5 Thoughts on Physician Leadership Styles

This week, we have the privilege of facilitating a workshop for the American Gastroenterological Association leadership fellowship program on Self-Awareness as the Basis for Effective Leadership.  One of the topics will be leadership styles.  We thought we share a few quick thoughts, here.

All Doctors are Leaders

A recent HBR article – “Why Doctors Need Leadership Training” points out that even in their training, physicians lead other physicians.  Quickly, they are leading multi-disciplinary teams.  Often, they progress to more formal leadership roles. Few physicians, though, receive any formal leadership training. Yet, we often ask a new physician to lead a diverse team, and be responsible for the success of a facility, all while continuing her growth and development as a clinician.

“Wait. There are different leadership styles?”

Medical training is, by its nature, hierarchical and autocratic. It’s no surprise, then, that physicians, by and large, gravitate towards an autocratic leadership style.  More importantly, I’ve found that most physicians have never actually given much thought to the concept of leadership “styles.”

Often, in our leadership training, it’s the first time physicians identify what they are most familiar with as “autocratic.”  It’s also the first time they’ve considered that there are other leadership styles – and that they might be more effective.

It’s one reason we often see physicians frustrated.  Their default leadership style fails, and they have no idea why.

Certainly, you can complicate this discussion.  Dan Goleman of Emotional Intelligence fame, for instance, breaks it down to six different styles – Commanding, Visionary, Affiliative, Democratic, Pacesetting, and Coaching. 

Autocratic vs. Transformational Leadership

I like to start just by comparing an autocratic leadership style to what we can call “transformational” leadership.  The former is where the leader decides the path, decides the solution, gives orders, and closely controls the team. 

Transformational leadership, on the other hand, has the leader focused on motivating and inspiring, building trust, engaging the team, delegating decision-making authority, and building “team” accountability (as opposed to accountability to the leader.)

How unnatural is transformational leadership to some physicians? I was doing a training recently and after I described these two styles, the first question from a participant was “What do you do in the transformational approach, when the person doesn’t do what you wanted them to do?”

The other issue that comes up?  Some physicians believe we want them to be a transformational leader because it will make the team “feel” better.  Physicians are surprised to learn, though, that in many situations, enhanced collaboration, driven by a transformational leadership style, is simply more effective at accomplishing the group’s goals.  In fact, there is evidence that transformational leadership enhances quality of care and cost control.  See, https://www.ncbi.nlm.nih.gov/pubmed/16330822

Leadership Style Flexibility

Research also shows that the most effective leaders can deploy different leadership styles in different situations.  Consider a surgeon in the OR – the nature of the work requires that she adopt a relatively autocratic leadership style.  Even here, though, an overly autocratic surgeon may discourage team members from speaking up when they see an error. 

The most effective leaders can deploy different leadership styles in different situations.

When that same surgeon is in a room with a multi-disciplinary team trying to solve a complex operational or process issue, however, a more transformational leadership style will be more effective.

It all Starts with Self Awareness

Think about a physician trying to influence hospital administration, or teams of individuals who do NOT report directly to the physician.  The autocratic approach is sure to fail.  It’s one reason we often see physicians frustrated.  Their default leadership style fails, and they have no idea why.

Fundamentally, leadership hinges on relationships and the ability to deploy different leadership styles requires a level of self-awareness. We can look at this through the prism of emotional intelligence – the ability to understand yourself and how you are being perceived, and adjusting, accordingly.  You can look at through the prism of personality, generally.  For instance, it’s going to be harder for an introvert or someone naturally low in social awareness, to adopt a transformational leadership style.

A transformational leadership style also requires more advanced communication skills. These skills come naturally to some, and not to others – but they are skills that can be developed.

Our work with physician leaders continues to confirm for us that self-awareness is the foundation.  If your goal is to influence the organization, you need interpersonal skills –because these are how you inspire, motivate and influence people. Interpersonal skills require deep intra-personal knowledge as the starting point.