Physician Leadership: New Responsibilities Require New Skills

Abstract

FOR RELATED ARTICLE, SEE PAGE 1147In the coronavirus disease 2019 (COVID-19) pandemic, health professionals have saved thousands of patients lives. Pulmonary and critical care physicians have been particularly outstanding in confronting this crisis. FOR RELATED ARTICLE, SEE PAGE 1147 That outcome is not a surprise. ICU physicians are experienced in leading teams that treat critically ill patients. Some of these leaders have advanced to become senior executives in their institutions. That trend happened over the last 50 years, as health care became one of the largest sectors of the US economy. During that time, the industry learned that experienced physician leaders are effective because they understand both medical science and patient care. The philosophy of “patient first” in quality and safety has led hospitals to place more physicians into leadership roles.1Berwick D.M. Nolan T.W. Physicians as leaders in improving health care.Ann Intern Med. 1998; 128: 289-292Crossref PubMed Scopus (167) Google Scholar,2Lee T.H. Turning doctors into leaders.Harv Bus Rev. 2010; 88: 50-58PubMed Google Scholar That change has led to better quality in many institutions.3Tasi M.C. Keswani A. Bozic K.J. Does physician leadership affect hospital quality, operational efficiency, and financial performance?.Health Care Manage Rev. 2019; 44: 256-262Crossref PubMed Scopus (26) Google Scholar,4Goodall A. Physician-leaders and hospital performance: Is there an association?.Soc Sci Med. 2011; 73: 535-539Crossref PubMed Scopus (188) Google Scholar Historically, the education of physician leaders was informal at best. Although some leaders pursued advanced degrees, many jumped into a new leadership role and hoped they could learn on the job. That era of “do one, teach one” is over, in both clinical medicine and medical leadership. Each requires its own structured educational program.5Stoller J.K. Developing physician leaders: a perspective on rationale, current experience, and needs.Chest. 2018; 154: 16-20Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar,6Sonnino R.E. Health care leadership development and training: progress and pitfalls.J Healthc Leadersh. 2016; 8: 19-29Crossref PubMed Scopus (38) Google Scholar In this month’s publication, CHEST begins a four-part series on physician leadership. The content, although focused on chest physicians, is useful for any health professional interested in leadership. The author, Dr James Stoller, is a well-known chest physician and educator, with extensive experience developing physician leaders at Cleveland Clinic. Health care is a challenging blend of social services, business, and rapidly changing medical discovery. The first essay in the series entitled, “Leadership Essentials,”7Stoller J.K. Leadership essentials for CHEST Medicine Professionals: models, attributes, and styles.Chest. 2021; 159: 1147-1154Abstract Full Text Full Text PDF Scopus (4) Google Scholar goes right to the point. No matter how well versed in medicine, most physicians have not been trained to lead people and manage organizations. Consequently, clinicians can find themselves unprepared for a significant leadership role. The good news is that leadership skills needed for such an assignment can be taught and mastered. As Dr Stoller explains, leadership is more sophisticated than one might imagine. For example, using “situational leadership,” leaders can solve different problems by using different leadership styles, such as telling, selling, participating, or delegating. This approach resembles that of a quarterback who uses different plays during a game. There is general agreement that leadership requires mastery in two areas. The first is “threshold competencies” (ie, content not taught in medical training). These topics include operations, finances, policy, quality, and negotiation. After acquiring such knowledge, the new leader focuses on learning the “people skills” of leadership. This CHEST series describes the core of these skills in three subsequent essays: “Managing Change”; “Emotional Intelligence”; and “Building Teams.” These important “social competencies” are best mastered during ongoing leadership experience. Because of the demand for more physician leaders, there are many ways to receive this education. Advanced degrees (eg, MPH, MHA, MBA) can be attractive but may focus more on professional content than leadership skills. Leadership taught in nondegree programs may concentrate more on “people” skills but also may include business topics. Some physician organizations offer a blend of both options. For example, the Association for Physician leaders and the American College of Physicians have organized leadership programs than can also include a master’s degree. Like medicine itself, leadership can be learned from sources with different strengths in teaching the core curriculum.6Sonnino R.E. Health care leadership development and training: progress and pitfalls.J Healthc Leadersh. 2016; 8: 19-29Crossref PubMed Scopus (38) Google Scholar Some institutions, such as the Mayo Clinic and the Cleveland Clinic, have developed their own internal leadership programs.5Stoller J.K. Developing physician leaders: a perspective on rationale, current experience, and needs.Chest. 2018; 154: 16-20Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar The goal is to continue to educate and support leaders as their experience and responsibilities expand. Over time, this creates a systemwide culture in which all leaders share common skills in supporting their teams and each other. This customized model of leadership education is becoming more popular, especially in other large health organizations such as MGH Brigham, Penn Medicine, and the Henry Ford Health System. Many physicians are currently in leadership positions—whether in their practice, hospital, or health system. These leadership roles range in complexity—from managing a small clinic to serving as the hospital CEO. Regardless of the assignment, success depends on teams and those who lead them. In this modern era of medicine, leadership training at some level is important for every physician leader. It is up to the individual to determine how, when, and where to pursue leadership education. This CHEST leadership series is an excellent introduction for beginners and may offer some new insights for those with experience. In many ways, leadership education resembles clinical training. The process begins with new knowledge, followed by learning new interpersonal skills. In medicine, physicians learn clinical science and the skills to interact with their patients. In leadership, physicians learn management and how to inspire their teams. In both scenarios, many lessons are learned in jobs that demand continuous education. The physician leader stands at the crossroads of health care delivery, clinical medicine, and its “business” infrastructure: operations, economics, human resources, and informatics. Skillfully aligning these forces to help patients is a noble task. To create a patient-friendly system that provides excellent, reliable, and safe care is the most important goal in medicine—and the most difficult. We need more physician leaders who are well prepared and eager to meet that challenge. Leadership Essentials for CHEST Medicine Professionals: Models, Attributes, and StylesCHESTVol. 159Issue 3PreviewIn the context that leadership matters and that leadership competencies differ from those needed to practice medicine or conduct research, developing leadership competencies for physicians is important. Indeed, effective leadership is needed ubiquitously in health care, both at the executive level and at the bedside (eg, leading clinical teams and problem-solving on the ward). Various leadership models have been proposed, most converging on common attributes, like envisioning a new and better future state, inspiring others around this shared vision, empowering others to effect the vision, modeling the expected behaviors, and engaging others by appealing to shared values. Full-Text PDF