Physician Leadership On Nonprofit Boards

Practical insights for physician board members and chief executives.

Physician leaders are often asked to serve on boards of nonprofit organizations.  Physicians in transition may also want to explore this—not only as an opportunity to apply their leadership skills outside of clinical practice—but also as way to give back to their communities.

I have found that a lot of ink has been devoted to the theories that drive nonprofit board leadership—but perhaps, too little about the nuts and bolts of ensuring effective boards.  While serving on a nonprofit board can be richly rewarding, it can also present a leadership challenge.  Depending on your past experience, you may want to take a closer look at the practical aspects of nonprofit governance, including formulating board structure and process, developing a strong partnership between board and staff, and structuring effective board and

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Physician Self-Leadership

The most challenging one to manage is you.

Self-leadership isn’t a concept most physicians think about very often.  Yet leadership capability relates as much to how we lead ourselves as how we lead others.  Some of the greatest barriers we face along the path to "making things happen" lie within us.

Most physician leaders can trace their greatest obstacles to something personal—a fear, insecurity, or self-imposed limitation.  As we consider past conflicts that really drained our energy—such as a partnership that didn’t work out or a team that fizzled under our watch—we must challenge ourselves to acknowledge our role in the failure.  Our flawed judgment is often the root cause.

As you lead others—in clinical practice or in a non-clinical role—you may very well be your greatest liability.  Self-leadership is about awareness, tolerance, and not letting your own natural tendencies limit your potential.

Find a Path to Self-Awareness

The forces of organization, community, and leadership capability often evade us because our tendencies—to generate more ideas, to isolate ourselves, and so on—get in the way.  Our best hope for staying on track is to notice when we drift off course and to figure out why—to be self-aware.  Self-awareness is a critical skill in leadership, but it is deeply personal.  It is not about our actions but about the emotions that trigger our actions.

With increased self-awareness, we become better students of ourselves.  When we make mistakes, we are able to identify what we could have done better more readily.  When we receive feedback from others, it becomes more actionable as we come to understand its correlation with our emotions.  The path to self-awareness never ends, but we must cross it nonetheless.

Learn From Your Mistakes and Failures

Most of us have a hard time with failure because we feel not only the professional loss but also the personal hurt when our ideas fail to gain traction.  But this tendency poses a problem for us as we commit ourselves to act without conviction.  Projects that encounter or end with failure have great value—but only if we can recognize it and reap the benefits.

When we experience failures, we must remain open to the lessons that can be learned.   Grasping the realizations that come with failure is a crucial part of the learning process.

When something goes wrong, there are three questions we should seek to answer: What external conditions may explain the failure, what internal factors may have compromised our judgment, and are there any “gems” in the unintended outcome?

Avoid the Trap of the Visionary’s Ego

During my time in the medical device and pharmaceutical industries, I had the opportunity to participate in a lot of meetings in the executive suite during both the expansion and bursting of the bubble that followed it.  I always found it interesting how every challenge was presented as an unusual one-off.  The business leaders would nod their heads in affirmation.  “This is an unusual time," someone else would say. 

Despite history, the tendency to think that a given opportunity or challenge is a one-off still persists.  Some call this tendency “visionary’s ego,” when a leader’s default thinking is that he or she is the exception to the rule.  As physicians, we may be susceptible to bouts of this form of narcissism.  While our tendency is to approach every situation with a fresh set of eyes, we should also accept a grounding realization: not much is entirely new—and yes, we can learn from the past.

Challenge yourself to have some perspective.  Don’t get caught up in the novelty of what you are doing that you lose touch with what’s been done before.  As you encounter negotiations in healthcare organizations, collaborations with partners, or unique decisions or investment opportunities in your business, ground yourself with the fact that the situation you face isn’t as isolated and unique as you might think.  Previous knowledge is yours for the taking, often risk-free and time-tested.  Today never feels like it will be history, but it will.  And more than likely than not, you will look back and realize that you should have known. 

Challenge Conventional Wisdom

As you harness the lessons from the past, you must also question them.  Of course, nobody should disregard good advice and fall victim to visionary’s narcissism.  But as physicians, we cannot become imprisoned by the status quo.  We need to reconcile our tendency to seek the advice of experts with out desire to do things differently—and perhaps better.  We should be wary that “best practices”—the tried and true ways of doing things—often become conventional wisdom—and conventional wisdom is often wrong.     

