This transcript of the discussion has been edited for clarity and length.
Mike Sacopulos: There are rare occasions when you meet someone for the first time and you instantly know he or she is a solid person, a person whose guidance and recommendations should be taken seriously. It is an ineffable quality, but a real quality. My guest today is just that type of person. Although he has the credentials and experience to command your attention, he doesn’t need those.
My guest today is Charles “Chuck” Stoner, who is an expert on the subjects of business administration and leadership. Dr. Stoner is a frequent national speaker and has authored more than a dozen books, including Inspired Physician Leadership. Chuck Stoner, welcome to SoundPractice.
Dr. Chuck Stoner: Hi, Mike. Thank you.
Sacopulos: It’s such a pleasure to speak with you today. Maybe we should start with the 30,000-foot view. What’s your definition of leadership?
Stoner: Mike, I take a very broad definition. I think people who are in positions of influencing others are engaged in the process of leadership. But that doesn’t necessarily mean that they have a formal title that suggests leadership. I think this is the case with many physicians — that just because of who they are and what they do and the people that they affect, they’re engaging in leadership even though it’s not perhaps a formally designated title.
Sacopulos: Excellent. So, it seems to me that it’s not clear how to measure leadership, and that may sound silly, Chuck. But it strikes me that it could be measured by what those being led think of their leader, or it could be measured by results of the organization, output. Is there a good way to measure if someone’s a quality leader? or maybe lacking in that department?
Stoner: I think one of the things that organizations, not just healthcare organizations but organizations broadly, have tried to do probably for at least the last 20 years, is to do some internal surveys to see what’s going on, how people feel, what the morale is, what their level of satisfaction is. Part of that is always geared toward the leader. That’s one measure that we have. Of course, the difficulty there is that there are so many variables that can affect those results, it’s hard to say that they are just due to leadership. I think leaders are people who enable others too.
One of the ways that I look at leadership and who’s really being effective is what happens with the people that they’re working with. Are they developing? Are they growing? Are they assuming positions of leadership? What happens with the units that they’re leading? Are they making progress? Are they on the cutting edge? Are they being innovative and creative? Those kinds of things are hard to specify and nail down, but I think they all become part of the gamut of looking at leadership. I want to come back just very, very quickly. There are some researchers out of Harvard who say, “Whether you like it or not, one of the ways that we look at and measure leadership today is what happens with your people.” I think that is something I would keep coming back to as are you growing and developing your folks.
Sacopulos: Great. Chuck, statistics tell us that at present, the majority of physicians out there work for an entity that is not headed by a physician. What does this mean long-term for physician leadership?
Stoner: That is a really good question, and we’ve tried to do some research to figure out whether those organizations that are headed by physician presidents/CEOs do better. There is some evidence that suggests that the answer is yes; however, the numbers aren’t large, and it’s difficult to put a lot of credence in that. More significant is, again, some more recent research that indicates that organizations — healthcare organizations that have physicians in leadership positions throughout the organization — do function a little bit better.
How do we get more physicians at the top of organizations? Well, I think it’s part of the process of having physicians throughout the hierarchy who are engaged in leadership, and they’ll more naturally move into those positions. We always get these pictures of Mayo Clinic, Cleveland Clinic, these major organizations that are headed by physician CEOs, but there are not all that many of them. It’s hard to say definitively, but again I want to come back — I know I’m repeating a bit, Mike — but I think if we have physicians in leadership positions within the organization, critical positions, I think that there’s evidence that that does affect patient outcomes as well as perceptions of morale as well as financial outcomes, at least in some of the research that’s been done.
Sacopulos: You have my vote. You’ve written about behavioral foundations of leadership, and I have to say, I found this particularly helpful and interesting. Could you please talk a little bit about behavioral foundations of leadership?
Stoner: Yes, that’s kind of interesting. Whenever you talk to leaders and you ask them the question “what keeps you up at night?,” it’s almost always people issues, behavioral issues, interpersonal issues. I have a colleague who says, “The difficulty is that people are just messy.” That’s true. They’re not pigeonholed and they change all the time. That’s one of the reasons why I think when physicians, who are so smart and have such great analytic and technical skills, move into leadership positions, they suddenly become aware that, “Boy, these interpersonal skills, these behavioral foundations, which I’ve known about, they really come to the forefront. They make the difference.” That’s why I emphasize that — Mike, I hope this makes sense to you — but when I lead workshops for physician leaders, ongoing workshops, I almost always start with how to have constructive, respectful conflict encounters.
Because interestingly, if you can have a disagreement, a difficult conversation, with someone and come away with a feeling that everyone feels like they’ve been heard, we’re moving ahead, we’re making progress, that really builds trust and it really enhances the relationship within the organization. I always do that, spend time on how do you deal with conflict. A lot of that has to do with just basic listening skills and emotional intelligence factors and relational intelligence factors, but they tend to make a difference. The other thing we know is that in some of the surveys that have been done of physician leaders, asking “What are you looking for? What are the needs that you have that you’d like to have better training in?” they always say finance. Well, yes, that is something they need to know. But these physicians pick up finance pretty fast because they’re so doggone smart and so analytic. The other factor that almost always comes out is the interpersonal issues, the behavioral issues. That’s why I focus on that. I’m an organizational behaviorist. That’s what I do. But I do feel that it’s a critical piece of leadership.
