Understanding Power Dynamics in the Executive Suite

The physician leader assumes two roles: as an administrator in the executive suite and as the chief advocate for the physician workforce. These two roles often conflict. How physician leaders handle these conflicts can determine their longevity as leaders.

Although data on physician leader longevity are sparse, some suggest that the average tenure of a physician leader (chief medical officer — CMO) is approximately three years, which is not an encouraging statistic.(1)

One key to success is the physician leader’s ability to manage the power dynamics in the executive suite — the interactions among the senior leaders. These interactions can be framed as personal relationships (both good and bad) and competition for ideas and influence, political power, and leadership. The nonphysician leaders in the executive office are generally more experienced at playing the high-stakes political game and can be friends and advocates for physician leaders or bitter foes.

In most circumstances, the physician leader reports directly to the CEO of the organization; therefore, fulfilling the CEO’s agenda is essential to the physician leader’s influence and longevity. The means by which the physician leader interacts with the CEO is critical in that regard. This interaction requires an understanding of how the CEO thinks and responds to issues.

Some CEOs are Level 5 leaders(2): strong-willed individuals who want to build enduring greatness in their organizations. They are generally incredibly ambitious, but they channel their strong egos through humility. They are modest and fearless.(2) Level 5 leaders are talented at building and sustaining their leadership team.

On the other hand, some CEOs display a narcissistic personality and use fear as their primary tool to control the individuals in the executive suite, which is destructive to the organization in the long run. They run the organization using command-and-control methods and passive-aggressive behavior, which creates a negative cycle of behavior in the organization.(3) Under these circumstances, it may be difficult for the physician leader to function in a meaningful way in the executive suite.

Physician leaders must balance the needs and requirements of the administration, the board of directors, and other key stakeholders with the needs and desires of the medical staff. They must be able to align the agendas of both groups.(4) This can be as challenging as dealing with the power dynamics in the executive suite because physician organizations can be just as political.

The ability to meet the diverse needs of their constituents generally does not come easily for most physician leaders — it is a skill that must be developed. This political skill allows the physician leader to maximize and leverage relationships.(5) Maintaining relationships and communicating effectively can keep physician leaders on good terms with their physician colleagues. The ability to motivate and influence others is important in achieving organizational and individual goals.

Navigating the Executive Suite

Physician leaders should consider four practices as they navigate the power dynamics of the executive suite(5):

1. Develop social awareness. Social awareness is a function of emotional intelligence and allows individuals to understand, appreciate, and appropriately act on the behaviors and motives of others.

   Emotional intelligence is a key characteristic of successful leaders because it allows them to connect with others not just by words and deeds, but by empathy and self-awareness.(6) In general, most individuals respond positively when their emotional side is addressed. Individuals who have high social awareness tend to be keen observers of their social surroundings and understand how their own behaviors play out in specific circumstances.(7)

   Most physicians have been trained to think in terms of actions and outcomes, which may hinder their ability to access their emotional intelligence. What might make the executive suite environment even more difficult for some physician leaders is that the perceptions and responses of the nonphysician senior leaders typically is not black and white.

2. Develop interpersonal influence.(5) The ability to influence others is a key leadership trait. Successful leaders generally have a charismatic interpersonal style that others want to follow. A successful physician leader is engaged on an interpersonal level with everyone on the senior executive team.

3. Network.(5) Networking allows physician leaders to build the necessary relationships not only within the senior leadership team, but also outside the organization. Through networking they can develop diversity of thought and gather potential resources to power the business. Networking is the platform for innovation and growth.

4. Be sincere.(5) Sincerity in the workplace means being open, honest, and authentic. This leadership trait leads to trust and engagement. Level 5 leaders combine this persona of trust with humility to inspire others to achieve greatness.(2)

   Physician leaders should understand their own personality type. Many physicians are introverts, which places them at a disadvantage in the political arena. They must work hard to influence others and tend to be less adept at networking. Extraverts, on the other hand, have strong interpersonal influence when working with others and network effectively, which gives them the advantage in a team-based environment.(7)

   Another issue physician leaders should consider is the concept of being action-oriented. Proactive people are able to influence their environment by taking advantage of opportunities as they arise.(7) The action-oriented, proactive approach shows others within the executive suite initiative and innovative thinking. However, physician leaders should be wary of not getting ahead of or embarrassing the CEO. Keeping the CEO informed about actions and plans is critical for success.

