3 Keys for Effective Physician Leadership

Ever since the travails of Odysseus were detailed in the great Greek epic The Odyssey, when he entrusted his son’s guidance and education to his friend Mentor, we have turned that name into both a noun and verb to describe some of the ways in which one person is guided and developed by another.

More recently, the term “coaching” has gained popularity as a means to improve performance in many walks of life. It is not unusual for some to conflate coaching and mentoring. We propose, however, that they represent overlapping, but distinct, approaches, and that both are applicable to improving a health care organization’s performance. This paper describes how the two approaches are different and how they can be used in a health care setting.

An important realization that has led to the adoption of mentoring and coaching is the concept that few new individuals are immediately capable of functioning at top form when they join an organization. In addition, existing individuals who are transitioning into new roles often require additional skills, especially if one is moving from the clinician role to that of a leader. Hence, additional preparation and learning should be a routine part of leadership transitions. Moreover, that development process works best if suited to the individual’s learning style. Both mentoring and coaching, because of their personal nature, are highly individualized and focused on an individual’s development.

The categories of mentoring, managing and coaching exist independently (see Table 1). Mentoring occupies a more global role than either managing or coaching. It appropriately could be seen in the historical context of craftsman and apprentice, with the former providing a supportive, individualized relationship to the latter, with the goal of personal and professional growth over time. Coaching, on the other hand, focuses on specific skill development, often provided by an outside expert. Management is focused primarily on organizational and individual performance, rather than on skill development.

Mentoring

What, then, does mentoring consist of? Martin(1) defines it as a role relationship where one person, the mentor, offers assistance, guidance, encouragement and support to another person to foster his or her vocational and professional development. It is highly likely that most, perhaps all, successful leaders have been assisted by one or more mentors during their careers. In fact, mentoring is often an informal, ad hoc occurrence in many health care organizations.

We know, based on previous studies, that a successful mentoring relationship is based on five key elements.(2)

• It has a focus on achievement or acquisition of knowledge.

• It consists of three components — emotional and psychological support, direct assistance with career and professional development, and role modeling.

• It is reciprocal, where both mentor and mentee derive emotional or tangible benefits.

• It is personal in nature, involving direct interaction.

• It emphasizes the mentor’s greater experience, influence and achievement within an organization.

In many cases, mentoring occurs informally. That is, an interested learner finds and recruits a willing mentor and they engage in ad hoc conversations when their schedules and inclinations allow. The mentor’s approach is based on his or her life experiences, rather than any formal training. The downside of this informal approach is that some potential leaders might miss out on the mentoring experience, to the detriment of their professional development and the success of their organization.

Formal mentoring is significantly different. Considered by some health care leaders to be an important part of executive development and succession planning,(3) formal mentoring programs require leadership and resources. They typically involve identification and training of willing mentors, formal matching of mentors and mentees, and tracking and evaluation of mentoring outcomes.

Why is it important to find mentors? Because this is the way skills are learned. Indeed, this often is the way that “technical” skills (e.g., suturing) or “relational” skills (e.g., dealing with angry families) are truly learned.

Coaching

Habit is a much more reliable predictor for future results than classroom instruction. Even the most-dedicated individual, when returning to the worksite from multiday training, will be hard-pressed to not return to old learning and behavior unless the newly learned material is actively incorporated into day-to-day performance. However, if the training has assisted the individual to gain new knowledge, and the manager has set a clear path for that knowledge to be used, this is where coaching can play a key role.

Coaching is generally delivered by an individual outside the immediate environment. While a mentor typically is a superior who possesses advanced skill in the same area as the mentee, a coach is specially trained in listening and problem-solving skills, and the learner uses the coach’s knowledge to advance his or her professional growth and skill acquisition. This encourages more accountability and personal insight. It is also customized for the individual and focused on their strengths and opportunities.

The coaching industry has exploded during the past decade. While still viewed skeptically by some, the data indicates that there is significant benefit from coaching. Symonds(4) notes that a 2011 study by PricewaterhouseCoopers established that the mean return on investment for companies using coaching was seven times the initial investment. Referring to people in leadership positions, his article states: “When they are able to walk their talk, people listen and are able to follow suit, improving the levels of enthusiasm, trust, and team effectiveness throughout a team or organization.”