Sacopulos: Absolutely. I like your opinion. Are there certain personality types that are better or worse at leadership? Maybe said another way, are some individuals born leaders?
Stoner: It’s hard to weigh in on that, but I probably would say that I wouldn’t go with the born leader model. The reason for that is we see successful leaders with so many backgrounds, so many perspectives, so many different personalities that I don’t like to label or bunch people together and say, “Oh, yeah, these are the characteristics that really define it.” I do think there are some behaviors and some actions that help, which we’ve just talked about. I think sensitivity to people, having a perspective on the future, those kinds of things really, really make a difference. But I wouldn’t say that there is a unique personality or type that’s a difference maker.
I’ll give you a real quick example. I have a fellow that I work with right now. He is loud. He’s demonstrative. He is very, very smart. You would think he’d be a great leader, and I think he is, but he has to temper his sort of over-the-top personality when working with other people because he can easily intimidate them. I work with another fellow who is kind of diametrically opposed, very quiet, very meek, doesn’t sound off a lot. But his people know that when he speaks, there’s something there you better be listening to. They have totally different ways of coming at leadership, but both are pretty effective leaders because they have tempered their tendencies or personalities to deal with the needs of their people.
Sacopulos: Well, that’s hopeful, right? Because it seems to me then that we can all work to improve leadership skills and get there, where if you were going to tell me that somebody had to be born that way or another then I would lose hope.
Stoner: I would lose hope too.
Sacopulos: I’m interested in nonverbal cues given by leaders. I remember the story of George Washington appearing at the Continental Congress dressed in a military uniform and standing tall when no one else was dressed that way. And without saying a word, it was clear to everyone in the room who was going to be in charge of the military. What nonverbal cues are available to physicians in their daily life?
Stoner: I’m glad to hear you use Washington. I am one who probably reads way too many presidential biographies, but they’re such great leadership lessons in those. You too. Yes.
Sacopulos: Yeah, me too. I’ll raise my hand.
Stoner: And they’re fun. They’re just fun, and you learn so much. I try to indicate to people that the nonverbals are one of the ways that you project to people a sense of your authenticity and warmth. Both authenticity and warmth are key factors to leadership. It’s the way you make eye contact. It’s the way you smile. It’s the way you don’t roll your eyes, those kinds of things. Sometimes it’s the way you interact with people, and that can be interesting. I have seen leaders in a crowd, really good leaders, have a one-on-one conversation with another person, usually one of their employees, as if there’s no one else in the room. They just have that connection that’s almost totally nonverbal, and a little paralinguistic because a lot of it has to do with inflection, too. Those little cues are really important. And as we all know, what we have to be careful of is the double-bind message where we say one thing verbally, but send a message nonverbally or paralinguistically that kind of refutes that. Of course, people pay attention to and believe the nonverbal, so those become important factors to keep in mind.
The place where I begin to work with physicians and physician leaders is recognizing that the nonverbals, the tone of your voice, the eye contact, the smile, the gestures, even the pacing of your conversation, suggests an awful lot to people. By the way, when I encourage physicians to have difficult conversations, one of the things I always tell them — they probably get tired of hearing it — is pace down. Slow your rate of speech. Let the other person have time to connect and understand what you’re saying and wrap their head around it. You want to get a message out, and that usually ramps up our speech. It’s not a nonverbal, it’s a paralinguistic, but I think it falls into that same category. Those little things become really important.
Sacopulos: I think you’re absolutely right. So often when it’s a difficult message or one that you anticipate will not be well received, there’s that urge to try to get through it quickly, right? Get the difficulty over with. I think you’re absolutely right. It may be best if we do precisely the opposite of that.
Stoner: In fact, in the project I’m working on right now — trying to help physicians figure out how to have difficult conversations with other physicians who are engaging in disruptive behaviors — one of the things I tell them is not only slow the pace, but begin the conversation with affirmation. This person is probably a good physician. This is probably someone who has great clinical skill and competence. It’s probably also someone who has moved into some unfortunate behaviors from time to time, usually under high stress. Start with the affirmation and build that positive affect and slow the pace. Little things like that do make a difference in how people respond and how they react. And Mike, anytime I say anything, and you and I both agree that it’s a good point, we know we’ve nailed it.
Sacopulos: Fair enough. Do you think that the same skills that make a good clinician make someone a good leader?
