13 Jul Leadership in Healthcare: Applying 10 leadership principles that matter
Have you ever wondered what makes a great leader? If you are like most people who have the desire to excel, the question may have crossed your mind, as you most likely are hoping to one day become a leader. But where do you even start?
This is what happens when you google “Leadership…”
About 2,510,000,000 results (0.65 seconds)
The amount of information is overwhelming. On top of the dizzying results there are so many leaders (pun intended) in the area of leadership. Simon Sinek, Stephen Covey, Daniel Pink, James Collins, John Maxwell, Peter Drucker. The list goes on, and I am certainly not on that list. And I encourage you to check out every single one of these writers and leaders and dive down the rabbit holes with them.
So why write one more article about leadership and why write it in the context of healthcare and leadership in the healthcare setting?
Because it is my personal belief that it bears repeating. The reason all of these authorities exist is because collectively, we are not listening to them. Or at least not implementing what they are saying. If that were the case every organization would be comprised of exceptional leaders, earnings would be outstanding, the economy would never faulter, joblessness would likely not exist, in short, we would likely live in a utopia. So, it bears repeating so that maybe one person gleans one idea from this article, utilizes it and makes an improvement. Or looks up one of the far more qualified authors, learns significantly more and then really applies what they have learned.
Healthcare is complicated. Not only is it complicated from a financial and operational perspective, it is complicated from a people perspective. The delivery of healthcare is predicated on people, from doctors to coding specialists. Those receiving the service are people. And while arguably people receive any services rendered in any industry, in healthcare people truly receive the service, because it is their personal health that is the outcome of services rendered. With so many people involved both in the delivery and receipt, it is no wonder that there is such complexity from a people perspective.
Let’s add a few layers to the complexity. Peoples lives are on the line, there are penalties for bad performance, there is tremendous financial pressure, it is highly competitive, it takes years to learn how to be a doctor, did I mention financial pressure? There are malpractice lawsuits, lobbying pressures, new regulations, laws, policies, and reimbursement considerations. Somewhere buried in all of this, clinicians are just trying to treat patients, and patients are just trying to be healthy. But in between all the layers, miring this otherwise straightforward exchange is human motivation, nature, and behavior.
As leaders, what are we supposed to do in order to help return the simple delivery of care to a person simply wanting to not be sick anymore?
I use the word ‘simple’ knowing that this is simple, but not easy.
The mire now exists in healthcare, making leadership one of the most important components in delivering care.
To lead means to guide or to direct. Both have very different connotations. When we think of being directed, we usually think of someone telling you exactly what to do. This is perhaps more akin to a manager and not a leader. The reason we have so many managers is because to become a manager, you excel at your job to the point where your higher-ups determine it is appropriate for you to manage someone else to do the job you used to do. Naturally, what do you do? Tell that new person how to do the job. That is management.
Leadership on the other hand is much more like guidance. Think of a guide. You are probably envisioning someone with a beard and a staff and flowing robes who speaks in platitudes. Regardless as guide helps you to find the path you would like to go down. Helps you to get where you are going. They do not spend time telling you what you are doing wrong, where you should be going, or critiquing your decisions. And isn’t that what a leader does? Guide the people and the organization?
As leaders it is our job to guide the organization to achieve its mission. Simple, not easy. Especially not easy in the mire of healthcare. But I would argue that the mire is irrelevant. When we are all operating in the same environment, it is not a bad environment, its just the environment. We do what we can, where we are.
Here are 10 guiding leadership principle that can help you not only become a better leader, but a better healthcare leader.
10 Leadership Principles
1. Leadership has nothing to do with title, you are thinking of authority
When we think of leadership, it is so easy to think of the executives. Or the VPs in our organization. The hospital CEO is the leader. In some cases that is right, but they are only a leader, not the only leader.
Leaders come in all shapes and sizes and all levels of any organization. In hospitals, there are nurses who are leaders with no functional authority. They go out of their way to make their patients feel comfortable and safe. They help their colleagues to finish charting or to cover a shift. They bring lunch when they know everyone has had an extra hard week. These are the people we want to be around, that make us feel good, and make us want to be our best.