Consider Yourself an Entrepreneur

Whether you work for a large corporation or on your own, when it comes to leading ideas, ultimately you are an entrepreneur.  Entrepreneurs are not the ones with the best ideas, says Andrew Weinreich, a trailblazing entrepreneur, “They’re just the ones willing to jump off a cliff without the answers." 

Some feel the hardest part of pursuing a new venture is pulling the trigger—being mentally into it or not.  So, when you come across ideas worthy of your time and energy, it is important to know which assurances you need—and which you don’t—before you decide to take the plunge.  You will never have all the answers, but you need to feel that the risk of giving it a go is less than the risk of not trying.  You don’t need to see the finish line, but you do need enough momentum to stay afloat.  What matters most is your ability to keep moving your idea or venture forward, day by day.   

Be Willing to Change Your Mindset

Physician leaders who have done extraordinary things often talk about times when they made decisions that were unpopular—but necessary for their success.  Perhaps it was leaving clinical practice to pursue their passion—or quitting a well-paying job to start a company.  Maybe it was saying no to an opportunity that seemed golden to others.  Because of their decisions, their paths were unconventional.  But in the midst of discouragement from their families and friends, they persisted and gained confidence from being challenged. 

Just remember that the uncharted path is the only road to something new.  As pressures mount, you need to stay the course and consider the doubts of others as an indication of your progress.  

Keep an Eye on the Clock

In hindsight, it’s easy to talk about assuming a different mindset and defying the status quo.  But it is very difficult to take the leap.  Many of us postpone our dream pursuits for a whole host of reasons.  We’re waiting for the right time—but are not sure when that time will come.  We may have good reasons for not doing something, but we pay a price for postponing action.

Consider keeping an eye on what you’ve done with your time.  Think about the last time you sat through a dull meeting.  Recall how you tuned out the conversation but became aware of the time you had lost.  During that time, were you taking any risks to develop other opportunities or move a new venture forward? Were you marketing yourself for an opportunity to get closer to your true passion—or develop a new area of expertise?  Were you expanding your network and connecting with the opportunities around you? Depending on your point of view, this could be either a painful reminder of wasted time and lost opportunity—or a motivational reminder to use every minute to pursue your dreams in the next chapter of your life.  

Physician Leadership Of Teams, Part II

Read Part 1 of Physician Leadership Of Teams here.

Developing Your Team and Increasing Its Effectiveness

Leadership involves skills and abilities that are useful whether you are a physician in clinical practice or an executive in industry.  You could be developing a new medical device or managing a clinical trial for a pharmaceutical company.  Simply put, leadership is everyone’s business.  And the ability to build a team and improve its performance is becoming increasing important.     

Charles Elachi, director of NASA's Jet Propulsion Laboratory, put it best: “No matter how good you are, the thing that makes the difference between success and failure is how good a team you have.”  The team you build, develop, and contribute to will reflect—above all else—the behavior you model.  The symbolic aspect of your behavior, both as a team leader and as a team member, is often its most influential dimension.

In my experience, the best teams demonstrate a number of key attributes.  Here’s what I’ve learned about high-performing teams—and what we can do as leaders of teams:

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Making Choices As A Physician In Management

Physicians in management and leadership roles can use a strategic choice framework to improve the quality of their decisions.    

Problem solving and decision-making are important skills for all physicians, in business and in life. Problem-solving often involves decision-making, and decision-making is especially important for management and leadership. There are processes and techniques to improve decision-making and the quality of decisions. Decision-making may be more natural for some personalities, so these physicians should focus more on improving the quality of their decisions. Physicians that are less natural decision-makers are often able to make quality assessments, but then need to be more decisive in acting upon the assessments made. 

Too often, the process of making a decision is cumbersome and unfocused.  

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Physician Leadership of Teams

Using a team charter to make sure your team is on the right track.

You could be a physician in clinical practice—or work for a medical device or pharmaceutical company.  Chances are you will need to be able to lead a team to achieve a desired outcome. 

Working in teams can be terrific—if team members work well together.  However, if people are pulling in different directions, the experience can be dreadful.  Without sufficient direction, teams can focus on the wrong objectives, fail to use important resources, or be torn apart with avoidable infighting.  What's worse is that they can fail, sometimes with dire consequences for the organization.

Creating a team charter is one of the most powerful ways a team can make sure it’s on the right track—and everyone is committed to the work of the team. A team charter is a set of agreements that define the purpose of the team, what it wants to achieve, why it is important, and how the team will work together. As the team encounters obstacles or roadblocks, the charter can serve as a “roadmap” to keep the team on course—and focused on the end result. 

