Discussion:  New Thinking Leads to Better Transitions

To be effective leaders, physicians must develop new skills and behaviors beyond those that made them successful clinicians.

ABSTRACT: Physician leaders are integral in today’s changing health care environment. To be effective leaders, physicians must develop new skills and behaviors beyond those that made them successful clinicians. This article focuses on what the authors propose as a sequence of actions for that to occur. Usually, behaviors receive the focus during change, but the authors suggest changing thinking for sustainable leadership growth.


Health care organizations are experiencing dramatic change, and managing transitions is a core leadership trait. Successful transitional leadership starts with the knowledge of what is not changing. For physicians, this foundation provides safe, high-quality and compassionate care to patients and the larger community.

However, cost and quality incentives put pressure on many health care systems. Most providers are experiencing revenue shortfalls while purchasers — including individual consumers — are looking for great experiences, easy access and clear value for what they spend on health care. There is growing demand for health care to be more affordable yet deliver outstanding clinical results.

Physicians understand these expectations as well as the difficulty of delivering great outcomes in the current, complex health care environment. But the environment of change will create new opportunities for leaders, requiring significant personal and professional growth. Leaders who cling to what has made them successful in the past are at risk of being marginalized today.

To avoid that fate, health care leaders need to change how they think. Thinking and emotional management are intertwined, and create a leader’s observed behaviors. Leadership behaviors will define the culture of an organization, and will drive performance over time. Therefore, high-performing leadership comes from fundamental shifts in personal thinking in response to a change in the environment (see Figure 1).


Wright Figure 1

Without a shift in thinking, it is unrealistic to expect different results from leaders.

It is especially important to change one’s thinking during a transition, such as when a leader takes on new roles and responsibilities. The ability to gain new insights also is enhanced when a leader can recognize outdated thinking. Frequently, the biggest hurdle for personal growth of leaders is overcoming former learning.1

From Productivity to Influence

A common scenario for physician leaders is the progression from “doer” to “influencer.” Initially, clinical professionals are hired and rewarded for their individual contributions. 

Leadership skills, however, add value on a different scale and largely are done through building influence in the organization. This involves the development of “soft” skills including relationship building, as opposed to the more easily measured “hard” skills, such as work relative value unit productivity.

Rather than working one patient at a time, a leader develops skills that can affect an organization’s culture, including improving the patient experience, addressing unwarranted clinical variation and decreasing the cost of care, among many others. The degree of influence leaders develop over time ultimately determines their effectiveness during times of dramatic change.

Consider the case of a successful surgeon who was appointed to a leadership role for a medical center’s busy operating suite. He was an expert clinician with outstanding clinical results and was financially rewarded for his productivity. In his new leadership role, he was exposed to competing priorities, shifting alliances and a complex decision-making process.

These dynamics were relatively new to him and required a different level of thinking to be successful. His clinical skills made him an excellent surgeon but now he had to develop new skills and grow his leadership presence. “What makes me an expert physician makes me a lousy leader,” he said in an interview.

He was accustomed to doing things himself so he could trust they were done correctly. He was good at giving “orders” for patient care, and didn’t need to build consensus in the operating room. Fortunately, he recognized the need to shift his thinking — and, therefore his behavior — when he was in leadership meetings, and successfully grew his influence in the organization.

This ability to develop leadership influence is not usually taught in medical school or residency. However, leading through influence and relationships might become even more important in the future of patient care, especially when one considers patient activation, chronic disease management and team-based models of care.

As physicians become leaders in organizations, their compensation will also not be based on productivity. Frequently, leadership incentives are based on metrics that are achieved through the coordination of efforts across organizational boundaries. Financial rewards for physician leaders are based on effectively influencing others for positive change, not on what they directly produce.

Transition to Senior Leadership

Another example of a leadership transition is the person who transitioned from operations into a senior executive of an ambulatory division in a large health system. Her work capacity and ability to manage details made her a remarkable operator. However, in her new role, she required skills that had to be developed from a change in how she thought.

Making a leadership transition is always personal. As leaders expand their roles, they frequently have to give up what they intuitively understand, enjoy and excel at.

In her executive role, she was required to participate in strategic dialogues, develop high potential leaders and find her voice in a complex leadership structure. In addition, her financial incentives were tied to the economic and quality performance of her division as well as the entire organization.

Fortunately, with coaching, her transition to senior leader was successful. She learned how to increase her influence, effectively delegate responsibilities, and broaden her thinking — all contributing to remarkable results in her expanded role.

Making a leadership transition is always personal. As leaders expand their roles, they frequently have to give up what they intuitively understand, enjoy and excel at. In exchange, they take on new responsibilities that can feel awkward and are full of ambiguity. This transition can be unsettling and, when combined with a shift of financial incentives, causes many physicians to back away from larger leadership roles.

