The Physician-Leader’s Pocket Guide
The transition from clinician to physician-leader is one that requires adaptability, curiosity, perseverance, patience, and open-mindedness. Most of all, it requires the ability of the physician to be versatile. Being versatile means having a willingness to change behavior and adapt to the situation or role of leadership. As you have read in previous chapters, the very characteristics that make for being an outstanding physician can be the same behaviors that undermine the work in leadership roles. In fact, having an unwillingness to adapt ensures that the clinician will fail at becoming an effective leader. As coaching guru Marshall Goldsmith has observed, “What got you here will not get you there” (Goldsmith 2007). In his book, Goldsmith takes the reader through the reasons why moving up in any organization requires different skills and behaviors than previous positions required. Nowhere is this more evident than with the physician who is moving into a leadership position.
Research on leadership has determined that the most effective leaders are those that demonstrate the ability to adapt their styles to the circumstances with which they are faced. In fact, the correlation between leadership effectiveness and versatility is 0.71 when looking at both how a leader leads and on what the leader is focused (Kaplan and Kaiser 2008). Versatile leaders are able to moderate their leadership behavior to fit the situation with which they are faced. What leaders focus on, tactics or strategy, is only half the story. The other half, and arguably the most important half, is how leaders lead, ranging from being empowering on one end to being forceful on the other. It is how the leader leads that will ultimately determine the degree of influence and followership he or she has achieved.
What we have attempted to show you in this book are the foundational skills physicians need to learn and the behaviors they need to adopt in order to become effective physician-leaders. We will review here the central characteristics required for that transition.
Understanding the Role
The transition from being a full-time clinician to having a leadership role, even part time, is a complex and challenging move. It is a move that requires learning new skills and changing some behaviors. We have reiterated that the capabilities and skills that make good physicians are often at odds with those that make good leaders. Our tendency as humans is always to default to those behaviors with which we are most comfortable. This is particularly true in times of stress or pressure. The ability to resist using old behaviors and risk using new ones is always a bit scary. Know that you will initially proceed by fits and starts as you try on some of the new behaviors necessary for effective leadership. They will become easier with repetition, practice, and success.
One of the primary changes from being a clinician to being a physician-leader is moving into a role of managing, rather than directing. This means that the physician will become more of an influencer than the authority. It means harnessing the wide expanse of skills and intellect in others. Using collaboration and negotiation are the centerpieces of effective leadership. This requires patience, taking a longer view, and thinking more strategically than is required in the purely clinical role. The physician-leader also needs to transition from the clinical hub-and-spoke leadership style to one in which leadership is shared, capitalizing on the strengths of individuals on the team.
The Business of Health Care
In the changing world of health care, the health care model is changing from one that is professional-centered and focused on effectiveness and volume to one that is patient-centered and focused on value. The business model for health care is still unsettled, but we know it is going to change and likely to do so rapidly. The physician-leader will need to understand what this means in terms of services, patients, physicians, vendors, insurers, pharmaceutical companies, and so on. When the focus is on creating value, rather than primarily on increasing volume, the physician-leader will have to know the many ways required to deal with this paradigm shift.
The leader will also need to understand what value discipline the hospital or health care organization will be working toward maximizing. Health care organizations will be required to excel at operational efficiency, product and service innovation, or customer intimacy. They will need to be outstanding in at least one of these aspects and average or above in the other two, in order to survive. Understanding how these value disciplines fit into the new health care business model will be a challenge every physician-leader will be facing. The physician-leader will also need to understand and be conversant in the metrics of health care. Understanding that it is metrics that serve as the scoreboard and help to identify system strengths and weaknesses will help the physician-leader know where to direct resources for maximum benefit.
The Personality of the Physician
Physicians have unique personalities, shaped by both genetics and the environment in which they developed. These unique personality traits are further shaped by the specialty that the physician has chosen. The demands of being a clinician and the responsibility of managing and overseeing the health of their patients typically create individuals who are more conscientious than the average professional. They also tend to demonstrate more agreeableness and more extraversion than the average professional. These traits vary some according to specialty, but are all higher than the population as a whole.
