Richard Gunderman, MD, PhD

Richard Gunderman, MD, PhD
ISMA President
ISMA Wellness Steering Committee Chair

Some contemporary health care observers might assume that hospital administrators and physicians are inevitably in tension, perhaps even at loggerheads with one another. But some health ecosystems in Indiana have found another path, forging collaborative and collegial relationships that have benefitted patients, those who care for them, and communities.

Kreg Gruber and Samir Patel, MD, provide one such example. Gruber is CEO of Beacon Health in Northern Indiana, and Dr. Patel is a radiologist and active partner in the leadership of the hospital system. They first became acquainted 20 years ago when Gruber moved to South Bend and happened to buy Patel’s house, but they soon grew to be colleagues and friends.

Gruber recalls a time early in his tenure at Beacon when there was talk of switching radiology groups. To his surprise, he found the medical staff content to see the current group ousted. He urged its members to do a better job of demonstrating their value and building relationships with other physicians. Patel took up the challenge.

He set about devising a system to capture all the value the group’s members were contributing beyond performing and interpreting examinations, as well as encouraging his colleagues to get involved in committees and leadership.

“Now, if someone mentioned changing radiology groups, physicians would express strong opposition,” said Gruber.

Gruber and Dr. Patel believe that much of the tension in administration-physician relationships can be traced to the groups operating in siloes. So they and colleagues have developed a dyad-focused leadership system that pairs members of both groups, strongly encouraging physicians to get involved as leaders and providing ample opportunity for leadership development.

“It is impossible to optimize things when everyone is working only in their own lanes,” said Gruber. “We need to realize that we all united in our aspiration to deliver outstanding care, and we all want to make our work better, for example by reducing inefficiencies and finding ways to make it even more fulfilling.”

“The health system encourages physicians to participate in a 2-year program of leadership development, with the expectation that by the end participants will either be involved in some formal leadership capacity or will soon be appointed to one,” Dr. Patel said. “The culture is one where physicians are collaborating in leadership at every level.

”Some examples of steps the health system has taken are supporting a women’s physician group, hosting an annual new physician welcome, and establishing a physician philanthropy counsel that enables physicians to contribute to a fund whose proceeds they direct, with the hospital’s help, to good causes of their choice.

In addition, educational presentations by physicians are a regular feature of board meetings, ensuring that board members and physicians get to know one another better. Board members often report that these presentations are some of the most engaging and illuminating components of meetings, and physicians know their voices are being heard.

In fact, Beacon and its local hospital boards boast substantially more health professionals, including physicians, as members than the average health system boards across the country. Physicians are not merely informing decision makers; they are numbered among the decision makers, and this fosters higher engagement among the members of the medical staff.

“Every hospital leadership team should want to have the wisdom and experience of physicians represented throughout the organizational structure,” said Dr. Patel.

Dr. Patel, a graduate of the Indiana University Kelley School MBA program, points to the program's more than 500 alumni as a bench of physicians well prepared to contribute.

Of course, problems arise, as they did when Memorial and Elkhart hospitals first merged to form the health system.  In response, Gruber and Patel went to meet with the medical staff, spending a great deal of time listening and then drawing on members' ideas and effort to help make it successful.  What might have been a revolt morphed into a stronger sense of community.

“Of course, physicians must take steps to ensure that they know enough and have sufficient experience to make a real contribution,” said Gruber.

A physician with no such experience can no more take on the role of vice president than a VP can start practicing medicine. Key attributes include curiosity, a desire to make a difference, and perseverance.

Gruber said he loves it when physicians want to learn more and become more involved.  “At a time when many newly minted physicians express no desire to have anything to do with the business of medicine,” he said. “it is vital that we develop a cohort of physicians who are actively involved in helping to lead every part of the hospital and health system.”

Dr. Patel is not worried about the sea change in medicine from physician ownership of practices to physician employment.  “What matters most is not independent private practice but the forging of effective partnerships that help everyone avoid a clock-in-clock-out mentality and work for the good of patients, the profession, the hospital, and the community,” he said. “Serving as a leader in the hospital or health system is a chance to make a difference that extends beyond caring for patients one by one, enabling not only physicians but all health professionals to do more impactful work and find greater joy in practice. Quite simply, we need to see how everything is connected and foster even greater connectedness.”