Not viewing working physicians as leaders is a mistake that needs to be fixed

Leon Moores, MD, DSc, FACS: ©Leon Moores

When we think about leadership training for physicians, we often think about preparing seasoned doctors to take executive roles in the health care hierarchy. And while physicians in the C-suite and senior management certainly do influence the strategy, vision, and culture of an organization, the hundreds or thousands of doctors in our clinics, operating rooms, emergency departments, and hospital wards have constant, direct impact on the performance of health care teams, day in and day out. And this kind of leadership tends to be overlooked.

What is leadership, after all? We can define it as influencing behavior to achieve desired results. Under this definition, it is easy to see that all physicians lead. And although they certainly aren’t the only leaders in health care environments, they often have outsized impact on their teams’ performance. But because we don’t necessarily view working physicians as leaders, we don’t routinely train ourselves to this competency. This gap in our thinking has a cost.

Why leadership behaviors and styles matter

This gap exists because most physicians are not exposed to formal leadership theory, principles, and techniques in medical school or residency. In our physician culture, the term “physician leader” most often refers to doctors assuming formal positions within the organizational structure, such as medical director, department chairman, or chief medical officer. It is typically when doctors accept an institutional promotion that they begin formal study of leadership principles.

However, physicians “in the trenches” are influencing behavior to achieve a desired result every day, often with life-or-death stakes. And yet, the leadership skills that could help those front-line physicians run more effective teams are not explicitly acknowledged, and are not taught in a cohesive, comprehensive way. The impacts of these leadership behaviors, styles, and skills are numerous and predictable.

Leadership behaviors affect team performance, which affects patient outcomes. It’s that simple. Imagine an emergency code being called in an intensive care unit, and the physician in charge of the code is anxious, yelling, or betraying uncertainty. This creates added stress. The hands-on performance of the team can be negatively impacted under stressful conditions. Health care workers under stress can make dosing or recording errors, drop or mishandle equipment, or fail to speak up about problems they’re observing or questions they may have.

Leadership style can also have a profound effect on a team’s functioning. And yet, physician leaders in health care environments often use styles that are less than optimal. Because they are rarely aware of, or trained in, multiple leadership styles, they may rely on a similar style in all settings, when a variety of approaches might be more effective. In the trauma bay, for example, a commanding style may be appropriate – the leader issues directives and the team follows them – but in the clinic, a democratic or affiliative style may be much more desirable.

Self-awareness of leadership and its impact

The simple mental step of recognizing oneself as a leader begins a “virtuous cycle” of self-improvement. On the other hand, physicians who fail to identify as leaders may flatline in their development. For example, they may experience an uncomfortable interaction with a teammate and simply walk away shaking their heads. By contrast, someone who knows they are a leader and recognizes the impact they have on the environment around them will be more likely to reflect on that experience, attempt to improve in the future, and perhaps even circle back to the other person to mend fences. They will use the failed interaction as an impetus for growth and development.

Leaders within the “small units” of hospitals certainly affect the environment of care. Team members who feel supported, encouraged, and respected by their leaders will treat other teammates with similar positive approaches. Those who feel belittled, unappreciated, or have a constant sense of walking on eggshells will also pass those feelings onto teammates – and patients and families.

The ability to speak up without fear of retribution or other negative consequences is a vital hallmark of a high-performing team. It is through open communication that teams learn and improve. But teammates will be afraid to speak up in an environment that is not psychologically safe. One of the key roles of a leader, therefore, is to provide psychological safety. Learning how to do this takes time and training.

Leadership at the physician level also affects retention – a critical metric in today’s health care environment, where costs continue to rise and job mobility is greater than ever. An old axiom is that people join organizations but leave bosses. Leaders who set a tone that gets teammates excited to come to work markedly improve retention. And when teams stay together for extended periods, they develop high-level communications, trust, and efficiencies. When members are constantly leaving, teams do not get a chance to coalesce. Performance suffers.

Make leadership a core competency for physicians

Many, if not all, members of the health care team can contribute to high performance and job satisfaction. However, in most clinical settings, physicians often have a disproportionate impact. It makes sense, therefore, that improving physicians’ leadership skills will have a very high ROI.

Recognizing that all physicians are leaders gives us a great opportunity – a mandate, really – to provide education and training in fundamentals of leadership, especially to those in high-stress, high-stakes environments. Explicitly telling physicians that they are leaders and that certain expectations come with that role will at least encourage personal reflection and study with the intent to improve.

I suggest we view leadership as a core competency for physicians and recognize that training to this competency is a necessity, not just a “nice to have.”

Leon Moores, MD, DSc, FACS, author of All Physicians Lead: Redefining Physician Leadership for Better Patient Outcomes, is a West Point graduate who was commissioned an infantry officer in the 82nd Airborne Division. Moores earned his MD from the Uniformed Services University School of Medicine and his Doctor of Science in health care leadership from the University of Alabama, Birmingham. He has served as chief of surgery at Walter Reed Army Medical Center, deputy commander in National Naval Medical Center Bethesda, commander in Fort Meade Medical System, and CEO of Pediatric Specialists of Virginia. A practicing professor of pediatric neurosurgery, he most recently served as the CEO and president of the largest medical group in northern Virginia.