It is these very traits that have made physicians such good clinicians. They possess the ability to engage with their patients, understand their symptoms, and prescribe the best treatment. In this role, they are the authority and make decisions independently. Although some of these traits translate well into leadership positions, some can be handicaps. In particular, the penchant toward perfectionism and the tendency to make decisions independently both have to be modified when moving into a leadership position. We recommend that clinicians considering the move into leadership positions assess their personalities to better understand what traits they will want to begin working on as they transition into a leadership role.
Qualities of an Effective Leader
Leadership is about influence. Without influence, no one will follow and nothing will get done. The good news is that the characteristics of an effective leader have been identified so that aspiring leaders can better learn the behaviors they will need to have to be most effective. We have created a formula for influence.
Influence = CARVE
The components of this formula are:
Courage: the willingness to stand up for what is right in the face of opposition.
Authenticity: having behaviors that are congruent with your expressed beliefs and values, that demonstrate a high degree of humility, and that are accompanied with personal vulnerability.
Rational Appeal: using intellectual reason, appealing to the rational side of those with whom you interact.
Values: having a core set of values that guide your behavior and are congruent with the values of your constituents.
Emotional Intelligence: understanding and managing your emotions and the emotions of others.
It is our experience that the best leaders have all of these qualities and use them on a regular basis to engage their teams. By regularly and consistently using these components, you will be able to turn these new behaviors into internalized traits. In other words, they become a part of you. Although being a strong leader and influencer is not easy, the quest is worth the effort. Talent is in high demand, but the shortage of good leaders is alarming.
In order to have an engaged workforce, it is important for those in the organization to believe that they are involved in meaningful work and that their work is tied to something greater than themselves. The most effective leaders understand this and know the importance of having a mission, vision, and strategies that are all aligned and consistent with the organization’s goals.
Effective leaders also know that organizations can only withstand so much change at a time. In fact, the more goals an organization has, the less likely it will be to accomplish any of them. The most successful organizations have no more than three to five major goals, all of which align with the organization’s vision and have metrics to track them. Creating a successful vision is the starting point for any organization to succeed. It provides the compass, road map, steering wheel, and engine to get to the final destination most efficiently.
Building a High-Performing Team
Nothing gets done without people. Nothing gets done well without a high-performing team. There are two areas in which teams must excel in order to be considered high performing, and those areas are productivity and vitality. Productivity may seem obvious. It is the total output of any team in terms of the products and services that it is creating or providing for customers. It would be expected that high performance goes hand in hand with high productivity. But there is a second, equally compelling characteristic that must be met, and that is how the productivity is attained. Vitality requires high morale, interpersonal cohesion and employee engagement, which are all necessary for the team to be considered high performing.
Productivity and vitality are both outcomes of having all of the elements of a high-performing team in place. A team needs to have the right people with the right skills; a clear charter with a clear focus; a strong climate that is safe and allows for differences of opinion and points of view; a process for effective execution, including collaboration, accountability, and incentives; and clear communication, including processes to resolve conflict. It is the responsibility of an effective leader to put all of these into place in order for the team to maximize its potential.
Magnifying Impact through Delegation
One of the biggest challenges of the physician-leader is that of delegation. There is always more work to do than any one person can accomplish. However, because physicians are so high in conscientiousness, they tend to be perfectionists and have difficulty trusting others to get work done appropriately. As a result, it is not uncommon for the physician-leader to either take on too much themselves or, when they do delegate, micromanage the work.
Learning how to delegate is more complicated than it would first appear. It is more than simply allotting work to others. The most effective delegators have a process in place that includes differentiating between what work can be delegated; what work is not worthy of being done now or maybe at all; and what work leaders must do themselves. Once they have differentiated, they have a clear strategy about whom to delegate to, rather than delegating randomly. Finally, they have a process of follow-up to ensure that work they have delegated will get done properly. Leaders need to think of delegating as a way to magnify their impact in the organization and not simply as a way to get work completed.
