Leadership Lessons for Health Care Providers

Leadership Lessons for Health Care Providers

Frank J. Lexa, MD, MBA

Chair, American College of Radiology Commission on Leadership and Practice Development and Chief Medical Officer, the Radiology Leadership Institute of the ACR & Project Faculty, Spain and East Asia Regional Manager, the Global Consulting Practicum and Professor (adj.) of Marketing, The Wharton School, University of Pennsylvania Philadelphia, PA, United States

Table of Contents

Cover

Title page

Copyright

Dedication

Acknowledgments

Introduction

Chapter 1: Leadership and its Challenges

Abstract

Leadership in time

Challenges to healthcare leadership and leaders

Changing healthcare

Healthcare costs and change

How to get started

Chapter 2: Profiles in Leadership: What Does it Mean to Be a Great Leader

Abstract

Does Leadership Matter to Healthcare Professionals?

Who Should Lead in Healthcare?

Chapter 3: Deciding to Lead: When and Why to Begin to Take on Leadership Roles

Abstract

Introduction

Making and standing by tough decisions: A business case study

Chapter 4: Your First 100 Days: Facing the Challenge of Becoming a New Leader

Abstract

Introduction

Your first 100 days: hit the ground running hard… very hard

Chapter 5: The Unexpected Leader: Challenges of Having Leadership Thrust Upon You

Abstract

Introduction

Preparation

Prevention by paying attention

Parachuting in

Chapter 6: Leading From Below

Abstract

Chapter 7: Qualities of Great Leadership

Abstract

Introduction

An expert’s view on leadership

Chapter 8: Delegation: Getting It Right to Lead Successfully

Abstract

Introduction

Drivers that force delegation in organizations

Effective delegation

Executive delegation, the extremes: Carter and Reagan

Getting delegation right: the rules

Chapter 9: Making the Grade: Levels of Leadership

Abstract

Introduction

The impact of leadership: the effect of scalability

Levels of leadership—what they mean: Collins’ classification

Bringing back grades: how do you implement this?

Chapter 10: Educating Leaders: A Foundation Curriculum for HealthCare Professionals

Abstract

Introduction

Level I: goals

Curriculum issues

Chapter 11: Learning to Lead: Best Practices for Getting Started

Abstract

Introduction

How to learn with a formal curriculum

Seminars, durable lectures, and other materials

Mentorship

Building a network

Chapter 12: Leadership—Organizational Styles and Types

Abstract

Introduction

Authoritarian organizations: the good, the bad, and the ugly

Democracy and its detractors

Executive structures: republican government

Chapter 13: Strategic Leadership: Setting Priorities

Abstract

Introduction

Setting the big strategic goals

Getting better at planning

So I know what to do as a leader, why can’t I get it done?

Leadership and other open-ended knowledge work

Chapter 14: Time to Lead

Abstract

Introduction

Time off the calendar

Time each day

Time for leadership learning

Time to interact with other leaders: networking

Chapter 15: Leading Change in an Organization

Abstract

Introduction

Dynamics in understanding change

Programs for implementing important changes

Some practical issues in change efforts

Interlude: making the plunge—how to be a leader in four easy steps

Chapter 16: Leadership in Conflict

Abstract

Introduction

Separate emotions from people and situations

Work from principles

Starting trouble is usually a symptom of weakness

Chapter 17: Leading in a Crisis

Abstract

Introduction

Prevention trumps reaction

Crisis management: phases

Chapter 18: Tough Choices: How Leaders Make the Hard Decisions

Abstract

Introduction

What are the hard decisions?

