Five points define the need for leadership development for physicians.
1. Great leadership is especially needed in health care because of the challenges the industry faces (e.g., quality, cost, access) and because physicians may lack leadership and followership skills.
Issues of quality, cost and access pervade health care in 2017. Achieving the Institute for Healthcare Improvement’s “Triple Aim” is a mandate. Specifically, how do we maintain (and enhance) the quality of clinical care to individuals and to populations while ensuring satisfaction with the clinical experience and access to care and reducing the per capita cost of care? Framing the challenge is the fact that the U.S. expends almost 19 percent of its gross domestic product for health care, a multiple of most countries. Achieving the Triple Aim will require effective leadership.
In the context of this challenge, there is a paradox in health care. On the one hand, the great clinical outcomes providers seek for their patients require teamwork. Ample evidence supports this conclusion, according to 2011 research published in the Canadian Journal of Respiratory Therapy. Also, patients’ satisfaction with their health care experience is framed by their perceptions of all caregivers working as a team in service of their recovery.
Yet, health care organizations like hospitals have traditionally been silo-based. For example, the traditional structure of academic medical centers includes a CEO of the hospital, a dean of the medical school and a chairperson of the faculty practice plan, all of whom are ideally aligned in mission…except when they aren’t. Furthermore, physicians are “collaboratively challenged” by the traditional criteria by which doctors are selected, according to a 2011 OD Practitioner article. The experiences of their training tend to cultivate “heroic lone healers” – sometimes called “Viking warriors” – rather than team players or followers.
This paradox requires great leadership.
2. Leadership competencies matter and can be developed.
While some proponents continue to believe that “leaders are born,” the weight of evidence shows that leadership competencies can be developed, according to “Research Companion to Emotion in Organizations.” Cleveland Clinic Foundation research indicates that these competencies, which form the core of a leadership development curriculum for physicians, include team-building, conflict management, situational leadership, fundamentals of accounting and financial reporting, communication, and, perhaps most importantly, emotional intelligence.
3. Leadership competencies differ from the skills needed for physicians to be great clinicians or scientists.
4. Leadership competencies are generally not taught in medical or graduate school.
5. The focus and time needed to become a great clinician or scientist eclipse any attention that physicians can give to developing their leadership skills.
Points 3 through 5 can be discussed together. The clinical and scientific competencies taught in medical and graduate school differ completely from the aforementioned leadership skills. Indeed, it has been argued that the protracted time and focused attention needed to learn medicine detract from any attention that physicians in training can give to learning leadership skills. Furthermore, the impact of the traditional training of “heroic lone healers” – a strategy that is thankfully changing as medical school curricula evolve – is antithetical to leadership training, in that physicians focus on their own mastery rather than on system benefits.
As Marvin Weisbord wrote in 1976 in the Healthcare Management Review, “Science-based professional work differs markedly from product-based work. Health professionals learn rigorous scientific discipline as the ‘content’ of their training. The ‘process’ inculcates a value for autonomous decision-making, personal achievement, and the importance of improving their own performance, rather than that of any institution.”
Taken together, these five lines of evidence point strongly toward the need to teach physicians how to lead. Fortunately, this perceived need is beginning to gain traction, and a variety of programs are being developed, by hospitals and health care organizations themselves (e.g., Cleveland Clinic, Duke, Hartford Hospital, etc.); by medical societies (e.g., the American Association for Physician Leadership, the American Thoracic Society, the United States and Canadian Academy of Pathology); and by business schools, sometimes in collaboration with health care organizations (e.g., Cleveland Clinic-Weatherhead School of Management Executive MBA, University of St. Thomas Physician Leadership College, etc.).
While a recent article in the Journal of Health Administration Education shows that evidence of the effectiveness of such training programs remains sparse, accumulating experience at the Cleveland Clinic shows that leadership development programs can be effective innovation incubators. In at least one program, 43 percent of the alumni of a health care organization-based program were promoted to a leadership position within that organization by 10 years after graduation. Clearly, more widespread availability of leadership training for physicians is needed, as is more rigorous research regarding the optimal way to deliver the training and the long-term organizational impact of such training.
James K. Stoller, M.D., M.S., is a pulmonary/critical care physician and serves as the chairman of the Education Institute at the Cleveland Clinic. He holds the Jean Wall Bennett Professorship and the Samson Global Leadership Academy Endowed Chair at the Cleveland Clinic and the Cleveland Clinic Lerner College of Medicine. Dr. Stoller has a master of science in organizational development and is an adjunct professor in the Department of Organizational Behavior at the Weatherhead School of Management of Case Western Reserve University.
Megan Frankel is senior director of global executive education at Cleveland Clinic. Prior to this role, Megan serviced as senior director of marketing account services at Cleveland Clinic. She is currently pursuing a master’s in business administration.