You applied for or were recruited to an important physician leadership position and you got the job! You may believe that because you were selected for the job, you are destined for success.
You might be right, but to minimize the risks of being wrong, stop and ask yourself, “How do I best prepare myself for success as an organization’s new leader?”
The leadership framework offered here focuses on the physician leader’s first year in the position — if you choose to accept. The framework may require some modification according to the type of organization the physician will lead, for example independent practice versus an integrated health system design, whether the position is focused on employed physicians, affiliations with independent physicians, or both.
Setting the Stage
The interview “dance.” Reading the room and turning the tables.
Ask the right questions during the interview process. Learning to read the room is important and requires skill. Physician leaders are hired by smart, experienced, and opinionated professionals who constantly are evaluating the risk/reward equation that affects their organization, job, and career.
Turn the tables and ask more questions than you answer. Probe the interviewers’ perspectives and biases pertaining to how you should do your job, including outcomes they would see as important priorities. Delve into their perspectives on the risks of new strategies, business plans, and services programming. Get a sense of how your vision, values, and predilections regarding physician organization leadership and development fits with theirs’— especially with your potential boss.
Make sure you understand how the senior leadership team would like to move the organization forward with you there, or not. While their perspectives may harmonize well with yours, it may be the case that with the right question, you will know this isn’t the case or the place for you. Presuming the interviewer is a leader in a position superior to the position you are interviewing for, probe for that person’s perceptions of the risk/reward path for the part of the organization that you would lead. Ask questions that may reveal specific strategies and tactics that the interviewer perceives as being too expensive or too risky to pursue for the organization.
Show some, but not all, of the cards in your hand during the interview process. Provide a few case vignettes on your leadership journey, including successes and failures, especially “big mistakes” you prefer not to make again, lessons you have learned, how you see the future of the industry, and the role of the physician leader in the type of organization you may join and lead.
Be careful with your response to the “what is your leadership style” question. There is no single “style” that is best for every leadership challenge, opportunity, or acute situational disorder in organizations. A reasonable answer to the question is “it depends”— it depends on the factors at the time, when the right decision must be made, and the likely risks and rewards in play.
Now that you have the job.
Get a coach. Pay the costs out of pocket if necessary. Select a professional who will tell you the truth. Have the coach talk to leaders, bosses, and peers in your last job. Get answers to at least this question: “Given where Dr. (your name here) is now working and what the job is, what one best piece of advice would you provide to ensure his/her success?” It’s lonely at the top. The members of the senior leadership team, including your boss, are not your friends or confidants, at least not out of the chute. Having a good coach provides you a safe source to test ideas, and express challenges, and concerns and anxieties related to the job and how you expect to pursue them.
Don’t fall in love with decision-making. Physicians are decision makers; however, making decisions for organizations is not the same as making them for patients. The higher leaders move in rank, the more distant they are to the results of the decisions made. Physician leaders should not become enamored with making decisions. The more decisions they believe they must make, the more people around will serve them up. Physician leaders who love making decisions will find their worlds shrinking around them, and those they lead will not grow. Avoid being the “lead decision-maker” unless it really matters. Senior leaders focus their decision-making energies with a handful of the “big issues.” The challenge is determining what those big issues are.
Find the formal and informal leaders and introduce yourself. Probe their perspectives on the organization: where it is and where it should go, how the culture of the organization should be prioritized where the organization should invest, and what organization leaders should know. Responses to “should” questions implies a moral imperative based on the respondent’s personal beliefs, values, goals and objectives, and commitments.
Be seen. Walk around. Introduce yourself. If the job involves affiliation with a hospital, spend time in the doctors’ lounge, be seen in the hospital, across all shifts, at least periodically.
Dig for information. Consult people who have valuable information, including personnel in the clinical area and beyond, such as those in finance, operations, marketing, business development, human resources, facilities, and strategy. Find the right people and ask the right questions, such as “What do you do here, and what are your opinions about the priorities for the organization? What should I know to best serve the organization? Which metrics do you monitor to inform your perceptions and opinions about organizational performance?” Make sure you listen more than you talk. Specific areas of interest include:
The financial condition of the organization in detail, at the levels of the whole, the clinical division, the clinical department, and the clinical program and service line levels.
Provider productivity patterns.
The patient experience.
Organizational culture.
Competitor strategies.
Key provider referral patterns within the organization and outside.
Staff recruiting and turn-over issues.
Key clinical outcome indicators, by specialty.
Perceptions about major strategic and business risks.
Market share for key clinical programs and strategies.
Putting your stake in the ground and launching your best plan.
Create a concise position paper and related talking points. Focus on your perspectives on such issues as where the organization is as compared with the perspectives of those in senior leadership, as well as other informal and formal leaders you spoke with. Identify key questions you believe require better or more in-depth answers. Admit what you don’t understand, don’t know, and may be confused by. This will take the edge off the “listen to me, I know what I’m talking about” risk in the exercise. Present your best ideas about where you could start with your work to test how the other leaders might react to your initial plan. This will minimize the risk of getting off to an irretrievably bad start.
Consider the feedback gathered from the previous step as you shape your longer-term vision (subject to change) along with your first-year work plan. Share the plan with your boss for reaction and discussion then with the full senior leadership team in the spirit of “a place to start the leadership plan discussion.” The goal is to understand how your vision and plan are likely to affect theirs.
After you move your work plan through the filter of the senior leadership team, form a broad ad hoc council to unveil the plan. Clarify that the council is not a decision-making body and is not part of the formal organizational structure. Membership should be multidisciplinary; physician-only groups tend to cause concerns in C-suites. Include identified formal and informal leaders.
