Personality Assessment and Physician Leadership: Using Data-­Driven Self-­Reflection for Professional Development

In the modern healthcare system, being an effective physician requires more than mastering the technical skills learned in medical school or residency. Being an effective physician requires a strong set of interpersonal, non-technical skills, including the ability to lead teams, units, or entire practices or departments.

Just as scientific inquiry has informed the technical practice of medicine, a science of leadership has emerged, informing our understanding of the process of leadership and providing empirical support for many best practices. The science of leadership has identified many factors that influence the process of leadership, including the knowledge, skills, and abilities of the leader; organizational constraints, resources, and policies; and follower preferences, abilities, and attitudes.

Of these influencing factors, leaders typically only have control over their own knowledge, skills, and attitudes; therefore, they can become more efficacious by better understanding their own inherent and stable abilities and traits and how these influence their interactions with the environment.

Specifically, empirical evidence has linked personality traits with leadership style(1); therefore, a data-driven understanding of their own personality and how that may influence their leadership behaviors in different contexts should allow physician leaders to become more intentional about their leadership style. This will ultimately allow leaders of all levels to take more control over the leadership process.

The primary purpose of this article is to clarify how data-driven self-reflection on their relatively stable personality traits can enhance the leadership process for all physician leaders.

Brief Overview Of Leadership Theories

Although an exhaustive review of the history of the science of leadership is beyond the scope of this paper, we find it pertinent to first briefly outline the development of modern leadership theories to advance a better understanding of the link between personality and leadership styles.

Many of the original perspectives of leadership built upon one another to create a clear link between distal predictors of leadership outcomes, such as personality traits, and more proximal predictors, such as behaviors. Specifically, leadership theories progressed from discussing what traits make a good leader,(2) to what skills a good leader possesses,(3) to the behaviors in which a good leader engages.(4) As the science of leadership developed, this understanding of leadership became more nuanced, moving from a view of leadership as an ability or an action, to a dynamic process that is shaped not only by the leader, but also by the work environment and the followers.

Modern leadership theories build upon this complex understanding of leadership as a process to capture leader traits, skills, behaviors, and interactions with followers and the environment. Below, we briefly highlight three of the most empirically supported modern conceptualizations of leadership: leader-member exchange theory, transformational leadership, and transactional leadership.

Leader-Member Exchange Theory. Leader-member exchange (LMX) theory highlights the fact that a leader creates a unique relationship with each follower.(5) Interactions between leaders and followers who have high-quality LMX are marked by mutual trust, respect, and rapport.(6) Leaders and followers with lower-quality relationships invest little in the relationship and work together to the extent required to complete the task.(7) These lower-quality relationships may create environments in which non-physician team members are unwilling to engage in beneficial team-oriented behaviors like mutual performance monitoring or challenging unsafe behaviors.

Transformational Leadership. One of the most widely cited and supported leadership theories, transformational leadership, suggests that an effective leader is able to communicate a clear vision of where the team/unit/department/organization should go, particularly during times of transition or uncertainty.(8,9) Not only are transformational leaders able to communicate this vision, they are able to garner buy-in from their followers, motivating them to pursue this vision of change, even in the face of challenges and possible failure.(10)

Transformational leaders are charismatic, act as role models, challenge their followers to think and solve problems independently, and are able to find the unique motivational drivers of each follower.

Transactional Leadership. Whereas transformational leadership is particularly effective in non-routine environments where change, even radical change, can be particularly beneficial, transactional leadership is often more effective in routine environments.(8) Transactional leadership encompasses methods of leadership such as rewarding effective behaviors and managing potential errors as, or just before, they arise.

Taken together, LMX, transformational, and transactional leadership theories all provide nuanced insight and guidance into the leadership process across all contexts (see Table 1). Original leadership theories, however, still inform our understanding of these modern perspectives. There has been much empirical evidence linking inherent traits, specifically personality traits, to each of these types of leadership.(1,11)

Below, we outline the science of personality and the linkage between personality traits and leadership processes.

The Science Of Personality

Personality is a set of relatively stable individual traits that vary along continua and determine, to some extent, an individual’s preferences and tendencies, which ultimately manifest as behavior. Although behavior and expression of personality varies across situations (e.g., behavior in the operating room differs from behavior with the patient’s family which differs from behavior at home with one’s own family), a set of immutable traits, driven by an interaction between genetic factors and the environment, underlies the human experience.

