Relational Leadership for Clinician Leaders: in Practice at OCHIN

“We are seeing people leave healthcare, because they're burned out. They're not feeling supported; they're not feeling safe. If, as a larger healthcare system, we don't figure out how to adopt more relational practices, we're going to run the risk of an even larger workforce shortage. 2020 laid bare the big disparities that exist within our current healthcare landscape. …something is going to have to shift. Relational Leadership is an important tool to help alleviate some really broken aspects of the healthcare system.”
— Cally Johnson

Intend Health partners with OCHIN to provide Relational Leadership for Clinician Leaders (RLCL), a 12-week course for community health leaders across the country. Now in its second year, the program teaches Relational Leadership (RL) concepts in one-hour modules, to accommodate schedules of and maximize learning for busy clinicians.

Founded in 2000, OCHIN is a nonprofit leader in equitable healthcare innovation, providing the clinical insights and tailored technologies needed to expand patient access, connect and augment care teams, and improve the health of underserved communities. Cally Johnson leads five teams within the operational excellence department, including a project management office. She also oversees the organization’s Epic Release Program and manages an evaluation and analytics team and the quality improvement team.

How Relational Leadership Came to OCHIN

“These tools helped me work more effectively in teams and inspire others, especially during the last two years, which have been collectively so challenging."

Cally Johnson was invited to join the Oregon Health & Science University (OHSU) Relational Leadership Institute (RLI) program as a pilot participant in 2017 by a graduate school classmate who was a trainer and facilitator for RLI.

“At the time, I didn’t know what I had signed up for, but I quickly fell in love with the curriculum and the community,” Johnson says. After participating in the pilot, she served as a facilitator, a trainer, and currently serves as a facilitator coach.

Johnson quickly recognized the value that Relational Leadership brings to the workplace and recruited several OCHIN colleagues to participate in RLI at OHSU. “I see how these tools helped me work more effectively in teams and inspire others, especially during the last two years, which have been collectively so challenging. All of these factors drew me to bring Relational Leadership to OCHIN in a more formal way,” she says.

After a successful pilot in spring 2021, two additional cohorts have participated in the program, with the next one beginning in the fall of 2022.

Johnson adds, “We know that people are really hungry for people-focused styles of leadership. Being able to work together more effectively helps ease burdens on care teams. That was how I was able to bring Relational Leadership to OCHIN.”

Relational Leadership Supports the Work of OCHIN

Relational Leadership aligns with OCHIN’s core goals of easing clinician burden and advancing health equity by offering solutions that are tailored to meet the unique needs of care teams in community health center settings. Internally, the organization is deeply committed to employee satisfaction and was able to connect a funding opportunity to this area.

Johnson describes how RL concepts fit with a grant that OCHIN received from the Health Resources and Services Administration (HRSA). The HRSA-funded Health Center Controlled Network Award focuses on nine objectives, one of which is designed to improve provider satisfaction and decrease burden and burnout. She was able to make the case that delivering RL content would be helpful in that effort.

In addition, RL concepts are a fit with OCHIN’s deep commitment to equity. Johnson says, “I felt like I was equipped with tools to foster psychological safety during the huge racial reckoning that began in 2020. Relational Leadership helped us with tough conversations about what was happening in the world. I see many opportunities for Relational Leadership to support organizations with advancing diversity, equity, and inclusion.”

A Flexible, Adaptable Program in a Time of Uncertainty

While she was making the pitch for OCHIN to partner with Intend Health, Johnson knew that the style of Relational Leadership offered at OHSU would be challenging for already overburdened community health centers during a public health emergency. Because of this, they have been able to tailor the curriculum and test different ways to deliver it over the past year in smaller, more digestible chunks, enabling OCHIN to create more access to the content, which is critical for busy clinicians.

The Impact of Relational Leadership at OCHIN

According to Johnson, Relational Leadership and RLCL have been well received at OCHIN. Participants in the first pilot were very positive about the program, and as a result, others at OCHIN are excited to see the program continue.

Alleviating Clinician Burnout

The main goal of the RLCL Program at OCHIN is to alleviate clinician burnout, and formal evaluations of the program indicate a positive impact in this area. Twenty-five people completed the program pilot, including three CMOs, six medical directors, and eight clinicians. Results indicated a ten percent decrease in total reported burnout from program beginning to end.

“People were already burned out before the pandemic, and it's really promising that those 25 folks experienced some positive impact during the program.” Johnson also notes that participants “reported a greater sense of community post-program, which is important given how isolated folks have been during the pandemic. Our next challenge is to figure out how to scale the program to reach more people.”

Practical Tools Put to Use

“These moments, of taking what you learn to work more effectively, make Relational Leadership powerful. It's not just theory. It's practical language, practical tools that you can quickly try on for size.”

