Physician Health

Developing future leaders from the inside out with Sanford Health


AMA's Moving Medicine video series amplifies physician voices and highlights developments and achievements throughout medicine.



In today’s episode of Moving Medicine, AMA Chief Experience Officer Todd Unger talks with Luis Garcia, MD, president of Sanford Health’s Clinic Division and Heather Spies, MD, physician director of clinician experience and well-being, about Sanford Rises, a unique program aimed at developing future leaders from within its organization—and how initiatives like this are directly tied to physician well-being.


  • Luis Garcia, MD, president, clinical division, Sanford Health
  • Heather Spies, MD, physician director, clinician experience and well-being, Sanford Health

Moving Medicine video series

AMA's Moving Medicine video series amplifies physician voices and highlights developments and achievements throughout medicine.

Unger: Hello, this is the American Medical Association's Moving Medicine video and podcast. Today we're talking with Dr. Luis Garcia, president of Sanford Health's Clinic Division, and Dr. Heather Spies, physician director of Clinician Experience and Wellbeing. Both are calling in from Sanford Health in Sioux Falls, South Dakota, to talk about how they foster a culture of physician well-being and develop future leaders from the inside out. I'm Todd Ungar, AMA's chief experience officer in Chicago.

Dr. Garcia, Dr. Spies, thanks so much for joining us today. Stanford Health is a clinician-led organization. It's earned numerous accolades, not just for its ability to treat patients, but also for creating a place where physicians want to work. And that's not an easy feat during a global pandemic. We can certainly say that. And part of that is because of unique programs like Sanford Rises. And we're going to talk a little bit more about that program, which helps to foster future leaders from inside the organization. Dr. Garcia, why don't we just start with you and get a quick overview of how that particular program works and why it's so important.

Dr. Garcia: Todd, thank you. First of all, thank you for inviting us to join you today. Heather and I are very appreciative of the opportunity, and we're equally appreciative. I'm proud of those recognitions that you mentioned for our health care system. But I would like to highlight that our goal has never been to get recognitions. The recognitions are the result of the work that backs that up. We're not driven by accolades. We are driven by our values.

Our organization has made our patients, our people and our communities, our priorities in that order, patients, people and communities. And we have promised the best patient care in the rural setting. And in order to provide the best patient care, we need the best people and we need the best people at their best. So when it comes to a clinician-led organization, we need to pay attention to what it is to become a leader in health care and in our organization.

So it is important to us to offer high quality leaders a path for growth. And this is where rises comes in. Our Rises program is a programming, which we offer 25 of our rising stars every other year the opportunity to engage in a very comprehensive leadership and development program in which we pay attention to their personal development, to their development as leaders and mentors. Also, how do they lead inside the organization through change. And in the last year of that program, we pay a lot of attention on the business aspect of medicine.

Unger: Dr. Spies, how do you identify those rising stars in the organization? What makes physicians stand out?

Dr. Spies: Well, first of all, we thought through what makes an exemplary clinician in the first place, right? So we want our leaders to be those that have already show that they take exemplary care of the patients, their exemplary colleagues, they can be trusted, and they really have their priorities on how we want to see things going in our culture at Sanford, their role models. And so we asked people to be nominated. A lot of times it was by their peers or the VPMOs of the clinic, VPs of the clinic to say, who have you identified already that are exhibiting these characteristics? And we're launching this Rises program for developing them further, investing in them as people and as our colleagues, as physicians. And we had over 65 applicants for the first pool and had to narrow it down to 20, which led to 25, because we had such great nominees that we ended up choosing 25 to go forward in this last group. So just who are those people that can lead our organization to the future that we're looking for.

Unger: Is there any particular quality that stands out among all the others?

Dr. Spies: I think just how they interact with each other. They've already shown that they've got the good moral ethical behavior that we want to be sure is at the foundation of everything. It's a foundation of how we care for our patients. It's a foundation of how we treat each other as people. As Dr. Garcia said earlier, the only way we can do well by caring for our patients is to know that we have those foundational values at the core of everything we do. And so I think that's the biggest thing. They can be trusted. They're already good clinicians and they're starting to show that in how they're leading their teams.

Unger: Dr. Garcia, if you turn the clock back to when this was just an idea, how did this come about? And compared to when you first started, has it evolved in terms of what you would hope it could be or want it to be down the road?

