Physician leadership

Tuesday, July 01, 2014 12:33 PM

Kate Alfano, CMS contributing writer

What it means as a discipline and a principle

Physicians are constantly challenged to stand up and lead their patients and communities to better health or through myriad health policy changes, but with increasing rates of practice consolidation many may not know where or how to start. A panel of experts spoke at the 2014 CMS Spring Conference in Vail, defining leadership as a discipline and principle and giving practical advice on how to make a difference no matter where you fall on the organizational chart.

First, the definition of leadership came from Kathy Kennedy, DrPH, MA, an associate clinical professor of preventive medicine and director of the Regional Institute for Health and Environmental Leadership, an advanced leadership training program: “Leadership is influencing others in the attainment of a common goal.” To get others to follow you to this mutual goal, leaders typically display five types of behavior, she said.

• Leaders are role models.
• They inspire others toward a shared vision that represents a better future.
• They challenge the status quo because they have a vision of how things could be better.
• They empower others to act.
• And they encourage people; leaders are a positive force.

The most obvious leaders have what’s called “positional authority.” They sit at the top of the organizational chart and their job titles have the word “chief” or “director” in them. Positional authority is given to a leader by agreement; people agree to an arrangement whereby the leader has certain rights and responsibilities: to hire and fire, make decisions on behalf of the organization, and to set and execute goals.

But reflecting on the five behaviors, she asserts that physicians do not need positional authority to lead. “In fact I think the whole reason we’re talking about this is because it’s important for physicians to think, believe and understand that they can lead without being chief of something.” Kennedy said she has often heard physicians express feelings of helplessness, that there’s nothing they as individuals can do to change things. “Nothing could be further from the truth,” she said.

Tamaan Osbourne-Roberts, MD, CMS president-elect, has struggled to think of himself as a leader but said that the nature of a physician – to serve others – reflects a genuine desire to make the world a better place. “When people see that, they want to follow us. People trust us because we all are – all of us, in some fashion – committed to service.”

The idea of followers leads directly into the concept of power, Kennedy said. While authority is influencing others as a verb, power is influencing others as a noun. “Power is the currency of influence. You earn power; people give it to you when they agree to be led by you. This is what followership is; it’s giving power to someone else. Power is a function of leadership, not a function of positional authority.”

Case study in leadership and affecting change

Jay Crosson, MD, the American Medical Association’s Group Vice President – Physician Satisfaction: Care Delivery and Payment, described his path to leadership over the course of his professional life. He and his wife, also a physician, took jobs at Kaiser Permanente in California 37 years ago with no family or friends in the area and a new sixmonth old baby. He said those first few years were tough balancing work and family, but they had jobs.

After those first difficult years he found that he genuinely liked the organization, felt that Kaiser’s culture and values agreed with his, and knew he and his wife would stay long-term. It was then that he started thinking about himself not as just a physician with a job but one with a career. “This transition from job to career created another set of values in me,” he said. “If there were problems in the institution, I knew I would try to fix them because now I have an investment.”

Later he experienced another transition from career to mission, what he calls the “fundamental element,” which came once he understood himself, who he was and what mattered to him. He knew he had skills he’d learned in his job that would benefit other physicians. “So all through the later part of my work there, that was the thing that drove me: Try to understand what was important, what had to change, what benefitted physicians but also patients, and follow that.”

It was this mission that gave him the confidence to retire from Kaiser and become an AMA vice president tackling a very ambiguous topic: physician satisfaction and how to make practice more fulfilling at a time of great change. “I accepted because I had gone from a person with a job to a person with a career to a person who was dragged into a sense of mission. And I think for many of us, particularly those who have gone through this transition, that then forms the platform from which you can lead.”

However, through all of his accomplishments, Crosson said the most important part of leadership is creating other leaders. “Some of the things I’m most proud of are not what I’ve done but the fact that as I’ve gone along I’ve been able to spot younger people who had some spark inside of them, and tried to influence and support them in their career, put them in positions of authority gradually where they could succeed, then experience the unique joy of watching an individual who has those capabilities flower and become a true leader in his or her own right,” he said. “There are few things in life that I think we can do that provide as exquisite a joy as that.”