As a physician leader, you can take an important step in guiding your team in the right direction. By using the chartering process, you can help your team clarify its purpose and values, develop goals and strategies to accomplish the desired outcomes, and create a written agreement that captures the common understanding.

For teams to get off on the right foot, team charters should be drawn up when the team is formed. This helps to make sure that everyone is focused on the right things from the start. However, drawing up a team charter can also be useful if a team is in trouble and people need to regain their view of the big picture.

Here is a checklist I’ve used in business to develop a team charter that can help drive momentum and keep the team focused on results:

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How To Engage Intensively

A practical guide for physician leaders when things go wrong.

There are two types of physician leaders: those that have dealt with a potentially catastrophic issue—and those that haven’t yet.  I’m referring to those incidents that tend to excite the media or bring regulators to your doorstep.  It could be a failure of your quality system or a product recall.  Even worse, it could result in a serious injury or death of one or more of your patients or staff. 

You may be a practicing physician in a clinical role—or a physician seeking a non-clinical role in industry.  Whether you are managing a clinical practice or a commercial enterprise, chances are you will face such a serious challenge sometime in your leadership experience.  The question is how to engage intensively—and lead others through the investigation and problem solving. 

Here is a multi-step process developed for the military that has been adapted for use in industry.  This process can also be modified to fit the needs of a clinical practice.    

Gathering Information

• Use multiple communication channels and early warning systems, such as dashboards, operating reviews, and skip-level meetings to monitor important performance dimensions of your business or practice.
• Take initial reports for what they are…initial.  Acting prematurely before having reliable facts may force you to “put toothpaste back in the tube.”
• Beware the vividness of the moment.  Time settles your emotions.
• Don’t shoot the messenger

 When Deviations from Plan Occur

• Expect bad news to travel to you slowly
• Expect and get over denial ASAP
• Expect the reality to become distorted as it traverses layers of management (not necessarily a result of devious acts).
• Anticipate a “victim” mentality (i.e., it wasn’t my fault) and counter-productive finger-pointing (i.e., it was someone’s fault), which further distort the true underlying causes.

 Getting to the Root Causes

• Collectively, the people closest to the problem (e.g., nurses, technicians, clerical staff, and clinical monitors) know the problem.
• Establish a direct line to these people—and preferably, see them on their turf and in the process.  Do not alienate their management chain—they need to support you and learn the lessons with you.
• A “root cause” is not a restatement of the problem or one of its symptoms—but rather a critical assessment of the underlying cause.
• Strenuously separate fact from opinion.  Keep asking “Why?” until you are satisfied that you have gone deep enough.
• Once you have broken the situation into its component root causes, you need to assemble a “shared reality” before moving forward to “solve the problem.” 
• Problems often stem from a series of causes; avoid focusing only on the last event.

 Problem Solving

• Tie the thread together that links root causes (facts) to corrective actions, which lead to potential solutions (opinions and recommendations).
• Vigorous debate of potential solutions leads to the highest quality decisions—but maintain an appropriate sense of urgency.  Encourage and reward dissenting opinions.
• Develop a detailed plan of action with a clear timeline and accountability.  A good leader shares accountability for the situation, but gives all the credit to the team once success is achieved.
• Be mindful to separate short-term fixes from longer-term systematic solutions—which may require different people, processes and/or a full-scale change management program).

 Lessons Learned

• After the dust has settled, assign a smart non-participant in the situation to do an objective “Lessons Learned” report.
• Teach the relevant colleagues the “Lessons Learned” to avoid repeating the mistakes.
• Remember that anybody can lead in good times.  The best leaders are those who rise up and inspire in times of adversity and uncertainty.

Are You Resilient?

We like to think we are ... but how well do you really "bounce back" from life's stressful events?

I recently heard a wonderful interview with a woman who is 109 years old, and who continues to live independently, "with all her marbles and profoundly engaged with the world around her", as the interviewer noted.

A gerontologist, the interviewer noted that while the woman most likely has a gene that contributes to her unusual longevity, she also exhibits a powerful trait that professionals in his field call "adaptive competence".  In other words, from his experience with thousands of patients, his opinion is that the key to living to a long and healthy old age is the ability to keep moving forward after life's inevitable setbacks.  It's about being resilient.

It made me start thinking about the physicians I work with in a coaching capacity.  Many of them, I've noticed, are somewhat low on the resilience scale.  Why?  Maybe you can help me understand it.