For physicians on the leadership path, there are distinct challenges that can require the clinician who is transitioning to executive to seek coaching.(5) It has also been suggested that coaching clinicians to be better clinicians can contribute to improved teamwork and organizational effectiveness.(6)

The research organization Gallup has gathered significant data on the key aspects of employee engagement.(7) An important part of the basis for deep engagement is a perception that the worksite focuses on individuals’ abilities and their development. Coaching promotes a setting that allows new knowledge to be used in a focused, habit-driven manner that promotes sustainability of the new behavior, and hence increases engagement.

Management

Management occurs within an organization. It focuses on setting priorities, helping decrease organizational barriers, providing feedback, and managing personal compensation and, when appropriate, corrective action plans.

Certainly, one’s manager can help with developing leadership skills; however, the primary focus is more typically on personal and organizational performance. In today’s complex organizations, leaders often have multiple managers in their roles, and developing these relationships is central to job satisfaction and execution of their responsibilities.

Compared to mentoring and coaching, managing is more structured, tied to organizational authority and frequently is less focused on personal and career development.

The Value of Mentoring/Coaching

It’s not enough to understand the differences between mentoring and coaching; we need to understand their value as well. Unfortunately, there has been little in the way of evidence-gathering in the health care arena. Perhaps the best analysis was one conducted more than 10 years ago in the arena of academic medicine.(8) This meta-analysis found that mentorship was reported to have an important influence on personal development, career guidance, career choice and research productivity.

These findings don’t tell us much about health organization function, however. Unlike health care organizations, other businesses have done more to assess the value of mentoring. For instance, Roche(9) performed a survey more than 40 years ago that showed that executives who had a mentor earned more money at a younger age, were better-educated, were more likely to follow a career plan, and were more likely to sponsor more protégés than executives who had not been mentored. More recently, research has shown that individuals with mentors are more likely to achieve greater promotions and compensation, enhanced job performance, organizational commitment and job satisfaction.(3)

One study of insurance agents(10) found that new agents with mentors outperformed other agents by 20 percent in their first year of work. Another study of 100 executives(11) estimated the ROI on the costs of coaching and found that the average return was 5.7 to 1. Even more recently, a meta-analysis evaluated the benefits of mentoring on the mentors themselves(12) and found that mentors were more satisfied with their jobs and more committed to the organization; mentoring was most associated with career success; providing role-modeling mentoring was most associated with job performance; and the quality of the mentoring was associated with the mentor’s job satisfaction and career success.

It is likely that the above data have contributed to the growth of formal mentoring and coaching programs in business. While it is difficult to assess how prevalent mentoring and coaching are, there is substantial evidence that the value of mentoring is widely recognized in business. One piece of evidence comes from the number of publications advocating for formal mentoring programs.(13-15) Conversely, there’s little data indicating how prevalent formal mentoring programs are in the health care space, other than in professional organizations.(16)

Anecdotally, we have seen little evidence that many exist in modern health care organizations. Conversely, we are aware that many large health systems have adopted formal leadership training programs to assist their clinician leaders. What appears to be missing from these same organizations is that they do not have formal mentoring or coaching programs. Interestingly, we have encountered formal mentoring programs in academic health care organizations, aimed mainly at faculty development. Even the prevalence of informal mentoring is difficult to assess. One such survey suggested that informal mentoring in an academic setting was less likely to occur for clinicians and women.(17)

In search of time- and cost-effective settings for employee improvement, organizations frequently send employees to training environments — classroom-type settings providing the academic base for knowledge acquisition. However, the outcomes can be questionable. In 2014, Forbes noted(4) that American industry spends more than $14 billion annually on leadership training, sometimes with dubious results because of a lack of follow-up with the information provided in trainings. Again, one can surmise that coaching and mentoring could sustain the learnings acquired in formal leadership development settings.

There are key advantages to adopting a formal, organized approach to coaching and mentoring. Namely, potential leaders are less likely to miss out on the advantages supplied by these two complementary approaches to professional development. Formal, organizationwide approaches are more likely to ensure that all potential leaders are identified and offered individual development programs and that there are adequate resources to support their development.