Dealing with difficult decisions

Chapter 19: Leadership and Mistakes

Abstract

Introduction

Illusions of perfectionism

The looking glass

Chapter 20: Thinking About Failures in Leadership

Abstract

Introduction

Judging failures

Handling failure and its risks

True failure and its consequences

A final thought

Chapter 21: Becoming a Level 5 Leader

Abstract

Introduction

Evaluating a leader: Collin’s levels of leadership

Application

Closing

Chapter 22: Choosing Greatness in Leadership

Abstract

Introduction

Three key differentiating points

Chapter 23: Winning in a Crisis

Abstract

Introduction

Handling a crisis: key points for ethical leaders

Chapter 24: Leading in Serious Conflicts

Abstract

Introduction

Assessment

Alliances

Planning

Have an exit strategy

Chapter 25: Leadership and Trust

Abstract

Introduction

Building trust as a leader

Chapter 26: Principled Leadership

Abstract

Introduction

Start with stewardship

Leading with a plan versus faking it

The leader is special

Who do you trust?

Chapter 27: Motivation and Leadership

Abstract

Introduction

What do you want to motivate

Is there really a problem and how important is it?

What do I want to encourage and why?

Chapter 28: Succession Leadership

Abstract

Introduction

Strategic planning for leadership transitions

Tactical steps in succession planning

Delegate and distribute

Evaluate

Mentor

Consider your personal plan

Chapter 29: Leadership: The Last 100 Days

Abstract

Introduction

Coming to the end: deep thoughts

Beginning with the end in mind

Letters for yourself and your successor

Chapter 30: Conclusions and Next Steps

Abstract

Step 1: Never stop learning about leadership

Step 2: Learn about other leaders and learn from them

Step 3: Get the best intelligence you can

Step 4: Be ambitious

Step 5: Seek out the company of other leaders

Bibliography

Index

Copyright

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Dedication

Dedicated to all of the leaders in medicine who have brought out the best in those who devote their lives to the healing arts and to all the leaders to come

Acknowledgments

There are far too many people who deserve acknowledgments for their contributions to this book and I apologize in advance for not being able to name everyone in this space. I do need to start by thanking Dr. Bruce Hillman, the editor of the Journal of the American College of Radiology, first for his suggestion that I do the project that grew into the leadership columns in that August journal, and second for his continuing support for this endeavor over the years as it has grown into book form.

In the history of ideas and inventions, it is remarkable how often the important innovations have resulted more from the interactions between people than from individuals (see Shenk, 2014). I have been fortunate in my career to work with many people who have helped me in understanding both the need for leadership and the nature of good leadership. There are both opportunities and perils at the interface between medicine and the world of business. I have had the experience of being creatively paired myself with such luminaries of the American College of Radiology as Drs. Larry Muroff, Jonathan Berlin, Richard Duszak, Geraldine McGinty, Alex Norbash, Giles Boland, Bibb Allen, Bill Thorwarth, Paul Ellenbogen, John Patti, Jim Thrall, Jim Brink, Van Moore, Michael Bruno, and many others.

I have also had the opportunity to collaborate and work with many rising stars in radiology who have already contributed greatly to many facets of medical leadership including: Dan Mollura, James Y. Chen, Matt Hawkins, and Jonathan Flug.

From my two stints of duty at University of Pennsylvania School of Medicine (now the Perelman School), I had the good fortune to work with luminary neuroradiologists such as Scott Atlas, David Yousem, David Hackney, Elias Melhem, and Robert Grossman, who have all gone on to become great leaders in radiology and in some cases beyond. Dr. Bruce Kneeland deserves special mention for encouraging me to give academic medicine a second chance and for showing how leadership can succeed despite serious challenges.

At Wharton, we teach leadership itself and we strive to train people in the disciplines that are critical for mastering leadership. Over the past 19 years, I have worked on over a 100 projects in one way or another with our faculty student teams in both the graduate and executive programs. I have lost track of how many countries we have been to, but the work has taken me to five continents so far and I have assisted on work that was ongoing on the sixth (nothing in Antarctica on the horizon). Along the way, we have always come back to the notion of how we can effectively train people to be more successful in their careers and how important leadership is to our students. We try to have them learn by doing. They learn to lead their student groups as well as working with a team of overseas students. We teach them leadership by having them take the lead on project management, on strategic thinking, and on client management. From the beginning, Len Lodish has been an inspiring mentor and along the way, I have learned a great deal from my colleagues, especially Rob Mann, Jeff Babin, and Steve Smolinsky.

