From Clinician to Executive Leader

Critical Lessons as Clinicians Move into the C-Suite
As healthcare organizations continue to redefine their business model in response to declining performance and intensifying financial pressure, they are recognizing the need for leaders from clinical backgrounds. The transformation they envision requires a fundamental rethinking of every aspect of the patient care continuum. Such a radical redesign cannot be done effectively without clinicians engaged as partners in the design process. They have the most complete understanding of the current processes and their limitations. And their support will be key to successful adoption of any change, support best achieved by giving them an ownership stake through their role in the design process.
As organizations seek to expand engagement of clinicians in leadership roles they are experiencing a number of challenges. Some of those challenges reflect the way in which clinical leaders are deployed. Other problems arise from failing to equip those new leaders with the behavioral competencies required for success in their new roles. For many of them, the skills that made them successful in their clinical roles have little to do with what is needed in their executive roles. Without the chance to build new muscle, it is not surprising that many struggle to find success.
Here are a few things for these clinicians, and their organizations, to keep in mind as they assume new roles in executive leadership:
1.   Develop an understanding of the differences in key competencies. The role of leadership in a complex healthcare enterprise requires different skills than those that make one a successful clinician. The focus of a highly effective clinician is on the reliable diagnosis and prescriptive response to a clinical issue (with understanding and compassion for the human reality that is part of that issue). It involves gathering essential information, processing it, making decisions and directing others in the execution of the appropriate tasks. It is predominantly task-oriented and skills-based, with an emphasis on technical knowledge. That is, of course, not the whole story. Effective clinicians understand that they work as part of a team and are skillful at managing the interpersonal dynamics of that team. But the essential nature of the work is around reliable determination and execution of a plan of care in accordance with the best current knowledge available.
Contrast that with leadership. In the words of one of my MEDI Leadership colleagues, Blaine Bartlett, leadership is the art and science of “creating coordinated movement.” It involves engaging and inspiring others around a vision designed to further the organization’s mission in an uncertain and turbulent future. Leaders must anticipate the impact of future trends and design solutions that weave together multiple functions into an integrated, high performing system. That system must produce results which create harmony across an array of performance metrics: clinical quality, patient safety, patient and family satisfaction, employee and physician satisfaction and financial sustainability. It requires skillfulness at collaboration, innovation, and change management. It involves leading through influence more than positional power. It demands comfort with ambiguity and prudent risk-taking.
If organizations are to realize the desired benefits of engaging leaders from clinical backgrounds, it is vital to recognize that new skills are needed and to be intentional to assure they are proficient in those skills as they assume their new roles.
2.   Provide opportunities for development beyond “training”. A frequent mistake we have observed when organizations add new clinical leaders is a failure to provide adequate development opportunities to equip those leaders for their new roles. Many of the critical competencies of leadership are behavioral, not technical. Building new behavioral competencies requires more than knowledge. It involves creating new habits, starting with building deep self-awareness of one’s profile and preferences in communication, decision making, conflict management and a whole array of leadership behaviors. With that increased awareness, leaders can work to build new leadership muscle through mindful, sustained practice in the context of their daily work. In our experience, learning about effective leadership in a classroom is not enough. Behavior change is most likely to occur through applied learning with the support and encouragement of a coach or mentor who can provide objective feedback and constructive challenge when needed.
In addition to providing opportunities for applied learning of new behaviors, it is also essential to give these new leaders an orientation to the context and information they need to be equipped to engage with their colleagues in leadership. They do not need to become subject matter experts in the complexities of reimbursement, finance, marketing, regulatory matters, process improvement or any of the other technicalities or disciplines of a contemporary healthcare enterprise. They do need, however, a sufficient orientation to be conversant in the basics, enough that they can meaningfully engage in and contribute to the dialogue. If they are engaged but not equipped, they will play a subordinate role, not the role of partner in the design of thoughtful, sustainable solutions.
3.   Create a “Third Table”. Another mistake many organizations make as they create positions of clinical leadership is relegating individuals in those roles to serving as a liaison to their clinical colleagues rather than an integral part of the leadership team. Rather than serving as a partner in designing the change they are dispatched to develop “buy-in” from their colleagues to changes that have already been determined. One of my MEDI Leadership coaching colleagues, Eric Norwood, has coined the phrase “Third Table” to capture the difference here. What is needed is not giving a clinician a seat at the “hospital table” or giving hospital staff a seat at the “clinicians’ table.” Instead what is needed is a new, “third table,” made up of clinical and non-clinical leaders working to design improvements by recognizing and leveraging the interdependence of hospital operating systems with evidence-based clinical practice.
4.   Shift the Mindset from “Advocate” to “Partner.” One final challenge for clinicians moving into leadership roles is shifting their mindset from an advocate for their discipline to a partner in integrating the needs of their discipline into the design of sustainable change. The word “advocate” is a powerful and potentially divisive one. It implies a mindset of seeking to advance one’s own interest without regard to the impact on the other disciplines that make up a system of clinical care. Claiming the moral “high ground” of patient/physician/nurse advocate to prevail over other concerns can often obstruct getting to solutions that not only serve those interests but address other critical considerations, like finance, as well.
It is understandable that physicians, nursing and other clinicians often adopt this advocate posture. In the hospital setting of the past, the administrative, nursing and physician disciplines often worked in silos interacting with one another in a hierarchical or power based relationship. As organizations recognize the limitations of that model and seek to build a new approach of collaboration and integration, each participant at the Third Table must do more than advance their individual needs. They must search for solutions that address the needs of all parts of the system and produce a balanced scorecard of sustainable results.