Management: Leader of the Band

Do your partners and staff look to you as a leader? Are you maximizing your practice’s resources to orchestrate the best results for your patients and your business?

Medical practices should take a cue from the business world and realize that it’s often the person directing an organization who determines its success - or catalyzes its downfall.

While it’s often assumed that physicians are natural-born leaders, the truth is that capable leadership requires a very different set of skills from those physicians typically possess or are taught in medical school and residency. In fact, the very qualities that make for a successful physician can sometimes be at odds with those of an effective business leader.

Successful leaders of medical practices do share some traits. We’ve assembled five general rules that can help you become a more productive physician leader.

Rule #1: Communicate

Without a doubt, the single most crucial characteristic of a successful leader is the ability to effectively communicate.

Anyone can talk, but not everyone can communicate. Being able to effectively communicate as the head or a partner in a medical practice means having the ability not only to accurately explain ideas and concepts to employees and patients, but also to convey those ideas in such a way that they are easily comprehensible.

Psychologist Daniel Goleman, author of “Social Intelligence” and the bestselling “Emotional Intelligence,” believes effective communication is crucial to the success of a medical practice as a business. “If you apply the business model to a medical practice, you realize that physicians are in what is called a ‘relationship business,’ which means that the critical factor for economic success is continued positive relationships with customers - or patients, as you call them.”

Take as a sobering example a study led by researchers at Vanderbilt University that found that obstetricians with the highest rates of malpractice claims filed against them were just as likely to provide quality medical care as their peers without such claims. What were the physicians being sued doing differently? Not communicating with their patients - or doing so very poorly. Researchers found that physicians who didn’t take the time to listen to their patients or to answer their questions were at a much higher risk for being sued for malpractice than were physicians who did take the time to listen and respond to their patients.

Physicians who communicate well with their staff likewise experience less resistance and more success.

“Your other physicians [and employees] need to know what you’re trying to achieve, where you’re trying to go,” says Hal Teitelbaum, managing partner and CEO of Crystal Run Healthcare in Middletown, N.Y. In other words, people often need to know not just what to do, but why their actions are important.

Yet while explaining the impact of your actions to employees is important, true communication doesn’t stop there. You must also listen to your employees, understand and appreciate their concerns, and realize the effect that your actions have on others.

“A leader is a steward or a servant, which is to say that leadership is not about the leader; it’s about the success of the organization and the collective mission,” says Goleman. “This is not the ER, and this is not surgery; you can’t just bark commands and expect people to perform at their best.”

Whenever confusion or even chaos begins to reign in your practice, its origins can almost always be traced back to poor communication of some sort. To restore order, effective leaders must be able to detect and bridge the communication gaps that damage their practices and then reach out to employees in ways they can understand.

It is tempting in these days of crowded daily schedules to use technology as a shortcut to avoid what can be lengthy one-on-one conversations. But messages conveyed by tools like e-mail and instant messaging can be misinterpreted, often inflaming any conflict that already exists.

Teitelbaum’s practice is even backing away from using the videoconferencing it once regularly employed to communicate among its locations. “We’re increasingly returning to the concept of having meetings of all of our physicians in one location where people can actually see one another, talk to one another, and communicate,” he says. “There is a lot more of an emotional component when you’re seeing someone face to face, talking to them.”

Rule #2: Lead; don’t manage

How many times have you heard the phrase, “It’s lonely at the top,” or, “There’s always a lead dog,” or even, “I’m the commander in chief”? The idea that one person pulls all the strings within a single organization - no matter how large - is so firmly ingrained in our culture that we often don’t even question the assumption. After all, doesn’t someone have to be the boss?

Well, yes and no. When most of us think of a leader, we typically picture the one person at the top of the organizational chart who makes all the big decisions. But that’s an outdated view of how organizations work. Particularly within medical practice, it’s important to distinguish between leadership and management roles.

Managing a medical practice encompasses all of its day-to-day operations - that is, making approximately umpteen bazillion decisions in order to maintain the processes that must be kept operational to ensure the practice runs efficiently. Such management encompasses everything from reception to billing to work flow to accounting, and it’s usually geared toward short-term necessities.