One of the themes of this book will be the universality of leadership—it is of course neither limited to my speciality, nor to healthcare. Without naming names, the many brilliant and fascinating people who made up the 14 in Cambridge and later the Cowper Street gang in Palo Alto have my gratitude for the inspiration that led to this project.

Finally to my family, my thanks for their understanding and help as I wrote this book: especially Alek and Matthew for putting up with the time I spent on this and my muse, Tanya for helping turn my ideas into prose. Thanks!

Introduction

Uneasy lies the head that wears a crown

—William Shakespeare in Henry IV – Part II (1597), 1564–1616

It’s good to be the king

—Mel Brooks in History of the World, Part I (1981), 1936-present

Image credit: Effigy of Richard I of England in the church of Fontevraud Abbey; Wikimedia Commons

This book grew out of a series of leadership columns that I wrote for the Journal of the American College of Radiology (JACR) from 2008 to 2013. This initial small experiment eventually grew to a total of 25 installments introducing and exploring the issues that medical leaders face. The topics ranged from how to prepare to be a leader, to what you should do first when you take the reins, all the way to how to gracefully step down and move on in your career and your life. They were short and focused both by design and also by necessity. I wrote them for an audience which is predominately US-based physicians in the specialty of radiology, but as nonradiologists looked at them an interesting thing occurred. I was told by friends who are in other medical specialties, as well as people who were in nursing, who were in dentistry, and in some additional fields that the advice was also applicable in their professions. Moreover, they asked if I knew of a good book for people like them (and me) for aspiring healthcare leaders. That was the moment when I had the thought of writing a user friendly book that they could use to get started in leadership and then have as a handy reference when the need arises during leadership challenges.

The focus both of those columns and of this book is on those medical and scientific people who need to learn more about leadership as they progress in their careers, but who don’t have time now—and haven’t had the time in the past to take time out from their career and pursue a degree or a program that includes dedicated leadership training. An apt title for this book could also have been Leadership for busy professionals. Many of the people who need to know more about leadership are also those who are so immersed in their day jobs that they don’t have the time nor do they have the opportunity to take time off and obtain formal leadership training. They face the conundrum of needing a leadership education but the needs of their day jobs, the demands of family, and sometimes the economic realities of their work preclude taking time off to go back to school. If you have felt this way during your career, then this book can help you with getting started on the path toward leadership.

This book is based upon my own career in medicine but I have also drawn on my experiences from the work that I have been doing outside of medicine: in strategic consulting, entrepreneurship, and venture capital. However, be forewarned (and probably relieved!) this is not a business biography. It is not a 100 pages of the twilight reflections of a retired CEO or general or chairman, reviewing how things were done back in the day. Those are interesting, but the insights that they share rarely are directly on point for those of us in a very different arena in a different time. Rather this tome is a series of lessons, discussions, and references that will hopefully help you to become a leader today. If your work in leadership has already begun, then it can aid you in becoming a better leader in your current position and/or help you as your responsibilities increase. To the extent that I have put my own experiences in here it is to help you avoid mistakes and get things right quickly. I will share not only my successes, but also some of my misses as well. As one of my flight instructors liked to say—usually when we were flying almost upside down over central New Jersey—it is better to learn from other people’s mistakes than to make them yourself. I hope though that the lessons here will give you a foundation to help you even though your circumstances, your practice, your hospital, and your times will be at least slightly different than mine.

By way of a brief introduction, I am a practicing physician, specializing in diagnostic radiology and working in the subspecialty of neuroradiology. I work predominately on the diagnostic side, interpreting MRI and CT of the brain and spinal cord. I am involved in taking care of patients with many of the highest impact diseases that afflict our society in the 21st century including stroke, dementia, spinal cord injuries, cancer, demyelinating diseases, etc. I have had the chance to work under many great medical professionals, as well as some who were not so great and also, (probably not surprisingly to anyone who is also in healthcare) occasionally with downright poor medical leaders. One of my observations that I pass along to younger physicians is that I have learned from everyone on that list—sometimes I have learned what to do and at other times I have learned the tough, but important lessons in what not to do when you are a healthcare leader.

