American Association for Physician Leadership

Surviving (and Finding Ways to Thrive) With Difficult Leader Phenotypes

Bryan N. Becker, MD, MMM, CPE, FACP


Mark Hallman, MHA


John Roy, MHA


Mary Jo Smith, MA


Nov 7, 2024


Healthcare Administration Leadership & Management Journal


Volume 2, Issue 6, Pages 280-284


https://doi.org/10.55834/halmj.2547773299


Abstract

The healthcare environment continues to demand great versatility, awareness, emotional intelligence, and leadership from its leaders. At times, however, difficult leader phenotypes manifest themselves. That has a direct — and often detrimental — impact on other leaders, managers, and the rest of the healthcare team and organization. It is important to recognize these difficult leader phenotypes and exercise logical strategies to continue to advance the organization’s mission and performance. Fortunately, not every experience with a healthcare leader is a negative one. There are marvelous leaders who also have discrete phenotypes whom you may encounter. It is both a positive experience and a tremendous opportunity to learn from them so that you too can display aspects of those phenotypes in your work and leadership.




Leadership literature often cites various traits and characteristics that align with good leadership and, in healthcare, quality outcomes.(1-3) When we encounter these individuals, we feel engaged and energized. These individuals often have experience and expertise, truly represent and are engaged in the organizational mission, and provide support for other individuals and team members. You see other traits in them such as integrity, a moral and ethical compass, and a willingness to be transparent and trusting.

Increasingly, however, and unfortunately, it is possible to encounter combinations of narcissism, control, favoritism, or even a loyalty “requirement” from certain leaders.(2,4,5) These characteristics are enervating and exasperating. Even the best leaders may slip into showing these personality traits on occasion. However, we have seen these traits or phenotypes arise among individuals who are what we would term difficult leaders. The expression of these phenotypes from these difficult leaders often leads to employee disillusionment, turnover, overall team underperformance and, at times, organizational underperformance in the long run.

We have worked in different healthcare organizations and higher education settings, including large universities, academic healthcare, community healthcare, public health and hospital systems, healthcare technology, healthcare consulting, publicly traded healthcare service delivery providers, and private equity and industry-backed for-profit provider organizations. Our observations of difficult leader types emanate from those experiences.

Difficult Leader Phenotypes

Several common personality patterns characterize difficult leaders as we have encountered them in healthcare organizations. We have categorized these individuals into eight phenotypes (Table 1): the Savior; the Glass Shatterer; the Saboteur; the Brush-off Specialist; the Redemption Seeker; the Matador; the Life Preserver; and the Blinders-on Leader. Crossover among these categories often is seen as well. Certain combinations appear to be more commonly linked together anecdotally. Two common examples of this overlap are Redemption Seeker plus Savior, or Brush-off Specialist plus Saboteur.


HALM_NovDec24_Becker_Table1


Recognizing the Leader Phenotype

It is important to allow leaders time to integrate and manifest their style, especially when they are new to a team or an organization. Sometimes it becomes apparent that a difficult leader phenotype is present. Actions and aspects of language are important clues that may help you in identifying the leader phenotype you have encountered. This can include enthusiastic questions following a presentation, leading to “I don’t think so. Not right now. Let’s study this some more” — a common refrain from the Matador. A frequent action from the Brush-off Specialist, whether in virtual interactions or in person, is to come to a set of individuals on the team at the end of a discussion, quickly asking, “Do you have any thoughts?” After hearing those thoughts, the Brush-off Specialist moves readily into assigning tasks, ignoring either the input or the individuals who have spoken.

Organizational stress can bring out the Savior phenotype. This individual will often declare “I am accountable for [name your metric of the week] to leadership. We have to get moving on these things.” The dichotomy that develops from this simple juxtaposition of “I” and “We” reinforces their belief that only that particular individual can truly achieve the objective.

The Redemption Seeker looks at organizational stress from a slightly different perspective. Based on past experiences, this individual identifies opportunity in the stress and often lays out a plan for performance that has singular reliance on her or his role.

The Saboteur can be one of the most challenging. She or he is usually ingratiating, appears collegial, and may even encourage engagement. This individual, however, will do little to have your back and often will inject last-minute questions or requests into your operating plans that divert almost everyone from the primary objective. Moreover, Saboteurs are expert at simultaneously suppressing good work and advancing their own.