Leading a practice means focusing on its long-term goals. Stephen Covey, the well-known management guru and author of “The Seven Habits of Highly Effective People,” once described the difference this way: “Management is efficiency in climbing the ladder of success; leadership determines whether the ladder is leaning against the right wall.”

“When you’re [leading] a large organization, you’re basically doing the ‘80/20 rule,’” says Mark Shields, a physician and the senior medical director for Advocate Health Partners, a physician hospital organization headquartered in Mount Prospect, Ill., that employs nearly 2,700 physicians. “You’re going to be focusing on the 20 percent of things that are really going to be responsible for 80 percent of the performance. You’ve got to push the other things off your plate.”

That can be a difficult approach for physicians, who are accustomed to taking in every detail in order to best treat their patients. The “80-20 rule” is obviously not how physicians should approach patient care, but it is often the way they should approach leadership. Effective leadership is about producing long-term results, not micromanaging every aspect of how a practice operates.

“In our own practice, we have a lot of people who are not physicians in important positions and management roles. You need people who have expertise in a variety of areas - human resources, financial expertise, operational expertise,” says Teitelbaum, who knows a thing or two about being an effective physician leader. His Crystal Run Healthcare expanded from a two-physician oncology practice in 1994 to what is today: a multispecialty practice with seven offices and more than 125 physicians. The Medical Group Management Association named Teitelbaum its 2006 Physician Executive of the Year.

Teitelbaum recommends that physician leaders leave the day-to-day management tasks to others. “The role of a leader is setting the strategic direction, the philosophy of the practice, and communicating that to people, as compared to simply being an effective manager,” he says.

Rule #3: Have a plan

It’s amazing how many people forget that a leader is supposed to lead - and leading implies that you are going somewhere.

“Being a leader is somewhat meaningless if you’re sort of just going around in circles,” says Teitelbaum. “If you don’t know where you’re going, it doesn’t matter what path you take to get there.”

Physician practice heads who are effective leaders possess the ability to communicate their vision and articulate a strategy for their business. That could mean focusing on increasing revenue, expanding the practice, promoting patient satisfaction, or enhancing quality of care. The primary job of any practice leader is to establish these types of long-term goals for the practice as well as practical strategies for achieving those goals.

“Physicians are much more likely to do something differently if they can clearly see why it has to be done and they can clearly see the strategy by which it has to be accomplished,” says Stephen Beeson.

Beeson is a full-time family medicine physician with Sharp Rees-Stealy Medical Group, a 290-physician, multispecialty practice in San Diego. In 2002, Beeson was selected by Sharp HealthCare to serve as its physician director for the Sharp Experience, formed
to promote the organization’s commitment to service and operational excellence. He recently authored the book, “Practicing Excellence: A Physician’s Manual to Exceptional Health Care.”

In “Practicing Excellence,” Beeson writes: “Individual physician engagement and change are more probable when the strategic priorities and mission are communicated to physicians by respected physician leaders, and they understand that their role is central to success.”

For example, if your practice doesn’t have a mission, you need to articulate one. The majority of practices we talk to say their overriding goal is better patient care. But how do they define better patient care? How do they measure it? What must they do to achieve their goal? Be specific about your practice’s mission, and communicate to your employees how you expect them to live up to it.

“If you don’t have communication abilities or vision or strategy … You’re not going to be able to instill change,” Beeson emphasizes.

Rule #4: Build consensus

Woodrow Wilson once attributed the success of his presidency to using not only all the brains he had, but also all the brains he could borrow. A successful physician leader should do the same.

Once you’ve developed a strategic plan detailing how your practice can achieve its goals, you need to set it in motion. Effective physician leaders build consensus among their employees so everyone is moving in the same direction with common goals in sight. Though it can be very tempting at times to adopt a more authoritarian approach (“This is what we’re going to do, and this is how we’re going to do it!”), leaders who do so typically find themselves disappointed more often than the leaders who make their employees active participants in their practices’ success. Taking on the role of an authoritarian can negatively affect your practice in many ways.

