Improved physician leadership: A key to better health care

People feel the high price of health care, but a less-discussed topic with wide ramifications is the cost associated with the lack of physician leadership education and training for all doctors. Because every physician, every day, is influencing behavior to achieve a desired result – i.e. leading.

But formal education for physicians does not emphasize leadership. Schools may offer leadership-related courses, but because these are not presented in a cohesive, strongly emphasized fashion, the content is often perceived as “soft skills” — not as important for the time-starved medical student to learn as anatomy or microbiology. As a result, many physicians develop a habit, early on, of downplaying the importance of skills that can make a difference.

Because medical schools, hospitals, and other health care facilities don’t view leadership as a core competency for physicians and don’t train to that competency, costs are felt throughout the health care system:

• Disruptive physician behavior — This is a problem that has long been noted by those who work with physicians. While we have made strides in interventions when the behaviors become extreme, we can do better by teaching medical students and residents better how to avoid the extremes in the first place. Physicians are often in a hurry and under stress. A terse, sharp manner may be used to impress urgency upon others. But if the goal is to achieve desired results sustainably — that is, efficient teamwork and good patient outcomes over time — there are better ways to go about this than snapping at people. These are lessons taught in every leadership course, but are lacking in formal medical education programs at every level.
• Low-performance, high-stress teams — Poor team performance can be a direct result of a physician’s behavior. Disruptiveness isn’t the only way physicians engender poor performance in teams; they sometimes fail to provide active, skilled leadership. When constant high demands are made on team members without a commensurate level of support, caring, communication, mission awareness, and appreciation of their work, stress results. Stress in the workplace leads to disengagement, poor performance, mental health issues, and increased staff turnover.
• Poor patient outcomes — This is the ultimate symptomof the lack of early emphasis in physician leadership training. The main reason I argue that physician leadership needs to be treated as a core competency is to improve patient outcomes. When staff members are highly stressed or disengaged, they are more prone to error. Errors in a medical environment can lead directly to worse patient outcomes. Disengaged team members create poor patient experience, which erodes patient trust. Disengaged employees, by definition, engage less with their job tasks, which, in a medical setting, means patient care. Patients look to health care staff to provide communication, encouragement, compassion, attention, care, competence, and confidence in the chosen treatment modalities. When those elements are lacking, patients suffer.

The benefits of better physician leadership

Improving all physicians’ leadership skills benefits team members and patients.When everyone involved in medicine, particularly physicians themselves, comes to embrace this idea, the entire health care system will reap the benefits — nurses, technicians, administrators, finance departments, HR professionals, and doctors themselves. But the chief beneficiary will be patients.

Physicians’ north star tells us to exert effort that we believe will improve health outcomes for our patients.We spend exorbitant energy improving our cognitive and technical skills, but very little on our leadership skills. What I’m asking, at the individual and organizational level, is to put in effort to learn skills you may not have been taught in medical school or elsewhere.

Why should you invest the time and effort when your plate is already full? Why should you tackle this “leadership stuff” when you could be using the time to read medical journals and polish your technical skills?

The simple answer: better health outcomes for patients. When your leadership skills improve in the clinic or the operating room, you begin improving your patients’ health care experience and health outcomes. The better you lead, the better for everyone.

The process works something like this:

1. The physician has a “moment of truth” and realizes, I am a leader.

Right now. Leadership is an integral part of my job.

2. The physician begins consciously developing leadership as a

core competency.

3. The performance of the physician’s health-care teams improves —

both immediately and in a gradual, sustainable way.

4. Patients are more comfortable and confident in the recommendations of the doctor and the practice, and more likely to make changes in behaviors.

5. Improved patient experience and ultimately health outcomes for patients — in the short term and the long term.

Good leadership motivates everyone and brings out everyone’s best. When you know your work is valued, you strive to bring your A-game every day. When you know you are heard and respected, you want to participate more in decision-making. When you feel cared for by leadership, you want to care for your teammates and your leader in return.

You cherish the camaraderie and the sense of mission you share, and you are willing to “take a bullet” for your teammates. Almost literally. Many of us saw this, day in and day out, during the height of COVID. Our team members were coming to work every day in what was in ways similar to a war zone, putting their own lives at risk for our patients and one another. Outside of combat or first-responder actions, one seldom sees such unity and dedication.

Teaching leadership as a core competency

I’m convinced that if physicians-in-training understood the key role leadership played in their careers, they would embrace it wholeheartedly. But that is not the culture into which we are currently recruited, educated, and trained. We think of a “physician leader” as a medical director, chief, chair, or dean – not every physician every day. As a result, physicians often learn leadership only by chance, observation, and self-study. When we graduate from medical school, we are exposed to further gaps in leadership development. Much of physicians’ training and modeling is provided by senior residents who may be getting their first taste of leadership but who did not receive much leadership training themselves.

But there are ways to fill this critical gap.

Six core competencies have been identified by the Accreditation Council on Graduate Medical Education:

1. Interpersonal and Communication Skills

2. Professionalism

3. Systems-Based Practice

4. Practice-Based Learning and Improvement

5. Medical Knowledge

6. Patient Care

All six competencies fit nicely within a mental model of leadership. And so, the ACGME is already saying, in a roundabout way, that leadership is the most essential aspect of being a physician. But still, these traits haven’t been tied together under the construct of leadership.

I am suggesting that leadership itself is a core competency. By viewing leadership as central to good medical practice, physicians-in-training can more clearly see the reasons why they must learn all these seemingly disparate skills. And educational programs can fill in the gaps in their training, providing more complete, more longitudinal training in leadership.

Medical schools can lead the way in establishing the conviction in young physicians that they are leaders and igniting the desire to be trained as such. Once medical schools are doing this, residency training programs and physician employers can build from there.A health care system has the ability to offer comprehensive long-term training because it “owns” its physicians’ time while they’re affiliated with the system. So, there are opportunities to give doctors protected time for study and devise a curriculum that will hold their attention for a year — or three years, or five years.

The bottom line: We should be teaching leadership as a core competency for all physicians. It should be presented as foundational, much in the same way we teach physiology, pharmacology and how to tie a surgical knot. A physician who is a more effective leader is a more effective doctor.

Dr. Leon Moores, author of “All Physicians Lead: Redefining Physician Leadership for Better Patient Outcomes,” is a West Point graduate who was commissioned an infantry officer in the 82nd Airborne Division. Moores earned his MD from the Uniformed Services University (USU) School of Medicine and his Doctor of Science in health care leadership from the University of Alabama, Birmingham. He has served as chief of surgery at Walter Reed Army Medical Center, deputy commander (SVP) in National Naval Medical Center Bethesda, commander (CEO) in Fort Meade Medical System, and CEO of Pediatric Specialists of Virginia.