Physician, Diagnose Thyself: Why Great Physician Leadership Is An Inside Job

Physicians are great at diagnosing other people, but they are not always great at diagnosing themselves.

Because excellent doctors are externally focused, spending most of their time looking at metrics and talking to patients, when they are asked to be leaders, it’s vital that they make the shift to looking inward. This can be a challenge, but it’s a necessary part of contributing to a high-performing organization.

Leadership is an inside job; we can’t take anyone any further than we take ourselves. We must become exemplary leaders before we are able to bring out the best in others. That’s why the first step in becoming an effective physician leader is to become more self-aware and coachable. These two characteristics are connected — one leads naturally to the other.

In The Busy Leader’s Handbook, I share the story of a venture capitalist who, when deciding whether to invest in a company, looks first for self-awareness and coachability in its leaders. This shouldn’t be a surprise; in my experience, organizations that nurture these qualities in their leaders tend to be strong, innovative, and profitable.

Leaders need to “know what they don’t know.” They need to be great learners. Today’s chaotic business environment — and certainly the healthcare industry — requires leaders to adapt quickly and relentlessly; they must be humble and open to feedback.

Checking Your Vital Signs

All that said, all physician leaders can benefit from turning their diagnostic skills inward.

How healthy are your levels of self-awareness and coachability? Hold up the mirror and ask yourself these questions, which can help you determine your “vital signs” in these critical areas:

Do you make assumptions without studying the metrics?

We sometimes assume we know the reason behind an unfavorable trend; however, it’s better to delve into the metrics. For example, if you have a high turnover rate, don’t assume it’s just the norm for a certain type of job (stressful), blame it on the high cost of living in your area, or attribute it to some other factor beyond your control.

Instead, take a look at employee engagement scores. Remember, people don’t usually leave their job, they leave their boss. Ask a lot of questions of those who are leaving and those who’ve been with you a long time. You will likely see trends that point to leadership issues.

Your organization’s HCAHPS results also might reflect leadership issues. The link between employee engagement and patient perception of care was brought home to me during the 1990s when I was senior vice president of Holy Cross Hospital in Chicago. I had been struggling to raise patient satisfaction scores until I studied the “Southwest Way” developed by Southwest Airlines. A key tenet of the Southwest Way is that customer satisfaction always starts with employee satisfaction. Sure enough, once we improved employee engagement, patient satisfaction improved as well.

What barriers might be blocking your self-awareness?

Too often we let denial prevent us from learning how to improve as leaders. We might rationalize, “My customer service rating is poor because only unhappy people bother to fill out the survey” or “That other hospital is doing better because they have more staff than we have.” We might fall back on blame: “The government (or the insurance companies) are not paying enough” or “Employment rates are so high that we can’t get good people.”

I know about excuse-making; I used to be a denier, rationalizer, and finger-pointer. Until I had a moment of clarity about 37 years ago, my life and career were stuck. It was only after a wake-up call that I realized I needed to stop blaming others, stop acting like a victim, and instead take accountability for my own actions. Then things started to turn around. As leaders, we need to get real about our barriers and do whatever it takes to start knocking them down.

Do you have an ego problem?

Great leadership is not about being “right;” it’s about bringing out the best in others and engaging them in doing what’s best for the company. This cannot happen when leaders are too attached to their own ideas or are convinced they are the smartest person in the room. An inflated ego can cause them to make bad decisions and lead the team down the wrong path. It can alienate people rather than engage them, create dependency rather than ownership, and promote individualism rather than teamwork.

If you’re not sure whether you have an ego problem, ask yourself:

• Am I constantly reminding the people around me how great or talented I am?

• Am I concerned with what I “deserve”?

• Do I believe I should get special treatment because of my position or abilities?

• Am I a perfectionist? Do I overreact to others’ mistakes? Do I believe I try harder than (and am better than) everyone else?

• Do I believe that menial tasks are beneath me?

• Am I inflexible, exhibiting a “my way or the highway” mentality?

These questions can help make you aware of a lack of humility. Most of us have humility slip-ups from time to time; the key is to be aware of those slip-ups and rein in the ego when it starts getting out of control.

Do you know what humility looks like in action?

Humility is not about being meek or submissive or thinking we’re not good enough. It’s about seeing ourselves as we truly are. It’s about knowing our strengths and weaknesses. It’s about taking ourselves out of the spotlight and placing it on others. It’s about staying open to learning and focusing on continuous improvement and growth. Here are a few ways to get intentional about leading with humility:

• Give others credit. Push compliments down to the team. Look for places where you can give someone else the win.