There are vice presidents who are not leaders at all. They spend no meaningful time with their teams. They are only worried about their own career and will only help their teams excel insofar as it benefits them. They tell people what to do and believe their way is right with no margin to disagree. Is that a leader? Or someone who has authority.
It is too easy to conflate authority and leadership when they are two wholly separate ideas. If you are a leader with authority, look up and down in your organization. There are leaders everywhere. Those are the people you should be promoting and leveraging across your hospital. And if you are not an authority, but a leader, keep going. Your leadership is invaluable and helping your peers and your patients.
2. Leadership is about creating safety
Think of your organization or hospital, do you feel safe? Not safe in the sense of protected from bodily harm, but safe in the sense that you can be yourself. Safe such that you can try your hardest, fail, learn, and keep going? Or do you feel afraid? Afraid that if you don’t perform to a certain standard that you could be fired?
Leaders create a safe environment within their hospitals and organizations. They allow people to try, fail, and grow. Again, thinking about yourself, who are you most likely to follow? Someone you know is only going to tell you when you messed up or succeeded based on their definition of both? Or someone who is going to help you become the best at what you do? I would certainly choose the latter.
Imagine the benefit to your hospital or practice if you really instituted a safe environment. Nurses could run quality improvement projects that could fail but could also save tens of thousands of dollars and potentially lives. Administrators could pilot new software they believed in to improve efficiency and improve throughput. Doctors could leverage best practices or new product innovations, track outcomes, and potentially see gains from the change.
But in order to do any of that, leaders must create a safe space in which to operate, with support.
Our idea for this comes from an innate need to improve and grow. Since we were born, despite no consciousness that anyone can remember, we try new things until we master them. Walking, talking, eating, reading, spelling. We are not sure why, perhaps third-party validation, or perhaps an evolutionary need to grow, born from the need to survive. Similarly, in ancient times, we created tribes. Loose small societies, aimed at one thing, survival. Survival was predicated on the tribe’s ability to eat and protect itself from danger. If the tribe was good at that, its people felt safe.
From the beginning, evolutionarily, we crave growth and safety. A good leader provides an environment for both.
3. Leaders must be transparent
Do you like when people lie? Do you feel safe not knowing what’s going on? If performance is down and a round of layoffs are coming, do you want to know, or would you like to be kept in the dark?
Hospitals are under constant pressure. While layoffs seem to be part of everyday business, hospitals may face something much more permanent, closure. Closure not only affects those who work it the hospital, it affects whole communities.
Imagine a world where your hospital CEO holds a town hall with all staff and says, “We are not doing well financially. We have about 1 year left until the hospital will have to close or be bought. I understand if you want to get your resumes together and look for other jobs. I will help anyone who asks to find placement. But I will also be working day and night to find a way to turn our performance around, so we do not have to close. If you believe in what we are doing, Lets make this year our best yet. I believe everyone in this room has the capacity and talent to turn this place around. If you are with me, I will do everything in my power to lead us out of this.”
While it may sound a little over the top, just pause for a moment and consider it. Full transparency. But the only way to really galvanize people. And it does not take facing disaster to reap the benefits of transparency.
Imagine this example. You are a leader and you have someone who is not performing well. Your conversation could go like this, “Mike your numbers aren’t great. They haven’t been for a while. I am not sure what we are going to do, but if we stay on this path, I am not sure what the future holds for you.”
Another way to approach that conversation is, “Mike, your numbers have been down 15% for the last quarter. I am getting pressured to let you go if they do not improve in one more quarter. I know you can turn it around, how can I help?”
Wow, what a difference. Transparency removes fear. It goes back to the second principle. When people feel safe, they can perform their best.
4. Leaders think like parents
If you do not have children, I recommend them. They are cute and you end up loving them a lot. If you do have children, you already know what I am talking about. Nevertheless, to be a good leader you must think like a parent.
Think of the goals in a parent’s life. The first is to get a full night’s sleep. The second is to provide their child with the best life possible. The third is to give the child the tools, coaching, attention, and love they need to be the best they can be. We take time out of our schedules to make sure our kids understand their math homework. We talk to them about challenging situations. We encourage them to get back up after they fall down. We give them the space to fall down.
