Leadership Skills That Are Commonly Lacking
In many of my articles I have advocated for a focus on the small units—the clinical microsystem—which is where medical care actually takes place. For physicians of my generation, this emphasis seems intuitive, as it reflects the way medicine was practiced when we were being trained. However, I have many opportunities to see young physicians enter practice and see what their expectations are, and I realize that they have grown up professionally in a world that is much more bureaucratic, and probably more hierarchical, than the one I grew up in. This is not to say hierarchies were absent—far from it. But in a university hospital there was the chief, the senior staff, the junior staff and the house staff—it was relatively flat and administrators did not appear on the list. They were there, of course, but they just did not register in the minds of anyone other than the chief, and perhaps some of the senior staff. The medical hierarchy has not changed much, but it does not take much effort to establish that administrative hierarchies have mushroomed. (I have to point out that unrestrained growth in biology is called a cancer, but this is apparently not taught in business school.)
Recognizing that we are not going back to the past, I have spent a good deal of time reading and thinking about how these organizations actually operate, as well as how they can be improved. Thus, it was with interest when I found an article by Liz Ryan, who is a consultant on workplace management.
“We are getting smarter about work and people and the intersection between them. More and more, working people are telling the truth about topics that they were afraid to talk about openly before. One of the stickiest topics is the quality of leadership found in large and small employers. We are starting to tell the truth about the fact that most people in leadership positions are lacking in critical skills. They don’t know how to talk to their employees and they don’t know how to listen. If they received any management training at all, they were probably trained to dole out work assignments and evaluate people. They don’t know how to probe for understanding or how to create cohesion on a team.”
She identifies these skills as perspective taking, “allowing,” intellectual curiosity, critical thinking, connecting the dots, and humility. It struck me that in medical organizations the most difficult of these skills is “allowing.” Ms. Ryan defines this as:
“Real leaders allow people to be who they are, and they allow all the good things and the bad things that happen in any workplace to happen, because they know that they and their teammates can solve any problem if they keep their cool and resist the urge to place blame.”
Anyone who has tried to institute a quality improvement program knows that the first, and most important hurdle is to build trust and drive out blame. I was talking to my hospital medical director the other day, who was excited about new dynamics that were emerging on his patient safety team, where true openness and problem solving skills were emerging. He could see the possibility of real growth after almost seven years of effort to overcome the built in institutional fear of failure and the possibility of being blamed.
Ms. Ryan suggested several questions that managers should use to open dialog and build team effectiveness. I thought these were so appropriate for medical settings that I am reproducing them verbatim.
As you can see, all of these questions are open-ended—the type physicians are taught to use in medical interviewing, but often drop under the pressure of time. However, I have found that routine use of “What do you think we should do about this issue?” in clinical practice actually saves time and often results in better decisions. Of course, for that to work, you have to invest the time in teaching your staff so they can have an informed opinion. You have to decide, and you have to own the decision, but you really don’t have to either know or think up all the answers by yourself. Give it a try—you might be pleased with the results.
12 August 2016
 Ryan, Liz. Seven Leadership Skills Most Managers Lack. Accessed 27 May 2016 at http://www.forbes.com/sites/lizryan/2016/05/26/seven-leadership-skills-most-managers-lack/#3529f5cc1cdb.
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