Communicating to Make a Difference
The ability to communicate effectively is the most important skill for health care management. This is not surprising since it is the most widely cited complaint employees have in most organizations. The most effective physician-leaders are aware of the need to keep their teams informed and understand that it is not only the content of their messages but also the way in which information is conveyed that is important. These leaders are consistently working to ensure that everyone has the information they need to get their jobs done effectively.
Dealing effectively with conflict is a type of communication that even good leaders tend to avoid or delay. Having difficult conversations is anathema to those physician-leaders high in agreeableness. These leaders just want everyone to get along! However, conflict in the workplace is inevitable. The smart leader is one that understands this and further understands that delaying or postponing difficult conversations will only exacerbate them in the future. Creating a process for having difficult conversations that are problem-solving in nature, rather than blaming or judging, is a necessary step for holding people accountable and ensuring fair treatment for all. The best leaders attack conflict head-on and with the expectation that the outcome will be the best for all parties involved.
Successful Negotiating Strategies
Surveys have found negotiation to be one of the top skills that physicians want to learn and master. It is no wonder because negotiation is a constant in a physician’s life from negotiating schedules to negotiating contracts. Too often, negotiations are entered into with a zero-sum game approach in which participants are determined to gain something from their opponent and expect that their opponent will have to lose something of equal value. It is the height of competitiveness and, in negotiation terms, is a value-claiming approach to negotiations characterized by low trust and high competition.
A more productive negotiation style is a value-creating approach. This approach relies on collaboration and high levels of trust. The goal is to create an outcome that is beneficial to both parties, and the methodology is one of mutual problem-solving rather than one of high competition. This is the more desirable of the two strategies but requires both parties to take the risk of believing that each party has the other’s best interest in mind. Regardless of your negotiation strategy, doing your homework to arm yourself with knowledge is the key to success.
Wellness in Physician-Leadership
Physician wellness has been a trendy and important topic in medicine for many years. There is little doubt that the pressures of being a physician and taking the ultimate responsibility for the health care of other humans are unique challenges that layer onto the typical frailties of the human race in a manner that has created an epidemic of physician burnout. Physician-leader wellness, while related, has its own set of hurdles.
In the previous chapters of this book, we have outlined many of the common difficulties that physicians face as they transition into leadership. A few of these obstacles factor strongly into the wellness equation for physician-leaders.
As with any career path, it is important for the physician-leader to recognize the aspects of their role that bring them joy. This is why it is so crucial for physician-leaders to understand why they are drawn to leadership. It is easy for physicians to be pushed into leadership, because the need is so great. It is equally common for physicians to run toward leadership roles because they are suffering burnout in their clinical careers. The good news is that leadership is diverse in its responsibilities. If the physician-leader can identify what brings them passion and joy in work, they can usually figure out a way to infuse that into their roles. Whether they are driven by mentoring and developing others, creating strategy, driving clinical quality, or even reducing burnout in other physicians, the intentional physician-leader can energize their careers by feeding their passions. The key is recognition and intentionality.
Prioritization is also a requisite skill for the healthy physician-leader. In clinical medicine, the checklist is a force unto itself. The clinician must accomplish every single task on the checklist in order to ensure that their patients receive the proper care. In leadership, this virtue is a curse. Administrative and leadership duties are not prescribed in the way that clinical care can be, especially in this age of evidence-based medicine. The to-do list for leaders is literally never ending. Beyond merely prioritizing potential tasks, the physician-leader must learn to draw the line at a reasonable place and not only accept but also be comfortable leaving all the tasks below that line undone. This is true of both short- and long-term initiatives and can be greatly mitigated with effective delegation. Failure to master this skill will result in frustration, self-doubt, and eventually burnout.