Doesn’t that sound like a leader? To give your team the space they need to fall down, to pick themselves back up, coach them, and watch them excel. Being a leader is like being a parent in other ways. While it is easy to point fingers at the kids, inevitably the parent gets blamed. And they should in most cases. We need to take full accountability for our actions. Our children’s failures are our failures. Our team’s failures are our failures.
5. Leaders have perspective
When leading any organization, any number of metaphors for where you are standing relative to the rest of the organization are appropriate. You should be out in front to see what is coming. You should stand in the back so that you can see the whole team. You should be in the middle so you can communicate up and down the chain of command. Irrespective of your preferred metaphor, what is important is perspective.
Leaders need to have a detached enough perspective so they can see the entirety of the organization clearly, objectively, and its position relative to the market dynamics in which it operates.
It is easy to bemoan leadership for never getting their hands dirty. But the reality is that they do not have the time and it would take away from the larger picture focus. I would argue that leaders need to have a strong foundational understanding of what everyone in their organization does, but all I am saying is that it may not be worthwhile for the CFO to be entering GL entries, though she should be capable of doing it.
Leaders need to see the whole playing field. Generals would often take a position on the high ground in the battles of yesteryear, so they were able to see the entire field. They could see their troops, the landscape, and the enemy’s maneuvers. Perhaps the high ground metaphor is the best in the case of leadership.
6. Leaders have no ego, leaders have no ego, leaders have no ego
You should probably say that one more time. Leaders have no ego. We have all met the CEO and said, “she just doesn’t get it.” Because we know that she is so far removed from the reality of the business and yet will not take any advice on her plans, because she knows she is right.
Good leaders, the best leaders have no ego. They will gladly take advice, feedback, and even perhaps direction from any member of the organization at any level. We might forget often in the mire of day to day hospital operations that nurses who treat the patients that keep our doors open, have a tremendous amount of knowledge that may just help improve our business. Not only that, even if your hospital CEO is a doctor, when was the last time she practiced?
There is so much constant change in healthcare that it is nearly impossible to keep up with it all, not to mention in the practice of medicine. Too many leaders stay secluded in their ivory towers, getting reports from the organization, which effectively amount to a giant game of telephone. By the time it reaches them it is watered down and morphed.
Leaders should not have so much ego that they allow themselves this much removal. They should be learning from those who make up the organizations they run. As a leader it is your job to guide your organization. It is a sign of great strength to admit that you do not know something. Think of all the folly that businesses could have avoided over the years if leadership had just checked their ego at the door, gone down to the line manager and ask, “what is wrong with this, I don’t understand? What should we do about it?”
The only way to get there is to kill your ego.
7. Leaders are decisive
Theodore Roosevelt said that when it comes to making a decision, the best thing you can do is the right thing, the next best thing is the wrong thing, and the worst thing you can do is nothing.
We do not always have all the information. We cannot always see 5 years into the future or know how a competitor is going to respond. Even as human beings, driving down the road, we can only focus on so much and therefore only truly have a fraction of the stimuli available to us to inform our decisions. And imagine if, that being the case, we all stopped driving because we didn’t know exactly what the driver next to us was about to do. It would be much worst than carrying on.
We are faced with so many decisions during the day and more long-term decisions in life. It would almost be easier to just give up making decisions all together. But in an organization that could spell disaster. I was in an organization once and we were doing our 2016 strategic planning in September 2016. Think about that for a minute.
Not only does that sounds insane, it is a clear example of not being able to make a decision. Management kept wanting the company to refine and refine and refine. More ideas, more data, more strategies. The best piece of advice that anyone can receive is the advice we use.
When there are so many directions to go, the most important thing is that you choose one. Nothing kills team morale and company spirit faster than chronic indecision.
8. Leaders start with empathy
Empathy is a superpower. People talk about it a lot, few understand what it is, and even fewer truly have empathy. Empathy is the ability to understand the feelings of another person. If we really understood other people, we would probably never be angry with anyone. We would understand that the jerk who just cut you off on the highway was running late for a job interview because he just had a flat tire. The mean woman waiting in line behind you at the grocery store just lost a loved one.
If only there were a way to ask. Luckily there is… asking. While you may not want to turn around to the stranger behind you and say, “are you ok? You are not being very nice,” it may be easier to have these types of conversations with your teams and in your hospitals and practices.
