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January 19, 2017

Leadership program puts doctors back in classroom

Doctor uses laptop with empty blackboard


When the Marshall Webster physician leadership program started in 2007 as a kind of mini-MBA for UPMC physicians, Steven D. Shapiro, who heads the Health Services Division of UPMC as an executive vice president, wasn’t sure the program was needed.

“It turned out to be brilliant — a brilliant idea that was very ahead of its time,” Shapiro adds, one month after the Webster program graduated its ninth class, “giving us a chance to watch the transformation of health care.”

Carrie Leana, the George H. Love Professor of Organizations and Management at the Katz Graduate School of Business and academic dean of the program, says she is unaware of other universities/business schools and health care providers teaming in this manner to undertake a similar effort joining management and medical education in a brief, physicians-only course.

The weekly, semester-long certificate program accepts only 30-35 physicians a year. Faculty from the Katz school and managers and executives from UPMC Physician Services Division cover such lessons as “Interpreting Financial Statements and the Budget Cycle,” “Insurance and Reimbursement” and “Effective Service Management.”

In addition, they cover such topics as leadership, strategic planning, management methods and conflict resolution.

Admission to the program is highly competitive, but tuition for participating medical professionals is paid by UPMC.

The Webster program, Shapiro says, “gives an elite group of emerging leaders the skills they need.”

In earlier decades, he notes, physicians were neither required nor expected to understand subjects, such as finances, that affected the practice of medicine but weren’t directly taught in medical school. Today, he says, physicians “can’t afford not to care.”

In practices and hospitals, the emphasis today is on treating higher volumes of patients at lower costs. Thus, Shapiro says, physicians need to be cognizant not only of how the medical profession is managed but how their patients are experiencing the world of insurance payouts, in order to maximize their benefits as well.

Overall, the program aims to get physicians to concentrate on seeking better health outcomes more efficiently by improving the quality of care and eliminating wasteful practices.

“Just getting them to understand they need to think about the cost was the first goal” of the Webster program, he says.

Leana notes that learning about best accounting practices, for instance, gives physicians a much better sense of how to handle budgets and forecast the needs of their hospital departments or practices.

By teaching physicians to apply business tools to medical practice, Leana says, “we’re not just trying to save money, we’re trying to make medicine more effective.

“There are a lot of tools, a lot of analytics, to improve bottlenecks” that prevent improvement in patient care quality, she adds.


Each semester, Webster physicians undertake projects to study health care improvements. In the program’s early years, they were asked to devise their own projects; now UPMC directs the class project toward an area it’s hoping to enhance.

Shapiro has seen Webster project results and recommendations become part of UPMC’s wider practice, affecting how UPMC views physician compensation, clinical pathways and IT practices. Physician projects also have changed the way UPMC employees care for patients and seek quality outcomes, he says.

Two projects from the most recent Webster class in fall 2016 examined better ways for physicians to communicate — with patients and with each other — in an effort to improve patient care.

For one project, Amy K. Ranier, UPMC’s senior director of patient experience, oversaw four Webster participants as they developed a curriculum to teach physicians how to better interact with their patients. Improved interaction is important for a number of reasons: UPMC websites now publish patient comments on their experiences with physicians — 10,000 a month — which also resulted in new ratings for physicians; some UPMC divisions now have incentives and salaries tied to patient satisfaction, which necessitates that physicians improve their patient communication; and some government agencies, such as the Centers for Medicare and Medicaid Services, now require patient satisfaction surveys.

Such efforts actually do lead to improved patient care, she says.

As physicians are urged to improve their patient interaction skills, Ranier hears them respond that “‘There’s no help: You can tell me I have to do well … but how do I get better?’” they say. UPMC, in fact, puts thousands of its employees through customer service training, Ranier says — just not its physicians.

For the Webster program project, a small group of doctors consulted with colleagues at Cleveland Clinic, learning how its mandatory training in patient communication worked.

The curriculum they devised as a result of their project began rolling out on Jan. 9, in the first of four pilot sessions, which UPMC physicians attend voluntarily. Much of the curriculum involves role-playing to teach very basic concepts, from eye contact and appropriate body language to handling medical-record data entry during the patient’s visit.

“It’s the first attempt of its kind within UPMC,” Ranier says. “It’s still in build mode — it’s not quite polished — but we are getting there.”

Tami Minnier, UPMC’s chief quality officer, oversaw this past fall’s Webster project that examined the morbidity review process — case reviews concerning those patients who die while in the hospital — at multiple UPMC facilities.

