It can be a balancing act, but senior leaders at Brooke Army Medical Center make it a priority to carve out time for clinical care.

When asked why they do it, their responses share a common theme: "It's all about the patients."

"We have to have an attitude in the command suite just like everywhere else in the hospital that patient care comes first," said Air Force Col. Heather Yun, deputy commander for medical services and an internal medicine and infectious disease physician. "I put clinical time on the calendar first and then work everything else around it."

Yun is just one of several senior leaders at BAMC who sees the benefits of staying clinically active despite a demanding position and back-to-back meetings. While her job overseeing all outpatient and outlying clinics keeps her busy, she still works in a half-day of clinic every week or two, and dedicates a week a month to infectious disease consults or seeing inpatients in internal medicine wards.

"Staying clinically active helps me to stay current on the context and issues across the organization," she explained. "This first-hand experience helps to better inform an organizational response."

Leading From the Front

Whether in the military or private sector, "leading from the front" is important as it instills trust and confidence among staff, noted retired Army Col. (Dr.) Evan Renz, deputy to the commander for quality and safety and a general surgeon specializing in the treatment of burn patients.

"Being present is foundational to successful leadership and ensures the director's staff remain current and in-tune with frontline issues and challenges," Renz said. "It builds rapport and strengthens confidence."

Clinical time also sets a positive example for other healthcare leaders, added Army Col. Jody Brown, deputy commander for inpatient services and a family nurse practitioner.

"If I can get on scrubs and be at the bedside with our nurses, any other nurse can do the same," she said.

A recent study, titled "Physician leaders' perspectives about balancing clinical and leadership responsibilities," published in the June 2020 issue of the American Journal of Accountable Care, appears to validate the benefits of clinical care for physician leaders. Of the eligible 447 participants, 84% reported participating in direct patient care. The vast majority noted that doing so "somewhat or greatly improved" their performance as leaders.

According to the study's authors, "A common thread is that physicians' first-hand patient care experience lends them unique leadership perspective that can be highly valuable to themselves and their organizations." Benefits cited include greater credibility among the clinicians they lead, a unique perspective on balancing financial and operational concerns, and better insight into "frontline" issues.

Crucial Touchpoints

Army Brig. Gen. Clinton Murray, BAMC commanding general and an infectious disease physician, agrees that patient care provides an important perspective.

"Being hands-on allows you to fully understand the problem set and to speak from the position as a subject matter expert," he said. "It also enables people in patient care to have more direct engagement with senior leaders to build trust and improve communication."

Murray approaches many of his clinical shifts with a dual-hat perspective. After infectious disease consults, he often takes the opportunity to visit staff in various clinics and inpatient wards throughout the hospital.

"I am able to better understand issues and concerns this way and bring them to the leadership table so together we can affect change," he said.

These touchpoints proved crucial during BAMC's recent transition to MHS GENESIS, the military health system's new electronic health record. MHS GENESIS replaces numerous legacy systems and is being adopted as a common platform across the Department of Defense and Veterans Affairs.

"My clinical time helped me to understand the challenges firsthand, and my leadership role ensured I'd be able to address them at a decision-making level," Murray said. "As a clinician, I'm in the same boat as everyone else, and this fosters camaraderie and empathy."

Hands-on care also leads to increased empathy for patients and their unique challenges, noted Army Col. Kimberlie Biever, deputy commanding officer and a nurse practitioner. Despite one of the busiest schedules in the hospital and an ever-present line of people at her door, Biever has never considered skipping an opportunity for patient care.

"Working in the clinic offers me an opportunity to keep my clinical skills sharp while ensuring I keep my finger on the pulse of patient concerns," said Biever, who often raises patient issues, such as lab or pharmacy wait times, at leadership huddles to initiate improvements.

From a military standpoint, keeping medical skills sharp is also vital to readiness, as clinical leaders can be called on to deploy downrange at any time, Renz noted.

Readiness and leadership engagement are key aspects of Ready Reliable Care, a Defense Department initiative that builds on best practices across the enterprise to ensure optimal outcomes for patients and staff.

"The fact that BAMC's leaders remain engaged clinically highlights our commitment to prioritizing the DHA's Ready Reliable Care model throughout the San Antonio Market," Renz said.

Balancing Act

While there are significant benefits, the study also emphasizes that balance is key to ensuring both clinical practice and leadership efficacy is maintained.

To help ensure leadership continuity, Yun relies on her colleagues to fill in for her at meetings and huddles when she's in clinic. This enables her the flexibility of time for patient care, while offering her colleagues an opportunity to hone their managerial skills and broaden their scope of experience.

"Everything we do, we do as a team -- whether it's patient care or leadership, and between all of us we can make it happen," she said.

Committed to Care

Another common theme for BAMC leaders is their passion for their profession.

Army Col. Sean Hipp, chief medical officer and a pediatric hematology-oncology physician, said he followed in his father's pediatrician footsteps to care for families. While he enjoys affecting change for families on a system level, he finds it just as important to personally impact families in the clinic.

"I spent my whole life wanting to become a physician; it is my passion and interest," he said. "Losing that part of my life would leave me less fulfilled."

Yun was also inspired to become a physician by her father, who was an internist in a rural Colorado town. "I saw the fulfilment he gained from taking care of his patients and the incredibly important role he played in the community, taking care of everyone regardless of their ability to pay. He remains my greatest inspiration in medicine."

Like her father, Yun said she benefits just as much from clinical time as her patients. "It's incredibly important for me to spend time seeing patients, some of whom I have decades' long relationships with, and teaching medical students, residents and fellows. Their energy and optimism inspires me and helps my own wellness."

Murray was inspired to pursue his specialty after hearing his parents' stories of growing up in the Congo in Africa, and the medical challenges there that underscored the importance of safe, quality healthcare across the world.

The physician-patient relationship is "special on many different levels," Murray said. "I also love the relationships I have with my colleagues to solve a clinical problem, and then as a team help the patient fully heal," he said.

Balancing leadership and patient care can be challenging, but is well worth the effort, Hipp said.

"It's not always easy to find time, but it's worth it to stay connected," he said. "It's easy to get lost in daily leadership meetings and emails. Clinical care keeps me grounded and centered on why I want to be physician leader."

No matter how packed the schedule, "patients are our priority," Biever said.