By: Peter Pronovost, MD, PhD, and Christopher Myers, PhD, Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine
Physicians increasingly are being asked to lead health systems and improvement efforts, so it is important that they have the necessary skills to do so. To see why and how these leadership skills matter, we propose a quick test. Below, we present three scenarios that a health leader might need to navigate. As you read these scenarios, we encourage you to reflect on whether you have a framework you could use to address the issues described, whether you have all of the necessary skills to address these issues, and whether you have a commitment and mechanism to grow and develop these skills.
Case 1: You were just hired as a new attending in a surgical division. A nurse comes to you confidentially to raise concerns about the quality of care provided in the division. The nurse does not want you to discuss the issue with others, because she fears she will suffer retaliation. She states that there is a strong culture of fear and distrust. What do you do?
Case 2: You are leading a project to introduce a new pathway for managing heart failure patients. You bring together the academic and community cardiologists and the primary care physicians. The main academic cardiologist says he wants to make the pathway as he is the world expert. He drafts a pathway and hands it out at the first meeting. The other physicians feel disrespected and do not want to participate. You are under pressure from your hospital leadership to implement the pathway and reduce practice variation. Yet the physicians do not want to join. What could you have done differently and how might you recover?
Case 3: You recently have been made the chief quality officer of a hospital. The boarding time for patients admitted through the emergency department is very high, and your Board and leadership want you to reduce it. You understand that it is a complex problem involving multiple departments. You also know that the interventional cardiologists and surgeons do not want emergency department patients to take their beds–they want to be able to accept transfers from outside hospitals. You call a meeting to work on the problem. How would you motivate the different departments and lead the change effort? The lead medicine physician and surgeon say you do not even need a meeting because the emergency medicine patients are a low priority. How do you approach the problem and get them on board?
All three of these cases illustrate issues of trust, teamwork, power, and change in organizations. These are issues that all leaders face every day, yet they are not the issues that physicians are trained to address. In all three cases, an understanding of leadership and organizational dynamics could provide the frameworks and tools to successfully navigate these challenges.
How did you do on the test? Did you feel prepared to handle the situations? If you need more training, where will you get it?
While we believe these topics need to be incorporated into the medical school curriculum, for physicians who are already in practice, we suggest looking for opportunities at business schools (particularly for those physicians at AMCs affiliated with large universities). Increasingly, business schools are offering specialized courses and opportunities for developing the leadership skills needed in health care. For instance, at Johns Hopkins, we offer a specialized five-day Executive Certificate in Health Care Leadership and Management, which is open to health professionals from any institution and offered for continuing education credit. This program brings together health leaders and management experts to develop the kinds of foundational skills and abilities described in our Academic Medicine article.
In addition to formal training, ongoing skills development through peer or formal coaching is also important. This training can be practical. For example, ask a trusted colleague to provide feedback on your performance in a high stakes meeting. Did you listen to others’ concerns? Did you align around a common interest? Did you reduce resistance? Whatever the source, though, it is never too late to develop these critical leadership competencies, and, by doing so, we can improve the quality of care we provide.