Examine questions that all physician leaders should ask themselves periodically to ensure that they are leading − and not bringing down − their staff.
Brian Tracy described the seven qualities of the best leaders in his book, How the Best Leaders Lead: Proven Secrets for Getting the Most Out of Yourself and Others.1 He found that these qualities seem to stand out among the more than 50 qualities deemed important for successful leadership:
It is difficult for even the best leaders to emulate all of these qualities all of the time, so it may be instructive to observe from medical leaders' largest faults to learn how not to lead. Ask yourself these 10 questions from time to time to assess if you are inadvertently demoralizing those who report to you.
Am I being autocratic?2
Unless the situation calls for urgent action, particularly a safety issue, an autocratic leadership style is generally ineffective in the long run. Organizations filled with autocratic leaders suffer from high turnover and high presenteeism, wherein the employees are not fully engaged in the goals of the organization and may simply be biding their time until a more fruitful opportunity presents itself.
Presenteeism is defined as lost productivity that occurs when employees come to work but perform below par due to any kind of illness.
These individuals who experience illness or low morale, or exhibit a poor attitude, contribute to productivity losses at work. In a 1999 study, sponsored by the Employers Health Coalition, researchers calculated that the costs of lost productivity are 7.5 times greater than costs due to absenteeism.
For example, presenteeism due to chronic conditions, such as migraines, allergies and back pain, can add up to 30 times the costs of absenteeism. Presenteeism is a term used by human resource professionals to describe circumstances in which employees come to work even though they are ill, posing potential problems of contagion and lower productivity.3
There is no more effective leadership style for making employees more fearful, resentful or demoralized than a consistently autocratic style.
Am I under-communicating or speaking in "doublespeak?"
Better communicators realize that both formal and informal routes are necessary for optimal communication. More health care organizations are taking advantage of the "grapevine" via social media to communicate formally and informally with employees. Employees crave forthrightness. Leaders may ask themselves:
- Is my communication style positive and inviting of understanding and feedback?
- Are my employees comfortable bringing both good and bad news to my attention?
- Are people punished for going over my head or another leader’s head if problems have not been addressed, especially if there is a safety issue?
A closely related phenomenon of suboptimal communication is "doublespeak," which includes euphemisms or ambiguity. According to Sourcewatch, "The word doublespeak was coined in the early 1950s.
It is often incorrectly attributed to George Orwell and his dystopian 1984. The word actually never appears in that novel. Orwell did, however, coin newspeak, oldspeak and duckspeak (speaking from the throat without thinking “like a duck”) and doublethink (holding “... simultaneously two opinions which canceled out, knowing them to be contradictory and believing in both of them.”)4
How many of us have heard the phrase “plausible deniability”? Whereas in the past doublespeak was condemned, it is now common and accepted practice in American culture. An example from health care is "negative patient care outcome" for death.
Am I failing to provide clear vision?
Failure to provide a clear, compelling vision, especially in health care, leads to confusion. All of the other elements may be present in a strategic plan, but if vision is lacking, followers are confused.
A leader may have a vision, but if that vision is not clearly spelled out and shared, it will be virtually impossible for others to follow.
A vision statement doesn't tell you how you're going to get there, but it does set the direction for your group.
Am I failing to share my goals and objectives?
Beyond vision, leaders must share the goals and objectives clearly. Many organizations have embraced SMART goals:
According to the website for Top Achievement, "To set a specific goal you must answer the six "W" questions:
- Who: Who is involved?
- What: What do I want to accomplish?
- Where: Identify a location.
- When: Establish a time frame. Which: Identify requirements and constraints.
- Why: Specific reasons, purpose or benefits of accomplishing the goal.5
Am I failing to give adequate support and resources?
Failure to provide adequate support and resources for projects that are medically necessary and strategically vital can be enormously frustrating, especially for those who are trying to accomplish organizational goals.
It is easier to justify more visible projects like expansion of operating rooms or the newest scanners in radiology. This may come at a cost of ignoring infrastructure such as the laboratories or improvements in primary care.
As W. Edwards Deming admonished, systems thinkers must have an "appreciation of a system" to see that all of the parts are vitally interconnected.
Am I failing to provide adequate training and education for others to improve skills?
Failure to provide proper training and education can lead to considerable anxiety and frustration among the most talented in your ranks. It is difficult to maintain an advantage in health care based on technology alone.
In the future, the best organizations will be nimble and staffed by motivated people who are well-trained at all levels. Beyond training, continuing education at all levels is a must. Though it is tempting to cut costs by decreasing continuing education, health care is advancing too rapidly to risk falling behind.
Am I failing to provide an action plan?
Failure to provide an action or implementation plan can lead to false starts. According to the website BusinessDictionary.com, an action plan includes “steps that must be taken, or activities that must be performed well, for a strategy to succeed.” An action plan has three major elements: 6
- Specific tasks: what will be done and by whom?
- Time horizon: when will it be done?
- Resource allocation: what specific funds are available for specific activities?
Without these elements, followers will be utterly confused on what they are supposed to do. A well-developed Gantt chart can be particularly helpful.
Am I acting in an overtly political fashion?
According to Leonard Berry, PhD, distinguished professor of marketing at Texas A&M University, leaders must demonstrate competence and fairness for followers to firmly commit to the health care organization.6
If followers perceive that resources are based on political considerations, rather than objective evidence such as improving the overall value of the practices, financial return or medical necessity, then decision-making may be viewed as political, rather than pragmatic. This will lead to loss of discretionary effort.
Do I hold everyone equally accountable, or do I ignore those who are underperforming?
Not infrequently, leaders are tempted to let underperformers, especially if they are in protected categories, receive special consideration and hold them to a lower standard.
The most talented members of the team observe when actions are perceived to be done in a subjective manner, rather than an objective and evidence-based fashion.
Health care organizations are like giant fish bowls. Everyone is aware of the discretionary effort of others. Allowing an underperformer to coast to retirement comes with considerable expense to the morale of the best performers.
Am I living in the denominator?
At our institution, we define value as service + safety + outcomes divided by cost over time. In a competitive environment, it can be enticing to "live in denominator" or to be concerned only with financial metrics or the financial margin. Unlike other businesses, many people are drawn to the health care field because they want to be part of something larger than themselves.
I once asked a senior systems engineer why he chose health care over another field. I pointed out that he was surely aware that, with his talents, he could command two or three times his salary in another industry.
His response? "I believe in the mission."
James S. Hernandez, MD, MS, is an associate professor of laboratory medicine and pathology at the Mayo Clinic College of Medicine in Arizona.
This article was originally published by the American Association for Physician Leadership in 2011.
- Tracy B. How the Best Leaders Lead: Proven Secrets for Getting the Most Out of Yourself and Others. AMACOM books; New York, 2010.
- Autocratic Leadership. Money-zine. Latest update Feb. 6, 2019. https://www.money-zine.com/career-development/leadership-skill/autocratic-leadership/.
- Presenteeism. Accessed at https://wfrn.org/glossary/presenteeism-definitions-of/.
- Doublespeak. Accessed at http://www.sourcewatch.org/index.php?title=Doublespeak.
- SMART goals. Accessed from Top Achievement, at http://www.topachievement.com/smart.html.
- Berry, Leonard L. Discovering the Soul of Service. The Free Press, NY. 1999.