Being a physician takes a certain type of person: highly intelligent, altruistic, and guided by the idea of creating positive change. Their medical training emphasizes independent thought and strong decision-making. All of these traits make for great clinical care, but can cause problems with the rest of the staff. It is the softer skills like motivating others, communicating well, and being a collaborator that turn great physicians into good leaders.
“Those intuitively strong skills can be overpowering when you put doctors in team-based environments,” said Peter Angood, MD, president and CEO of the American Association for Physician Leadership. “Strong leaders need to understand their training and early career experiences won’t make them good managers.”
In a paper published in the Journal of Health Administration Education (2008:25:307-328), James Stoller, MD, chairman of the Education Institute at the Cleveland Clinic, outlined leadership competencies needed by physicians and found 6 key domains: technical skills and knowledge of operations, finances, and human resources; healthcare industry knowledge; problem-solving skills; emotional intelligence; communication; and a commitment to lifelong learning. Of these, Dr. Stoller said, the most important is emotional intelligence, which includes attributes such as self-awareness, self-management, and awareness of one’s impact on others. These can be a challenge for physicians who are trained to do what he calls “deficit-based thinking.”
For instance, when a patient comes in with pain during urination, there are a handful of potential reasons why this is occurring. A physician will go through the possibilities to ascertain the problem and find a solution. This works well in a clinical context – looking for a problem and seeking a solution – but not as well when dealing with a staff.
“There is a whole school of thought that if you frame things as a series of problems, you get a different answer than if you think of challenges as opportunities,” he said. “If you ask, ‘What opportunities do we have to get better?’ it is different than asking, ‘What are the problems and how do we fix them?’”
This way of thinking conditions the way physicians give feedback, which Dr. Stoller said can be critical. He said physicians would do well to move from the deficit-based thinking to an appreciative way of articulating issues when interacting with teams.
Other traits that make a good physician but can be challenging for leaders is intelligence and a scientific mindset, said Andrew Garman, CEO of the National Center for Healthcare Leadership. Physicians tend to be the smartest people in the room, and as they work with teams, they have to “let others be brought along with what they are thinking,” he said. An investigative mindset is great clinically, but he said physicians must appreciate that their team will understand evidence, but react in an emotional manner toward things like transformation and change.
Instead of just saying, “We are doing this because the literature tells us to,” physicians can help employees understand the changing environment, be aware of the essentiality of it, communicate the process, hold people accountable, and involve staff in decision-making throughout the process.
How to change
Garman highly recommends involving staff in the process. “They will be the best source of information on how a leader is doing,” he said. “By asking [for] feedback, they are modeling behavior that they would want to see from folks they are working with as well.”
When requesting feedback from staff, he recommends building in opportunities to hear how the team perceives the physician, where their strengths are, and where they need to improve.
Another approach is personality testing. There is a host of testing options available, including the Myers-Briggs Type Indicator, which gives physicians an idea of how they perceive and therefore react to the world around them, Angood said. Another option is the DISC test, which informs people how to communicate effectively and adapt their personal style to react appropriately in various situations.
“This can give physicians a sense of their inherent aptitudes and how others perceive them to be,” he said. “What others think of us is often different than what we think of ourselves.”
A final way to improve leadership is through the assistance of mentors. Physicians have mentors who challenge them in a range of different areas, and this is a great place to explore leadership.
Becoming a good leader does not happen overnight. It includes learning how to be humble, a good follower, a better communicator, and a good listener. As team-based care becomes increasingly important, so will being a good team leader. As more physicians seek employed relationships, they may be called upon to take on leadership roles. Being a good leader can increase staff loyalty and engagement and reduce turnover, all of which can lead to better care.