Great organizations possess great leaders, and health care organizations are no exception. As the face of the health care industry continues to change, there is an overriding need for leaders who possess both clinical expertise and substantial leadership abilities.

The health care environment, like all business environments in 2020, faces challenges never seen before. The COVID-19 pandemic that has ravaged the world is the most obvious, and the future remains uncertain. But even once we move beyond this frightening time, many other challenges are afoot.

The health care industry is transforming not only at a rapid pace, but on numerous fronts at the same time. From cost containment to patient privacy concerns, questions about quality care and transparency to an uncertain future, there is a responsibility to address the needs of the business and health care consumer simultaneously. Executives industrywide are trying to discover the necessary answers in this ever-changing environment.

Regardless of the concepts that will or won’t affect us even a few years from now, one thing is certain: The degree of leadership complexity and knowledge will need to increase substantially over time.

Distinguishing Between Managers and Leaders

The fast pace of change and competing priorities within the health care environment “have created an urgent necessity for strong leaders at all levels in health care organizations,” according to “Distinguishing Competencies of Effective Physician Leaders,” a paper published in the May 2015 issue of Journal of Management Development. Truly progressive organizations are looking to engage physicians in becoming a part of the essential organizational leadership roles addressing these critical issues and ultimately in decision-making. This, according to MB Guthrie in “Challenges in Developing Physician Leadership and Management,” is because many of the issues confronting health care organizations can only be solved with physician involvement, partnership and understanding. There is an increased need for the physician’s knowledge, clinical skills and, in an environment of limited resources, understanding of how business decisions directly impact the provision of patient care. Physician participation in decision-making is not only a necessary tool to achieving other physicians’ participation in the state of desired change, but it provides opportunity for there to be an intermediary voice between clinical providers and organizational management, minimizing miscommunications and maximizing agreement and understanding, Guthrie writes. Physician leaders have a unique understanding of the physician mindset, which is a completely different mindset than that of the typical health care executive.

Leadership used to be about getting results, regardless of the way they were obtained. In today’s business environment, there is recognition that the person in charge can have a large impact on the company’s workforce and its outcomes. According to a 2014 Gallup Workplace article, “Why Your Workplace Wellness Program Isn’t Working,” leaders can account for up to 70 percent of the variation in how engaged employees are with their employers. In addition, Gallup’s “State of the American Manager” report revealed that one in every two adults in the United States, at some point in their career, has left their job due to their manager.

Although the common vernacular may use the words “manager” and “leader” interchangeably, there is often a distinction between the skills and displayed behaviors of the two. In his article “What Leaders Really Do,” John P. Kotter states that leadership and management are each unique and have their own functions within the business environment. A manager is usually the individual who works in the present day to day to coordinate the efforts of their employees to accomplish the business goals and objectives by efficiently and effectively utilizing available resources. The manager helps the organization, particularly large organizations, maintain consistency in the areas of quality and profitability. A leader is an individual who leads or guides other individuals, teams or entire organizations into the future, according to Kotter. A leader is responsible for setting direction, innovating, inspiring trust and challenging the status quo. A leader assists the organization with managing change. Not everyone can be effective at both leading and managing because, “Some people have the capacity to become excellent managers but not strong leaders. Others have great leadership potential but … have great difficulty becoming strong managers.”

Whether they possess a clinical or business background, health care requires individuals who can take on the role of leadership, capitalizing on preparing the workforce for a focus on high-quality, customer-​centered care and collaboration across departmental boundaries. In order to accomplish these organizational initiatives, leaders in today’s environment require the skills of organizational awareness, emotional self- control, empathy, influence, relationship building and a positive outlook, write Michael J. Dowling and Charles Kenney in Health Care Reboot: Megatrends Energizing American Medicine.

What Makes an Effective Leader?

There has been much research conducted regarding the skills required to be an effective leader. As a matter of fact, for each individual who has studied effective leadership, their own distinct definition and version of the accompanying theory has been offered. Each explanation has its own unique theoretical groundings, empirical support and application to problems found in the business world.

Although there are many different leadership theories and styles, they all have one thing in common — influencing team members to accomplish a common task or an organizational goal. In her article, “A Meta-Analysis of the Relationship Between Emotional Intelligence and Effective Leadership,” Lane B. Mills states that there are three common elements to leadership: group interactions, utilizing influence and attaining goals. Great leaders work hard to drive success for both themselves and their organization. According to research conducted by Daniel Goleman detailed in Leadership That Gets Results, the most effective leaders use not one leadership technique but a variety of leadership styles, applying each of them at the right time and in the right situation. Each style has a unique impact on culture and results for an individual team or an entire organization. The benefit of having multiple techniques is the ability to be flexible and adjust in each circumstance to ensure the best results are obtained.

Although this new environment requires physicians to step up and participate as equal members of the transformational leadership team, many question whether or not they are instinctively prepared for this new and expanding role. How do the physician leaders of today and tomorrow know how to perform these indispensable expertise when little in the formative portions of a physician’s career prepares them for these types of leadership responsibilities?

Effective leadership requires the capacity to work collaboratively, display empathy and obtain buy-in from various interdisciplinary stakeholders. Physicians, like other leaders, are expected to succeed in an environment where they not only lead themselves but help to develop the clinical and leadership skills of others, something that is in opposition to the development of their clinical competencies. Traditionally, physicians are not trained, socialized or expected to play well together within organizations. Rather, physicians have historically been taught, through medical school and residency programs, to focus their attention on providing excellent individualized patient care by establishing expertise and amassing an ever-growing base of medical knowledge, according to the Accreditation Council for Graduate Medical Education.

