Medical systems need leaders at every level. First, if we are to avoid having those who are motivated solely by financial interests guide the future of medicine, we must have physician leadership at the system design level. Second, in order to ensure that operational decisions are made with patient interests in mind, we need physician leadership at the hospital and clinic levels. Finally, to make certain that the practice reflects the values of the physicians who work in it and that patients are treated well, physician leadership is needed at the practice level.
AT A GLANCE
• To develop your skills as a leader, start by understanding that leadership results from creating a successful team.
• Share with your team your values, as they are the ones who should drive your actions.
• Until the advent of socialized medicine and third party reimbursement, physicians traditionally provided the structure and leadership in medicine. Now, because of a lack of business training among physicians, more nonphysicians are the leaders of health care systems.
• Today, stronger private medical systems are needed, and physician leaders must become patient advocates.
As physicians, we have the only holistic view of medicine, with awarenesses of both the cost and the purpose of what we do. Yet many physicians opt out of leadership, giving over control to nonphysicians. The result is often suboptimal, with bloated costs and inadequate patient care.
Imagine working in a company in which only 25% of employees are enthusiastic, 50% of employees do just enough, and the other 25% of employees are totally turned off by their jobs. This typical profile of a US company implies that the economy is running at 30% efficiency, at best, because so many workers are not contributing as much as they should.1
Well, now consider this: Your own medical practice may be one of those companies.
Your practice needs you to develop your skills as a leader. You can start by understanding that leadership results from creating a successful team. Although you can encourage everyone to have a voice by asking them for their ideas, in the end, the leader takes on the responsibility and control of the practice.
KEYS TO SUCCESS
Successful teams have three key characteristics.
No. 1: A clear and compelling purpose. This characteristic is the foundation of all successful teams. The purpose determines the culture and provides a framework for everything that follows. Physicians understand that purpose, and they must convey it to their team members in order to succeed. Purpose-driven leadership resonates with people who work in medicine, as they are often motivated by interests that go beyond financial self-interest.
No. 2: Communication. It is important to have a team working for you whose members are able to connect with each other, not just through the leader. Members should be able to have energetic conversations with each other, explore outside the team, and bring information back to all.
No. 3: Attention to team members’ needs. Decades of research on leadership have shown that leaders must pay attention to their purpose and push it forward, but they also must pay attention to the people they work with. One without the other is ineffective, but good leaders are adept at both. The leader must recognize those who work with him or her and know about them. It is best to walk the floor and ask staff members personal questions or inquire about how work is going. The process of improving employee engagement starts with the basic step of asking employees how they feel. This may seem like a feel-good initiative, but it is not; it contributes to important factors such as productivity.
CONNECTING WITH STAFF
In the 1990s, the Gallup Organization developed an instrument to measure employee engagement called the Q12 employee engagement survey.2 This tool presents a dozen questions to measure worker engagement that are linked to business outcomes such as retention, profitability, customer service, and safety. To be most effective, this tool should be coupled with specific corrective actions when problems are identified. This demonstrates the leader’s commitment to providing a rewarding experience to employees.
No one can do everything. To be an effective leader, you have to delegate, facilitate, and orchestrate all your team members to live up to their potentials. This in turn will produce the results you want. The best leaders do little themselves because their teams have a clear understanding of expectations.
Share with your team your values, as they are the ones who should drive your actions. Think about your core values, make sure they are your guide, and share them with the team.
STYLES OF LEADERSHIP
Leadership style is not a function of personality, it is a strategic choice. Instead of choosing a style that suits your temperament, ask what style can best address the demands of a particular situation (see The Six Basic Leadership Styles).
It is important to be able to adapt your leadership style to what is needed when it is needed. Effective leaders are self-aware and sensitive to the impact of their leadership on others. In practice, few leaders excel at all these styles and know how to use them all.
If it does not feel natural to change from one style to another, work on expanding your repertoire. When you understand which styles you are lacking in, you can work to improve them.3 If necessary, you can build your team with members who employ the styles you lack.
Physicians who work in private practice often lead enterprises of significant size, and most do so without formal business training. No one would expect a business graduate to practice medicine, yet many people expect physicians to practice business simply because they are doctors. This puts physicians at a significant disadvantage. There is, however, a wealth of information available in the business realm that physicians can and should access.
layers of bureaucracy and regulation
The reimbursement system, which varies from country to country, can make the business of medicine even more complex. There was a time in the practice of medicine when the physician would charge the patient directly for services provided. This straightforward arrangement created financial responsibilities for both parties, in which both would try to obtain the best common-sense medical result at the lowest possible economic cost.
In modern health care systems, in which the responsibility for payment for services is often passed to third parties (ie, the government, in the case of socialized medicine, and/or private insurance companies), this relationship has been altered. The addition of many layers of bureaucracy and regulation makes these systems more expensive. It is no surprise, for example, that of total US Medicare expenses in 2014, only 12% went to physician payments, even though nearly all of the money spent on patient care was at the direction of a physician.4,5
Because of the lack of business training among physicians, for the most part, nonphysicians are the leaders of health care systems. Nonphysicians have little or no understanding of the patient-physician relationship, and they often prioritize economic profit over patient interests. As a result, health care costs continue to increase. In today’s medical systems, profits increase as the system becomes more expensive, whether or not the higher costs serve patients.
Until the advent of socialized medicine and third-party reimbursement, physicians traditionally provided the structure and leadership in medicine. Costs were lower, and health care existed to serve patients, not to generate profits. Today, stronger private medical systems are needed, and physician leaders must become patient advocates.
If these things are to be achieved, physician leadership is a must.
1. Bates S. Getting engaged. HR magazine. February 1, 2004. https://www.shrm.org/publications/hrmagazine/editorialcontent/pages/0204covstory.aspx. Accessed April 4, 2016.
2. The Gallup Organization. Q12 Employee Engagement Center. http://www.gallup.com/products/170969/q12-employee-engagement-center.aspx. Accessed April 4, 2016.
3. Goleman D. Leadership that gets results. Harvard Business Review. March-April 2000. https://hbr.org/2000/03/leadership-that-gets-results. Accessed April 4, 2016.
4. The Henry J. Kaiser Family Foundation website. The facts on Medicare spending and financing. http://kff.org/medicare/fact-sheet/medicare-spending-and-financing-fact-sheet/. Accessed July 24, 2015.
5. Centers for Medicare and Medicaid website. Statistics 2014. US Department of Health and Human Services; page 30. https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/CMS-Statistics-Reference-Booklet/Downloads/CMS_Stats_2014_final.pdf. Accessed April 8, 2016.
Carlos Manrique de Lara, MD, FACS
• Manrique Custom Vision, San Antonio, Texas
• Financial interest: None acknowledged