“I think the view that the physician is the captain of the ship has gone. Healthcare is much more complex than that,” says Patty Gabow, medical director and CEO of Denver Health, an integrated healthcare system that employs 164 full-time physicians.

Sure, someone has to make the final decisions. Every team elects a captain for a reason. But a smart captain involves all members of the team and motivates them to pursue a common goal. Great physician leaders are collaborative by nature. They utilize the best talents of people with whom they work, whether they are physicians or ancillary and administrative staff members, and they unify the group behind a single strategy for success.

That may sound simplistic, but anybody who works in a medical practice knows just how difficult it can be to accomplish this. Teitelbaum recalls a paper he wrote in business school on this very subject. He called it “Herding Cats.”

“I think it is definitely a challenge to stimulate physicians, many of whom consider themselves the last rugged individualists, each working independently toward a goal of providing good care for their patients,” says Teitelbaum. “It’s a challenge to get that group of people to work together, to realize that we can in fact accomplish more if we do work together than we can if we work independently.”

Teitelbaum credits his experience in business school with teaching him the importance of teamwork. “The whole concept of teams is important to business school and business in general,” he says. “That is not the case in medical school. In medical school, everything you do pretty much is done on an individual basis. … I think that says a lot in terms of how physicians are taught to think about things.”

Again, it all boils down to an individual’s ability to communicate effectively. “I know that I spend five hours a week with my leadership team and executive staff,” says Gabow. “I have never been able to find a way to create a common vision short of spending time together.”

Of course, communication is effective only to the extent that it is a two-way process. Listening with an open mind is just as important as talking. “One of the things that can be destructive to an organization is a leader who is not open to differing or opposing views,” warns Shields.

That’s not always easy for physicians, who are accustomed to having the final word on all things clinical.

Rule #5: Obtain hard data

How successful are you at meeting your goals? How can you know for sure?

It’s difficult to achieve a goal unless you can measure your progress toward it, and you need to distinguish between objective measurements and gut feelings.

“I think great physician leaders depend on measurement to objectify performance. They say so-and-so is a great physician because he’s a great internist,” notes Beeson. “Why is he a great internist? What are your measurements that tell us that he is a great internist? Is it the quality, is it peer review, is it productivity, is it patient satisfaction?”

Only hard data can help leaders separate facts from feelings. Schedule regular, objective evaluations of your practice’s performance using predefined, measurable benchmarks to gauge your success in reaching clearly articulated goals. This will help you make realistic assessments of the next steps you and your employees must take to promote your practice’s success. An effective leader will always help staff members understand their performance expectations and provide training and resources to assist employees when necessary.

Of course, if your evaluation indicates that you are not on course, you must be prepared to modify your action plan. “What happens in every organization, no matter how good, is that there are pockets of low performance, pockets where change is a necessity,” says Beeson. “The No. 1 reason leaders fail is their inability to deal with low performance.”

Bring it all together

Whether you are the leader of a small, three-physician specialty practice or the CEO of a 40-physician multispecialty organization, following these five rules will give you an advantage over many of the medical practices in today’s marketplace. Even if you’re not “the boss,” adhering to these guidelines can still make a significant difference at your practice.

“Every physician in practice is a leader,” says Beeson. Maybe you don’t hold a leadership position, but that doesn’t mean you can’t have an effect on the practice culture, the range of services your practice offers, or patient satisfaction and quality of care.

“There are different degrees of leadership,” explains Teitelbaum. “You may take on some leadership role within a division of the department or a practice. You may head a particular specialty division.”

At their core, physician leaders are self-motivated problem-solvers. If you see something that isn’t working at your own practice and you perceive a workable solution, assert yourself. “Just as necessity is the mother of invention,” says Teitelbaum, “I think that necessity may be the mother of leadership.”

Robert Anthony, a former associate editor for Physicians Practice, has written for the healthcare and practice management industries for five years. His work has appeared in Physicians Practice, edge, Humana’s Your Practice, and Publishers Weekly. He is based in Baltimore.

This article originally appeared in the February 2007 issue of Physicians Practice.