and medical functions. This requires a great number of physicians to act with administrative responsibilities. The business structure of MCHS NWWI is similar to that of the Mayo Clinic.
Physician leadership training has been recognized nationally as a growing need for medical facilities.(1-5) This need has been reported in multiple countries and multiple specialties.(6-14) Facilities with strong physician leaders may perform better in many areas.(15) Many institutions have presented their own versions or suggestions of how to educate physicians,(16-18) whereas others have recommended learning from other organizations.(19)
The Problem Defined
At MCHS NWWI, we realized that many of our physicians do not have formal business or leadership education. Because many different physicians are needed to chair and serve on the many different clinical committees, we believed we needed to increase our physician’s business acumen to support ongoing growth and success of the organization. We desired a program to facilitate growth in management and leadership knowledge, skills, and attitudes to increase physicians’ competency beyond their clinical roles and improve their performance and comfort as administrators.
To increase our cadre of leadership trained physicians, we decided to start our own leadership training program. We reviewed several nationally advertised programs from highly regarded institutions. In doing so, we realized that any formal education program our physicians might attend might not be cognizant of, or compatible with, the culture of physician-run healthcare or the Mayo Clinic specifically. Some of our team members have been to these types of courses and found them valuable, although time-consuming, expensive, and not universally applicable to our institution. Therefore, we attempted to develop such a program internally, but quickly realized that outside expertise would be highly advantageous. After realizing we did not have the expertise internally to develop such a course, we chose to form a joint venture with a formal educational institution.
Partnering with University of Wisconsin-Eau Claire
We pursued a joint venture with the University of Wisconsin-Eau Claire (UWEC) to develop and implement the type of physician business education program we envisioned. We chose to partner with UWEC for many reasons. UWEC is in physical proximity to our central NWWI campus and has a long history of adult and undergraduate education in over 200 academic programs.(20) It is a highly ranked regional and national institution with expertise in adult learning and is the lead campus for the nationally ranked UW Consortium MBA.
Course development followed an iterative process, beginning with a conversation between the Chief Executive of MCHS NWWI—a position known in the Mayo system as the Regional Vice President (RVP)—and the Regional Chair of Administration (RCA) to flesh out the needs and viable solutions. The RVP then recruited a physician leader, in January 2020, to become the course director. An administrative lead partner also was assigned to the project. Our RCA had been meeting regularly with multiple city and county businesspeople; and had previously met the dean of UWEC’s College of Business. He introduced our physician course director to the business school dean. This group met regularly to develop the basic curriculum and content. Then, as each session was developed, appropriate faculty were identified who worked with the relevant Mayo leadership figures to develop and deliver content customized to MCHS-specific needs.
Course Development
The COVID-19 pandemic caused us to pivot to a virtual format for our first cycle, but we chose to return to in-person sessions as soon as safely feasible. UWEC already had experience with distance learning using Zoom technology, which greatly facilitated our efforts.
The entire course outline, as well as each day’s agenda, was discussed at length. The course schedule and subject matter were deemed optimal for MCHS’s needs. The daily topics were chosen as those most needed in the region. We decided to try four one-day seminars spaced throughout the year on several topics. We planned the topics to build on one another. We divided each day into morning and afternoon sessions.
Instructors for each session were then assigned by the UWEC dean. Each instructor collaborated with the relevant personnel and MCHS policies, leading to a highly customized program that maximized the content delivered to the cohort while minimizing time out of the clinical environment.
Administrative needs for the total course work activity were extensive and involved the instructors, MCHS NWWI administrative staff, and Mayo Clinic School of Continuous Professional Development (MCSCPD) staff.
Our first one-day course was offered on a Saturday and was well-attended. As expected, it was very challenging for the learners. We decided to present the next three sessions on Fridays to minimize the intrusion on weekend time.
Course Subjects and Implementation
The coursework for the four days was scheduled as follows:
Day 1: Finance 1 and Finance 2;
Day 2: Finance 3 and Strategy;
Day 3: Leadership and Communication; and
Day 4: Human Resource Strategies for Physicians
Our first cohort began the program in October 2021, and required 13 months to complete all four classes, because we took a pause of several months after session two to evaluate progress to date. We had planned on the program lasting a calendar year, with classes offered approximately quarterly. In the second iteration of the program, currently underway, we have adopted the calendar year format and will use it going forward.
Initial Decisions
We made several initial decisions that flavored the activities, including the following:
We partnered with an organization experienced and expert in adult learning (UWEC) rather than trying to develop the program on our own. We discussed how best to apply adult learning techniques to physician learners.(21) UWEC personnel had a great deal of experience with executive education and guided the project well.
The networking value of having a consistent in-person cohort for all four sessions was substantial. For this reason, we decided that all participants should come from the same MCHS region. Other regions were encouraged to sponsor this program if they believed it would be beneficial in their circumstances. We required each cohort of physicians attending to have started at the beginning of the course series. We wanted each class to consist of the same individuals, for networking and relationship-building purposes.
To further encourage networking and collegiality, we limited the class size to approximately 25 learners.
We started with a physicians-only class to encourage openness in the learning process. We plan to add classes for APPs and nursing professionals as we progress.
To minimize barriers to participation, we funded this as a region rather than making each physician fund their own participation.
