Leadership

Introduction

Healthcare organizational structures and dynamics have evolved throughout the years, creating the need to effectively manage scarce resources, redefine models of care, integrate clinical and administrative activities to achieve economic efficiency, and improve quality outcomes. In the healthcare context, a physician leader and a nonphysician administrator have specialized skill sets and roles. While a physician is trained to provide patient care, an administrator is trained to address organizational issues, which creates and perpetuates functional silos. Facing such challenges requires a better integration of clinical and administrative functions and a close collaboration between physicians and non-physician leaders. To effectively manage turbulent times and align the clinical and administrative functions, healthcare organizations have begun to implement dyad leadership models, in which two individuals with different skill sets, education, and backgrounds are paired to better fulfill the mission of the organization. The dyad leadership model is implemented by healthcare organizations as a solution for bridging the divide between these separate functions. Thus, the following questions served as a premise for this research: How is the role space shared and practiced within a dyad leadership model as contextual forces evolve?

While implementation of a dyad leadership model within healthcare organizations is trending upward, issues regarding the dynamic of dyad leaders persist. In particular, both leadership researchers and practitioners are challenged by role enactment, distribution, and how leaders interact together and with other members around specific organizational issues. Particularly, for healthcare organizations that traditionally perpetuated functional silos, it is challenging to transition to a dyad model when the scope of the dyad roles is not clearly defined and structured, and when there is no established framework for the dyad leaders on how to interact and function with one another and with other organizational members. 

Research Findings 

For healthcare organizations that have traditionally perpetuated functional silos, it is challenging to transition to a dyad model when the scope of the dyad roles is not clearly defined and structured, and when there is no established framework for the dyad leaders on how to interact and function with one another and with other organizational members. This research uncovered three salient themes:  

1. Role clarity between administrative and physician leaders 
2. Leading together within the dyad model 
3. Frequent interaction and communication  

Role clarity was a challenging part of the dyad model. This theme demonstrated that at a micro-level within a dyad, roles are not static, but rather are dynamic in nature and morph over time based on the organizational and situational requirements that arise. Each dyad establishes its own modus operandi with a more personalized rather than institutionalized approach to practicing roles within the dyad model. In some instances, the roles had not been prescribed prior to engaging in a dyad, but were being developed as the relationship between the leaders evolved. The role clarity theme uncovered that physicians tended to focus on physician issues and clinical activities, while managers focused on administrative functions, cost containment, and financial solvency.  

Leading together is a unique attribute of the dyad model, as the source of leadership comes not from a single leader, but rather from two leaders. To lead together, the dyad leaders engage in joint decision-making, keep each other informed, and exercise influence within the dyad model. Nevertheless, the leading together theme revealed both how leaders practice their roles, as well as challenges that the leaders encountered. When it comes to leading together, the administrative leaders appeared to have more clarity around decision-making and authority. While physician leaders retained their decision-making power and authority within their respective clinical divisions, within the dyad model, they played supporting and advisory roles. Physician leaders exercised their roles by providing input and showing support for organizational decisions disseminated to the dyad.

In addition to leading together, frequent communication and interaction between the dyad leaders are important. As in the other themes, the dyads developed their own modus operandi dictating the frequency and depth of interaction. Communication did not manifest as a discrete activity, but rather as a continuous activity around managerial aspects such as decision-making, strategic planning, or problem-solving, as well as around the interpersonal relationship between the dyad leaders. Furthermore, the communication between the dyad leaders was facilitated by proximity, frequency of formal and informal interactions, and dyad leaders’ ability to address emerging disagreements. In addition to emphasizing the importance of constant communication, dyads are subject to codes of behavioral rules or norms that guide the interaction of the group.  

These themes revealed that sharing and practicing the role space in a dyad model is a dynamic, collective, and relational process that occurs between the dyad leaders. Dyad structures are unique, each with its own established modus operandi. Even though dyads represent small groups of two actors and require greater unity, actors are allowed to preserve their individuality and maintain a degree of autonomy. Additionally, dyad structures are not only characterized by the individual actors, but also by the actors’ interaction with one another in a dynamic organizational environment. The complexity of organizations and the role of leaders result in greater demand for dynamic, collective, and relational processes that enable leaders to collaborate, exercise their roles, and jointly lead in dynamic organizational settings.