Dr. Garcia: Thanks for that question, Todd. And Heather and I have been collaborating comprehensively in our strategies around well-being. And one of the things that we discussed is you cannot have true well-being without a solid leadership development opportunity. I think that as a leader, you have to be present and our leaders are present when they find the sense of value, when they find the sense of contribution and when they know that they're living a legacy. So we know in Sanford that we have the talent. It's just a matter of how do we identify that talent, how do we support them in their leadership development, and then, how do we develop them further to the next stage? Because as Heather pointed out, we are looking at these clinicians as the future of the organization. And so we had to become a little bit more systematic in the approach.

A lot of these leaders were pursuing that development individually. So we decided as an organization, if we say that our people are our most important asset, we should invest in our people and we should be systematic on the way we do it. And that's how the Sanford Rises idea started growing. And then as we developed the program, I'm going to be honest. We have our bumps on the road and we have had to modify some things. We're wrapping up the first year of the first cohort, the feedback that we've getting from our clinicians have been phenomenal. They recommend it to anybody. And as a matter of fact, they want to participate in future cohorts as part of the faculty and staff of the program.

So right now, what is evolving is that we are refining the program itself to make it an excellent program. But we are also looking at alternative pathways of leadership development, for example, for our nurses or for our program directors. We have 18 residencies and fellowships. So how do we support our program directors, our academic faculty in a different way that our regular clinicians? And then also, we love to learn from others and we love to share our experiences. So just right now with you, with American Medical Association and other organizations, we're always open to share and to learn from others and to make our workforce better.

Unger: The topic of leadership development, it's one that I hear a lot when I'm talking to physicians, leaders in the field, even down to students. But when I ask them more about, what does that mean to you? A lot of times that there's a lot of trouble translating what do you want out of leadership development into a set of things that we could do to help. When you think about the things that compose say the program itself, what are people most hungry for in terms of leadership development?

Dr. Spies: Yeah, I think we've found exactly that. We are basing it on what they are hungry for, and that's why we've been learning from the very beginning to be nimble and being able to pivot with what they're looking for. But I would think, again, the base is looking to be together as peers and to be able to look to each other, right? So one of the basic fundamentals of each of our sessions is a well-being check-in at the beginning of every session. And the first meeting, the first session, it was very, obviously a little superficial, if you may say, just because they didn't all know each other well. By the third session, people were sharing really important things with each other, helping each other through some situations or issues that they just needed some support on or advice on in their leadership journeys.

And so I think that's one thing that I think is foundational for any leadership program is to really say, we have to make sure as leaders that we're going to take care of ourselves and each other, so that we can be our best selves and be our best leaders, work on the strengths. We did do some strengths finders and different things like that, too, just to help them identify those strengths. And then going forward, we really want to emphasize, like we talked about at the very beginning, this is building from the inside out. So as they go through this program, like Luis said, they're going to start training the next people coming through. And I think there's a big variety of people in this cohort from clinicians who've only been in practice for a few years all the way to people who have been here for 25 years and well established leaders. And so to have that within that group already that they can teach each other along the way has been priceless. There's nothing better than learning from someone else's experiences and getting that real feedback.

Unger: And you're answering my next question, which is really about, I can already hear it from just hearing a description of the program. And are you finding that, the way that you're doing the program is having an influence on the culture of the organization even in the short period of time or is that where you're headed?

Dr. Spies: Yeah, I think so. I think that people are realizing that part of leadership is just being a mentor, being a coach, being a friend and colleague to those that you're working alongside every day on your teams as you care for patient, in the meetings as you're maybe in some type of administrative role or on a committee. So yeah, culture encompasses everything. And I think the more that we can invest in our people to encourage them to lead by example, the more leadership development plays into that culture.

Unger: Dr. Garcia, this is probably a tough time to start a new program like this because the pandemic has brought with it its own incredible set of challenges. Having this culture in place in training, so to speak, how's that served you during the pandemic, did you learn anything new throughout that?

Dr. Garcia: Yeah. Todd, thank you. And I feel for all the health care industry right now and for all the health care providers that have had to endure the last couple of years. But you bring up a great point. A lot of people think, is this the right time to have an expense on this type of stuff? And first of all, we don't see it an expense. We see it as an investment. If you are not ready to invest in your own people, you're not ready to invest on anything. Let's put it that way.

I mean, our people, they're our most valuable assets. They allow us to provide that excellent patient care that we have promised, particularly in the rural setting. So we need to continue to invest in them.