Another peril that awaits the physician-leader involves the concept of delayed gratification and subtle rewards. Clinical medicine is rife with long hours, daily annoyances, and sad patient stories. However, physicians repeatedly report that it is the intermittent wins like making a good diagnosis or having a great patient outcome that keeps them going. In leadership, the wins are different and the time frames of initiatives protracted. As a result, physician-leaders can find a dearth of positive reinforcement in the short term. Even in the long term, it is easy to work on an initiative for many months only to successfully achieve the goal and move on to the next initiative, never stopping to recognize the accomplishment. The successful physician-leader will learn to recognize the small victories. These may be milestones along the way to accomplishing broader goals. Moreover, leaders must derive gratification from accomplishments such as having an engaged staff or a positive organizational culture. Physician-leaders will also need to understand that the work of leadership is measured over years, not days or weeks. It takes experience and faith to embrace this concept. Leadership can be very isolating, so developing a support structure of trusted colleagues can help to keep success in perspective.
Wellness is now an entire field of study, and concepts such as meditation, mindfulness, and practicing or journaling gratitude can certainly benefit the physician-leader. We believe that pairing the leadership-specific material contained in this section with other universal wellness techniques can help ensure that physician-leaders maintain healthy and fulfilling lives.
What You Need to Know about Being a Physician-Leader: FAQs
There are several questions that we have been asked that go beyond the scope of this book but are important to becoming a physician-leader. We try to answer the most popular ones here.
- •Do I need an MBA to be a successful physician-leader?
This is perhaps the most common question asked by aspiring physician-leaders. A Master of Business Administration (MBA) or similar degree is certainly useful to provide physician-leaders with the basic knowledge and skills for management. It is also a positive factor on the resume when applying for a leadership position. However, an MBA alone is like attending medical school without doing a residency. The skills and experience gained in actual leadership roles are much more impactful in creating effective physician-leaders. So, while an MBA might help secure a first job in leadership, its benefit for an experienced physician-leader is somewhat muted. As with all great questions, there is no easy answer, and each physician-leader must answer this question for themselves. A student entering medical school with the idea of pursuing physician-leadership would be well served to consider one of many existing joint MD–MBA programs. An already practicing physician will likely have a more complex cost-benefit analysis.
There are a variety of other avenues available for physician-leaders to gain leadership education. The American Association of Physician-leadership offers regular conferences and a curriculum to become a Certified Physician Executive (CPE). Medical Group Management Association (MGMA) and the American College of Healthcare Executives (ACHE) also have educational offerings that can be useful for physician-leaders. Opportunities for physician-leader education grow every year, and a quick Internet search can reveal many options.
- •How can I move from the clinical work I do into a full-time leadership role?
Clinicians often ask us how they can move into leadership roles. Very few people apply to medical school with the intent to become a physician-leader. As such, the path to physician-leadership varies widely from one leader to the next. The commonality is that most begin their careers as clinicians and spend some time dabbling with various administrative roles before making the leap to being a full-time physician-leader. There are ample opportunities in any health care organization for physicians to serve in limited administrative roles. This is usually the first step for clinicians who want to become leaders. By volunteering for committees or workgroups, clinicians both express their interest in leadership and demonstrate to established organizational leaders that they have the foundational skills to be a leader. Examples of readily available committees are in the areas of quality, patient safety, peer review, credentialing, utilization review, and case management. Physicians who can demonstrate the foundational skills described in this book are sure to be noticed as potential leaders. There is such a need for physician-leaders that one opportunity usually leads to another, larger opportunity. The committee member becomes the committee chair. The committee chair becomes the medical director, and so on.
This process usually takes years but can move much faster depending on the organizational needs. During this time, physicians should find and take advantage of chances to gain formal leadership education from courses or conferences. Often, organizations are willing to support this education with time and resources. Up and coming physician-leaders must eventually decide that they want to make the leap to a full-time leadership role and keep themselves abreast of such opportunities that develop at their institutions. It is usually easiest to transition into a full-time leadership role at your own organization as you are a known commodity. Once you have the experience and the title on your resume, the path to a leadership role at another organization is much easier.
