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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Have You Checked Your Own CVP Lately?

Most physicians are familiar with the acronym CVP, which stands for Central Venous Pressure. As an emergency physician I can’t actually remember the last time I measured a patient’s CVP. Unless you’re dealing with seriously ill patients in the ICU, most other physicians aren’t measuring the CVP either.

In my physician coaching practice I try to measure a different kind of CVP. This CVP stands for Clarity, Vision and Purpose. A low CVP results from living with lack of clarity, limited vision and an unclear purpose in life, which leads to a life of struggle, being a “victim of circumstances” and lack of fulfillment.

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Rocks & Hard Places

Loyalty vs. Integrity

Earlier this week I was in Chicago for a meeting of well known health care organizations to address a nagging and persistent issue in health care: dealing effectively with patient safety and quality issues.  Like many meetings that involve important issues in health care, the first group of professionals singled out for criticism was physicians.  More specifically disruptive, hostile, arrogant, and intimidating physicians. 

A few brave souls mentioned that the problem is not confined to physicians - senior nurses can be far worse than physicians in treating other nurses.  Other health care professionals also exhibit these behaviors.  But there's no question that as physicians, we're often at the center of these issues, whether as the perpetrator, or in trying to deal with the organizational issues that arise from these unpleasant, uncomfortable, and dangerous situations. 

How would we deal with a Charlie Sheen on the medical staff?  Everyone in the organization, from the board on down to the front line professionals involved with patient care, should feel responsibility and accountability to improve the situation.

According to attendees at the meeting, every time this issue is brought up, the lines at the microphones become huge.  The emotion and frustration of those commenting and questioning is noticeable.  Though the issue may be getting attention, it's hard to see improvement across the industry.

The overt behaviors described above are only the tip of the iceberg.  Underneath the surface are behaviors that are passive and insidious.  If physicians and others behave this way toward colleagues, how do they treat patients?  It may be the more subtle actions and behaviors of professionals that ought to be addressed more forcefully.

How many times have you heard a hospital or health system CEO say something like, "I hope we can count on your loyalty here", or "Whose team are you on, anyway?", when discussing a quality or safety issue that involves the inevitable big admitter, or friend of the board chair?  If patients are being harmed, and the facts are unassailable, these behaviors from the leaders of the organization may be the worst possible kind of intimidation!  Never out of control, always stated calmly, and spoken with full knowledge of the power gradient of the speaker, leaders who choose to behave this way set examples for the entire organization.  These are not safe places for patients, and are not safe places to work.

Professionals who find themselves caught in organizational situations like this have a gigantic ethical issue to deal with - often with no one else there to support their struggle to do the right thing.  As physicians, I hope we can join their struggle, and insist that the organization do the right thing, and not try to sweep embarrasing or unpleasant events under the rug.

My oldest son is a commercial pilot. He taught me, along with Jeff Skiles (co-pilot on the Miracle on the Hudson flight), that we should seek to make our mistakes visible, rather than hide them.  We can't fix what we don't acknowledge to be a problem. We can't prevent events of harm from happening to someone else if we hide our failures. 

I saw a great quote about loyalty recently. 

"If your boss asks for your loyalty, give him/her integrity. If your boss asks for integrity, give him/her loyalty." 

As a leader, I will never ask for loyalty. Why? Because loyalty must be granted - willingly and without coercion by others in the organization. All too often, organizations ask for loyalty from employees, but do nothing to show loyalty in return.  

As professionals, I hope we ask those who work with us for integrity - not loyalty. 

Leadership Attributes In Industry

Physicians in industry must be leaders—not just experts in their field.

What does it mean for a physician to be a leader in industry?  What attributes are companies looking for in physicians who are seeking careers in industry?

Physicians looking for non-clinical careers may find a good fit in the medical device or pharmaceutical industries.  Some will have no difficulty in demonstrating technical mastery of the job.  After all, they are domain experts.  Unfortunately, physicians in industry are expected to be strong leaders—not just experts in their field of medicine.