For years, the process has been different in each hospital, Minnier says: “While morbidity review processes are very well done within hospitals, there has not been a good way to learn from these processes and to share them elsewhere.”

Webster physicians studied how this review is accomplished both at UPMC and at other hospitals across the United States, then devised a process that encompassed best practices, and that could be uniform across UPMC.

Now, she says, UPMC is taking this Webster project outcome and creating a new electronic tool for use across its system to gather answers to standardized questions, which will feed into a database to be shared confidentially across UPMC.


For physicians participating in the Webster program, the experience still proves valuable months and years later.

Says James Boyle, chief medical officer and vice president for UPMC Medical Affairs at UPMC Passavant, who attended the program in 2008: “When you are a physician, you go through some pretty intense training for many years and none of it relates to business, finance, strategic planning, negotiating skills. The vernacular — the think — is very different on the business side.

“It introduces you to at least some of the terminology and vocabulary that your CFO is going to use,” Boyle says of the Webster experience. “Physicians bring a unique perspective” to approaching administrative issues in medicine, “and if they can’t communicate that in a language that is understood to the finance people, you’re in trouble.”

He has found UPMC to be both large and diverse, and the Webster program “gave me a connection with a large number of physicians throughout the system, and at least a face and a connection with UPMC executives.” The Webster program still has an impact on his work nearly a decade later, he says: “It helps me counsel and support physicians when they are arriving in administrative roles. Physicians have to be actively involved with administration to optimize the care we give to our patients.”

David G. Metro, faculty member and vice chair for education in the School of Medicine’s Department of Anesthesiology, was a Webster program physician in 2014. Metro agrees with Boyle: One of the lasting effects of the course was the connection it facilitated across UPMC. It helped him “to not only learn the concepts that were being taught but to meet the leaders within UPMC and see when they were applying these concepts within the health system. What I’m applying from the course — what I got most out of it — is knowing the key players in the right areas and knowing who to pursue to get something done.”

Seeing the business theory, through the Katz professors, and its application, through UPMC executives, also was crucial, he says: “talking about the budgeting process from the theoretical standpoint and going over an actual budget from a department and seeing how UPMC was applying those concepts.”

Metro’s Webster project studied a crucial moment for maintaining patient safety: moving patients from the operating room to an intensive care unit. His team consulted surgeons, critical care physicians, anesthesiologists and patient safety representatives from UPMC about current issues surrounding this critical time following surgery and how to fix the issues from a physician’s perspective. “That was good for me because of my specialty and my position,” he says. Their conclusion: “What only one part of the team sees as the best solution isn’t necessarily seen the same way by the other parts. Getting this transition right requires that more people have input and feel they are part of the solution,” including nurses and residents.

Shapiro says that Webster projects pay off in additional ways, including lessons UPMC executives and managers have taken from the physicians they are teaching.

“The doctors are seeing the patients and they know the problems on the ground,” he explains. “They’re really a bright group of people, thinking about this differently and coming up with new ideas, so it’s always great to get their unique perspectives.”


Marshall Webster, for whom the physician leadership program is named, was in the middle of a decade’s tenure as president of UPMC’S physician division when the idea came to fruition.

“There was a collective feeling that many of our physicians would benefit from a deeper understanding of the business of medicine,” Webster recalls. Many UPMC physicians are already in, or likely headed for, leading administrator roles in medicine, he points out, “so they are managing big businesses.” But major business training, through an MBA, would take too much time for the average physician to complete.

He credits Anna M. Roman, vice president of UPMC Medical Education, with much of the organizing that led to the physician leadership program and its partnership with the Katz school to make education in the business of medicine more accessible.

More recently, he says, the success of the program helped inspire Katz administrators to institute a full executive MBA program for health care professionals, which will begin this May.


Will the program need to shift its focus, should the Republicans under a new president succeed in scrapping or replacing the Affordable Care Act (ACA, also referred to as Obamacare)?

The ACA was intended to accomplish two things, Shapiro notes: increase patient access to health insurance and reduce the cost of health care, which is currently at 18 percent of the nation’s gross domestic product.

“The problem is the same” no matter who is in the White House, he says. He hopes, for one, that people remember that the ACA is modeled after a Republican idea. “The very people who elected Trump now … are actually benefiting from it,” he says of the ACA. “They like their Medicaid and they don’t even know it is part of Obamacare.”

If the ACA is repealed and replaced, “the road’s going to be bumpy,” he says, “but the problem isn’t going away.” America can either have new health care cost reduction methods imposed upon it by some new health care law or physicians can devise better care itself, he concludes — perhaps through such things as the Webster physician leadership program.

—Marty Levine

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