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Sanford

Weil

Kathleen D. Sanford, senior vice president and chief nursing officer, and Dr. Robert J. Weil, senior vice president and chief medical officer, work as a dyad team to lead the Clinical Enterprise division of Catholic Health Initiatives, an Englewood, Colo.-based health system that operates more than 100 hospitals in 18 states.

"Health care is leading the way," said Sanford, who also co-authored the 2015 book Dyad Leadership in Healthcare: When One Plus One is Greater than Two with Dr. Stephen L. Moore, then-chief medical officer at CHI. Sanford is a registered nurse who holds a doctorate in business administration

Companies outside of health care are using the dyad model, but Sanford said, "the health care industry is not behind business on this."

Sanford defines a dyad as "a small team or mini-team of two people who work together and co-lead a specific system, division, clinical service line or project." An example would be an information technology officer and a physician leading a short-term project for installation of a new computer system, or a nurse and physician guiding CHI's cardiovascular service line.

"Almost everyone has a blind spot or two or three, so (the dyad model) is almost giving you eyes on other parts of your head to obtain a broader view of the world," said Weil, who has worked as a dyad with Sanford since 2016.

"We all belong to a tribe — nurses, physicians, finance people — and we tend to come up with solutions that are conditioned by those tribes and we don't tend to listen to others," he added. "It's valuable to listen to others who don't have the same approaches as me, the same biases." He added that effective dyad management requires "being an equal partner in work and in others' perception of our teamwork."

Last summer, Sanford, who has been working in dyads at CHI for a dozen years, and Weil led a workshop session on the dyad model at the American Hospital Association's Leadership Summit in San Diego.

"People who don't know health care think (doctors and nurses and other providers) work well together," Sanford told the association's audience. "We work together — but we've been on parallel paths. ... People are still having trouble figuring out that we need to work together — we need to combine our skills."

Speaking to Catholic Health World, Sanford acknowledged that "when we first started talking about (dyads), people didn't know what we were talking about." But now, she said, "it's become part of our lingo."

That doesn't mean every health care system should jump into dyad leadership without any preparation, the CHI team said.

"Being a dyad is a popular thing right now. But throwing two people together is going about it the wrong way," Sanford said. "Things only go well if you make the right selection of people."

The qualities needed in a good dyad leader are the same as those demonstrated by any transformational leader, the two said. These include a commitment to teamwork and collaboration, along with a commonality of goals and shared values.

A major part of the job is "helping other people buy into the vision of shared leadership," Sanford said. "If you are not good at being in a dyad, it could be that you are also not good at doing teamwork."

The two CHI leaders demonstrate their collaboration when making slideshow presentations, for example, by switching speakers with each slide, Sanford said.

"People ask me, 'Do you really get along that well?'" But working together well as a dyad "doesn't mean we agree on everything," she said. "We talk about and improve on each other's ideas, but then we have a united front when we leave the room."

Those working under the dyad's leadership also know that they can come to either member of the team with a problem or concern and get a response that the other leader will support, she said.

"They had to get over that idea that nurses can only talk to nurses and physicians to physicians," Sanford said.

Weil said it is also important to "ensure that the other leaders who are expecting you to form a dyad relationship know what they want" from the partnership. "If they do not understand its power and its pitfalls, you cannot succeed," he added.

"If the job is to straddle gaps, leadership has to identify those gaps and be very deliberate about saying, this is what we expect our dyads to do," he said.

Before becoming a dyad with CHI's chief medical officer, Sanford said, "I thought I knew everything about what physicians did. But you learn so much when you have the opportunity to see how other people lead.

"Health care is changing so fast today; the challenges change every day," she added. When health care professionals engage in what she calls "parallel play," they can develop "a silo mentality."

"But it is a great benefit to the organization if it can get the right two people who can work together and create synergy," Sanford said.

Weil said the dyad relationship allows them to "really focus on solutions to questions that are meaningful and durable for patients and their caregivers.

"The desire to enhance quality outcomes for our patients has been for us a very compelling part of our partnership," he added.

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