The most consistently empirically supported representation of personality captures five primary dimensions known as the Big 5: extraversion, conscientiousness, agreeableness, neuroticism, and openness to experience. Each encompasses a multitude of more narrowly focused facet-level traits.(1)

General behavioral tendencies tend to be better predicted by the Big 5, while more specific behaviors (e.g., keeping a tidy desk) are more closely related to specific facet-level predictors (e.g., tidiness).(13) When considering a complex behavioral process like leadership, most research has examined correlations with the general-level Big 5, although there is certainly value in considering relationships with the facet-level traits, particularly when considering specific aspects of leadership.(14)

Before linking personality traits to leadership style, we will briefly outline the current conceptualization of each of the Big 5 personality traits (see Table 2). Personality traits are typically measured using self-report surveys such as NEO-PI, IPIP, Hogan, Adept 15, and Deeper Signals.

1. Extraversion: A general tendency to be outgoing, socially dominant, and people-oriented.

2. Conscientiousness: A tendency to be rule-oriented, organized, and motivated.

3. Agreeableness: Marked by warmth and a need for affiliation with other individuals and social harmony.

4. Neuroticism: Marked by emotional volatility, anxiety, withdrawal, and fear.

5. Openness to experience: Captures a sense of imagination, a preference for intellectual stimulation, and a tolerance for ambiguity.

Extraversion, conscientiousness, and to an extent agreeableness are associated with leadership efficacy. One more frequently discussed individual trait, which is a mélange of cognitive ability and personality, is emotional intelligence, which is the ability to recognize and manipulate one’s own emotions and the emotions of others.(15)

There is meta-analytic and primary empirical support for the association between a leader’s personality and the quality of the relationship between the leader and follower (LMX). Dulebohn and colleagues found meta-analytic support for a moderate relationship between LMX and leader extraversion and agreeableness.(11) This suggests that the more extraverted and agreeable individuals are, the more likely they are to have a high-quality relationship with their followers. Schyns and colleagues found that not only do extraverted leaders tend to have higher-quality relationships with individual followers, they can have these high-quality relationships with teams of many followers — a challenge for many individuals.(24)

Counterintuitively, however, leaders who are high in agreeableness actually have lower-quality relationships when considering all relationships within the team, not just one-on-one. And, although Bernerth and colleagues found support for a positive relationship between conscientiousness and the quality of relationships a leader has with followers,(25) Schyns and colleagues found the opposite.(26)

Given that the leadership process is inherently linked to the context of the team, it is possible that these differing relationships are indicative of differing roles of context.(26) Presently, there is little data linking openness to experience or neuroticism with LMX quality, suggesting that perhaps attention is best focused on extraversion, agreeableness, and conscientiousness.

Data also suggest that the less similar a leader’s personality is to the follower’s, the lower quality of relationship they will have.(27) Specifically, if a leader and follower have very different scores on traits like neuroticism, conscientiousness, or agreeableness, they will be less likely to have a relationship marked by high levels of trust and mutual respect.(27)

Meta-analytic evidence suggests personality traits and emotional intelligence have significant relationships with the different aspects of transformational leadership.(28) For example, neuroticism shows a moderate negative correlation with leader charisma (a key component of transformational leadership that encompasses the ability to motivate followers and be a role model), while extraversion, openness, and agreeableness all show positive correlations. The same pattern emerges when considering intellectual stimulation, the aspect of transformational leadership that captures a leader’s ability to challenge followers to problem-solve on their own.

Regarding individualized consideration (recognizing followers’ unique needs and drivers), neuroticism still shows a weak but significant relationship, while only extraversion and agreeableness show significant positive relationships.

In a primary study, Judge and Bono found that assertiveness and positive emotions (aspects of extraversion), feelings and values (aspects of openness), and straightforwardness (an aspect of agreeableness) were the facets most related to transformational leadership as a whole.(1) Evidence suggests that transactional leadership, on the other hand, has less-consistent relationships with personality. For example, contingent reward behavior — providing praise or tangible benefits for good performance — was only weakly positively correlated with extraversion and agreeableness, and negatively with neuroticism. Similarly, personality showed no significant link to a type of transactional leadership behavior akin to micromanaging (management by exception-active). Only neuroticism showed a significant correlation, albeit small, with a passive leadership style of transactional leadership.

