The Skills All Leaders Need

After earning her master’s in management and entering medical school, Nichols noticed a disconnect between the leadership principles associated with business and those associated with physicians. She shares her thoughts about that leadership/physician leadership disconnect, three categories of leadership behavior, the skills physicians have and need, and her reason for writing a book about physician leadership.

Why did you write a book about physician leadership?

My short answer when people ask me this question is “because no one else did.” I usually get a curious look that seems to say, “Really? ANOTHER book on physician leadership?”

So let me explain. I’ve been teaching leadership to physicians in practice and in training for well over 20 years through lectures and workshops as well as mentoring and coaching. After such presentations, participants generally ask for resources to expand the points I’ve made.

I find a couple of really good texts very helpful, but they are each more than 500 pages long. No physician will access such a text, let alone have an idea of where to start.

Why do you think there is a disconnect between leadership and physician leadership?

I had earned my master’s degree in management with a specialty in healthcare administration before matriculating into medical school. In medical school, I wondered why we weren’t using the same leadership principles. Why weren’t we using the same leadership words?

Finally, I saw what was causing this issue. We physicians have been educated and trained and tested and credentialed, on and on, for at least 8 years, maybe 12 or 16. And we have been carefully taught to approach the patient in certain ways that work very well for good patient care.

I truly believe all physicians are leaders and are leading, whether they think of it that way or not. However, that effective patient care approach doesn’t translate exactly into an effective leadership approach.

How do you categorize physician leadership?

As I see it, the way a physician approaches a leadership situation falls into one of three main categories.

The first category includes those leadership skills and approaches that are best implemented in exactly the same way they are employed in patient care. The second category encompasses leadership principles that are employed exactly the opposite in leadership situations as they are in patient care. The third category is intriguing as it includes leadership skills and principles that are implemented exactly the same in patient care as they are in a purely leadership position. The difference is that we don’t do in leadership what we know very well that we must do in patient care!

For example:

Category One: Skills/principles employed the same in leadership as in patient care.

The best example is how we deal with perspective differences in leadership and in patient care. I had Navajo patients and I had patients who were newly arrived Polish immigrants. I was well aware that they would each have different perspectives.

Two other skills/approaches that should not require explanation and that apply in identical manners in patient care and in leadership: having an honorable character and functioning according to ethical principles.

Category Two: Skills/principles employed in leadership in exactly the opposite ways as they are in patient care.

In this case, examples are the complementary skills of negotiation and compromise. I don’t know any physician who agrees to negotiate or compromise on treatments and medications. We know what proven approaches and medications are best for our patients. Negotiation and compromise imply that we have not chosen appropriately and that we are willing to agree to less than acceptable care for our patient.

However, in the leadership arena, negotiating and compromise are the coin of the realm, as they say. Explaining firmly that we as physicians have investigated the specific leadership situation and have the right and only answer is not an effective approach.

Another skill that is quite different for the physician as compared to that for the leader is being familiar with one’s own approach to interactions. I was truly stumped by this discovery.

As a physician in private practice for 17 years, I was courteous and direct. I followed the SOAP protocol, managed the assessment, and devised the plan, carefully monitoring and adjusting as appropriate. My approach worked well.

When I became a full-time dean, I had 15 department chairs and two assistant/associate deans, none of whom I had even met before. So I embarked on a listening tour with each person to understand what they did and why. I had the luxury of taking my time to conduct these interviews over about a month’s time, as the school had just passed its accreditation site visit with minimal and insignificant requirements.

I embarked on a study of personality types and approaches in order to better understand what I was seeing. As a result, I came to learn the importance of “situational leadership,” different approaches for different sets of circumstances. Who knew?

Another surprise? My own personal approach didn’t always suit the situation well. There are several leadership style/typing systems AND it is wise to remember that the systems are descriptors, not predictors.

Several other skills are used differently when functioning as a physician vs. functioning in a purely leadership role. The next topic to look at is that of building relationships.

While the need to work through relationships may vary with the type of physician practice, the physician/medical enterprise puts a certain structure in place for providing medical care. Relationships are critical to a leadership situation.

One more skill that is much more critical to effective leadership than it is to effective physician leadership is persuasion. That said, one area in which physicians’ persuasion skills are getting a workout relates to persuading patients to get vaccines, primarily for COVID-19.

Generally, however, the physician provides medical care, and one of two things happens. Either the patient follows the physician’s guidance, or the patient simply goes elsewhere. If persuasion is necessary to encourage a patient to follow medical advice, the persuasive approach is based on the physician’s medical knowledge and answering the patient’s concerns.

Category 3. Skills that a physician and a leader find effective if approached in identical ways.

First, communicating. When doctors see new patients and learn about the chief complaint, the doctors ask questions! “What does this chief complaint mean to you?” And they clarify definitions of those words.

For example, a patient presents with the chief complaint of “fatigue.” No physician would ever say, “fatigue is always due to anemia, we’ll schedule you for a blood transfusion.” Instead, the physician asks if fatigue means the person feels weak, if the person drops items they used to be able to lift with ease, for example. What prompts the fatigue, what relieves the fatigue, on and on. Ask questions/clarify definitions.

But so often we don’t do that in leadership situations! Everyone knows what commonly used words mean, so we fall into the trap of assuming we know what is intended and what is implied.

Another great example of this third category of skills is decision-making. This is another well-practiced skill every physician masters. It starts by crafting a differential diagnosis and then the appropriate plan in the proper order of significance and likelihood.

As physicians, we start at point A and quickly proceed down the alphabet to conclusion H, considering and assessing each step appropriately. It may even appear to the casual observer that the physician is skipping from A to H without those intermediate steps, but that is only because those intermediate steps have been assessed so many times over, the assessment may occur almost instantaneously.

Now switch over to the leadership situation, again starting with A, heading to H. The problem is that while the physician has walked this medical path many times, that is simply not the case in leadership situations. Many physicians in leadership roles will actually jump from A to H, skipping those intermediate steps without even realizing it, then not understanding why their conclusion doesn’t suit the situation well.

Are there other leadership books you’ve found helpful?

I have fully enjoyed reading Peter Angood’s book, All Physicians Are Leaders. Well written, well explained, and he agrees with my perspective! I particularly appreciated the Bonus Special Report at the end of his book. These two books complement each other.

And there is one more perspective I would add to his excellent book. While learning finance, budgeting, and wage and salary administration are all important, they are the second rung of the ladder. Those skills build on the first rung of the ladder as outlined above, which includes communication, persuasion, and decision-making.

What do you hope to achieve with your new book?

My most fervent desire is for us to develop more physician leaders. Physicians understand better than anyone how the medical enterprise truly works and can bring that knowledge to leadership roles that will benefit our hospitals and systems. As they say, it’s not brain surgery. The problem is it’s not intuitive either. We physicians can learn how do lead!

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