When asked about additional benefits of Relational Leadership, Johnson mentions the power of facilitation. OCHIN staff are facilitating the RLCL program and are taking the program tools and using them in their work. “That’s exciting for me, because a lot of these people report to me, and together we’re able to build this culture of inclusion, setting norms up front, checking in, and building and maintaining psychological safety. I see this happening more frequently, and this is building trust with others across the organization.”

“These moments, of taking what you learn to work more effectively, make Relational Leadership powerful. It's not just theory. It's practical language, practical tools that you can quickly try on for size.”

Relational Leadership Supports Career Growth, Creates Leaders

Johnson speaks to the impact of Relational Leadership on her own career growth. “At the very least, signing up for a leadership training program was a signal to my first boss that I was ready to grow. I give a lot of credit to the OHSU Program and Intend Health, because I don't know what type of leader I would've been without this community. It's shaped how I show up at work and apply tools like narrative leadership, one-to-ones, and the coaching framework. I use the coaching framework often, maybe weekly.”

Johnson continues, “I always feel like I show up as the best version of myself when I'm participating in Relational Leadership. It's partially because I'm reminded of the things that I should be doing on a daily basis when I'm participating in a cohort. It’s also because of the community of people who are steeped in this, who are committed to people-focused leadership and are building positive relationships. I absorb that energy and show up as a better leader, as a result.”

Relational Leadership: Potential Impact on Healthcare Systems

In discussing the potential of Relational Leadership to be supportive or helpful in the larger healthcare system, Johnson says, “we are seeing people leave healthcare, because they're burned out. They're not feeling supported; they're not feeling safe. If, as a larger healthcare system, we don't figure out how to adopt more relational practices, we're going to run the risk of an even larger workforce shortage.”

She continues, “2020 laid bare the big disparities that exist within our current healthcare landscape. If we don't know how to build psychological safety on our teams, facilitate inclusive meetings, and nurture relationships within care teams (along with what we’re each supposed to be doing), something is going to have to shift. Relational Leadership is an important tool to help alleviate some really broken aspects of the healthcare system.”

How Relational Leadership is Different

"The program not only provides tools, but it teaches how to leverage those tools in the context of power dynamics. That makes this program really unique.”

When asked how Relational Leadership differs from other leadership training, Johnson says, “I'm not sure how many other leadership programs center conversations around power. Power has been an important topic of conversation in the context of Relational Leadership. The program not only provides tools, but it teaches how to leverage those tools in the context of power dynamics. That makes this program really unique.”

Johnson also notes the experiential quality of the program. “I love that one of our norms is to encourage folks to ‘skateboard.’ Try something, fall down, get back up, and try something else. And if it doesn't work, you can try again, and you'll get feedback.”

Leadership Pathway

Johnson acknowledges that her RL experience may differ because of her involvement in the Leadership Pathway, whereby interested professionals serve on Intend Health’s extended team as coaches, facilitators, and/or trainers, as they develop their Relational Leadership skills. “I would highly encourage anybody participating in Relational Leadership to join the Leadership Pathway. It has been hugely helpful to my own development as a leader.”

Johnson joined the Leadership Pathway as a facilitator of small group activities in the OHSU RLI Program. Paired with a more experienced facilitator, she was encouraged to try new things, such as co-training about conflict. While initially terrified of public speaking, she is no longer, since it’s now routine.

As Johnson describes it, the Leadership Pathway provides “opportunities to step into roles and responsibilities where you wouldn't normally place yourself. There’s a safety net to catch you if you stumble on your words or if you're stuck on a conflict in your personal or work life; you can talk through it.” She also mentions the power of training others. “There’s something so transformative about coaching others. It has been so valuable.”

The facilitation skills Johnson has learned in the Leadership Pathway have been helpful in her role at OCHIN, because she is often facilitating meetings. She has learned to be intentional about the structure of meetings, and to ensure that everybody is included and has a voice at the table. “These are essential skills that you pick up on the Leadership Pathway, and they can set you apart in the workplace.”

Advice for Those Considering Relational Leadership

“If you've ever had team members who were grappling with racism, deaths in their family, or interpersonal conflict on their team, the skills that you pick up in Relational Leadership help you navigate those difficult conversations."

Johnson says she would advise other leaders considering Relational Leadership to “just do it; no question.”

“If you've ever had team members who were grappling with racism, deaths in their family, or interpersonal conflict on their team, the skills that you pick up in Relational Leadership help you navigate those difficult conversations. They also help you have fun at your job. Last year, my team began meetings with icebreakers every day for three months, because we hadn’t yet met in person. The only time we had to connect was during these 30-minute huddles, and once we knew each other, it was much easier to work together successfully.”

“I don't know what my life would be like without the programming that Intend Health offers. We're still learning, but there's so much potential here, and I'm really excited for the future.”