The Power of the Physician Executive and Physician Assistant Dyad

In the world of academic service lines, the alignment of physician executives and physician assistants is paramount. On this episode of Value-Based Care Insights, Jason Raidbard, Executive Administrator at the University of Chicago, unveils the challenges and strategies of crafting a dyad partnership of leaders within academic service lines. Gain insights on the importance of a shared patient-centric culture that unites academic, research and clinical operations under one resolute purpose.

KEY TAKEAWAYS: 

• Focusing on a shared culture ensures unified collaboration and a patient-centric focus. 
• Balancing priorities with academic missions and clinical operations help deliver optimal performance. 
• Dealing with academic politics and focusing on mutual respect is critical to achieving goals and building strong partnerships.

LISTEN TO THE EPISODE:

 

 Transcript:

Daniel J. Marino: 

Welcome to value-based care insights. I'm your host, Daniel Marino. 

On our program. We've talked quite a bit in the past about leadership development, and many of you have listened in know that this is an area I feel really passionate about. I've worked in operations for many, many years and having strong leadership is important. But what's more important is ensuring that you're aligned with a good physician leader.  

So an administrative leader, combined with the physician leader. That dyed structure in my mind, and from what we seen from looking at high performing organizations, is really critical to the success. But I'm really pleased today to have a colleague of mine join our conversation. Jason Raidbard is an executive administrator at the University of Chicago, Department of ophthalmology and Visual Science Department. Jason has had 20 years of healthcare operations, experience, finance, strategy, experience, both on the community hospital or healthcare side. And now, on the academic side. Jason. Welcome to the program. 

Jason Raidbard:

Thank you for having me, Daniel, appreciate it.

Daniel J. Marino: 

So, Jason, when you, when you work in leadership in in operations the community aspect of healthcare working with the hospital or medical group is definitely different than working in an academic operational structure. How's that transition been for you as you've went from working at, You know that that community hospital, so to speak, and managing operations now with the University, Chicago?

Jason Raidbard:

Sure. So the transition is different, no matter where you go. So even different community organizations I've worked at have add a little bit of different nuance. I think the different part about the academic institution for me is the tripart Day Mission. You have the focus on education, the focus on research, the focus on the clinical enterprise, the ambulatory operations, and the hospitals. So whereas when you work in the community based settings you're really more focused on just the clinic operations there. There may be some clinical trials here and there if you're on oncology or neurosciences for and on college cancer research. But, generally speaking, that's the big differences. You have one institution that's really focusing on health outcomes as far as the In person visits. 

Daniel J. Marino:

So I think, you know, adding that into the mix for me was a little bit different. And even the economics around that are different. So when you're in a community leadership role, you know, it's all about productivity. It's all about the revenue. It's all about maximizing your collections on the academic side. As you said, it's a 3 part mission right? But the clinical operations are really would drive the revenue. However, you've got to manage your research and your programs. You have to manage education if that's part of the full, the full mission. 

So you know, when you're working through that.  

Have you found that with your community experience, has it really helped you, and kind of driving some of the clinical operations, the clinical revenue activity within the academic setting?

Jason Raidbard:

I think so. I think so. The team that I'm working with right now. I think we recognize both our particular expertise as far as what I had done prior, what they were doing, currently what they had done prior, and what I could bring to the table to help because whenever you go into a situation where you're in a new position, and this is much more of a higher leadership position that I had before you have to learn what's going on. What's the new environment you're in and work? How do things tick? Once you get past that stage? And while you're on that stage. I think it really important you gain trust hopefully. I mean, if you do it right, you gain trust with the folks you're working with whether it's in the university side, or if it's an ambulatory operation side. 

That said, I think there was a way that I could look at maximizing efficiency. Whether it was something as simple as exam room allocation or template optimization. So, looking at physician schedules, what could we do to improve patient access? How are we having an issue with cycle time in the clinic? Is that the issue? Is it an issue with our Emr system? Maybe there's not the right templates. Or is it more of we just need to review the template as a whole, because there's just not enough access, because appointments are too long.  

Daniel J. Marino:

So bring that over to the academic environment, boy. I think that's such a huge value. Add to really drive a lot of the performance. So I can see how that would really be beneficial for you in your role. Talk a little bit about how you developed your dyad partnerships over the years, you know it. It sounds like to me when you were in the community setting aligning with your medical director is key, and you know that that was a big element of success. Obviously, within your current role. It's going to be equally important. Talk a little bit about what’s what. What that roadmap has looked like for you.

