What makes a good leader? The answer can surprise some doctors
Leadership skills don't always come naturally
One of the physicians at Sutter Health in Sacramento was a born leader - a high performer, very energetic, with an innate ability to get things done. But, says chief medical officer Thomas Atkins, MD, "in the process, he often left a wake of disrupted relationships and distrust. He was unpredictable in his reactions to things, and his anger would surface if things didn't go his way. All the intuition and intentions were right, but he couldn't build a team, and his lack of communication skills impeded our team's progress."
The answer to the problem was to send him through Sutter Health's Leader Lab program, a three day course that helps physicians determine their strengths and weaknesses and create goals to make them better leaders.
Atkins, who has sent his group's entire senior medical management team through the labs, says that 80% of those who complete the program substantially change their behavior in a positive way.
For the doctor who was cutting a swath of destruction through his team, the outcomes were positive, but it was a difficult process, Atkins says.
"This is the first time physicians have to really deal with others' perceptions of them," he says. "It was traumatic for me, and I'm sure it was for him. It's hard to hear words like nonsupportive, arrogant, doesn't listen. It's presented as objective data and is hard to ignore. But if you are committed to making your leadership successful and you are hearing that your behavior is an impediment to success, then you have no choice but to change."
The physician in question changed fairly quickly, Atkins says. "Sometimes he reverts back, but he doesn't lose his temper any more, and he is better at listening. He runs better meetings, and in his area, goals are met more quickly. He is one of my most effective people now."
Sutter Health, with about 4,000 affiliated physicians, is the second largest health provider in northern California. The labs started about four years ago and train a maximum of 10 physicians per class three times a year.
According to Gene Scott, PhD, vice president of education and organization development at Sutter, those selected to attend must be sponsored by their department head, clinic administrator, group chief medical officer, or some other superior who agrees that he or she has leadership potential.
"That sponsorship link is really important," says Scott, who developed the course with Deborah Olson, a vice president at the Hay Consulting Group in Los Angeles. "If we are going to have a lot of leverage, having the organizational sponsor who is also invested in the physician's attendance and learning is important."
First step: Get feedback from peers, others
Once approved for attendance, the physician gives the outside consultant a roster of bosses, peers, and subordinates who will provide feedback on his or her leadership behavior. The minimum is six people, and Scott says 10 is the preferred number.
Those people are asked to complete a leadership profile survey on the physician's behavior. The physician must also complete a self-evaluation, a Myers-Briggs indicator questionnaire, and a picture story exercise, a series of six stories based on pictures, which provides data relevant to a motive profile for the attendee.
The profile process - called a 360 Survey - is completed about six weeks prior to the seminar, says Scott. "All this work means you have to show some commitment. The work you fill out on yourself takes a minimum of an hour and a half. Even the folks providing input on your behavior, if they are doing it with any seriousness, take a half hour to complete. There has to be a real commitment to this throughout the organization."
The workshop itself starts with a discussion on why each person is there and what kind of difference he or she wants to make in the organization. Scott says he tries to make it a heterogeneous group - in terms of geography, practice location, and whether the participant is from a medical group or IPA or is a medical staff leader or institutional or organizational physician. He even tries to ensure a good gender mix. "That's a lot harder than you think," he adds.
Next, participants hear the results of the Myers-Briggs tests. "This helps them to see that their behavior isn't totally random," says Scott. "There are patterns."
The second day is spent hearing the truths told by participants' bosses, peers, and subordinates. "This is the hardest part," says Scott. "Physicians, in one sense, are used to feedback - through peer review and on an immediate basis when patients get better or not. But outside of their clinical selves, they tend to be one of the most feedback-deprived groups that one can find."
After a break, Scott and his partner from the Hay group start a series of one-on-one meetings with the physicians during which they are given more interpretation about the data they received and explore their feelings about the data, says Scott. In some cases, the meeting also starts a "deep reflection about what they are doing and where they want to go, and what they want to do with their professional life."
Some discover they are not leaders
Sometimes, the participant feels it is all too much and decides he or she doesn't have the commitment and satisfaction for leadership and administrative positions. Scott says he sometimes fields calls from irate bosses who feel they have lost a member of their team. "It may take awhile, but I have to convince them this is a raging success. It's achieving one of the important outcomes for Leader Lab. We want participants to come away with clarity. Realizing they don't really want to be in leadership positions saves everyone a world of wasted time, energy, and emotion."
The third day is spent developing a plan of action to deal with two - or at most three - areas for development. "Even if they have every area that is two standard deviations from the norm, we don't want them to work on more than three at a time, and two is preferable."
Atkins says poor communication is one of the biggest problem areas. How to exercise influence is another, says Scott. "Physicians frequently have no clue on how to build and exercise influence within a complex organizational structure," Scott says. "I donmean a big structure like Sutter, I mean one as complex as their own medical group."
If that is one of the areas on which the participant wants to work, the faculty will help him or her develop goals to improve the behavior. Each doctor is given a resource guide with a list of activities, readings, and workshops or seminars that might help improve that area. (For a partial list from the training's impact and influence section, see box at left.)
Built-in accountability
The process doesn't stop there. There is an accountability built in and a repeat of the 360 Survey a year later, although on a voluntary basis. Members of Atkins' group go through the survey regularly, just to monitor their progress.
Scott says the success of Atkins group with the labs is remarkable. "In the majority of cases, there is improvement, but it isn't an overwhelming majority."
For now, the process is limited to physicians only. But Scott says that in the future, it may be adapted to other providers - such as nurse practitioners and physician assistants - and non-physician administrators.
Practices that want to replicate the Leader Lab experience for their own doctors have to be committed to the process. "It isn't cheap to do this," he says.
But for those who see the benefit, Scott has four suggestions:
1. Develop a success profile that is relevant to your situation.
Determine what leadership behaviors are valued in your organization that top performers do more frequently. That's what you want to replicate.
2. Develop a way to give your target participants some means of feedback against the target profile.
Most good HR consulting firms can help in developing a 360 Survey process.
3. Have a way to translate the feedback into action.
Feedback needs to happen in a reflective, supportive environment, says Scott, where participants can absorb, learn, and translate intention into action.
4. Monitor the action plan.
Put some accountability into the process.
Although Sutter doesn't allow outsiders into the Leader Labs and is not currently selling the program, Scott says those who are interested in it are welcome to call him for more information.
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