The first area where empathy is really a superpower in healthcare, is where patients are concerned. Patients come in scared, sick, and alone often. We don’t know them and until we ask, we cant understand them. So while it may be frustrating that a 51 year old male with diabetes is non-compliant with his diet routine, a moment of practicing empathy may pay dividends. If we took the time to ask, we might learn that he recently lost his partner who did all the cooking. He is grieving and has no way to know how to get on a good eating regimen.
Now that we know that we can focus on either not being mad or get him the help and resources he needs to get better. Empathy for patients is paramount.
Within our organizations, empathy is equally as critical. As leaders it is imperative to ask what is happening in the lives and work of our teams, especially as they work one of the highest stress jobs there is, practicing medicine. If your quality metrics go down in one department, what might your knee jerk reaction be? To get mad, go down there and give everyone a piece of your mind. After all they are going to cost you 2% in penalties.
But what about a different approach? Go to the department head and ask. “What is going on, is everyone on your team OK?” You may just learn something that not only relieves your anger but that you can fix and improve overall, rather than just cover up a mistake or risk losing talented people.
Empathy is context. It is understanding. It is critical when trying to lead people to first understand them.
9. Leadership is a dichotomy
If you are interested in another far more expert in the area of leadership than me, look up Jocko Willink. He wrote a book called, “The Dichotomy of Leadership.” Not only did I get the idea of the principle from this book, as a former Navy Seal and platoon commander he certainly has the leadership pedigree you should be interested in when stepping up your leadership game.
But for this short foray into leadership principles, it is worth noting that leadership is in fact a dichotomy. For example, you must be accountable. Like a parent, everything falls on you. You own the mistakes. But at the same time your team is responsible for their actions. They also own everything and need to be empowered to take action. Read the book, it is a master class in leadership.
Relative to healthcare it is something that has always existed. Doctors know how to treat patients. They are responsible for the well being and recovery of their patients. But as leaders of the hospitals in which they work, we are responsible for the doctors. They are empowered because, we do not (in some cases) practice medicine. Yet, their mistakes are our mistakes. We did not give them the tools they needed, the training, the process. If there was an error, leadership owns it. But the doctor does too and was always empowered to make it in the first place.
We must put trust in our people. If you do not trust your team, you should fire them. If you do, empower them, but own it all.
10. Leaders put their people first
This last principle ties everything together and is perhaps a summation of leadership. Simon Sinek, one of the most notable modern experts in leadership wrote a book entitled, “Leaders Eat Last.” This book is effectively the espousing and expansion of the principle.
In your hospital, what is the most important thing? If you said patients, you are right. But what about the most important thing to you? If you are a clinician, don’t answer because the answer will still be patients. But if you aren’t, then the answer should be, anyone who treats or supports the treatment of patients.
Remember, as leaders we are far removed from the day to day of our people, and necessarily so that we may maintain the proper perspective. So then, if patients are the number one priority, what should our priority be? Not ourselves, but our teams who are directly or indirectly involved in the care of patients. We can see then, why it is so important to put your people first.
If that is not reason enough, ask yourself a simple question, why would anyone want to follow you?
Simple, not easy.
Although it may seem hyperbolic, let’s think about the greatest leaders of all time, Abraham Lincoln, Winston Churchill, Mahatma Gandhi, Nelson Mandela, Martin Luther King Jr. What did all these greats have in common? Well a lot of things, but one thing in particular was their willingness to put everyone else first. These men became famous and exalted not because it was their goal to achieve high levels of revere and fame, but because they had unyielding missions that would benefit their people first and foremost.
It may be unfair to compare ourselves to these greats, but it is worth looking up to see what we can do better. One thing is certain, any time you see where you can put your team, your organization first, you are at the start of the path to being a great leader.
There have been tomes written on the topic of leadership. Entire departments at leading academic institutions are dedicated to its study and many, many experts are in the field. This article while one drop in the ocean, I hope it might have been a worthwhile drop. Leadership is important in every industry, but perhaps more critically in healthcare. Because it is such a complicated landscape, with people between each layer of complexity, having the skills, tools, and principles to be an effective leader is paramount. Understand your people, create a safe environment, start from a place of empathy, and want nothing more than for them to succeed to their fullest potential and you will have the trapping of a great leader, poised to change healthcare of the better.