The Glass Shatterer is theatrical. She or he does more than question convention. This individual’s actions literally disrupt common practice or process, often with an unfounded critique, to the extent that the practice or process simply does not function well. At that juncture, this individual often calls out the perceived inadequacy of that process and then attempts to completely rearrange it.

The Life Preserver and the Blinders-on leader are both a bit more challenging, because at first they do not present as difficult leaders in any obvious way. The Life Preserver may be well versed in company, practice, or health system values and demonstrate them proficiently. So too, can the Blinders-on leader. These individuals are exposed when it comes time to test the team with a change in process or strategy or relevant data. Suddenly, the streak of maintain-the-status-quo-at-all costs in the Life Preserver or the Blinders-on leader shutting their eyes to obvious data trends exposes their traits.

Strategies for Difficult Leaders

It is critically important to have personal strategies in place to work in the midst of such leaders. These are not always rational approaches that will change the course of events. More often, they are survival strategies that will still allow you to make progress with your teams toward your objectives and goals.

First, always remember that you are trying to advance the mission of your organization, its strategy, and the operational performance of your team or area. This sounds obvious, of course. Nonetheless, challenging interactions often divert attention from what is really important. Second, when you communicate with or about the leader, that communication should be open and respectful. Third, using general approaches that work to place your ideas in the conversation as if they were the leader’s ideas is essential. Similarly, it is important to recognize when others are putting ideas or results into the mix and to reflect back on how the leader’s influence is present.

It is highly likely that others also have picked up your difficult leader’s phenotype. Ironically, such leaders may view their behavior as being supported or rewarded. This does not provide grounds for ganging up on the leader, however. Remember, you are a team, and your objective is to function as well as possible. Some leader-specific considerations that the team can discuss and strategize as to how you would implement them include the following:

  • Savior. Acknowledge that individual’s authority and special place and ask the question, “how can I/we help you with your ideas?”

  • Glass Shatterer. It is critical for you to recognize what is broken that would benefit from change anyway. Once this is noted, you can propose building blocks for the reconstruction of that capability in a way that aligns with the leader’s vision.

  • Saboteur. This one is tough. The best approach is full transparency and adhering to the principles and values of the organization and calling those out every time in a positive way. This casts the Saboteur’s behavior in a very different context and allows you space to move forward.

  • Brush-off. It is essential to accept the Brush-off — it will not change, and you will not receive acknowledgment or recognition. This is where servant leadership on your part is critical, and you can help the members of your team who are being called out, because they will likely need it.

  • Redemption Seeker. Ask this individual for input on everything and advice on key questions, positioning it as her or his decision, not yours. Do so even if you believe you have a fail-safe way of achieving the objective or moving the project forward.

  • Matador. Find the most compelling problem or issue related to your team’s performance or a project, and when the discussion moves to pass on the item, redirect the dialogue to the question “What if we looked at it this way?”

  • Life Preserver. This is another tough one. It may take some examination, but find the part of the status quo that is positive and move forward with that area at the beginning of any dialogue or even in the way you formally present information.

  • Blinders-on. Take advantage of the Blinders-on leader’s narrow view and call out competition, whether internal or external. “Who is going to pass us and why do we think that?” This strategy may enable you to overcome the inertia of that leader’s standard approach.

Ironically, these can be moments to expand yourself and your skills related to working with people and emotional intelligence. Dealing with such leaders entails several personal actions that fundamentally rest on using emotional information and your intelligence.(6) You can reflect on how you interact with members of your team and other members of the organization. You can seek to understand other factors that may be influencing the actions and behaviors of others, including your leader. This can include professional influences as well as personal factors and life stressors that may be top-of-mind for your leader and unspoken. You can even go so far as to ask questions that are open-ended to solicit ideas or input from others: for example, “What if we looked at this differently? Are there other ways to interpret this? What could we be missing that could help our leader and help our team?”

As you work with your leader, it can be important to try to understand their motivations. Sometimes, a leader’s difficult or predominant behavior stems from their relationship with their own leader, stress, lack of training, or personal or family issues, as mentioned earlier. It is critical to approach your leader and your interactions with empathy and even help identify a root cause for the behaviors or interactions you see and experience.