Discussion

It has become standard for health care organizations to offer onboarding — training and socialization — to new employees and to support existing employees through both skill development training and leadership development programs. We propose that real improvement is more likely to happen if these programs are supplemented through personal programs that focus on real-time professional growth (e.g., mentoring) coupled with focused coaching programs. We also posit that such programs can result in increased employee engagement and reduced employee turnover — both contributors to improved productivity and quality as well as reduced cost. Perhaps just as important is the need for succession planning and its attendant mentoring as part of the development of leaders.(18,19)

For these activities to occur, certain events must happen. First, there must be a leadership commitment to coaching and mentoring programs, accompanied by appropriate resource allocation and planning. Second, these programs must have a formal structure that allows for selection of mentors and coaches, with criteria for identification of mentees and coaches. Third, there must be an evaluation process to assess the impact on the participants and on the organization. Fourth, there should be a reflection and learning process that allows the evaluation to inform changes in the program over time.

At the same time, there is still a paucity of data on how prevalent coaching and mentoring activities are in health care organizations. There also is limited data on the value of such programs. Future research efforts should seek to define how and where value accrues from such programs, which should help in clarifying how and where to structure them.

In this tumultuous, rapidly changing environment, we are confident that organizations that follow such a path are more likely to foster an environment and culture that will lead to longer term success.

References

1. Martin G. Coaching and mentoring. Chapter 44 in Australian Master Human Resources Guide, 4th Ed., Alexandria, NSW, Australia: Zookal, 2006.

2. Jacobi M. Mentoring and undergraduate academic success: a literature review. Rev. Educ Res. 1991; 61(4):505-32.

3. Groves KR. View from the top: CEO perspectives on executive development and succession planning practices in healthcare organizations. Journal of Health Administration Education, Winter 2006; 23(1):1-18.

4. Symonds M. Executive coaching — another set of clothes for the emperor. Forbes, Jan 21, 2011.

5. Winters, R. Coaching Physicians to become leaders. Harvard Business Review, Oct. 7, 2013.

6. Beeson S. Physician Coaching: Clinicians Helping Clinicians on the Things That Matter Most. NEJM Catalyst, Nov. 15, 2017.

7. Edmond L. 2 Reasons why employee engagement programs fall short. news.gallup.com, Aug. 15, 2017. https://www.gallup.com/workplace/236147/reasons-why-employee-engagement-programs-fall-short.aspx

8. Sambunjak D, Straus SE, Marusic A. Mentoring in academic medicine: a systematic review. JAMA 2006;296(9): 1103-15.

9. Roche GR. Much ado about mentors. Harvard Business Review, January 1979.

10. Clutterbuck D. Quiet transformation: the growing power of mentoring. Mt. Eliza Business Review, 2000/2001, Summer/Autumn, pp. 38-41.

11. McGovern J, Lindemann M, Vergara M, et al. Maximizing the impact of executive coaching. The Manchester Review, Manchester Consulting, 2001; 6(1).

12. Ghosh R, Reio TG. Career benefits associated with mentoring for mentors: A meta-analysis. J Vocational Behavior, 2013; 83 (1): 106-16.

13. Reitman A, Ramirez Z. Creating a Mentoring Program: Mentoring Partnerships Across the Generations. Alexandris, VA: American Society for Training and Development, 2014.

14. Murrell AJ, Forte-Trammell S, Bing D. Intelligent Mentoring: How IBM Creates Value Through People, Knowledge and Relationships. Boston, MA: Pearson Education, 2008.

15. Klasen N, Clutterbuck D. Implementing Mentoring Schemes, Abingdon, UK: Taylor & Francis, 2001.

16. Hawkins JW, Fontenot HB. Mentorship: the heart and soul of health care leadership. J Health Care Leadership, 2010; 2:31-4.

17. Johnson WB, Koch C, Fallow GO, Huwe J. Prevalence of Mentoring on Clinical Versus Experimental Doctoral Programs: Survey Findings, Implications and Recommendations. Newberg, OR: Faculty Publications, Psychology Department, George Fox University, 2000, paper 46.

18. Stoller JK. Developing physician leaders: a perspective on rationale, current experience, and needs. Chest, 2018; 154(1):16-20.

19. The Daily Beat Blog: Mentoring is critical to organizational longevity — so why is it such a struggle? Becker’s Hospital Review, Feb. 14, 2014.