Playing the Game

Acquiring the tools to be effective in the executive suite aside, the ability to play politics is the framing skill for every physician leader. If they cannot develop the ability to play the game of politics, none of the other important tools will be helpful.

By definition, political skill has been characterized as a “comprehensive pattern of social competencies, with cognitive, affective, and behavioral manifestations that have both direct effects on outcomes and moderating effects on predictor-outcome relationships.”(7) A more easily understood way to look at political skill is how people use their social astuteness and experience, their position in the organization, their ability to understand others, and their ability to influence others to create specific outcomes.(7)

Framing the power dynamics in the executive suite is all about developing political influence. Failure to execute a great idea or at least have the idea vetted by the senior leadership team often comes down the physician leader’s lack of a political skill set to influence others. Clearly, it is imperative that physician leaders, and particularly new physician leaders, acquire the political skills necessary to function within the power dynamics of the executive suite.

There are five specific political skills that a physician leader needs to acquire.(7)

1. Perceptiveness. This is the ability to monitor one’s own behavior. A key attribute of perceptiveness is the ability of an individual to maintain an outward focus rather than an inward focus. The transition from a medical practice to a senior leadership team can create social interaction problems for physician leaders who do not understand that they are now a member of a team and therefore need to interact as a team member.

2. Self-confidence. Someone who is self-confident demonstrates calm in the face of potential difficulty. This specific skill set provides some control over the physical leader’s environment. Individuals who appear to be self-confident attract others who want to be on the winning side.

3. Affability. Affability means being likable with a pleasant disposition and a positive attitude. These characteristics are inherent in extroverts and less so in introverts. This is why it is so important for new physician leaders to undergo a personality inventory evaluation in order to understand how they function.

4. A strong action-oriented focus. Most CEOs want their leadership team to be proactive and take action. Proactive personality types tend to identify opportunities and act on them. In other words, they demonstrate initiative and are goal oriented.

5. The ability to learn from experience. Early on, physician leaders should acquire a mentor or mentors to help guide them — preferably an experienced executive leadership coach with whom the physician can meet regularly. Meeting in a secure environment on a regular basis will go a long way toward helping the physician develop into an effective leader.

Leadership coaches can help physicians develop their personal goals, provide insights into the personality profile, establish a self-evaluation system, and help guide the physician through the daily land mines. In addition, the physician leader should observe other professionals and attempt to role-model positive behavior. This should be an ongoing activity during the workday.

In addition to the above political skill sets, new physician leaders should consider how they are viewed by others in terms of dress and body language. When they enter the executive suite, they must remember it is a business environment, not a medical office. They should dress appropriately, role model their behavior to match the other senior leaders, and always be on time for meetings and other group activities. They should be careful how they use electronic media and what they say and how they say it in their emails — including double-checking their spelling and grammar before hitting the send button.

A personal anecdote: At a senior leader meeting of a large health system a number of years ago, the CEO projected onto the screen an email that his CMO had just sent him. The email was laced with poor grammar and misspellings. It was an embarrassing moment for the CMO. Never let yourself fall into such a situation.

References

1. Day GS, Malcolm R. The CMO and the Future of Marketing. Marketing Management 22(Spring):34-43, 2012.

2. Collins J. Good to Great. New York, NY: HarperCollins. 2001.

3. Tichy NM, Cardwell N. The Cycle of Leadership: How Great Leaders Teach Their Companies to Win. New York, NY: HarperCollins. 2004.

4. Mellman D. The Reality of the Hospital: Physician Leaders in Harm’s Way. 2007. The Physician Exec. 2007; 33(3):22-3.

5. Braddy P, Campbell M. Using Political Skill to Maximize and Leverage Work Relationships. Greensboro, NC: Center for Creative Leadership. 2014.

6. Goleman D, Boyatzis R, McKee A. Primal Leadership: Realizing the Power of Emotional Intelligence. Boston: Harvard Business School Press. 2002.

7. Ferris GR. Treadway DC, Perrewe PL, Brouer RL, Douglas C, Lux S. Political skill in organizations. Journal of Management 2007; 33(3):290-320.