Case Study Analysis - Valley Health explain Dr. Waynes abilities as a leader, manager and communication strengths or explain any leadership weaknesses then, explain how these leadership abilities or weaknesses impact strategic management concepts correlating comments to your research. also, add any recommendations that you may have for Dr. Wayne in order to assist strategic management at his facility

"We see you as a cowboy, Dr. Wayne," explained Dr. John Richmond, Felton Wayne's corporate director from South Carolina. "You seem to be up there in North Carolina doing your own thing and getting people at corporate upset." These words really stung 12 months into Wayne's tenure as the chief medical officer (CMO) for North Carolina operations at Valley Health (VH). He knew there was a component of truth to Richmond's statement, but was it necessarily a bad thing to be seen as a cowboy? Was he the problem, or was it corporate? Maybe it was both.

Franklin Memorial Hospital and Valley Health

Franklin Memorial Hospital (FMH) was founded by a physician in 1905. Over the years, it had grown into a strong community hospital with a well-respected medical staff. But times were changing in health care, and the days of the independent community hospital were coming to an end. The hospital was still operating in the same location as the original building built in 1919, and there was no room to grow.

FMH's leaders started looking for a partner in 2007 and eventually selected VH in August 2009. Unfortunately, the merger process was conducted in relative secrecy due to a local competing hospital system's interest in purchasing FMH. When the merger with VH was announced, most of FMH's physicians were surprised by the news. Thus began a clash of two organizations and their respective cultures.

At the time of the merger, VH was a nine-hospital system based just across the border in South Carolina. The CEO had started with one flagship hospital in Park City in 1990 and gradually acquired many of the surrounding facilities. Purchases were conducted with an eye toward the financial impact they would make, and VH developed a reputation as "a business that happened to deliver health care."

Due to VH's rapid expansion and the nature of the corporate leadership team, authority was centralized at the Park City office. Local-facility CEOs had limited ability to fix issues and initiate the projects necessary for their hospitals to remain locally competitive. Historically at FMH, when a physician had a problem, he Of she would talk to the CEO and it would be resolved. This had created a culture of strong physician autonomy and engagement with hospital administration. Within a year of the merger, corporate approval was required for all but the smallest issues. In an attempt to create an integrated systems approach, the corporate office developed a "one size fits all" mentality that severely limited the physicians' ability to control their local world.

The sense of loss among the medical staff was intense. After a brief period of denial, most of the physicians became angry, and some left the area. Those who remained did the best they could to operate within the new paradigm. One stepped up to serve as the CMO in 2009, but after two years resigned in disgust at the inability to effect change. Staff morale and engagement had declined even further by the time the second CMO arrived in 2011. He lasted nine months.

Dr. Felton Wayne

After four years as a physician in the U.S. Army, Wayne had come to Lee County in North Carolina to start a practice with his friend Dr. Benjamin Emerson in July 2000. Over the next 10 years, they built a practice that changed the face of health care in the county. Wayne was recognized for his accomplishments when the American Academy of Physicians selected him as Physician of the Year in 2010. After receiving the award, Wayne tried to grow services and make changes in stafflng, and problems began to develop.

I had been through a malpractice case the year before the award and unexpectedly lost the case. It was during this very challenging time that I started asking myself if perhaps I had accomplished what I came to do in Lee County. I quickly dismissed the thoughts, but they never really went away. The more I tried to effect further change at [my practice,] Appalachian Family Medicine, the more I felt I was in the wrong place. My wife had developed a cutting-edge integrated pharmacy service within the practice, and conflict with this service escalated with one of the other partners. I really didn't understand it at the time, but I knew something was going to have to change. After soul searching and extensive conversations with my wife, we decided I would leave the practice and enroll in the University of Virginia's Darden School of Business MBA for Executives program.

The summer of 2012 saw rapid-fire change for Wayne and his family. He sold his interest in Appalachian Family Medicine and was selected for the role of CMO at Franklin Memorial Hospital. His wife took a position with a local pharmacy school, and they moved their family across the mountain 30 miles to be closer to their new work locations. Wayne described the transition:

My sense of loss was intense. In a four-month period, I said goodbye to 10 years of community, church, and work relationships and stepped right into a 60-hour-a-week senior executive position serving five hospitals spread across 13 counties with no patient contact time. At the same time, I started my MBA at U.Va. There was no time to grieve.

