Leadership for Physicians

Physicians are expected to be leaders in healthcare. However, many medical schools still lack formal medical education in leadership. Over the years, I have taught basic leadership skills to medical students and residents. Below is a summary for those interested in a refresher or wanting to advance their leadership skills. The need for more physicians to be formal leaders is exemplified by research suggesting a positive link between hospital quality and physician leadership.

One definition of leadership is about making things happen that weren't there before. It involves modifying the attitudes and behaviors of others to achieve shared goals. A leader can be identified by whether people are following them.

Some people confuse leadership with power. Power by itself doesn’t cause leadership, but it does influence one’s ability to lead. According to French and Raven, there are six bases of power: coercive (threat), reward (financial/social), legitimate (appointed/elected), referent (respected), expert (physician), and informational. Each of these bases of power can be used in different ways to advance one’s ability to lead, regardless of the motivation to lead.

Effective leadership is heavily dependent on the relevant skills of a leader. Essential leadership skills include flexibility, self-awareness, managing expectations, leadership presence, resourcefulness, engaging others, managing emotions, decisiveness, and integrity:

• Self-awareness is understanding how others perceive you and the environment. It can be developed through tools like 360 evaluations and feedback.
• Integrity means doing what you say you will do. It involves managing expectations, educating others on values, and practicing honesty and transparency.
• Engaging others means involving them in decision-making, communicating frequently, fostering teamwork, and using personal influence.
• Open-mindedness/flexibility is the ability to consider other ideas. It can be practiced by arguing for opposing views, avoiding ownership of initial ideas, and looking for unintended consequences.
• Leadership presence involves having desirable leadership qualities. This can be achieved through self-confidence, professional dress, rehearsed performances, good body language, and using the word "because."
• Resourcefulness means doing more with less. It involves good time management, fostering contacts, asking for favors, and researching needs closely.
• Effective communication is about transferring information clearly. It can be achieved through closed-loop communication, using multiple channels, and making "rounds" to connect with others.

There are various models for leading change with the Kotter model being one that is widely quoted and employed. Kotter's eight-step process for leading change includes: creating urgency, building a guiding coalition, forming a vision, enlisting volunteers, enabling action, generating short-term wins, sustaining acceleration, and instituting change.

Leadership styles include autocratic, bureaucratic, charismatic, democratic, laissez-faire, servant, situational, transactional, and transformational:

• Autocratic leaders hold all authority and make quick decisions but offer little flexibility.
• Bureaucratic leaders follow fixed duties and a hierarchy, providing clear authority but lacking innovation.
• Charismatic leaders inspire followers and create drastic change but may not be sustainable.
• Democratic leaders involve subordinates in decision-making, which is preferred by most but requires extensive communication.
• Laissez-faire leaders give all authority to followers, offering minimal interference but being the least satisfying and effective.
• Servant leaders focus on serving others' needs, allowing subordinates to grow but requiring significant effort from the leader.
• Situational leaders adjust their style to followers' development levels, making it easy for followers to understand but difficult for leaders to adapt.
• Transactional leaders use rewards and punishments to achieve goals, which is effective in crises but susceptible to the status quo bias.
• Transformational leaders inspire followers with a shared purpose, modeling integrity but finding it difficult to inspire everyone with a shared vision.

In conclusion, leadership is about inspiring and guiding others to achieve common goals. It involves various skills, power bases, and styles, each with its own advantages and disadvantages. Effective leaders adapt their approach to the situation and prioritize the needs of their followers.