Plan B

Sometimes, challenging circumstances prevail, and the strategies discussed may fail. What can you do then? First, and most importantly, you have to take a moment and realize that you are going to be okay, and you can only navigate what is under your own control. At these junctures, it is critical to take stock of what you really value and why are you doing what you do. Frequently, this leads to a short-term refocus on the tasks at hand and extra energy to move projects or items along in the performance cycle.

Concomitant with that, you have an opportunity to focus on core values or behaviors that you want to address and promote no matter what. This often leads to additional self-realization about what you prioritize and value and allows you to put into place an attitudinal buffer between yourself and your difficult leader. You are defining what you will make certain to deliver on no matter what for your team and the organization. Such a commitment flips the dynamic from how to respond to the difficult leader to how you are going to align and respond to yourself. This is essential in maintaining levels of performance and self-confidence in situations that have deteriorated due to difficult leaders.

There are some other actions that you may take in such circumstances. It is logical and important to document incidents objectively and to maintain a fact-based record of conversations, problematic situations, and how you and your team have attempted to resolve issues and achieve desired levels of performance.

Communicating with Human Resources and Leadership

On occasion, you may desire to speak to other individuals in your organization. This includes Human Resources. If you perceive situations with your difficult leader escalating in a way that you believe might be insurmountable, it is appropriate to reach out to Human Resources for their guidance. They may be able to intervene delicately and provide a shift in team dynamics as well as additional leadership development for your difficult leader.

You also may have the opportunity to communicate directly with leaders higher up in the organization about some of these difficult leaders. Approach this with a note of caution. Although the highest level of leadership in any organization may well know about some of the dysfunction that you are experiencing, they may have a different perspective than you. They may recognize those difficulties but have given priority to other areas or differential performance within the organization. They may have promoted or mentored this individual into this leader role. Or they may be aware and may even be sanctioning the behaviors and actions of your difficult leader.

In light of these considerations, it makes sense to enter such conversations with an open mind and highlight areas where you believe the team could perform even better in support of the mission and goals of the organization. You may then have the chance to highlight how different inputs and the influence of other leaders and subject matter experts in the organization might be able to help the team get there, provided that your leader agrees with that.

Executive leadership, especially if they understand and recognize the difficult situation that you are in, may turn around and offer you incentives to continue to push forward. Recognize this does not address the primary problem and represents a Band-aid for you. Sometimes the Band-aid is worth it, and sometimes it is not.

Self-Extraction

Sometimes, there simply is no way to thrive, and surviving is the best you can do, but that is not healthy long-term. At some juncture, barring a change in leadership for your team, there comes a time to find another opportunity, whether it is within the same organization or in a different one.

During your time working with your difficult leader, it is critical that you do several things to ensure that you are well-prepared if you do decide to take either one of these routes. First, identify several other individuals in the organization with subject matter expertise and with whom you work and interact professionally. Connecting with these individuals on other teams is critical, because they represent potential references. They have worked with you, have seen your work product and presentations, and are very likely aware of some of the challenges that you are experiencing. And do not forget, before assuming that they will be references for you, it is appropriate to ask them if they will provide a good reference.

Second, review your own documentation of what you have done and completed working on the team and with others in the organization. This not only helps you compile and update your resume, but it also helps you identify accomplishments and themes that are important to highlight when you are interviewing and telling your story. You have an opportunity to gain clarity on what you have done, what is important to you, and how you can bring that into your next role. It is important not to gossip or cast your difficult leader in a villain role in an interview.

Enjoy the Great Leaders That You Encounter

Fortunately, not every professional situation comes with a difficult leader. There are many times during a career when you encounter an amazing leader. It’s just that on occasion, you may take this for granted and assume that all leaders are like that.

Whether you are working in a small start-up or a global enterprise with tens of thousands of team members, good leaders will bring with them experience and expertise, which may be general and multifaceted, not always specialized. They almost certainly will reflect and express the core values of the environment with positivity and reinforce those with you. In addition, you will ultimately find that these leaders also are continuous learners.

There are numerous positive leader phenotypes aligned with great people, performance, and organizations. Four, in particular, that we have seen surface over the last few years in our work environments have discrete, positive impact on their teams and their organizations: the Bi-Directional Coach; the Focused Thoughtful Soldier; the Observant Farmer; and the Seed Crystal (Table 2).