Medical schools are steeped in tradition, and the curriculum has remained relatively consistent over the past century. Physicians are traditionally prepared “to be independent thinkers, skeptical scientists and self-reliant professionals,” write Stuart Henochowicz and Diane Hetherington in “Leadership Coaching in Healthcare.” The professional culture emphasizes autonomy, self-​directedness, analytical thinking, prompt decision-​making and confidence, and it displays little tolerance for ambiguity.

In providing patient care, clinical departments/​specialties are often like independent silos, which further undermines collaboration and encourages physicians to notice specific abnormalities and variations before noting generalizable patterns. As clinicians, physicians are praised for this type of behavior, Guthrie writes. However, this is in contrast to the role of an executive, who has the key leadership skills of collaboration, delegation and ability to address a multitude of issues simultaneously.

Getting Physicians the Leadership Skills They Need

In “Developing a Leadership Pipeline: the Cleveland Clinic Experience,” the authors state, “Because competencies to lead differ from clinical or research skills, there is a compelling need to develop leaders and create a talent pipeline.” As a reaction to the milieu’s mandate, health care organizations need to either include physicians in their current ongoing leadership development activities or develop new programs that take into account a physician’s previous training (including methodologies) and work to better meet the specific needs of this population and the role they will play in the future of the organization. The organizations and its physicians will benefit from taking a proactive approach to advancing their readiness, including developing a leadership skill set that will allow them to perform highly at the bedside with patients as well as in the business environment with their team members and other executives.

Anyone who has worked in organizational development or in the learning environment recognizes that it takes time to acquire the attitudes, behaviors and knowledge needed to successfully participate as an organizational member. David Battinelli, chief medical officer at Northwell Health, states that in his experience, “It usually takes about six to nine months for new physician leaders to be comfortable in their role and begin to make impactful decisions.”

Organizations, now under immense pressures, cannot afford the delay in leadership autonomy and the workplace inefficiencies that come from physician leaders not being proficient and ready to lead. There is growing recognition that even when new leaders are onboarded properly (within their first 90-120 days), problems can still arise when they start working on large departmental/organizational initiatives with new colleagues facing unfamiliar cultural norms, beliefs and expectations. Regardless of when this “waiting period” or period of being less than competent hits, it can have a negative impact on morale, employee recruitment and retention, as well as the bottom line.

Gail Corkendale, in her 2008 Harvard Business Review article “Overcoming Imposter Syndrome,” speaks of many individuals experiencing feelings of inadequacy despite their many career points that mark or evidence success. She states that high-achieving and highly successful people who experience imposter syndrome suffer feelings of self-doubt and a sense of intellectual fraudulence after taking on new roles that require different skill sets. Gail Gazelle, an assistant professor at Harvard Medical School, said that physicians are particularly susceptible to this type of thinking as a result of their early years of training, which focuses on “deficits, not strengths.”

Physician leaders, while they may be hesitant to admit their inexperience and lack of needed skills, can benefit from targeted development to unravel the imposter syndrome cycle. Imposter syndrome for physicians is built on a foundation of thought that is hyper-focused on what they are not doing well and a belief that everyone else has mastered the knowledge but them, according to Gazelle. Participation in leadership development programs helps them break the cycle by seeing that other leaders (including physicians) share similar gaps in knowledge, that there are resources to close those gaps, and, like with residencies and fellowships for their clinical skills, they can gain familiarity with the new types of scenarios they will be encountering within a safe space.

Breaking the Poor Leadership Cycle

Another reason to engage physicians in leadership development activities is that studies have shown that ineffective leaders tend to pass along their bad habits to their direct reports through role-modeling behaviors. Leaders, more through their actions than their words, define the values, behavioral norms, atmosphere and level of engagement in the teams they lead. This is also seen in the literature regarding the imprint socialization into medicine has on medical students and residents for years to come.

Medical school indoctrination has been associated with negatively impacting certain aspects of a physician’s professional development, including idealism, ethics and empathy, all key functions of providing remarkable patient care and leadership. A 2018 article published in the Journal of Applied Psychology, “Breaking the Cycle: The Effects of Role Model Performance and Ideal Leadership Self-Concepts on Abusive Supervision Spillover,” concluded that new leaders model their behaviors off of the supervisory behaviors of their leaders, even when the behavior is abusive. The article states that the abusive behavior is particularly destructive because it can be infectious.

A growing body of research has demonstrated that individuals who endure abusive behavior at work will eventually behave the same way toward others, seeing it as a part of organizational norms. This means that we would not only have ill-behaved leaders today, but lower-quality leadership pipelines as over time, the cycle of negative actions continues, reinforcing poor performance through future generations of employees. Without effective leadership development programs and succession strategies, it will be increasingly difficult for large and small health care organizations (or any organization) to retain skilled, motivated and productive employees.

The Future of Health Care Leadership

Toby Cosgrove, in the article “Value of Physician Leadership,” states that the shift from clinician to leader is a hurdle that requires mental flexibility and fortitude, because unlike within the operating room, when you make a leadership-based decision, you may not truly know the impact until two years later. To master this type of environment, tomorrow’s physician leaders will need to be agile learners — individuals who are willing to learn, unlearn and relearn based on a variety of cues within their complex environments.

Agile learners are able to adapt to changing circumstances, experiment with new ideas and approaches, and gather information that allows them to reflect on their performance. The good news is that physicians are highly intelligent, conditioned to facilitate their own learning to transform their knowledge and clinical skill sets, have a strong drive and work ethic, and have a deep affection for the medical profession, according to The Best Medicine: A Physician’s Guide to Effective Leadership. This combination of attributes makes them the perfect candidates to take on the demanding role of health care leadership.

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