• Don’t be afraid to acknowledge what you don’t understand or don’t know what to do.

• Admit mistakes. People appreciate vulnerability in leaders.

• Be accessible. Don’t lock yourself in your office. Leading with humility means getting down in the nitty-gritty with the team. Work with them, spend time with them, try not to be aloof or unapproachable.

• Be open and transparent. Share information when you can. Don’t keep secrets or withhold information just because it came to you first.

• Don’t talk about where you are; talk about who helped you get there. Appreciate the opportunities and breaks you got along the way. Leaders do not get to the top on their own.

Do you see yourself as a lifelong learner?

Considering all the continuing education requirements they must meet, most physicians know there’s no finish line in learning, but knowing learning is a lifelong endeavor and leading like we know it are not the same thing. We must remember that there is always more to learn, that we are not always the expert, that teachers come in all shapes and sizes with all sorts of job descriptions and credentials.

That’s why it’s crucial make “beginner’s mindset” a daily practice. For example, check your attitude before you go to a meeting. Always come into the group with the intention of learning something. Rather than thinking “This isn’t relevant to me” or “This is not what I’m interested in,” ask yourself, “How could this apply to me? How could this be useful for me now—and if not now, later?”

Do you have a trusted mentor? Do you welcome feedback?

Bert Thornton, retired president of Waffle House, wrote a book called Find an Old Gorilla. His message: find someone, old or young, with whom you can share your insights. Many times, the clarity and answers you need may come just from the sharing. That’s the power of a mentor; however, a person doesn’t have to be a formal mentor to provide a valuable perspective.

Make a habit of regularly asking those around you for input and feedback. Be sure people feel “safe” enough to tell you the truth; leaders need to foster a culture of psychological safety. When people give you bad news or tell you something you don’t want to hear, don’t shoot the messenger. Don’t get upset or start playing the blame game. When you behave this way, people avoid telling you the truth early on, when issues are still fixable; unresolved issues continue to grow until one day, they explode.

What obstacles might be reframed?

Obstacles might be your opportunities or strengths in disguise. For example, I am hearing impaired. While this causes challenges, it also has helped me to be a better listener. Why? Because I must truly focus on a conversation or a presentation. I also have a speech impediment, which helped me acquire resilience and the ability to handle failure.

Finally, when I was 31, I acknowledged that I am an alcoholic. I thought that getting sober meant no more fun for me! Yet being in recovery provided me a better way of living that molded these past 37 years. Yes, doors close, and it is painful, but I like the saying that “when one door closes another one opens.” I also like the saying “It can be hell in the hallways.” My recovery has helped me deal with those hallways.

Do you dread and fear change?

If so, it’s crucial that you change the way you think about change. Healthcare is tough right now; it probably has never been tougher to be a physician, but we live in a time when constant, rapid change is simply how we live now. If we don’t commit to nonstop forward motion every day, we will fall behind. The bottom line is that we need to get comfortable with being uncomfortable. It’s a part of growth and it’s part of a leader’s job.

That doesn’t mean you have to like everything that’s happening. When I was going through a painful situation in my own life, someone told me, “Accepting does not mean liking.” This changed me profoundly. I realized that we may not like our circumstances, but until we accept them, we won’t be able to move forward. Usually, there are actions we can take to make things better, even if in a small way.

Are you grateful?

This last point may seem a little lightweight. It isn’t. I have seen again and again that when we lead (and live) from a place of gratitude, we are more likely to stay in a state of humility. Our relationships with employees and colleagues will be better and we’ll set the tone for a more positive workplace culture. (This is important. Positive cultures tend to keep people happy, engaged, productive and creative.)

One simple step you can take is to notice one or two (or three) things you’re grateful for each day. Write them down in a journal or even in your daily planner; this practice will make you more grateful in general. A heart full of gratitude leaves little room for anything else. Yes, at times life is hard; however, those people who make a gratitude list on a regular basis seem to handle life’s ups and downs better than those who do not.

Your Plan of Care

Diagnosis is the first step toward positive change. Once we ask ourselves these questions (and answer them truthfully) we can see where we need improvement. This is the first and most important step in a leader’s journey. Whether we make the needed changes is up to us. As with the patient who is advised to stop smoking or lose weight or take a certain course of medicine, whether you follow your plan of care will determine what your future looks like.

It is my hope that we all work to be better leaders — it’s what our organizations need, what our employees and colleagues need, and what our patients need. It’s also what we need. As we become better leaders, we also become better human beings. I believe growing and getting a little bit better every day is why we’re here.