HALM_NovDec24_Becker_Table2


Two of the most significant attributes common to these positive leader phenotypes are self-awareness and an ability to construct the right team for performance based on composition and sustained chemistry. The former, self-awareness, is abetted by the leader willing to have regular reviews of their approach and conduct along with feedback and input from the members of the team and other leaders, something akin to a periodic spot check-in 360-degree review. The latter aligns with the principle of finding the right members for the team. The positive leader often recognizes the benefits of adjusting responsibilities or roles among team members to be congruent with either their strengths or the opportunities that the leader is creating for them, or both.

Conclusions

Difficult leadership styles have a direct impact on those delivering healthcare, affecting turnover, morale, and the quality of the healthcare delivered.(7,8) It is likely that you will encounter individuals in your work and your leadership journey who fit one of these difficult leader phenotypes. It is better to recognize individuals who have these phenotypes and take appropriate steps when feasible rather than have that completely derail your experience and efforts. Moreover, it is an opportunity for you to learn how you respond to this type of situation. Your ability to begin to understand both individual and broader organizational circumstances may help you survive your present circumstances. They will provide you with experiences and knowledge that will allow you to prevent yourself from falling into the same leadership phenotype traps when you have additional responsibilities or are challenged by new and extenuating circumstances.

References

  1. Hargett CW, Doty JP, Hauck JN, et al. Developing a model for effective leadership in healthcare: a concept mapping approach. J Healthcare Leadership. 2017;9:67-78. https://doi.org/10.2147/JHL.S141664 .

  2. Judge TA, Piccolo RF, Kosalka T. The bright and dark sides of leader traits: s review and theoretical extension of the leader trait paradigm. The Leadership Quarterly. 2009;20:855-875. https://doi.org/10.1016/j.leaqua.2009.09.004 .

  3. Sfantou DF, Laliotis A, Patelarou AE, Sifaki-Pistolla D, Matalliotakis M, Patelarou E. Importance of leadership style towards quality of care measures in healthcare settings: a systematic review. Healthcare (Basel). 2017;5:73. https://doi.org/10.3390/healthcare5040073 .

  4. Hancock AJ, Gellatly IR, Walsh MM, Arnold KA, Connelly CE. Good, bad, and ugly leadership patterns: implications for followers’ work-related and context-free outcomes. J Management. 2023;49:640-676. https://doi.org/10.1177/01492063211050391 .

  5. Schyns B, Schilling J. How bad are the effects of bad leaders? A meta-analysis of destructive leadership and its outcomes. The Leadership Quarterly. 2013;24:138-158. https://doi.org/10.1016/j.leaqua.2012.09.001 .

  6. Caruso D. Defining the inkblot called Emotional Intelligence. Issues and Recent Developments in Emotional Intelligence. 2003;1(2). https://www.eiconsortium.org/reprints/ei_issues_and_common_misunderstandings_caruso_comment.html . Accessed June 18, 2024.

  7. Meese KA, Boitet LM, Sweeney KL, et al. Don’t go: examining the relationships between meaning, work environment and turnover intention across the entire healthcare team. J Multidisc Healthcare. 2024;17:353-366. https://doi.org/10.2147/JMDH.S437816 .

  8. Vaughn VM, Saint S, Krien SL, et al. Characteristics of healthcare organisations struggling to improve quality: results from a systematic review of qualitative studies. BMJ Qual Safety. 2019; 28:74-84. https://doi.org/10.1136/bmjqs-2017-007573 .

Bryan N. Becker, MD, MMM, CPE, FACP

Bryan N. Becker, MD, MMM, CPE, FACP, is president of Acclaim Physician Group and executive vice president, JPS Health Network in Fort Worth, Texas. He previously was chief medical officer for DaVita Integrated Kidney Care in Denver, Colorado. bryanbecker630@gmail.com


Mark Hallman, MHA
Mark Hallman, MHA

Mark Hallman, MHA, Managing Director, 3AIM Partners, LLC, Benbrook, Texas.


John Roy, MHA
John Roy, MHA

John Roy, MHA, President, Onward Academic Partners, LLC, Madison, Wisconsin.


Mary Jo Smith, MA
Mary Jo Smith, MA

Mary Jo Smith, MA, Executive Director, MJS Solutions, LLC, Valparaiso, Indiana.

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