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American Association for Physician Leadership
American Association for Physician Leadership

Motivations and Thinking Style

Key Elements of Engagement

Stanley E. Harris, MD, MA


The key elements of engagement range from simplistic and inexpensive, such as a smile, to staying connected to people you don’t even see.

The key elements of engagement range from simplistic and inexpensive, such as a smile, to staying connected to people you don’t even see. This challenge includes concerns of ensuring collaborative, efficient teamwork, sharing insights and knowledge between team members who are working miles apart. Active listening becomes a critical skill, along with effectively communicating in a manner that conveys clarity, respect, and confidence in those you want to be fully engaged.

The Power of a Smile

Our brains are equipped with special neurons (cells) that enable us to automatically mirror or respond in a like manner or behavior projected by another person. Consequently, the smile is the most inexpensive, easily executed, and most-appreciated form of engagement. A smile has been scientifically and practically proven to be an easy first step in engaging most people.

It has always been easier for me to smile rather than to walk around with a grim expression, even if I was struggling with stressful issues just beneath the surface. It was not until I was a mature adult with a medical degree that I was able to grasp how a smile can instantaneously evoke a positive reaction.

I had just come out of a convenience store on Main Street in my hometown. For some reason, I was smiling. Perhaps the smile was from a pleasant exchange with the clerk inside or something I saw in the headline of the newspaper. As I proceeded down the street, an older gentleman walking toward me said, “I like what you are wearing.” I had on a jacket, slacks, and tie, nothing exceptional. As I glanced down at my clothing, he quickly said, with a smile, “Your smile.”

From that day forward, I have purposely tried to be a positive neuronal mirror. I smile on elevators, in stores, and whenever I can make eye contact with someone. A warm handshake and sustained eye contact also facilitate effective communication. I hope that setting a positive example will encourage others to do the same.

While a smile is an overwhelmingly positive tool for engagement in my life, this may not be true for everyone in every setting. A smile at the beginning of an announcement regarding impending layoffs is neither empathetic nor engaging. In the world of political correctness, a smile may be viewed as flirtatious. A smile can be a first step, but certainly not a mandatory one, to establish meaningful engagement.

Active Listening

Listen not with the intent to answer but rather to discover the perspectives, passions, and insights of others. Listen to become engaged in meaningful communication. Listen not just for agreement or validation of a point of view but also to assess whether the other person understands your intended message. As you listen, be sensitive to nuances that signal a lack of clarity or understanding of expectations. A slightly furrowed brow, a muffled sigh, widening of the eyes, or tilting of a head are a few clues that your comments may not have been as clear as you thought.

Communication Style

When leaders communicate effectively, their message is clear, and the potential for employee engagement increases. Conversely, if a leader’s message is unclear or overshadowed by negative nuances or intonations, the recipient will likely focus less on the message and more on how it was delivered.

My mother was a housekeeper at a local college. Quiet, unassuming, yet dignified, she always carried herself with pride. She was able to command respect from nearly everyone she met. Students appreciated her kindness and generosity — she often invited students to Sunday dinner followed by long relaxing conversations. She listened attentively and was never judgmental. Students were pleased to have someone with whom they could share feelings of stress, anger, or frustration. Her responses were supportive and encouraging.

I often sought her council and deeply appreciated the guidance she offered and the example she set for how to treat people. I am eternally grateful for her lessons in humility, integrity, and generosity. Engaging in intimate, supportive conversations is increasingly difficult in today’s work environment. Many managers and leaders have not developed the skills to participate in these exchanges.


The challenges of engaging those you lead are significantly increased when your team members work different shifts, are based in different locations, work from home, or are on leave.

In the last years of my full-time employment, most of my team members worked from home. I was fortunate to have a team of colleagues who had been with me for many years, so there was little danger of them being out of sight and out of mind. Nevertheless, I scheduled quarterly meetings to not only update the team on important business-related issues, but also to catch up with them about their families and their lives outside work.

My team members each had unique skill sets and knowledge bases that they could share easily when they sat next to each other in the office. Because these meetings were teleconferences, I did worry about the extent to which the staff members were able to relate to and support each other.

To get a better understanding of what was happening with the team, I set up individual sessions with each team member. I was happy to hear their ideas about improving our operational efficiency and was glad to learn that they made earnest efforts to connect with one another via computer and phone. Despite their demanding workload, nearly everyone was enthusiastic about doing what they could to sustain the level of excellence the team had achieved.

These sessions also helped me identify interpersonal conflicts, often caused by a lack of mutual respect or unprofessional communications. I followed up on each of these issues by inviting the participants in the conflict into my office for a face-to-face meeting. I began by asking each person to express what they thought the conflict was about. Then, I reviewed what I saw as the legitimate concerns of each party and engaged them in a discussion about why certain behaviors, intonations, or actions could be viewed as disturbing to the other. I ended each session by emphasizing the importance of being an efficient, effective team, which meant respecting the value that each member contributes.

These individual sessions reaffirmed their level of professionalism, commitment, and willingness to share their knowledge and experience. The interactions also provided an opportunity to stimulate more creative thinking and strengthen the bonds of engagement.


Adkins A. Majority of U.S. Employees Not Engaged Despite Gains in 2014. Gallup. January 28, 2015. George de Mestral—Famous Inventor.

Iacoboni M. Mirroring People: The Science of Empathy and How We Connect with Others. New York: Picador; 2008.

Roberts W. Leadership Secrets of Atilla the Hun. New York: Warner Books; 1985.

Excerpted from The People Value Proposition: See one, Do one, Teach one ... LEAD - A Physician's Journey to Leadership by Stanley E. Harris, MD, MA.

Stanley E. Harris, MD, MA

Stanley Harris, MD, MA, is a physician executive with more than 30 years of experience in medical management operations and leadership development. He most recently served as senior medical director at Horizon Blue Cross Blue Shield of New Jersey, where he directed a team of physicians, nurses, and healthcare professionals who researched, developed, and coded medical policy that defined access to medically necessary care/benefits for 3.8 million subscribers. He also coordinated the meetings of the Physician Multispecialty Advisory Committee and the Professional Advisory Committee.

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