Given the varied strength of the relationship between personality and leadership behaviors, one might ask how this is useful. In essence, personality traits tend to be distal predictors of behavior, interacting with the situation to drive observable actions. Measuring only the personality is powerful (e.g., being extraverted, agreeable, and emotionally stable is linked to being a better leader),(1) but still misses an aspect of the equation: the situation. By contextualizing personality within the unique demands and resources of one’s specific work environment, the utility of knowing one’s own personality may increase.

To develop better leaders, it is not enough that they measure their own personalities, but that they engage in some sort of reflection on those data, evaluating how their natural drives and tendencies tend to manifest as behavior or actions in their work environment.

Data-Driven Self-Reflection

Personality data have been used successfully in healthcare in a variety of ways, from improving mentorship relationships,(29) to potentially improving fit with residency types and programs.(30) A key factor in the effective use of personality data, however, is reflection on their meaning. This can come in the form of organizational psychologists or professionally trained subject-matter experts guiding physicians through their personality data in one-on-one or group sessions, or potentially through guided reports and self-reflection aids, similar to debriefing aids used for guided team reflection.

Many physicians do not have the luxury of engaging in services of this type, but they may have ready access to online assessment services and even guided self-reflection reports. By completing empirically validated measures of personality and then comparing one’s scores to norms within and beyond their occupational field, physicians can garner a better understanding of how they fit as leaders.

Given that personality traits are normally distributed, it is unlikely for all physician leaders to be extraordinarily high in extraversion, agreeableness, and emotional stability. Knowing where one falls on each of these dimensions, however, and being prompted to think about how this may manifest in different situations (e.g., under stress, in interpersonal interactions, while completing paperwork or making decisions), can help individual physician leaders better understand their default leadership styles and how to harness their personal strengths to best lead their subordinates or teammates.

By reflecting upon one’s own preferences and tendencies (e.g., the tendency for less-agreeable individuals to talk less in conversations), a physician leader can recognize how this may translate to the leadership process (e.g., lower levels of LMX or individualized consideration). The physician leader can then emphasize other personality-based strengths that still may result in similar behaviors, but by relying on a different pathway. For example, the leader may recognize that his or her natural tendency is to be quiet, but that this may be interpreted as disinterest and may actually be harming his or her efficacy as a leader, thus engaging in the behavior regardless of personality because of the motivation to succeed and provide the best care to patients.

Surgery Contextual Example

Reflection upon one’s personality data can influence LMX, transformational, and transactional leadership. Specifically, we consider two contexts that bring out different forms of leadership: during surgery and due to a clinic-wide change.

First, in considering the team dynamic present during a surgical procedure, we recognize a relatively fluid membership in which team members may be present during the entire procedure or portions of it, particularly with shift changes over the course of longer surgeries. There also is the presence of subteams such as anesthesia, nursing, and advanced practice professionals (PAs, NPs), and the presence of trainees, including medical students, residents, and fellows.

In our hypothetical example, all team leaders (surgeon, anesthesiologist, senior nurses) have taken online, empirically supported personality assessments and have been able to compare their scores to national and occupation-specific norms.

The leadership process in the operating room begins before the start of the procedure. The use of a preoperative “huddle” in which the details of the planned case are discussed with all members of the team is an important step not only in ensuring a smooth procedure but in providing leadership to the entire team. At this point, armed with the results from her personality assessment, a slightly introverted surgeon may recognize the reason for her discomfort leading a discussion but may be able to draw upon her emotional intelligence more intentionally to not let this discomfort affect her performance. She also may be unlikely to greet new perioperative professionals as they join the team mid-surgery (a form of relationship building critical to LMX), but recognizing this personality-based tendency, she may make an effort to intentionally draw upon her high levels of agreeableness to welcome her new team members.

It also is important for the surgeon to recognize that there are other leaders in the room who may engage in a variety of leadership behaviors throughout the surgery. The anesthesiologist, for example, plays an important role and may be responsible for other individuals assisting in this responsibility (nurse anesthetists, residents, fellows, and anesthesia technicians). A particularly agreeable anesthesiologist may recognize that his agreeableness makes him less likely to challenge the surgical team when they seemingly rush through the surgical checklist (a form of backup behavior critical to transformational leadership). However, being aware of this tendency, because of the results of the personality assessment, he works to empower the entire team to speak up, thus capitalizing upon his agreeableness rather than being hindered by it.