Making the major goals clear and establishing priorities.
Regardless of the work plan or strategies to be undertaken, you need ensure the expected outcomes are clear. In other words, what do you expect the organization to achieve under your leadership? Such declarations establish your expectations and values as a leader. “Must-have” performance requirements must be established. Categories for such goals can include quality of care, patient experience, organizational culture, operational and financial performance, market performance, and cost of care management. Make the “must-haves” crystal clear. The “how” can be discussed and debated; the “what” cannot.
Establish a performance dashboard and use it regularly. By doing so you establish what performance metrics are important to you, to your position, and to the organization. Dashboards are “living documents” that change. That’s OK. If you can measure it, you can manage it.
The Social Psychology of Organizations and Leadership
Success as a physician leader extends beyond “being a good doctor who is great with patients.” These characteristics and competencies are required, but are not sufficient in the role of the physician leader.
Supplementing one’s business acumen with seminars, one-off courses, or advanced degrees in healthcare administration and organizational leadership can be useful; however, an oft-overlooked and under-appreciated competency by physician leaders is a grasp of and grounding in the social psychology of professional services organizations, including medical services organizations. Those who refer to social psychological groundings as “that fluffy stuff” don’t often last long as leaders.
There is a social psychology that is intertwined with the culture of every organization. One theoretical framework with practical applicability for the physician leader is Rotter’s social learning theory.
A simplified description, as applied to professional services organizations, explains that an individual’s attitude and behavior in an organization (attitudes are behaviors) is a function of the state, stability, culture and functionality of an organization; the perceived value of the tangible or intangible reward; and the expectation about whether the reward will be attained. These factor sets can operate independently or together to affect behaviors of individuals and organizations.
Leaders must understand that behaviors of highly educated and trained professionals are affected by their expectations for sufficient control over their professional lives and related decision-making; perceptions that the operating rewards system is fair, equitable, and sufficient; and perception that the work environment is stable, well-led, and reasonably predictable. When perceptions relating to any one or more of these factors shift, behavioral change can follow (see Figure 1).
Figure 1. Rotter’s Social Learning Theory.(1)
A brief, real-life, case study is helpful here. A medical group integrated with a large health system is subjected to a pay cut for everyone, including providers, coupled with a layoff of some portion of identified “non-essential support staff.” At the same time, communications from the top let physicians know that the organization is in talks to “partner with” another larger health system headquartered out of state. Key physicians and staff leave.
The social learning model of organizational behavior presented here would have explained the effect of the actions taken, as well as predicted the likely outcomes.
Real tangible rewards (compensation) were reduced.
The physicians had no control or even influence over the decision to reduce staff.
Leadership put into play the high likelihood of some form of presumed “takeover” by an unknown, out-of-town, third party (a potential destabilizing, psychological shock to the organization).
What could have physician leaders done to manage the situation better?
Revisiting the Need for a Leadership Plan Framework
Let’s return to the initial premise with a finer point: being hired as a physician leader doesn’t make you qualified or competent for the job ahead. It merely puts you in the position to lead. The key question is “what’s the plan”? The right plan typically reveals itself if you give it due time, and the right process guidance. Some of that guidance is provided here.
Our own work with organizations and leadership development demonstrates a lesson learned the hard way by some leaders: leadership success requires willing followers. No reasonable follower expects perfection. They do expect a clear and worthy mission, a vision of where the organization is heading, a crisp tactical plan, and measurable performance indicators.
With these in hand, the expectations of the physician leader are based on organizational culture surveys.
A few key predictors of factors that affect physicians’ and staffs’ perspectives of the leadership culture in medical services organizations, include:*
“All are held to the same levels of accountability.”
“All leaders work collaboratively in the best interests of the mission of the organization (and not their own).”
“Leaders make clear where the organization is headed and why.”
“I will be treated fairly when it comes to how I am rewarded.”
“My experience and opinions are listened to and are sincerely considered.”
“When I make mistakes, my leader will see my mistake as an opportunity to learn and develop.”
If you are at a stage in your career where you are eligible for an organizational leadership position, you are also sufficiently seasoned to know that the framework presented is offered from a position of direct experience, empirical evidence, and leadership culture research conducted in organizations. Physician leaders are encouraged to take from the framework what is useful and modify as needed.
*Note: Survey results were gathered from medical group administrations of the CulturePulse©, a proprietary leadership culture instrument owned by Keystone Culture Group. (daniel.zismer@castlingpartners.com).
Resources
Zismer DK. Leading a High-performing Culture — Ten Practical Lessons. Physician Leadership Journal. 2021; 8(3).
Zismer DK. Leadership Culture and Its Connection to Organizational Performance. The Governance Institute E-Briefings. 2020;17(2).
Zismer DK. Framework to Gauge Physician Burnout. Physician Leadership Journal. 2019; 6(3).
Zismer DK. The Science of Culture: A Look Inside Health Systems. Minnesota Physician. 2021; 34(10).
Zismer, DK, Utecht, BJ. Culture Alignment, High-Performing Healthcare Organizations, and the Role of the Governing Board, Part 1. The Governance Institute E-Briefings. 2018; 15(3).
Reference
Kelland MD. Basic Constructs in Rotter’s Social Learning Theory. Social Science LibreTexts. August 2020. Available at https://socialsci.libretexts.org/Bookshelves/Psychology/Book%3A_Personality_Theory_in_a_Cultural_Context_(Kelland)/18%3A_Social_Learning_Theory_and_Personality_Development/18.06%3A_Basic_Constructs_in_Rotter’s_Social_Learning_Theory