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Vital Signs

Trustees call for a doubleheader at DHMC

By Laura Stephenson Carter

The Roman Republic did it. Hewlett-Packard did it. Goldman Sachs did it. Now Dartmouth-Hitchcock Medical Center is doing it—proving that two heads are better than one.

Structure: A new co-leadership structure for DHMC—to be known as the Office of the Presidents—was endorsed by the relevant Boards of Trustees two months ago, and Nancy Formella, R.N., M.S.N., was named president of Mary Hitchcock Memorial Hospital and of the Dartmouth-Hitchcock Alliance. Formella had been in that role in an acting capacity since the retirement last year of long-time MHMH-DHA president James Varnum. And the shared presidential structure—a collaboration between Formella and Dr. Thomas Colacchio, president of the Dartmouth-Hitchcock Clinic and a professor of surgery at DMS—had also been in place unofficially for the past year.

DHMC is following in the footsteps of companies like Hewlett-Packard, Goldman Sachs, Intel, TIAA-CREF, and other enterprises that have made shared leadership work. Even the early Republic of Rome thrived for 400 years with consuls and other magistrates who served as co-leaders. But DHMC may be one of the first academic medical centers to function in this way. "We're kind of leading the way," says Formella. "For us right now, this is the right thing for the organization."

Experts who study management systems have found that co-leadership works best when the people at the top have complementary skills. Formella and Colacchio fit that mold.

Colacchio, who joined the DMS faculty in 1981, combines administrative duties with a day and a half in the clinic, so he "understands the clinical practice from a physician's point of view," says Formella.

Colacchio and Formella now officially lead the lineup at DHMC.

"And my background as a nurse is in care provision, and being a manager and an executive in a hospital. So, together, that's a pretty powerful package—that kind of clinical depth of knowledge with administrative knowledge."

Process: Their personal characteristics are complementary, too. "I would say my strengths are very much in the arena of building relationships and inviting conversation and group process kinds of things," says Formella. And "Tom's strengths are in sifting through a lot of information and a lot of data and getting to the conclusion and being more direct in the decision-making."

The coequal nature of the leadership structure was underscored by the Trustees' announcement that Formella and Colacchio will be paid the same salary—$600,000 each. The Trustees said they were impressed by what the two leaders have accomplished so far, citing "the remarkable progress made by Dartmouth-Hitchcock over the past 12 months in its financial performance and in the setting of a set of ambitious priorities for the future."

Formella sees challenges ahead,

however. "This is an organization that is wedded to the status quo," she points out. "We're not where we need to be or where we want to be, and we haven't been particularly passionate about changing it."

Until now. Under Formella and Colacchio's leadership, DHMC is taking a systematic look at all its processes and functions. "Things like patient access, how do we make appointments, what's really our commitment to getting patients in here in a timely way?" says Formella. She anticipates improving information technology, performance reviews, and clinical and administrative systems.

"We've been an organization that has been good at launching a project, and we don't hold our own feet to the fire," she adds. "We're designing these improvement projects in a way that—the best way I can say it is—will hold our own feet to the fire—[by developing] metrics and . . . building accountability."

Formella—who has more than 30 years of experience as a staff nurse, a clinical nurse specialist, and a nursing executive—came to DHMC as senior nurse executive in 1999. She had previously worked for a national consulting firm for three years and before that held leadership positions in Mayo system hospitals for 15 years.

Magnet: In 2003 she led the effort to obtain Magnet status in nursing for DHMC. In 2004 she was named Nurse Leader of the Year by the New Hampshire Nurses' Association. And in 2005 she was honored for Nursing Management Excellence by the New Hampshire Organization of Nurse Leaders. She holds a B.S.N. from the University of Iowa and an M.S.N. from Marquette University.

"It is so humbling to be asked to take on this role at this time in this organization's history," says Formella. "It is just very, very gratifying."

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