Is it a function of highly intelligent people,  linear thinkers, who spend too much time thinking about the "what could happens", and the "likely probabilities"...?.  Is resilience, or "hardiness" as talked about in the psychological literature, something that's beaten out of you in medical school and residency, with a myriad of difficult experiences feeding off of each other in some kind of a closed loop?  Are physicians highly trained, with deep but narrow skills that tend to create a feeling of insecurity around their "other" abilities, and a sensitivity to rejection, hardship, or perceived failure?  What keeps docs from having an easy time "bouncing back"?  And what, if any, are the bigger ramifications of this, either for them personally, for their practice of medicine, or for their professional fulfillment?

What we do know is that resilience is one of those psychological traits that really matters both personally and professionally ... it affects how much stress you feel, how well you keep perspective on difficulties, how able you are to maintain healthy coping skills.  People low on the resilience scale tend to dwell on things, feel victimized, get overwhelmed and turn to unhealthy coping mechanisms such as avoidance of issues and escapism (such as substance abuse).  Conversely, people high on the resilience scale have higher levels of trust, tolerance for ambiguity, optimism and adaptability - all things associated with strong leadership and higher degrees of personal and professional success.

The APA (American Psychological Association) specifies a combination of factors that contribute to a person's resilience.  They include:

• The capacity to make realistic plans and take steps to carry them out
• A positive view of yourself and confidence in your strengths and abilities
• Skills in communication and problem-solving
• The capacity to manage strong feelings and impulses

How do you rate yourself?  How well do you:

• View problems as opportunities?
• Learn from your mistakes (and accept that you make them)?
• Seek out new and challenging experiences?
• Have a sense of humor and realistic optimism under stress?
• Succeed despite hardships?

In today's practice environment, the need for resilience is stronger than ever.  In order to thrive in an atmosphere of uncertainty, increased performance demands, rapid change, and a growing feeling of loss of control, many physicians are forced to either "bounce" or flounder.

The good news is that even if you are one of those docs that tends towards the low end of the resilience scale, you can develop these skills ... even if they aren't second nature to you.  Here are 10 tips for building your resilience (thanks to the APA):

• Make connections. Good relationships with close family members, friends, or others are important. Accepting help and support from those who care about you and will listen to you strengthens resilience. 
• Avoid seeing crises as insurmountable problems. You can't change the fact that highly stressful events happen, but you can change how you interpret and respond to these events. Try looking beyond the present to how future circumstances may be a little better. Note any subtle ways in which you might already feel somewhat better as you deal with difficult situations.
• Accept that change is a part of living. Certain goals may no longer be attainable as a result of adverse situations. Accepting circumstances that cannot be changed can help you focus on circumstances that you can alter.
• Move toward your goals. Develop some realistic goals. Do something regularly -- even if it seems like a small accomplishment -- that enables you to move toward your goals. Instead of focusing on tasks that seem unachievable, ask yourself, "What's one thing I know I can accomplish today that helps me move in the direction I want to go?"
• Take decisive actions. Act on adverse situations as much as you can. Take decisive actions, rather than detaching completely from problems and stresses and wishing they would just go away.
• Look for opportunities for self-discovery. People often learn something about themselves and may find that they have grown in some respect as a result of their struggle with loss. Many people who have experienced tragedies and hardship have reported better relationships, greater sense of strength even while feeling vulnerable, increased sense of self-worth, a more developed spirituality, and heightened appreciation for life.
• Nurture a positive view of yourself. Developing confidence in your ability to solve problems and trusting your instincts helps build resilience.
• Keep things in perspective. Even when facing very painful events, try to consider the stressful situation in a broader context and keep a long-term perspective. Avoid blowing the event out of proportion.
• Maintain a hopeful outlook. An optimistic outlook enables you to expect that good things will happen in your life. Try visualizing what you want, rather than worrying about what you fear.
• Take care of yourself. Pay attention to your own needs and feelings. Engage in activities that you enjoy and find relaxing. Exercise regularly. Taking care of yourself helps to keep your mind and body primed to deal with situations that require resilience.

I encourage all of you to think about how your degree of resilience may be affecting your ability to attain personal or professional fulfillment or make positive changes in your life.  When there isn't much you can control, this is the one thing you do have a say in.  If that horse knocks you off, are you likely get right back in the saddle?  Or do you wait a while, nursing your wounds ... or not get back on at all?  It's worth exploring, for your sake and for those who you come into contact with every day.

Especially if you want to live to be 109.