- •What things do I need to learn to be an effective physician-leader?
The leadership skills discussed in this book are foundational and will translate effectively to any leadership role. There is also subject matter specific to health care and physician-leaders. Quality and patient safety are areas that all physician-leaders should understand. From basic quality improvement tactics such as a plan-do-study-act cycle to more advanced techniques such as six-sigma and lean management, physicians-leaders must possess at least the foundations of this knowledge. Once armed with this quality improvement skill set and a willingness to embrace change, a physician-leader’s clinical training can make them uniquely qualified to contribute to clinical quality improvement efforts. The compliance and regulatory realm is another territory where physician-leaders need to be comfortable. Understanding Stark and Anti-kickback laws, The Emergency Medical Treatment and Labor Act (EMTALA), Joint Commission regulations, and a myriad of other health care regulations is crucial. Physician management often falls under the purview of a physician-leader, so knowledge of credentialing, privileging, peer review, and physician health/rehabilitation is essential. A basic knowledge of finance and accounting becomes increasingly important as a physician-leader moves up in an organization. This includes the ability to understand budgeting, profit and loss statements, and pro formas. These represent some major areas of required expertise for physician-leaders, but there are many others. Each of these topics warrants a book of its own so we did not attempt to address them in this book. We encourage all physician-leaders to make these topics a part of their education.
- •Is there any value in engaging an outside coach to help me learn about leadership?
As we have discussed in detail, the skills that are required for becoming an excellent physician can sometimes interfere with the ability to become an effective leader. It has been our experience that engaging an executive coach to help you with this transition can be extremely helpful for developing new behaviors and insights for leadership. One underrecognized benefit of coaching for physician-leaders is the reassurance that a coach can provide. All leaders are prone to feeling alone and isolated. As the saying goes, it can be lonely at the top. New physician-leaders often go through a period of self-doubt and discomfort with their new role even if they are doing a great job. A coach can provide the reassurance needed to push on. A word of caution: do your due diligence. Because there are few regulations or standards for advertising oneself as a coach, there is a very wide variation in expertise and quality. It is important to have a coach that understands health care, business, leadership, and psychology. Comparing resumes and credentials could be helpful.
- •Would a personality assessment help me become a better leader?
Having greater self-understanding can be an asset to any position in which you find yourself. This is particularly true when making the transition from a clinician to a physician-leader. When used with ongoing coaching, personality assessments can help focus the coaching and lead to positive behavior change. Like coaches, there are a wide variety of individuals who provide this service as well as a wide variety of assessments available. Having an unqualified assessor with a poor instrument can be of little value. As we have stated in Chapter 3, assessments that look at the Big Five Personality Traits have become standard in the personality assessment field. In particular, the Hogan suite of assessments are what we recommend without reservation (hoganassessments.com). In addition, we have found the Leadership Versatility Index (LVI) to be an excellent 360-degree assessment (kaiserleadership.com). Although there are good assessments available, make sure that the assessments you use have high levels of reliability and validity and that they are administered by individuals with certification or licensure in your state.
Lessons along the Way: Leadership Pearls We Have Learned
In our over 50 years of combined experience in health care and learning about leadership, several pearls of wisdom have guided us, on which we rely to make decisions. These pearls have come from both the school of hard knocks and from sage mentors and teachers we have had. As a closing note on our book on leadership, we want to share these with you. You can use them like a reference card in the pocket of your white coat when you need help—Leadership Made Ridiculously Simple. We hope you will add these to your own lessons learned. It is our hope that these pearls become part of your ongoing education as you move into a physician-leader role.
- •Not everyone is like you:
All people have their own way of thinking and acting. Since your perspective and approach is the one most familiar to you, it is common to fall into the thinking that other people should think and act the way you do. This can create frustration for leaders as something that seems simple to the leader may be an enormous challenge for others. Change management is a core task of leadership, and it is so difficult precisely because people are all unique in their thinking. We have repeatedly coached frustrated leaders to remember this concept and seek unity in diversity, rather than discounting those who may think differently.
