New Leadership Skills for Physicians?
David Brooks wrote a column in the New York Times on 17 March 2015 he titled Skills in Flux. His focus was on the non-measured skills that made teachers effective in the classroom, which he illustrated with several examples. Quoting another article he reported “these subtle skills are often not recognized or even discussed by those who talk about education policy, or even by those who evaluate teachers.” Sounds familiar to physicians, too. As I argued in The Quality Paradox, what patients value the most is an empathetic, effective encounter with a clinician that leaves them satisfied their problems have been addressed. Since this is difficult, if not impossible to measure, we currently focus on “outcomes,” by which we usually mean process measures that we hope reflect meaningful results.
Brooks goes on to identify several skills he thinks have become increasingly valuable in the modern world, and I want to recapitulate them while translating them into the clinical idiom. The first skill is “social courage.” By this term he means those who are social connectors—people who make, manage, and keep friendships with large numbers of people. This is the group also identified by Malcolm Glidewell in The Tipping Point. Physicians used to be people who did this activity in their clinical microsystem—they knew the something about the staff who helped them care for patients and had a list of people they had met who were expert in rare problems that could be consulted or to whom patients could be referred. Unfortunately, today’s high turnover institutions make this problematic, although probably even more important before in making care better, as I have discussed before.
A second skill he identified was those who can identify and name amorphous trends, thereby making them more real to others. He used Karl Popper’s nomenclature of clock problems versus cloud problems to illustrate this notion.
Clock problems can be divided into parts, but cloud problems are indivisible emergent systems. A culture problem is a cloud problem, so is a personality, an era, and a social environment. Since it is easier to think deductively, most people try to turn cloud problems into clock problems, but few people are able to look at a complex situation, grasp the gist and clarify it by naming what is going on.
Think for a moment about those physicians you have known who were the real masters of the craft. Wasn’t this exactly what they did? Didn’t they have the ability to talk to a patient, take an amorphous collection of complaints, physical findings, and lab tests, and turn them into a diagnosis which could be explained clearly to the patient and to those involved in treating him/her? Rather than thinking of physicians as mere technical experts, perhaps healthcare organizations would be better served by seeing physicians as experts at naming things, thereby making it possible for the organization to address the issues more effectively.
He listed a few others briefly, and I will simply quote them.
Making nonhuman things intuitive to humans. This is what Steve Jobs did.
Purpose provision. Many people go through life overwhelmed by options, afraid of closing off opportunities. But a few have fully cultivated moral passions and can help others choose the one thing they should dedicate themselves to.
Opposability. F. Scott Fitzgerald wrote, “The test of a first-rate intelligence is the ability to hold two opposed ideas in mind at the same time and still retain the ability to function.” For some reason I am continually running across people who believe this is the ability their employees and bosses need right now.
I agree these are important leadership skills, but I don’t really think there is anything different about these. Great leaders have always had the ability to do these things, but great leaders have always been in short supply. The last skill he mentioned, though, is one that might, indeed, be particularly appropriate for physicians.
Cross-class expertise. In a world dividing along class, ethnic and economic grounds some people are culturally multilingual. They can operate in an insular social niche while seeing it from the vantage point of an outsider.
Isn’t that what those great physicians you were thinking about earlier doing? Physicians, like all people, are products of specific cultures with specific unspoken, and often unconscious, assumptions and habits of mind. But when practicing medicine, we confront the fact that our bodies operate in basically the same way despite all of these things. The great physicians, as opposed to the ordinary physicians, though, could take that insight and find ways to relate to patients who did not share their cultural mindsets. They could make accurate assessments about where the patient was starting from on and translate their diagnoses and treatment recommendations into things the patient could relate to, understand, and possibly apply, as opposed to giving them a computerized patient information sheet.
There is a lot of press about discontent among physicians, and I agree that the level is probably higher than usual right now. Now some discontent is because “the times are a-changing” and that always makes people restless. For those who still think this is what they are called to do, perhaps recasting our skill sets in these “modern” terms, as opposed to trying to learn new habits, might lead us to see how we can still contribute to the success of our clinical enterprises in a new and different way.
3 September 2015
 Brooks D. Skills in Flux. The New York Times, 17 March 2015. Accessed 18 March 2015 at http://nyti.ms/1Lm9j7F.
Doctors and hospitals operate with different cultures and unexamined assumptions may cause conflict.
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