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Geriatrics: ••Winter 2003/Vol. 7, No. 1 |
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Physicians
as Leaders:
"Leaders understand that activity is not necessarily accomplishment." -- John C Maxwell1:p175 All physicians are leaders. We are leaders in the operating room, the emergency room, and the executive boardroom. Because many of us have not received formal training in leadership, it is important for us to understand what it is to be a leader as well as how we can mentor other physicians to be leaders. Supporting the development of all physicians as effective leaders is the key to our success. The future of our medical group and the quality of care and service we provide our patients will depend on the effectiveness of physician leadership. I will share six universal and timeless characteristics of great leaders. These characteristics are principles of life and, if mastered, will help you to become a more effective leader. Share in a Vision "The empires of the future are the empires of the mind." -- Winston Churchill2:p317 The first characteristic of a great leader is vision. Our physician-leaders most understand the vision of Permanente Medicine.3 Our medical group, through physician leadership, provides high-quality care and service at an affordable price. Accomplishing these goals requires assimilating information in business, quality improvement, and customer service. Failing to understand the big picture or believing that the goals or objectives of the medical group are unattainable are examples of attitudes that will demoralize our medical group. The first
step in developing a good vision is to be boundaryless.4:185-204
Try not to think of vision in terms of the restriction of the status quo,
but, instead visualize the potential of your medical group without boundaries.
"Boundaryless" means no boundaries. We do not let bureaucracy
or job titles get in our way of Boundaryless does not mean that we cannot face reality. We all live in a world that is bound by budgets and time. We cannot afford to waste time and money trying to solve a particular problem. Boundaryless means that we eliminate those barriers (bureaucracy) that prevent us from implementing a good idea that will help our team to succeed. Finally, the vision must have metrics and targets. Without a scoreboard, we will not know where we stand. Surround Yourself with Great People "It's lonely at the top so you'd better take someone with you." -- John C Maxwell1:p115 Strong leaders surround themselves with strong people. Great leaders understand that it is a myth that one person can do something great. They realize the benefit of strong interdependence. Great leaders realize early in their careers that by surrounding themselves with other strong individuals, they can maximize their strengths and minimize their weaknesses. Primary care physicians are often overloaded with messages from patients. Even the most effective physician can be overwhelmed in trying to review lab results, to see patients, and to answer all of his/her messages before the day is complete. The nursing staff can help the physician by organizing messages by topic (medication refill, lab review, or "needs appointment"). The nursing staff may proactively order charts that may help the physician answer his/her messages. The result is that the staff helps minimize a perceived weakness and strengthens the team's ability to return messages before the day is complete. You may be a great coach, but if you do not surround yourself with talented people, you may lose to a team that is smarter or more effective. On the other hand, if you have two teams with equal talent, the team that is better coached will probably win. Therefore, always recruit and work to retain the best team members possible. When recruiting new physicians or colleagues for your team, look for people who have high energy levels, energize others, make tough decisions, and deliver on promises. These are characteristics of great leaders.4:p6 It is also important to identify stars who make things happen. Every team should have one or two stars. Stars are physicians or other team members who are filled with passion and committed to making things happen. They are open to ideas and find a way to break down barriers so that projects run smoothly. A star physician will listen with empathy to a staff member's problem because s/he realizes that a problem must be understood before it can be solved. These stars should be identified and given the tools to allow them to succeed. Stars build great organizations. Importance of Physicians Coaching Other Team Members "When angry count (to) ten before you speak, if very angry count (to) a hundred." -- Thomas Jefferson2:p729 For teams to be successful they must develop good team chemistry, which includes demonstrating respect for each team member. The chemistry of the team develops when we model good behavior, mentor new team members, monitor results, and reward good behavior. By rewarding success, we develop teams that focus on performance improvement. Leaders proactively develop team members coaching them on a regular basis to become better team players. Let people know how much you value them, but help them grow by providing real, constructive suggestions.a This investment will pay great dividends. Learning
to be a team leader requires a certain way of looking at the world. Most
physicians are not born leaders. Acquiring personal leadership skills
and developing team members takes effort and years of practice. One of
the most important skills is the ability to control your emotions. An
emotional response to a situation may cloud your ability to see a situation
clearly. Anger is the most destructive emotional response. If you lose
your temper, you lose the respect of your team. Learn to control your