The good news is that the attributes of a good leader can be learned.  Contrary to what some believe, these qualities are not passed down through the DNA of well-known business leaders.  Physicians can develop or strengthen their leadership skills—and apply these skills in new career opportunities.  But they will need to be deliberate and intentional about this—and go into industry with their eyes open.  Top companies will have high expectations for leadership—perhaps more so than for the technical aspects of a job.     

Some companies simply display their mission and vision statements—and almost never refer to them.  For others, theses statements are very much a part of their culture or “social architecture.”  They constantly talk about why they exist, what they want to achieve in the future, what they value most—and what they consider to be the key attributes of leaders in their organization.  In these companies, management and staff continuously evaluate themselves and each other against these standards.  Technical know-how is necessary—but not sufficient.  Physicians will need to be proficient in medicine—but also true leaders in a dynamic business setting.   

Different companies may use different terms to describe leadership—but the key attributes are essentially the same.  These core qualities are vital to most businesses and certainly apply to companies in the medical device and pharmaceutical industries.   

Charts the Course (sets the direction and plan)

• Translates the business strategy into challenging, actionable objectives and plans
• Conveys a sense of purpose and mission that motivates others
• Maintains direction, balancing big-picture concepts with day-to-day issues

Delivers Results

• Consistently achieves results in line with company values
• Establishes high performance standards, uses measurable goals to track progress, and   continually raises the bar on performance and expectations
• Focuses their organization on high-impact activities by clearly communicating expectations, accountabilities, and responsibilities
• Conducts periodic reality-based, results-focused operating reviews and drives quick corrective actions

 Develops Best Team

• Recruits and retains high-performing individuals and develops successors for key positions
• Builds diverse and empowered teams
• Provides honest and constructive feedback on an ongoing basis.

 Role Model

• Lives the company values and sets expectations for others to do so
• Displays self-awareness and seeks self-improvement
• Demonstrates technical mastery of the job
• Develops insightful strategies based on deep knowledge of external and internal operating environments
• Champions opportunities for change and innovation
• Has the courage and judgment to take appropriate risks

For further reading on this topic, check out the following resources: The Leadership Challenge by Kouzes and Posner, Leading Change by John Kotter, Execution: The discipline of Getting Things Done by Larry Bossidy and Ram Charan, and High Flyers: Developing the Next Generation of Leaders by Morgan McCall.

Why Does Leadership Appear?

Leaders emerge for three reasons.

Carl Larson, Professor Emeritus of Communications Studies at the University of Denver, has spent his professional life trying to understand leadership. organizational behavior and team performance. In his book "Teamwork", co-authored by Frank LaFasto, they describe the characteristics of efffective teams:

• A clear, elevating goal
• A results-driven structure
• Competent team members
• Unified commitment
• A collaborative climate
• Standards of excellence
• External support and recognition
• Principled leadership

Not surprisingly, it almost always comes down to leadership.

I recently had the opportunity to hear Prof. Larson talk about the origins of leadership. As he pointed out, most scholars look at the performance characteristics and personalities of leaders at a given point in time, usually during a crisis or at a time of great challenge, for example, Roosevelt and Churchill during the war, Guiliani during 9/11 or Jack Welsh during the haydays of GE. Prof Larson's approach, however, was to try to identify the sources of leadership and how it evolves. He concluded, after studying 30 highly successful leaders in the not-for-profit world, that there were three patterns that emerge at a very early age.

The first was a critical inciting event. One social entrepreneur witnessed the shooting death of both his parents and went on to create a foundation for orphans. Another saw homeless children in India while a pre-teen and created a charity to feed hungry children. A third was left fatherless as a result of a war and originated a organization supporting the children of veterans.

The second pattern was evidenced by those leader entrepreneurs who felt such passion and empathy for a cause, that they literally could not do anything else other than help. Think Tom's shoes.

Finally, some leaders had the good fortune to have models or examples of leadership at home, school or community and were able to replicate it.

Research on predictive entrepreneurial success factors indicates that the one best test is how young someone was when they created their first company. Likewise, Larson's research reminds us that leadership traits appear at a very young age.