We applied for and received Continuing Medical Education (CME) credits from the MCSCPD, which helped our physician learners justify time away from clinical practice and allowed them to receive credit for the time involved. Funding for this was provided by the MCHS NWWI region administrative office.
We used Mayo-specific examples and accounting principles to decrease the information presented that was not specific to our institution and circumstances.
The regional VP attended all classes, and the regional CFO attended the finance classes. This was extremely helpful in giving physician learners the “final answer” on many questions. We hope to continue this attendance into future courses.
We endeavored to minimize disruption to physician schedules. The number of days assigned to the program was discussed and was chosen to limit physician total time away from clinical practice. We limited the pre-course homework to no more than one hour.
Participants were selected for invitation by senior management, at least for the first two cycles. (There is ongoing discussion on how to broaden the impact of the program.) Selected individuals were then contacted by the regional vice president and course director and encouraged to attend. Those who had missed one of the classes in the first year were invited to attend that class in the second year.
Operational Implications
As we chose to move the program from Saturday to Friday, this required more than 20 physicians and senior administrative partners to be off the clinic schedule (attendees plus the physician and administrative leaders attending to provide support and “Mayo-specific” answers). This equates to a sizable financial investment that we believe is worthwhile to the institution.
Reflection and Feedback
Formal and informal feedback opportunities were offered after each session, which fine-tuned the following sessions. The formal feedback questionnaire was required for CME attribution, improving our confidence in the feedback process. After each session of the initial cohort, MCHS leadership and UWEC College of Business leadership met to review feedback and to fine-tune both the course and teaching methods. Subjects discussed included the course information, the teaching methods, and the learning processes. Here again, the UWEC staff were extremely insightful and offered their experience in our course improvement actions.
Feedback was generally very positive, although in one case a faculty member was replaced in future iterations to ensure better fit with MCHS needs. The length of the day-long sessions was also reduced by 30 minutes.
Additionally, there was one instance of miscommunication between the planning staff and the course instructors which gave one session a suboptimal outcome. The course instructor involved had thought we preferred a format such as might be used for first-year college students, with primarily a lecture style; this was quickly recognized and discussed, with plans to have more interaction, case studies, and mature learner methodology in the future.
Outcomes
Twenty physicians began the program, with ten of them successfully completing all four days of the program; the other participants attended three days (or in two cases, only two). The programs were scheduled to be offered quarterly, though the third course was delayed an extra quarter due to internal programming needs. In several cases, the date of each session was not posted in time for participants to avoid pre-planned vacations, which accounted for most of the missed sessions. These individuals plan on making up these missed sessions in coming years.
The average satisfaction rating for each session was 4.56 for day one, 4.12 for day two, 4.83 for day three, and 5.0 for day four, all on a five-point scale. Many positive comments were received. Notably, many physicians had not previously understood the complexity of the financial aspect of medical care that our administrative partners deal with on a regular basis. Given the success we experienced, we plan to offer this program on a recurring basis. Those providers who were unable to complete all four sessions, for various reasons, will be offered the opportunity to attend the missed sessions in later program cycles.
Lessons Learned
This program was the first of its kind for MCHS NWWI, although UWEC has extensive experience with this type of adult learning methodology. A physicians-only class was novel for them, however. Both organizations were quite satisfied with the process, experience, and final product, as were the physician learners. During the process we found that:
We needed great flexibility in learning styles and program types. COVID-19 became a pandemic in the middle of our planning activities, and we were forced to pivot the learning platform to video-based interaction. We used Zoom technology. We tried to get to a face-to-face as soon as possible yet were never able to due to the length of the pandemic and its effect on healthcare.
Physicians were amenable to and adept at interacting in the video environment. Attendance and interaction held steady for the entire day’s teaching and for all four days.
Four days seemed sufficient to our needs. This was a big question for us, and this time investment seemed to be optimal. This will be an ongoing concern to monitor.
Partnering with an experienced higher educational institution (UWEC) greatly improved outcomes, compared with our previously held assumptions, on both the performance and value of this program.
Adult learning techniques, including case studies, were extremely well received and valuable to our learners.
Physicians often require more than six months’ notice of class dates due to vacation scheduling needs on their part.
Conclusion
Physician-led healthcare organizations require physicians educated in business and leadership knowledge, techniques, skills, perspectives, and attitudes. Many physicians have obtained some of these through prior life experiences or training, yet few have a comprehensive background or training in business leadership. Our organization desired to provide a platform to improve all physician leaders’ capabilities. We believe this is especially important for developing future physician leaders. Fortunately for us, UWEC had both the expertise and experience to provide substantial resources for this joint venture.
The collegiality of the leadership from both the MCHS and UWEC teams was critical to creating an excellent program that was highly customized to Mayo needs and was even more important in determining how to further improve the program as we moved forward with the second cohort of students.
Each of the early considerations and initial decisions affected the manner in which the course was presented, as well as the information presented itself. UWEC was very adept at using Mayo-specific examples and principles in their teaching methodology. All physician participants expressed that they had learned a significant amount. We are confident that this will translate into more optimal physician leadership in the future.
Future Directions
Currently we are in our second cycle of quarterly classes. We have now educated more than 40 physicians. We do not think that we will need to educate more physicians in our region for a few more years; we will revisit that decision annually. We are, therefore, currently looking at extending this course to allied health staff, with that decision to be made in the next year or so.
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