Everyone has a perception of themselves and their own abilities. It is not uncommon for this perception to differ from that of others as well as from objective measures. We have found that the most effective people and leaders are able to recognize the gap between their perception and reality. Diminishing that gap between reality and perception is a necessary condition for self-awareness, maximal effectiveness, and authenticity. It has been said that the most dangerous doctor is the one that doesn’t know what they don’t know. This is a perception–reality gap.
- •Narrate your leadership as you would narrate your care:
In a leadership position, staff and subordinates are very much like your patients. They become anxious when they don’t know what to expect, what you are going to do, and what their role is in your plan. The more you communicate both your plan and your expectations, the less the anxiety and the greater the buy-in and compliance you will get.
- •Be comfortable swimming in the gray:
The physician/patient role is one in which both parties want certainty. Patients want to know their diagnosis and treatment. Physicians want certainty with patient diagnosis and treatment. Human beings, in general, take comfort in certainty. However, in leadership roles, things are almost never black and white. In fact, there is typically significant ambiguity when solving systemwide problems, and there is often more than one solution. The tasks of leadership also commonly take time to come to resolution. Physician-leaders need to become comfortable with not knowing and with the process of patiently exploring rather than having definitive answers. This is easier said than done. The discomfort of uncertainty and swimming in the gray has been the downfall of many new leaders.
- •Success is in the process, not just the outcome:
As a leader, when solving large, complex, and unfamiliar problems, it is important to put in place the best processes and trust that the best answers will emerge. Being able to separate the outcome from the value of the leader is a difficult but important skill. The best leaders recognize that their responsibility is to address every challenge in the best way possible as that will produce the highest likelihood of success. At the same time, the healthiest leaders are capable of accepting that negative outcomes sometimes occur despite their best efforts, as not everything is within their control.
- •Patience is your ally:
The great Russian author Leo Tolstoy observed that in life “[t]he two most powerful warriors are patience and time.” Clinical practice requires that decisions be made on the spot and, sometimes, with very little time to consider multiple options. The opposite is true in leadership. Although there are threats and crises that require immediate attention, they are very infrequent. By far, these are the exception rather than the rule in leadership decision making. Effective leadership requires processes that include seeking input from multiple sources, weighing the benefits and risks of various scenarios, and looking for trends that indicate a theme. These processes require leaders to have patience and to be willing to take more time when making big decisions than is afforded the clinician. In leadership, time and patience are your allies.
- •Don’t oversolve the problem:
The philosopher Voltaire observed that “the perfect is the enemy of the good.” We have learned that physicians are typically highly conscientious, often to the point of being perfectionists. When working with patients, this trait is extremely helpful in making an accurate diagnosis and creating effective treatment plans. However, this same level of perfectionism in a leadership role can serve to bring progress to a halt because of the extraordinary time involved in getting to the “right” solution. The problems of systems often do not require a perfect solution, but only one that is “good enough.” It is important not to overengineer solutions. Do not let your pursuit of perfection sabotage getting a good solution in place.
- •Leadership is a series of ups and downs, victories and losses, problems and solutions:
In a leadership role, it is critical to effectively manage your emotions and keep the long-term perspective in mind. This means not getting too high with wins nor too low with defeat. You will likely encounter both ends of the spectrum on a daily basis. It is important not to let the negatives overly impact you. The role of the leader is to deal with multiple problems as they arise and maintain an even keel emotionally and a problem-solving attitude cognitively. The daily fire drills are why you have a top job. If it were easy, anyone could do it. Take the negatives in stride and solve the problem. Keep in mind that most problems get better with time, patience, and persistence.