In William Bridges´ landmark work around transitions, he describes a “Neutral Zone” concept,2 in which leaders move from an environment where the goals and processes are clear to one that’s uncertain and filled with risk and ambiguity. Being in this zone can be stressful and occasionally paralyzes clinical leaders.

On the other hand, the Neutral Zone can also be a time of tremendous personal development. In fact, successful transitions happen when leaders avoid rushing through it and embrace it as the growth opportunity it is. We have found that coaching during leadership transitions can be powerful, especially when there is a focus on the exact new skills needed to be successful.

This was the case for a physician leader who moved from clinician to significant leadership. She is a specialist who frequently gave lectures across the country and is well known in her national specialty society. In addition, she is a natural leader who was frequently invited to strategic conversations in her health system. Eventually, she was asked to serve as a senior physician executive in her system, with a wide scope of responsibilities.

Despite her excitement, she had reservations about moving away from her clinical career and taking on such a large administrative role. Her professional identity was tied to her clinical work, and there was significant risk and ambiguity with her transition. Fortunately, she asked for help to navigate it. Through a series of coaching conversations, we identified the critical skills she needed to be successful, and created a list of behaviors to focus on during her transition. It included advocating beyond her specialty, developing her relationship with senior leaders, creating a stronger stewardship presence and contributing to strategic growth initiatives for the system.

Being intentional upon her leadership transition, and creating clarity on the changes in her thinking to be successful, allowed her to focus her energy and develop new leadership behaviors. It was impressive to see her grow as an authentic leader, and watch the organization respond to her growing influence.

Physicians as Strategists

As noted, health care organizations are responding to an environment that demands better outcomes at affordable prices. The need for managing the change to value-based reimbursement is occurring across the country. It is also at the core of why physician leadership is important, and why high-profile leadership transitions are occurring in many organizations.


  • As my leadership role changes, how should my thinking evolve? How do I measure how much my thinking has changed?
  • What new behaviors do I need to develop to be successful in my role? How do I measure these behaviors? To whom can I be accountable for these behaviors?
  • How am I analyzing my current situation? Is my filter one of operations or strategy? Are there areas that I can combine operations and strategy?
  • How do I want to “show up” in my new role? What areas of thinking do I need to change to be more effective?


While thinking differently will benefit physicians as they experience leadership transitions, changing one’s thinking is difficult. Well-timed questions can help trigger new thinking during leadership transitions (see Figure 2).

Clinical leadership transitions frequently require physicians to develop influence in their organization’s strategic dialogues. Strategic thinking can be defined as the ability to critically consider the problems an organization will face in the future, and what parts of the organization will be affected the most.

Mark Chussil’s Harvard Business Review article on strategic thinking is helpful.3 He suggests good strategists formulate “could” questions. What could we do? What could be the consequences? In today’s complex environment, there frequently are no right or wrong answers, only different consequences for a decision. A strategic thinker considers which is the best (or maybe the least-bad) option, given their understanding of the future.

A strategic exercise Chussil suggests is imagining it’s the future and you’re saying, “I wish we would have thought of ‘X.’ ” Determining that variable comes through higher-level thinking, which is stimulated through asking the right questions. Asking the right questions frequently is more important than growing one’s technical knowledge base. Effective strategists have many ways to ask powerful questions.


Physicians who are being considered for leadership roles have typically been successful with their current responsibilities.

However, successful transitions require physician leaders to consider new ways of adding value to an organization. Personal growth is facilitated by being intentional about thinking during a transition.

Leadership is a journey and not a destination. Behaviors that led to success in the past may not be what’s needed for the future. Creating a list of powerful questions, sometimes with the help of a coach, can lead to successful leadership transitions.

Today’s health care environment has no shortage of challenges. Caregivers are frustrated by change and competing priorities. Providers are experiencing burnout, and there are barriers to providing great care while making the organization sustainable for the long run.

It is in this background that clinical leaders are stepping into new roles, with significant risk and reward. Physician leaders can be highly influential, especially if they are intentional about their own personal growth. Great leadership is what caregivers crave, and is the key for making health care rewarding for providers and the communities we serve.

Craig Wright, MD, is chief medical officer at The Portland Clinic, a multispecialty private practice in Oregon. He also provides executive coaching for clients around the country. He is the former senior vice president for physician services at Providence Saint Joseph Health System.

Karl Pister, LCSW/PCC, is principal of Oregon-based The Coaching Group, an executive coaching practice focused on physicians, nurses and health care executives in the western United States.


  1. Bonchek M. “The Problem with Learning is Unlearning.” Harvard Business Review, Nov. 3, 2016.
  2. Bridges W. Transitions: Making Sense of Life’s Changes (Revised 25th Anniversary Edition). Da Capo Press. 2004.
  3. Chussil M. “How the Very Best Strategists Decide.” Harvard Business Review, Oct. 24, 2016.

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