Jason Raidbard:

Sure. And I should preface by saying that in many, if not all, the institutions I've worked at over these 20 years, currently, right now and prior, I feel that when it comes to position leaders that I've worked with, whether it's been a medical director of the facility, or a location, or it's been a chair, or even a chief medical officer of an amateur enterprise. I've worked with some great people I've been fortunate in that way. But I would say that helps so much. 

Daniel J. Marino:

Right? So when you're on the same page, and you and everybody kind of, you know. Both the physician, leader and the administrative leader kind of know their roles and work together. In my experience you get the one plus one equals 3 factor. You're just so much more productive. And it's so much more fun.

Jason Raidbard:

It is, it is. And I think if there is a mutual respect. if there's a shared culture, I think if there is a appreciation for each role and what they do and what they bring to the table. And I think it's important to define the roles, too, because sometimes certain relationships start because one of those positions is vacant, and then the other person is coverings. You have a physician leader doing a little bit more of the business, or maybe you have. You know, the executive administrator or Operations director, or whatever that position is covering a little bit more on the clinical side, or leading out on some of the clinical meetings. I think it's important that there's a distinction, but a mutual respect. But there has to be a shared culture, a shared vision, a shared. What does this look like at first. I mean, looking at you know, what are we trying to do here? What's the end goal, you know? Are we trying to expand to multiple clinic locations in our m market. Are we trying to go beyond that? Are we trying to grow our research portfolio, our development portfolio for fundraising, I mean, depending. You know, where we try about community based setting. 

Or we're talking about a setting in an academic institution. You have to have clear goals. You have to be organized, but you both have to be on the same page. But just, you know, unlike politics, maybe in Washington, DC. Or in Springfield, or wherever you're talking about. There has to be compromise, too, so you cannot go into these meetings or these discussions, or one on ones with your physician leader, expecting you're going to get everything you want just is the same as they won't either. And that's where the prioritization happens. Included in the trust. 

Daniel J. Marino:

The shared culture of the mutual respect. If you don't have that, it's like a house, you have no foundation, and you can't really go anywhere, and it becomes a very uncomfortable relationship, and it usually dissolves in one way, shape, or form, at some point. Well, and you know to your point as you start to align around those common goals as you as you both align around what you want to achieve. The physician leader is critical in driving that communication and the change with their physicians, and in this case their faculty. Right? So, although you know, I'm sure you have probably a pretty good relationship with the faculty. They report directly up to your chair. So, being able to have that communication mechanism, that mutual respect both with the vice chair, with the chairman, and then with the corresponding faculty, that's how you really drive a lot of improvements. Right? You drive a lot of change. So I think that's critical. 

Talk a little bit about culture, though you brought this up earlier. That is, we talked about in the program here and in our own consulting work. We are very cognizant of the culture and culture has to evolve over time, you know, as they've said time and time again, you can have the best strategy in the world but culture, strategy every day of the week. How have you, or what have you done to help to kind of advance the culture into either, you know, high performing organization, or just making it more exciting for the faculty for your team to achieve some of your goals. 

Jason Raidbard:

Sure, you know II think again, and I may mention this a few times during our conversation today. But you have to have that foundation. First, you have to have not just the mutual respect, but the trust. And okay. So you ask yourself, okay, how do you build that? You're walking into a new situation. Or maybe you're in an existing organization, and you moved into a different position with people you've never worked with and lot of healthcare organizations and universities are large. So it's moving from one place. Another could be like a completely different experience. You have to appreciate and understand what everyone's doing. Now, you in the back of your mind may say, Okay, we're doing a lot of redundant work, or there's some lost efficient. Sure, no one wants a leader to come in and just say everything's wrong. Start over and there may be a ton of things that are right. So I think we have to recognize what's working. Celebrate the wins. If you will focus on the positives, there's nothing worse than walking into work and working with a leader. That is just negative. All the time I've worked in organizations where the person near or at the top is just solely focused on the negatives, and there's no joy, there's no happiness, and I guarantee you in those organizations. Your turnover rate is probably 20,30, 40, you know, in my career I can probably myself on. Generally speaking, my turnovers been under 2 with the folks that I've worked with and I would say about half of that is, people that got promoted either in the organization or outside the organization, and you do that by listening and having the mutual respect. 

I think it's important when you listen to understand the current state of what's going on the relationships beyond what you see. Because when people start to trust you, they tell you all kind of stories of how a physician or a member of the staff, or maybe a member of the organization outside your department, is treating people or not treating them well, you know, whatever it could be good could be bad and I and I think you know, recognizing the wins, listening and then working together on a mutually agreeable plan. Yes, you may be at the top of the department, or one of the top people in the department, or the medical group depending on your setting. 

Daniel J. Marino:

but at the end of the day you have to include others. They may have solutions that can really fix.