Perhaps a particularly neurotic surgeon tends to micromanage his team, especially in high-stress surgeries, berating the team when mistakes are made (a less effective and potentially abusive manifestation of transactional leadership). Having data from his personality assessment to highlight this tendency may help this surgeon recognize that he is being driven by his neuroticism, thereby allowing him to intentionally change his behavior to be more supportive of his team.

By being presented with data that highlights their default tendencies, these leaders can be aware of potential leadership pitfalls during an operation. By using validated measures of personality to better understand their own standing on extraversion, agreeableness, conscientiousness, neuroticism, openness to experience, and emotional intelligence, physician leaders can enhance their ability to build high-quality relationships with the other members of their team, working to not only motivate and inspire their team, but also manage goals and expectations during longer, stressful surgeries.

Departmental Change Example

Leadership occurs at many levels within an organization, and understanding how their personality impacts their leadership style may be particularly important for physician leaders in charge of entire departments, practices, or hospital domains.

Take, for example, a medical director of an urgent care clinic. This leadership role comes with many responsibilities, across a variety of smaller teams, that impact the entire practice. Particularly agreeable and neurotic individuals may find that they shy away from conflict, even in cases where conflict is necessary (e.g., individuals are not enforcing newly implemented policies); however, because of the results of an in-person developmental experience in which an expert explained the results of a validated personality assessment, the medical director may be more aware of this tendency, leading her to delegate this responsibility to others who are more comfortable with conflict or to practice conflict-management skills to ease her anxiety.

Further, if results from the personality assessment informed the medical director that she was more extraverted than average, this may empower her to capitalize upon her extraversion to lead the clinic through changes. Specifically, because she was presented with data about her extraversion, the medical director may choose to interact in a more face-to-face way with frontline caregivers (e.g., open-door policy, office hours) so as to facilitate social interactions that may engender buy-in for recently enacted change.

If the medical director is informed that she may be lower than average in emotional intelligence, she may make it a point to ask her colleagues if she is correctly interpreting their reactions to proposed ideas, so as to avoid confusion. This allows her to use data about her own personality, along with expert advice, to intentionally capitalize upon her high levels of conscientiousness to compensate for her low level of emotional intelligence.

Summary And Future Directions

Overall, use of empirically supported personality assessments as the basis for data-driven self-reflection can enhance leader performance across all levels of healthcare organizations. Our general preferences and tendencies can influence how we react to situations and those around us. By being aware of this, we can better manage our behaviors, helping to ensure we create high-quality relationships with our followers, inspiring high levels of performance, and creating psychologically safe spaces to speak up when errors have potential to occur.

Further research should look at combinations of personality traits and how they affect physician leadership behaviors, and how they interact with particular situational cues (e.g., membership change, medical errors, physician fatigue) to ultimately predict leadership behavior.

The link between personality, self-reflection, and physician leadership behaviors is intuitively and practically appealing; however, research still leaves many questions unanswered. First, we suggest that future research examine how self-reflection about one’s personality and leadership style affect leadership behaviors both in the moment and across longer periods of time. Most theory and interventions focus on more lasting changes and patterns of relationships, but we argue that these effects can unfold over multiple repeated episodes. Certainly, an intervention in which physicians complete personality assessments and are guided through their results can begin long-term change, but that change happens gradually with a series of choices across multiple episodes of engagement (e.g., during a period of conflict in a surgery, while discussing symptoms with a patient and nurse). By understanding how these relationships can be changed on a moment-to-moment basis, and how that change can result in more long-term change, we can better understand how to improve physician leadership.

We also suggest that researchers explore how physician leaders decide what behaviors fit different scenarios. Leading during a surgery should not look the same as leading during patient assessment, but not all physicians treat these as different contexts. Understanding how personality influences a physician’s decision/ability to tailor his or her behavior to the situation, and whether there are certain situations that are better suited for certain personality profiles, may help further both the science and practice of physician leadership.

We conclude with practical recommendations for healthcare leaders looking to put personality theory into practice in their organizations (see Table 3).

Acknowledgments:

The authors would like to acknowledge and thank Susan Frauenhofer for her invaluable help in formatting this manuscript.

Conflicts of Interest: None

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