The challenges of the pandemic are the same for everybody. And I think that as an organization, we take the responsibility of supporting you as a clinician. So as a nurse, you never should open a drawer and not have a mask or not have a sterile gown or not being able to perform a procedure because of lack of resources. So as our organization has committed that those resources will always be there. But in addition to that, I think that we need to see our clinicians, not only as clinicians, but as human beings. And we have to be able to support them as human beings. And a lot of that, once again, is in the leadership development.

We have promised our patients that we're going to deliver the best care and in order to fulfill that commitment, we need to invest in our people. And we see our people as such, as talented people that come and share their talents with our patients in their times of greatest need but also as human beings that deserve the opportunity to be supported that way as well.

Unger: Dr. Garcia, one of the other outcomes, of course, of the pandemic are challenges with workforce shortages and Sanford Health treats a largely rural population. And I know that can sometimes make recruiting and retaining physicians difficult. Are you also struggling with those types of issues right now? How are you addressing them?

Dr. Garcia: Yeah, absolutely. And I think that struggle, Todd, is baseline for us. I mean, you pointed out that most of the people do not plan to practice in the rural setting. Most of the people, particularly if you're subspecialized training, you want to go to a bigger city to execute your talent. So for us, recruitment is a baseline challenge and all that was exacerbated by the pandemic. So what we have done really is we have gone through all the strategies and technical aspects of recruitment and retention, just like any other health care system. And I can go through a list of strategies that would be repetitive to anybody that have seen them. But what it is important, once again, is that in our organization, we are creating the culture of belonging, the culture of being part of something bigger, the culture of being part of a family. And as a family, we care for each other.

And it is interesting, Todd, to see that ... And I'm a prime example, I'm from Mexico City. You think about the Dakotas and you go, like, "Why would I go there?" Right? But once you get exposed to our culture, to our health care system, to our communities, people stay and people stay for the right reasons, which is provide excellent patient care in communities that are safe and that are welcoming and in practices that are fully supported by a great organization.

Unger: Well, the commitment that you've shown to well-being has been recognized as Sanford Health was a recipient of AMA's 2021 Joy in Medicine award. Just one of 44 health systems that were recognized for its commitment. And I know it's very hard to qualify for that. Dr. Spies, what advice do you have for other health systems as you look back on the road that you've traveled to get to this point, be an award winner like that?

Dr. Spies: Well, thank you. And like I said or like Dr. Garcia said earlier, it's really not about the accolades of that. It's really about, how can we use those resources to move forward in this work? So Dr. Garcia has been laying the foundation for this for years with other leadership here. And luckily, we had the buy-in before COVID. And with other health care systems across the country, I think COVID has helped move some of these good things forward, because we've realized really acutely how necessary it is that we're paying attention to the human aspect and that our needs as physicians.

But when we started partnering with the AMA, there's really such a strong base of resources. The framework that the Joy in Medicine program provides is actually a useful tool. It's not just, "Oh, you're working on this and you've done this and great," it's really, "You've committed to doing this. Now, how are you going to keep moving forward with it?"

And like Dr. Garcia said earlier, how are you going to share it with other organizations? Right? So we've been meeting with AMA colleagues. We've been meeting with other organizations and partnering to keep moving all of us forward together, which is so meaningful. And then when you see the different ways that it's helping in other organizations, maybe one organization is six months ahead of you, two years ahead of you, someone else might be six months behind you. You can help each other. It's really fulfilling.

I think one of the biggest things we just started with, because we had to start somewhere with the actual work for the AMA recognition program was establishing our clinician wellness council. And that's been really beneficial in just guiding the scope of where we want to be focusing on. What can we do to help with efficiency and practice? What can we do to help with development of our leaders? And so once you get the right people that are really passionate about this sitting around the same table and meeting regularly, then you can start moving it forward as an organization.

Unger: I know the team here will just be so gratified to know about the impact and what an honor it is to work with you and your system. Dr. Garcia, Dr. Spies, thanks so much for being here today. That's it for today's Moving Medicine video and podcast. We'll be back with another segment soon. Just make sure you don't miss one. In the meantime, click subscribe on our YouTube channel or check us out on Apple, Spotify or wherever you listen to your podcasts. You can find all our videos and podcasts at Thanks for joining us. Please take care.

Disclaimer: The viewpoints expressed in this video are those of the participants and/or do not necessarily reflect the views and policies of the AMA.