Stoner: Some of them, yes — for example, tenacity, grit, intelligence. Interestingly, too, physicians by and large, because of what they do, they tend to be good listeners. They have to listen. But one of the things that they do is, from a clinical perspective, they tend to listen rather selectively. They are looking for data to confirm or enhance the probability of knowing what sort of a treatment plan to come up with. I think the listening is still important, but it’s a broader kind of listening. I listen now not only to what’s being said, but to the emotion that’s behind it and pick up on some of those kinds of themes. Certainly intelligence, being quick studies, like I said, the integrity, the grit, the tenacity — I think all of those factors, which we think of as characteristic of physicians, really do become important.
I will also point out that the high need for achievement, which physicians generally have, and the high need to avoid failure, which physicians generally have, are important in leadership, but they also can get you in a little bit of trouble. Because leaders sometimes have to step out into the forefront where there’s not a high degree of certainty. Sometimes the need to avoid failure might be a little bit of a stumbling block. I’ve kind of danced around your question. I think in general the answer is yes, but it has to be tempered a bit.
Sacopulos: I’m interested to hear your thoughts on medical education in leadership. Do our medical schools do a good job helping students develop leadership skills?
Stoner: I would say historically, probably not so much. Again, I’m a little bit out of my field here in talking about medical education, but what I would say is increasingly today, I think we’re seeing more of a focus. Just this week I signed a contract, for example, to work with our local medical school in providing leadership training for their residents. I don’t know if that’s a new thing, but it’s got to be relatively new. I know when I’ve done it in the past, they respond well to it. I think they see that this can be used not only from a leadership point of view, but the things we talk about, the behavioral skills, can be used in interacting with colleagues, interacting with patients, interacting with staff. I think we’re seeing more of a focus in that area. Historically, that’s we probably not been as strong as we’d like it to be. Moving forward today, I think we’re getting much better,
Sacopulos: More good news. How, if at all, has leadership changed in the age of social media?
Stoner: That’s a whole topic in and of itself, isn’t it? I think it’s given us access to information and access to one another, which is really important. I remember when we first went to remote teams and everyone was concerned, “What’s that going to mean? What’s that going to do?” Now we’re so comfortable with it. I’ve worked with companies that said, “No. If we have a client in Germany, we have to travel, get on the plane and travel to Germany.” We don’t have to do that anymore. I think not only the technology, but the whole realm of social media has opened things up.
Of course, we know there’s also a curse to social media. I’m thinking of Jean Twenge’s work out of San Diego State, and the idea that we have a group of individuals today who are entering the workforce who were reared on social media. The last thing they see at night before they go to bed, and the first thing they see at morning when they wake up is that phone, and they’re connecting. I have to wonder a little bit what this will mean to people as they work in the organization, as they become socialized in the organization? Do they have the right background, the right skill? Has social media taken some of that away? I worry a little bit about the ability to interact in teams. Again, I’m not sure. I think we’re seeing things evolve. We’re seeing things change, and again, it’s like my previous answers, I think there’s a plus and a minus or a caution that we have to take into account.
Sacopulos: And that’s probably like most things in life, right? Not 100% white or 100% black, but some shade in between.
Stoner: That’s the kind of response that if one of my MBA students gave that, to me, that would be a C.
Sacopulos: Well, as our time draws to a close, I would like you to tell our audience how they can improve their leadership skills. Do you have any specific advice for a physician wanting to become a stronger leader?
Stoner: Well, there are a couple of things I would mention. More and more healthcare organizations, hospitals, broader healthcare organizations are involved in leadership training for their physicians. I think that’s an important avenue to get into. The second thing I always tell physicians who want to move into leadership is to volunteer for some committees, some projects. They might even be relatively low profile, but something that you’re interested in. People will see you. They’ll see the way you think, they’ll understand a little bit about what you have to add. And they’ll think, “Here’s a bigger project. Let’s get Dr. so-and-so involved.”
I encourage people to take the leadership opportunities where they are. The MBA program I work in through Indiana, the people come in, they want to change healthcare. A lot of them come in thinking, “Yeah, I’m going to be the CMO.” Well, that’s not where we start. We start slowly, more incrementally, and it builds. My thought is practice some of these behavioral skills, work on some projects, on some committees, get known, let people see you. Indicate your desire within your organization that, “Hey, I would like to take on a little bit more leadership responsibility.” That’s tough for clinicians, because now they’re playing a mixed role. They’re still a clinician, but they take off that hat and they put on an administrative and leadership hat, and the world’s a little bit different there. That’s the kind of thing that I think is important.
Sacopulos: Well, that’s great advice. Something specific and tangible people can do. But you are too modest, because we should mention that people interested in improving their leadership also should read your book, Inspired Physician Leadership.
Stoner: Thank you, Mike.
Sacopulos: Well, thank you. My guest has been Dr. Chuck Stoner. Dr. Stoner, thank you so much for being on SoundPractice.
Stoner: Thanks, Mike. It was a lot of fun.
Sacopulos: My thanks to Chuck Stoner for his time and insights. He is a leadership coach we would all be lucky to have.