Jason Raidbard:

When I was part of a 3 different organizations in a 10 year span. Probably, you know, in the early 20 tens when paper charts were moving to Emr, I mean. That was a very critical time that was shifting the way medicine was documented across the entire country, and I think if you don't listen to the concerns that people have about templates, or how an Emrs working. I mean, you could a clinic could come to a screeching halt? 

Daniel J. Marino:

Yeah, it could totally implode. If you're just tuning in, I'm Daniel Moreno, and you're listening to value based care insights. I'm here with Jason Raidbard, and we are talking about creating a high performing diet partnership within an academic service line. Fascinating discussion.  

So, Jason, 1 point that I want to touch on and you mentioned this a little bit, and I think it's worth kind of exploring. The economics within a clinical service line obviously are different than slightly different than in a community setting. You know, you've got clinic operations, and you know the department generates a lot of revenue from clinic operations. And then you've got research. And then you've got the educational component, that sort of thing. being within the academic area where you're looking at the department. How are you aligning or working with your partner? Your physician? Chair, if you will. How are you aligning the goals of the hospital and the clinic operation with the goals of the medical school or the academic mission.

Jason Raidbard:

Sure. So I think it's a fine balance. It's a bit more of, I would say, a balancing act or a tightrope, than say when I was just solely focused on clinic operations only, and that has its own web of different goals and politics and issues in and of itself. So I don't mean to disregard it. This is my first real, true endeavor into the tripart mission. So the Balancing act, I mean, I think it's again you're going to need to figure out where you want to allocate your resources. You're you may have goals in your mind but ultimately those goals will turn into a strategy that says we're going to spend X or Y in some certain area, I think in the academic institutions. I think one thing, that no matter what that there needs to be a focus on that, you really don't have in the community. Based settings is your development, your fundraising. That's important. And I think I did not fully realize this until II came to my current institution. The chair that I work with now is excellent. At this aspect of the tripart mission it supports can support clinic operations generally supports research, clinical trials and education creating sound endowment plans creating gift accounts, research accounts that is, external funding, and it can be from grants, from the government, could be from grants, from private institutions, could be from just people that we may have treated in clinic that had a very successful outcome. Of course, in Opy, when you're having vision issues and they get cured. It's an instant gratification of, I can see now 

Daniel J. Marino:

So foundational work it. It may be a bit easier than some of the other chronic illnesses that we see. So I think that's a critical piece to it, too. Now your clinic operations has to provide funding. Of course you have clinical operations and funds. A big part of any type of a department or a section within the academic side.

Jason Raidbard:

It does. So if you're on the academic side, and you're working with your hospital partners or ambulatory partners, you know, when you propose a strategy of adding a new physician or adding a new location. You have to show its value, not just value in the dollars and cents, but downstream revenue opportunities, partnership opportunities. And then how it's going to benefit. The community, you know, one of the things that I brought with, you know, currently was developing a dashboard for certain eye diseases. So we could track clinically healthcare outcomes and prove value beyond even just dollars and cents. Because we all know he just measures is something that insurance companies have. They're important insurance companies, and it's important that a patient have an office visit with any practitioner and have a good health care outcome.  

But balancing the 3, you know you, you really have got to maximize the time your clinicians, your practitioners, your physicians, are working within the clinic, because, unlike in community based settings, there's a set amount of percentage of time that they're dedicated to provide training for the residents training for the medical students. It there is, and that is time that they would normally be in the clinic if they work working in ABC. Health care community clinic down in, you know, Johnstown, or something like that. Now, now they're, you know, 60, 70, 80% of their time as opposed to maybe 99% of their time is in the clinic, the rest of that is supporting other of our tripartite missions. Exactly. But I think if you have, you know, a sound foundation as far as what you're trying to do, and you have defined whether it's performance development plans, a clear understanding of what grants you can get, because it's very easy to develop a budget. And say, we're going to get all this grant money when there's so much competition for public and private are limited. I mean, there's only so much that are out there, and I'll and I'll tell you so. 

Daniel J. Marino:

Years ago I had an opportunity to work as an interim executive director of a clinical service line, large internal medicine group. That was an academic facility down in Texas. And what you described. Was really what I had just thrown into this role, and what I had learned, and I found it fascinating, fascinating to balance both the goals and the objective culture and politics of the hospital and the clinic operations with the goals, the objectives, the you know, the culture, the politics of the Medical school of the Academic arena, and what I quickly learned was my success was really predicated on communicating to those the objectives of both of those areas in a way that you can really bring it together and drive the results. And I think that is so important for the faculty to understand right. And that's where I think the partnership becomes really valuable. Because if you've got a chair that can that that can communicate that vision, and then you have a strong administrative support person that can activate that combined vision boy. That's I mean, that's what's going to drive the success. And it sounds like, that's a lot of the role that you're playing.