- •Don’t forget to celebrate every achievement:
In terms of keeping a team motivated, great leaders know the importance of celebrating achievements to keep morale high and to keep people engaged. Research by well-known business consultant Tom Peters found that the reason people stay engaged is not primarily financial. In fact, remuneration ranks below factors such as finding meaning in one’s job, receiving appreciation from a manager, and receiving recognition for a job well done. As Peters said, “Celebrate what you want to see more of.” When you celebrate and affirm achievements you are really celebrating and recognizing the talent you have. Never hesitate to publicly recognize and applaud the efforts behind even a small success.
- •Followers respect leaders who are both tough and kind:
As we have discussed, leadership is about influencing. In this sense, leaders are always balancing getting results with relationship management. It is important to keep in mind that being tough on issues but kind to people is the best approach. Very few people respect leaders who are only tough or only kind. We believe that accountability is the hallmark of an effective organization. However, accountability includes both a focus on results and a focus on the people achieving the results. Focusing exclusively on one without the other will lead to either an unproductive organization or one that seeks results at the expense of morale, which can be costly in the long term. A good leader manages both simultaneously.
- •Each medical specialty and the physicians that comprise it have their own personality and culture:
Earlier in this chapter, we discussed the importance of leadership versatility. Being a versatile leader means that you adjust your behavior on the basis of the role you occupy and the audience with whom you are working. The same is true when working with other physicians, particularly in a leadership role. There are stereotypically commonalities among physicians within a specialty and differences between specialties. No doubt you have laughed at memes about this very subject while recognizing that there is some degree of truth to all the jokes. You cannot treat all physicians or specialties the same. Rather, you can only be successful treating each of them as independent entities. This is best illustrated in the coaching of legendary University of California at Los Angeles (UCLA) coach John Wooden. He knew that each of his players responded uniquely to different motivational tactics. He needed to be tough with some but gentle, almost fatherly, with others. He recognized that to get the maximum effort from his players, he needed to adapt his coaching to their needs.
- •Most people are consistent in their behavior:
If you encounter behavior that is notable in either a productive or nonproductive fashion, take note. An unexpected change in behavior often suggests that there has been a change in the individual’s life. Changes can be the result of any number of issues, including depression, experiencing excessive pressure, and family or work problems. Regardless, it is important to have conversations as soon as you notice changes in work habits or productivity. Too often, we have seen managers ignore these problems in the hope that they will go away on their own. The results of this approach are typically disastrous. Address changes you see quickly, directly, and empathically to get optimal results.
- •The best predictor of future behavior is past behavior:
Shakespeare noted wisely that the past is prologue to the future. Like Freud, Shakespeare knew that the best predictor of future behavior is past behavior. This is a psychological principle on which you can rely with high levels of confidence. When you see a pattern of behaviors, assume these will continue to occur in the future. The antidote to this is an intervention in which this pattern is addressed and a plan to change it is put in place by an individual motivated to change. Do not expect behaviors to change on their own.
- •The team is smarter than the individual:
When the right group of individuals and the right leader are assembled to work on difficult problems, anything is possible. The talent of the team almost always produces better results than any individual could. The challenge of the physician-leader is to gather the best talent for the problem at hand. The second challenge is to manage the group in such a way that the group’s collective energy and wisdom can be harnessed and directed to solve the problems. In these circumstances, the team is always better than the skills of the individual alone.
You are about to embark on an exciting and bold transition as you move into health care leadership. As we discussed in our opening chapter, at no time in recent history has health care been in more flux. The issues are complex and divisive. No one understands health care at the grassroots level as well as the physician treating patients on a daily basis. The need to have physicians in health care leadership roles has never been greater. As you consider making this leap, we hope that you will know that we are available to help you decide if it is the right thing for you. Do not hesitate to get in touch with us. Our contact information is at the end of our biographies.
Goldsmith, M. 2007. What Got You Here Won’t Get You There: How Successful People Become Even More Successful. New York, NY: Hyperion Press
Kaplan, R., and R. Kaiser. Summer, 2008. “Developing Versatile Leadership.” MIT Sloan Management Review 44, no. 4, pp. 18–26.