Have you hit the physician leadership wall?

Physicians are by nature leaders, allowing them to excel in guiding care teams, committees or small group practices. They also tend to be lifelong learners, always absorbing information, building knowledge and improving their capacity as clinicians and leaders.

At some point in their leadership journeys, however, many physicians hit a wall. It may be as they move from managing a team of 10 to a team of 50 or when they're asked to lead an entire department or major initiative. For others, the wall appears closer to home, when a growing practice adds its first advanced practice provider, takes on a new payer contract or faces a staffing crisis that no clinical training prepared them to navigate. As leadership roles expand, what worked in the past doesn't work well enough anymore.

They find that merely accumulating knowledge — as they've always done — doesn't make them better leaders. And, whereas they once relied on a few core competencies such as instinct and decisiveness, they find the challenge of leading becoming more subtle and uncertain.

In larger, more complex settings:

• Decisions are made collectively rather than autonomously; consensus is required to move forward.
• Success becomes fuzzy and nuanced, as decisions and actions have myriad short- and long-range consequences.
• Clinical knowledge takes a back seat to other areas of expertise: organizational, business, operational, technological, regulatory and so forth.

Since no one person can master all areas of focus, physician leaders find themselves ill-prepared. They feel confused and stuck, facing a wall. How, then, to scale it and become an effective leader in large, complex settings?

Looking through lenses

These past few years, we've been working with physician leaders at all stages of career growth, as individuals and cohorts. We ask them to see their leadership challenges through four lenses:

Visionary. (Think of this as a telescope.) Leaders must navigate complex issues, think holistically and continue to innovate to position their organization for long-term success. This arena requires enterprise-level thinking beyond one's own department or domain, an appreciation for how decisions impact the whole and industry-level awareness of where healthcare is headed. They must communicate strategy and vision clearly to get others on board.

Operational. (Microscope.) Operations involve aligning structures, systems and processes to execute strategic priorities. Competencies required include systems thinking, data-driven decision-making and continuous improvement. As we noted earlier, physicians are always improving and they certainly understand the concept of a system. This lens, rather, explores ideas of operational excellence (including basic concepts of Lean Management).

Relational. (Stethoscope.) Leaders in larger capacities must effectively manage competing needs of multiple constituents. The ability to be engender trust and good-will is paramount. So is the ability to lead up, across and down.

We've heard executives dismiss the relational components of leading as “soft.” Yet research shows that teams built on strong relational foundations — psychological safety, shared purpose, and mutual respect — are more innovative, engaged and better equipped to handle pressure. In such environments outcomes improve. We see relational savviness as a force multiplier. As we've written before, "Relationships are not a soft overlay on strategy. They are the vehicle that allows it to move."

Self-Management. (Mirror.) We list this lens last and yet it is the most fundamental and critical. Rooted in empathy, self-management is the ability to truly know oneself. We have yet to meet a leader who has achieved sustained success without it.

Daniel Goleman defines self-awareness as the capacity to recognize our emotions and their effect on others, the foundation of emotional intelligence. Tasha Eurich cautions that empathy can erode over time and few of us are able to see ourselves as others see us. Fortunately, with intentionality empathy can be cultivated and self-management improved.

It's not about perfection

Taken together, the lenses allow physician leaders to see their growth beyond the accumulation of knowledge and skills. They provide a template for understanding oneself as a leader and enhancing success. All four lenses are critical, we believe. Yet utilizing them is not about mastery but shoring up areas of weakness and playing up strengths.

There are steps leaders can take to develop each lens, which we've written about at length. (See Developing Physician Leaders: A Leadership Lens Approach.) In the space of this article, allow us to provide recommendations for leadership development within the context of the four lenses and what works for the physician leaders we advise:

1. Dedicate time and space for growth. Part of self-management, of course, is finding time to reflect and learn from mistakes and success. As you seek to grow as a leader, set aside time within your incredibly busy schedule to focus on yourself. This can mean journaling, taking courses, engaging with a mentor or coach or any activity that allows you to step back and think about how and why you do what you do.
2. Be vulnerable and open to constructive criticism. Whether this criticism comes from yourself or a colleague, examine it and strive to grow with humility. Being a relational leader means truly listening to the input of others, embracing the need to grow, and even admitting flaws or missteps.
3. Don't do it alone. Our best experiences as advisors are with groups of physicians who learn from each other as well as bond and find comfort in realizing that every leader is a work in progress. Look for formal and informal opportunities to engage with leadership peers inside your organization and outside, physicians and non-physicians alike. Learning to use your own lenses involves seeing how others employ them.
4. Balance. Finding balance in a complex, often crazy healthcare environment is something you've been doing your whole career. Remember that, with every step up in leadership, more time should be dedicated to the task of leading. Whether you keep a clinical practice or not, maintain a sane, productive schedule as you advance in your career. This includes "me time" and downtime.

Ripple effects

The future of healthcare is inextricably tied to the success of physician executives. There are things about patient care and healthcare operations that only physicians (as well as nurses and other caregivers) can understand. They are vital to making healthcare more efficient, more effective, more affordable — better.

When physician leaders approach their roles with the desire to learn through differing lenses, the results and ripple effects are profound. Best of luck on your journey.

A renowned pediatric critical care physician, healthcare executive, child advocate, and disaster response and health policy advisor, Michael R. Anderson, M.D., M.B.A., F.A.A.P., F.C.C.M., F.A.A.R.C. has more than 30 years of experience across the medical landscape. As a Principal in WittKieffer’s Academic Medicine Practice, he supports the recruitment of presidents and CEOs, physician executives, deans, department chairs, and other senior-level positions. As Co-Executive Director of WittKieffer’s Physician Leadership Institute, he mentors senior physician leaders across the healthcare landscape. He can be reached at [email protected].

Raj Ramachandran, Ed.D. is a trusted talent advisor and experienced business leader focused on helping executives and their teams courageously navigate the complexities of their roles. As a Senior Partner for WittKieffer’s Leadership Advisory practice, he collaborates with colleagues on fostering executive development and success. As Co-Executive Director of the firm's Physician Leadership Institute, he supports the training and growth of clinical executives. He can be reached at [email protected].