Jason Raidbard:

It is, it is. And I think you know, in my role it can be as simple as going down to the clinic and trying to help out with maybe a phones not working and trying to escalate something very mundane, very simple, but very important, or it can be, you know, working with your executive director of finance and trying to tastefully persuade the reason why we need said position to be open. You know whether we're in a recruitment window, or you know whether you know there's a certain regulatory reason for education program that provide this or it is here. This is actually a positive clinical funding position that will it near instantaneously be able to fund itself in other programs. And then some because in academic institutions, because your teaching institution, you have to provide certain services so that your medical students and your residents can train I. And there's a certain number of procedures, and these states they have to see in their rotations and you may have a sub specialty that is not as profitable, or may work at a loss. You have to figure out how to offset that so that you can still fund the clinic profitably. You can still find the research program, but still provide the education that you need for your students, because those that's the future of medicine, those people that you're training clinic.

Daniel J. Marino:

Good point. If given where the where health care is going and resources continue to be a challenge. Both cap, human capital resources and financial resources. And then, when you think about the pressures to kind of drive that that clinical revenue? You know, it's tough, I mean it is. It's really tough to get everybody aligned. When you think back about your role and think back about, I mean, think about you know where healthcare is going, what's been, You know, the top challenges that that you see, that you know that has been unique for you and your role and for the department and things that you're really trying to work towards.

Jason Raidbard:

Sure. I mean, there's if we want to talk more of, you know. on a macro level, I think just what I've noticed especially going back 10 years. Even, you know we we've had a whole large generation of baby boomers that continue to retire in droves thousands and thousands today. Many of those were in the healthcare world. Many of them were physicians, Apn's nurses, etc., frontline staff workers, and I think, as a country we have not opened up enough slots for you know, then that's something that really is triggered by the Federal Government to provide more residents because there is a need. And I think one of the things, too. We just like kind of look at. Really, Macro, level the way that we treat patient. I had a very insightful medical director Kind of review this with me a few years back. The way we treat people medically today is extremely different than we did 40 years ago. With preventative care, plus there are more venues and avenues to treat them in non traditional health system settings. So there's a demand for labor to be able to meet the consumer demand. But there's an actual quality demand, too, that we may have not had, and it was something when he told me that, it was kind of eye opening because I hadn't looked at it that way, and he was like maybe a decade ago. I can't remember, he said. You will see by the thirties.

Daniel J. Marino:

Right, if not sooner, you will have a shortage of not just frontline staff, but you all have shortage of physicians and advanced practice providers, and we sure have it. And this was maybe in 2011. I think I had the conversation with him given that you know the he was able to kind of see the access challenges and spot on. And you know, obviously, access is an issue for all of us. But in the academic. I think it's even a little bit worse, because you have patience with complex situations that frankly they need the service of the academic faculty provider to really drive a lot of the change.  

Well, this has been great. II really II appreciate your time. I think you know you've shared some interesting insights, certainly, as it relates to leadership in in the academic arena. You know, for any of our listeners, especially those that are within academics, or maybe within the community setting, who are interested in getting academics any pieces of advice you might share. 

Jason Raidbard:

You know. As far as that goes, I think the most important thing you can do, and whatever position you're in is to ensure that you listen. Listening. You know I I've trained as a high reliability trainer in a prior lifetime. As part of my job. I'm certified in that area. And whether we're talking about clinic outcomes or just general management of any team, whether it's 3 people or 100 generally listening to your people being thoughtful in your rounding, being genuine in your approach. I think it's important. You know, if folks had additional questions and wanted to reach out to me. Best way they could reach out to me is finding me on Linkedin. They can send me a message, and I'd be happy to help. You know I love networking and chatting shop.

Daniel J. Marino:

Oh, fantastic! Well, I'm so glad that you've done that, and you know again you can find Jason Raidbard on Linkedin. Well, Jason, I want to thank you for coming on the program today. This was great conversation. You've clearly done very well in your role, and I wish you tremendous amount of success going forward.

Jason Raidbard:

Thank you, Dan, and I appreciate your time, and I wish you the best of luck as well with your consulting work.

Daniel J. Marino:

Thank you. Well, I want to thank everyone today for listening for tuning in. Until the next insight, I am Daniel Moreno, bringing you 30 min of value to your day. Take care.

About Value-Based Care Insights Podcast

Value-Based Care Insights is a podcast that explores how to optimize the performance of programs to meet the demands of an increasingly value-based care payment environment. Hosted by Daniel J. Marino, the VBCI podcast highlights recognized experts in the field and within Lumina Health Partners