emotions. Do not feel that Focus on Perfection "The gem cannot be polished without friction, nor man perfected without trials." -- Chinese proverb2:p643 Great leaders focus on perfection. Perfection is not easy and requires work and focus. One can only think of the great teams produced by coach John Wooden. How did he get the teams to play with perfection? John Wooden always preached that if he could get each of his players to play to their potential, it did not matter what the other team did on the basketball court. The UCLA Bruins controlled their own destiny. The focus was on effort, not on winning. This process does not need to be complicated. As a rule, keeping it simple results in the best outcomes. To be perfect, you must focus. Physician-leaders can often lose focus by taking on too many projects at one time. Few leaders can take on many tasks without one of the tasks suffering from lack of attention. As a team leader, you must stay focused on developing your team. You need to learn to say no to projects that will take you away from focusing on your team's success. Develop Emotional Intelligence "The significant problems we face cannot be solved at the same level of thinking we were at when we created them." -- Albert Einstein5:p30 Emotional intelligence is defined as leadership competencies that deal with the ability to handle ourselves and our relationships with others.6:p6 The term emotional intelligence has been associated with the concept of self-development before attempting to develop other people. Emotional intelligence is a skill that can be learned. Physicians are not born with emotional intelligence. Before developing others, we first must be competent with our own development. There are four dimensions of emotional intelligence.6:p39 These include self-awareness, self-management, social awareness, and relationship management. Self-awareness means having a good understanding of one's emotions as well as of one's strengths and weaknesses. Great leaders focus on developing their strengths and minimizing their weaknesses. For example, a physician who is a great general surgeon may benefit the medical group by focusing on surgery and trying to develop a center of excellence in his/her field of expertise. Leaders must understand where they belong. Self-management means that one understands one's own emotions and does not let emotions control his/her actions. Great leaders understand that between stimulus and response there is a space. This space is where self-management skills allow you to control your negative emotions and focus on the task at hand. Self-management allows you to see situations clearly. After acquiring the skills of self-awareness and self-management, resonant leaders develop the skills of social awareness and relationship management. Social awareness means that we have empathy. We sense others' emotions and understand their perspective. Physicians should be empathetic to their patients. But are we empathetic to our business team members? Social awareness and empathy build on self-management. Empathetic leaders are experts at reading body language and understand the "flow of a meeting." They want to hear what people have to say. They are good listeners and respond appropriately to the concerns expressed by other people. Empathy is the key to retaining talented individuals in the medical group. Relationship management is the final dimension of emotional intelligence. Here we find the most visible tools of a leader. These tools include persuasion, conflict management, influence, and cooperative team building. Relationship management is the ability to move people in a positive direction. For example, great leaders understand that it is more important to develop people than programs. After months or years of investment, a program will come along that needs the consensus of many physicians to succeed. If the relationships are not developed over time, the program might not gain the momentum needed to succeed. Relationship managers understand that anything important to the medical group does not get done alone. Learn to Multiply "A man with knowledge and great moral principles is a great man." -- Dwight D Eisenhower5:p12 The potential of our medical group depends on the growth of our leadership. Every leader in our medical group should make leadership development one of his/her highest priorities. Residency training is built on this concept. Young physicians learned from more experienced physicians who later trained less experienced physicians. The old house officer rule also applies to leadership development: See one, do one, and teach one. Your colleagues will see how effective you are in managing teams and your patient population. They will want to be like you. You will have an obligation to train them into being effective leaders like yourself. Once we understand and implement this principle of multiplication, we will see a progressive, positive change in our medical group. If a medical group has poor or self-centered leadership, the group will eventually fail. If a medical group has strong leadership and they keep reproducing themselves, the group will get stronger. A great example of this process of reproduction is the case of General Electric under the leadership of Jack Welch. Before Jack's retirement, General Electric had become one of the best companies in the world. The company prided itself on leadership development. When Jack Welch finally passed on his leadership role to Jeff Immelt, the two other executives who were competing for the CEO job immediately were offered CEO jobs at other companies. Another example of leadership multiplication can be seen in the case of professional football coaches. In a very competitive business, more than ten National Football League coaches have been mentored by the same person, Bill Walsh. Bill Walsh was the head coach of the multiple Super Bowl Champion San Francisco 49ers. Jack Welch and Bill Walsh are great leaders. They developed a culture of leadership development. They knew what it took to succeed, and they passed this knowledge on to other leaders. Their law of multiplication: know one, show one, and grow one.7:p133-41, 8:p243-56 Conclusion The great physician-leader is the individual who will help good medical groups become great medical groups. They are catalysts for success and perfection. The physician-leader is responsible for developing future physician-leaders. The great leader models, mentors, monitors, motivates, and multiplies. I have been in leadership positions for more than ten years. I am convinced that the future success of our physicians, as leaders of their teams, will depend on how well we identify and train physicians in the art of leadership. Our growth and success will depend on strong leadership developing a culture of strong leadership. The physician as leader carries responsibility. We have a responsibility to ourselves and to our medical group to continue the success of Permanente Medicine. We will succeed because we will identify, develop, and reward the best physician-leaders.
a Personal communication, Oliver Goldsmith, MD, CEO, and Chairman of the Board, Southern California Permanente Medical Group References
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