Those experiences have driven much of the work that led to this book, but it is only half the story. As I noted in the foreword, in another life, I have been teaching at several business schools since 2001, the largest shares are (1) as an adjunct professor at the Wharton School of the University of Pennsylvania and (2) at one of the top European business schools, the Instituto de Empresa in Madrid. My time at the Wharton campuses in Philadelphia and San Francisco has taught me many things about how leaders are made. One of the most surprising is that anyone (almost anyone anyway…) can learn to become a leader. This is an interesting and important notion—just about anyone who is reading this book can learn to become a leader. The only proviso that I would add to that statement is that the individual needs to want to become a leader. Someone who genuinely doesn’t want to take on a leadership role can’t be forced into a position and then become a great leader. I have seen that mistake now in several institutions. Leaders do need to believe in themselves and have a desire to contribute to their group or department. Without that drive, leaders will just go through the motions and will very likely fail.

A second theme that will run through this book is that every medical leader (no qualification required here) can learn to be better at the job of leading in their institutions. The best leaders already know that. Like being a pilot or becoming a skier or a musician, there are always going to be opportunities to challenge yourself to get better. No one is perfect in their leadership work and you will never run out of things to learn. I will not only pass along that insight, but more importantly will also provide you with advice about how to keep moving forward as you master the lessons in this book and move further along the road of leadership.

As the contrast between the opening quotations at the top of the introduction highlights, we often have more than a little ambivalence when it comes to leadership. As much as we crave the guidance of good leaders, we can also be quite hard on them. This may be found in many aspects of our society, but it is often particularly acute in the field of medicine. Those of us who are trained in the healing arts—physicians, nurses, dentists, pharmacists, nurse practioners, physician assistants, technologists, and the many other—too many to list—categories of those who dedicate their lives to curing disease, alleviating discomfort and promoting good health—often focus our energies primarily on our individual skills and our crafts rather than on the tasks and training that it takes to lead our groups or to take charge in our institutions. Our lack of attention to leadership may make us devalue or distrust those who do.

In addition to inattention to leadership in our careers, there are other impediments that may keep a top nurse or surgeon from developing his or her leadership skills. Negative attitudes toward leaders in hospitals and academic departments are not uncommon and are often compounded by subtle (or fairly overt) snobbery from the medical professionals. There is a tendency to look down on those who have to count the beans, that is, the bureaucrats who keep things running in our institutions and the business professionals who manage the organizational side of healthcare delivery. Healthcare professionals may not value the skills of those who are not in the medical arena and may feel that the perception is mutual.

The gulf is further exacerbated by pervasive deficiencies in or even a basic absence of leadership education in many sectors of healthcare education and training. In many other important fields in our society, for example in the military and in parts of the business and nonprofit sectors, leadership training and development is deeply integrated into the institutional culture. It is part of the training and the work you do, rather than something separated from your educational and vocational activities. While there are of course exceptions on the medical side, many medical professionals often get to the middle of their career with little or no substantial training in how to lead others or how to manage in medicine. That statement is all the more astounding to nonhealthcare professionals, given the long and arduous years that it takes to finish training in many parts of healthcare. With all that time, it surprises my colleagues in the military and business world that there isn’t much in the way of leadership training.

For some medical professionals, the amount of required post college education and training can easily surpass a decade, and yet despite that lengthy process, leadership training is often scant, shallow, or conspicuously absent. The paradox that I see is that leadership skills can help you in your career regardless of your setting and also regardless of whether you are the leader or not. Whether you are in solo practice, a small group or a large hospital chain, leadership skills will be important to you in both personal growth and in developing your career, bringing both to their maximal potentials.

When I put this book together I knew that I couldn’t cover every single facet of leadership, let alone every academic debate over the nuances of good and bad leadership in a format of this length. Instead, I wanted to get in enough information to get you started on the trip. Since it is beyond the scope