Texas Health’s Dyad Leadership Model: Risks and Rewards

As large and often slow-moving  healthcare companies figure out how to best adapt to a changing market, shaking up the organizational structure and leadership can offer advantages. Texas Health Resources recently announced that they would be restructuring their leadership model, moving to a channel strategy that focuses on operational sectors like hospitals rather than a geographically organized model, but another shift may have a greater impact.

The system will be moving to what the organization described as a more efficient dyad structure, with executive vice presidents Dr. Jeffrey Canose and Winjie Miao working together alongside Texas Health CEO Barclay E. Berdan, serving the clinical and business interests respectively.

But what is a dyad model, and how might it impact the way the system functions? Jennifer Perry is principal of the healthcare practice at the human capital advisory firm FMG Leading, and described the dyad as a way to divide leadership oversight between a clinician who manages the clinical care and patient flow while a business-minded leader oversees the operations and business aspects. The model is sometimes necessary because physicians can lack the business experience to run an organization effectively.

The specialized focus provides more expertise in each area, but if communication isn’t strong and goals aren’t clearly aligned, the system may not provide the benefits organizations want. A power struggle between between the two leaders in the dyad can be  disastrous for the organization. For Perry, THR will need to focus on two aspects to make the dyad leadership model successful: 1) All parties must be clear on a shared purpose, and 2) Incentives, responsibility and accountability have to be aligned to meet those shared goals.

In all the years of medical school and residency, most physicians haven’t had exposure with the operational and business aspects of running a clinic or hospital, so allowing a clinical leader to work closely with and learn from a business administrator can be very effective, Perry says.

But there are inherent inefficiencies when there are two leaders instead of one, and physicians can often ignore the business aspect of the organization if there is another leader working alongside them, ultimately limiting their leadership potential and contributing to the lack of physician leaders throughout the healthcare system.

‘There needs to be clarity around decision making,” she says. “When it works well, people are clear on what they are responsible for with joint decision making, communication, and collaboration. There needs to be trust and clarity when conflict comes up.”

Because the business and clinical leaders have different emphases and backgrounds, there is risk that they will not be able to hold each other accountable, especially if goals are not aligned. Doing what is best for the patient or provider can often come into conflict with what is best for the bottom line at a hospital, so there is always a risk if goals are not shared between all the powers that be.

As the healthcare system moves away from fee-for-service and takes on more risk for the way they treat patients, the clinical and operational side of the healthcare system have to be more integrated than ever. Perry says that organizations need to invest in leadership, especially on the clinician side, to develop physicians who better understand management and business operations, creating a pipeline of physician leaders who have experience handling the business side of a healthcare facility.

Perry says she has seen the dyad model be successful in organizations that began as medical groups such as Mayo rather than hospital based systems like THR. There is often more tension between physicians and the hospital in a large hospital system, where it has taken longer to give doctors leadership positions than in physician led groups. But that isn’t to say that strong communication and collaboration can’t make the system work for THR.

Promoting clinicians into leadership is a way to give providers a voice so they feel like they are being well-represented at the highest levels of the organization, and can improve buy-in from providers when changes need to be made. Perry encourages organizations to consider physician leadership earlier, allowing them management experienced and tailored professional experiences. This may include executive coaching, leadership development, or mentoring to prepare physician leaders for future roles.

“It will allow them to build some skills and gain insight and awareness,” she says.