The First 90 Days

In the month leading up to starting his role as CMO on July 1, Wayne read as much as he could about the work he would be responsible for doing. Nothing could have prepared him for what he encountered.

The staff at FMH were demoralized and apathetic. They did not trust VH and did not see it committed to making FMH be the best hospital it could be. But thanks to the long tenure of the CEO and his humble, caring nature, the staff still had some faith that the local leadership wanted to do what was best for FMH.

Wayne entered into an intense listening period in which he met with all the offlcial and unofficial physician leaders. Sometimes the residual anger was directed at him, and it took significant discipline on Wayne's part to remain calm and engaged in the discussion:

As a middle child, I grew up as a people-pleaser and had never changed. I needed people to like me, and I relied on these interactions to affirm my decisions. I had to really work hard to change this internal script and develop my internal locus of control.

Results of the listening period

Out of this listening period came one core vision and three supporting initiatives.

Core vision: An engaged, self-governing physician community empowered by a culture of respect and trust to innovate and collaborate.

Supporting initiatives:

1. Maximize the hospitalist team's performance. This team at each facility is the key to improving quality and efficiency metrics.
2. Form strong relationships with the chief of staff and his/her official medical staff leadership at each facility. Invite them to and include them in decision making at the highest level.
3. Develop enough of a relationship with the many unofficial medical staff leaders to get them to commit to activities that would provide interaction with corporate administration. This contact will help corporate and medical staff to view each other as "thou" instead of "it."

Wayne would later learn that these steps closely echoed the first four steps in leading change outlined by Dr. John Kotter. ^l At the time, however, he discovered that the effort spent on these initiatives did not immediately change anything. Indeed, empowering a medical staff that was already viewed as difficult and rebellious by corporate administration was not considered a smart move. Steps taken to improve medical-staff communication and create a local vision were interpreted by corporate as attempts to be different from the rest of the system.

Doubt and the Dominant System of Thought

Despite the disapproval of his fellow CMOs in other parts of the organization, Wayne continued to develop his vision and plan for the North Carolina facilities (Exhibit 1). At every opportunity, he exposed his medical staff to the realities of the changing health care landscape. When corporate brought in a nationally renowned speaker to discuss health care reform, Wayne was able to get more physicians from North Carolina than South Carolina to participate, despite the fact that the South Carolina medical staff was twice as large as North Carolina's.

Wayne pushed to get permission to recruit additional physicians into the corporate physician leadership program. When the program started in January 2013, physicians from North Carolina formed the majority of the class. As he learned about leadership development and experienced the Darden teaching methods, Wayne saw improvements that needed to be made in the leadership program. He partnered with a fellow CMO to convince Richmond to let them revise the program to focus more on emotional-intelligence development and team learning activities.

Wayne worked closely with the physician leader of each hospitalist team. At FMH, this leader was well liked by the team but would not make the hard decisions necessary to standardize and enforce the team norms. Eventually, he stepped down, and Wayne assumed temporary leadership of the team. Despite Wayne's spending signiflcant time with the unofficial group leaders, the fallout from the enforcement of standards initially made things worse, and a number of physicians announced their intention to work elsewhere. Wayne described this period:

¹ See http://www.kotterinternational.com/the-8-step-process-for-leading-change (accessed May 21, 2015).

I was exhausted. When I wasn't at my desk trying to keep up with e-mails, I was at corporate headquarters battling the dominant system of thought and trying to explain the value of my time spent developing the medical staff. I was in the middle of my third term of my MBA, and I would come home and go straight to my office to do homework or participate in a distance learning session with my team. One day I walked through the emergency room, and the director, who was a friend of mine, swiveled his chair around, looked at me, cocked an eyebrow up, and commented, "Dr. Wayne! We haven't seen much of you the last month." I realized then that I had drifted away from my initial routine of management by walking around spending face time with the physicians.

Wayne felt something needed to give. He had been working incredibly hard for nine months and had little to show for his efforts. He felt unappreciated and ineffective in his role. After his meeting with Richmond about being a "cowboy," Wayne wondered whether he should just go back to doing what he was good at taking care of patients.