Stepping Into a New Leadership Role to Change a Culture

You have accepted a new position as Medical Director for a medical subspecialty service line for 2 suburban hospitals.  This is a new role for you and the position is newly created where there had been none before.  While familiar with these 2 hospitals, you have had no primary role there before and will be moving into this region from another region within the same health system. There is currently a practice at each hospital each consisting of ~4 physicians that interact primarily in that they share call (some would say reluctantly).  Additionally, while both practices are within the same health system and share some basic administration personnel, most of the administration/staff are specific to each office.  Hospital A has approximately 200 beds and is considered a fully functional hospital.  Hospital B has approximately 40 beds and does not offer a complete complement of services (some of which are critical supporting services that would enhance your service line at that hospital).  The physicians are on a productivity model and tend to see and perform procedures on their own patients.  You have been tasked with combining these 2 rather independent practices into a single functioning practice across 2 very different hospitals.


  • This is a new leadership position for you. How do you start to gain the trust of the physicians in these practices, who did not elect you into this position nor are they excited about new, outside leadership?
  • How do you start to integrate these 2 practices? Particularly, at the staff/administration level?
  • How would you approach your first 30, 60 and 90 days?
  • How would recommend starting to change the culture to a more team based approach for the physicians?


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Participant comments on Stepping Into a New Leadership Role to Change a Culture

  1. Someone once told me, when walking into a new leadership role, it’s critical to “make emotional deposits” in those first 30 to 60 days, because you will very soon need to debit those accounts. You want to make sure you have enough in the bank. This may mean engaging these individuals outside the auspices of the hospital environment. Perhaps there are educational seminars in the specialty (off site) where you could coral a few of the docs from the different groups together. Maybe create a steering committee with members of both sides, to create a strategy and find common ground?

  2. The great advantage is that the leader is new with no history. This makes it possible to define the leader role from day one, where nobody has + or – relations with you. It would be central to interact personally with the doctors who show informal leadership. Make them feel that you are there for them to do their best.
    Probably it would be neccesary from day one to say out loud, that there will be changes. And you need input to find the best way to get to the goals.

  3. Physicians want authentic peer leadership that places no priority above the best interest of the patient, and emphasizes the primacy of the physician-patient relationship (and the time this requires). If you lead from this place, the physicians will follow.

  4. Great questions. I would suggest an open data gathering phase first asking for input from the 2 different location teams around the biggest pain points for each location and some new ideas how to improve them. This way you can engage the teams in thinking about their biggest current challenges and some potential solutions. Then I would share the feedback with each location team with some specific recommendations that you plan to try based on the team direct feedback data.

    Integration of the different location staff teams sounds like it will be a gradual process. One idea would be a combination of some in person introduction events, perhaps a couple social hours, and possibly a shared initiative across both sites where the sites could potentially work together on designing a new process together or comparing their two different workflows in a given area and try to compare the workflows to find the best approach together.

    First 30-60 days I would likely use for information and perspective gathering, and then the 60-90 day time to share what you have learned in aggregate back to the two teams.

    Is there is a way to create a sense of interconnectedness across the two sites for the physicians? Does one site do some things better than the other? Could the physicians meet in person a few times to talk about ways to improve their workflows and schedules, for instance share the EMR productivity tips to improve the quality and efficiency of their documentation flow. Are there a couple EMR superusers who could share ideas with the groups together? Also, having a once a month or every other month physician update page by you could help to communicate major topics relevant to the two groups together, this helps to bring them together in a team identity over a simple team communication approach.

  5. I agree with the comments above, so I won’t repeat …

    If you are about to change the culture, you need to change the values first and convince people that was their idea 🙂
    Than you have got to live those values that is going to change attitude of other and finally the culture of the new integrated services. No easy at all, ask for “some time” to make it happen.

    But the sense of urgency that the CHANGE is inevitable means that they are either part of the change and could define it or have to follow what others set. The later nobody likes.

  6. There is sometimes nothing harder than culture change. If you read Kotter/change management literature, you can follow the steps.

    Create the burning platform for change.
    Create the common values and live them
    Find some quick wins in the first prescriptive period (90 days).
    Learn and align with defacto leaders and difference makers of both groups and work through the major hurdles that will destroy any positive momentum.
    Align under quality initiatives that all will agree to and get behind.
    Rinse and repeat…

    When you make this work, there maybe nothing more exhilarating and exciting professionally. Good luck.

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