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Good Leaders Make Good Doctors

Most people think of doctors as scientists, caregivers or educators. But we must also understand doctors as leaders.

by Dhruv Khullar, M.D.

This article was originally published in The New York Times on Nov. 21, 2019. Reprinted with permission.

During our final year of medical training, I would take turns with the other senior residents responding to cardiac arrests in the hospital. We’d spend weeks camped out in the doctor’s lounge, our hearts racing at the prospect of a patient’s heart stopping, bracing for the moment a shrill pager or overhead speaker would signal an emergency.

When the signal came, two dozen clinicians of different ranks and specialties would descend on the patient’s room. It was then the on-call senior’s job to conduct an efficient, morbid, sometimes miraculous symphony to revive a patient whose heart had stopped beating.

The clinical aspects of running a code are straightforward, requiring little more than a handful of medications and a stopwatch. But the leadership task is exceedingly complex. Within seconds, the doctor in charge needs to impose order on a chaotic room rife with alarms, shouts, needles and tears. Who’s performing chest compressions? Intubating the patient? Checking lab work that might unearth a clue? Who would be alerting the I.C.U. that a patient will — hopefully — be transferred within minutes?

Most people think of doctors as scientists, caregivers or educators. But we must also understand doctors as leaders. Physician leadership is critical for better patient outcomes, clinical performance and professional satisfaction. That’s true not only during emergencies, but also for managing chronic diseases or improving hospital efficiency.

Consider a recent effort to improve care for patients with heart attacks — who are twice as likely to die at low-performing hospitals as high-performing ones. In a two-year program created by Dr. Leslie Curry of Yale and Dr. Elizabeth Bradley, now president of Vassar College, the Leadership Saves Lives initiative trained clinical leaders from 10 hospitals, with a focus on changing hospital culture and promoting proven practices. Clinicians received leadership education through yearly meetings, semi-annual workshops and continuous remote support.

Hospitals where leaders were able to transform culture — through engaging staff, better managing conflict and communicating more effectively about new care processes — saw large reductions in heart attack death rates. The Leadership Saves Lives Toolkit has been promoted by the American College of Cardiology and is now being used by some parts of the National Health Service in England.

“We know culture matters,” said Dr. Bradley. “But we wanted to show that you can take tangible steps to improve culture by training leaders. We thought we’d see an effect. We didn’t expect to see it so fast.”

Strong leaders are not only good for patients, but also for doctors, as a program from the Mayo Clinic illustrates.  Each year, clinicians at Mayo assess their supervisors — all of whom are physicians — on a Leader Index, a simple 12-question survey of five leadership domains: truthfulness, transparency, character, capability and partnership. Does the physician-leader support colleagues? Are they approachable and fair? Do others feel psychologically safe working with them?

The results have been impressive. For every one-point increase in a leader’s score, there is a 9 percent improvement in professional satisfaction and a 4 percent decrease in burnout among frontline doctors. Across departments, nearly half of the variation in satisfaction can be explained by the Leader Index score of the chairperson.

“If you had an orchestra, you wouldn’t want a conductor who’s never played an instrument,” said Dr. Stephen Swensen, former director of leadership and organization development at the Mayo Clinic. “It’s the same with hospitals and physicians. Physician leaders are important — and the most important leader is the one closest to you.”

More broadly, developing physicians as leaders may be good for the medical profession as a whole. A central force behind doctor dissatisfaction is bureaucratic intrusion and loss of professional autonomy. The number of non-physician administrators in the American health care system has skyrocketed in recent decades, and many physicians feel frustrated by policies imposed by those they perceive as disconnected from the realities of clinical care.

Grooming doctors to assume leadership roles could help. Physicians are happier when their bosses are also physicians, and hospitals with physician chief executives seem to perform better than those with non-clinical leaders.

And it’s probably good to start the process early. Medical school admissions have traditionally focused on test scores and GPAs, but assessing leadership skills may be just as, if not more, important for selecting students who will become good doctors. Some residency programs, including my own at Massachusetts General Hospital, have recognized the need to formalize leadership education and have introduced business school-inspired courses on management and emotional intelligence.

Increasingly, medical groups are also creating dedicated pathways for physicians to hone leadership skills and assume graded levels of responsibility over time. For example, Sound Physicians, a company that employs more than 3,000 physicians across the country, has a pipeline for doctors to advance through structured rungs of leadership — emphasizing a different mix of clinical, strategic and business skills at each stage, from individual practitioner to the C-suite. The training includes in-person and online courses, as well as an annual conference, to help doctors develop management and leadership competencies, and learn how to apply these skills within their organizations. Since introducing its leadership development program, the company reports less turnover, higher morale and better growth.

Today, talk of leadership is so pervasive it can sometimes feel empty — the stuff of resume-padding and political advertising. But in medicine, effective leadership has tangible benefits. As our health system continues to struggle to devise ways to improve quality and reduce costs, it’s increasingly clear that a healthy culture can lead to better medical care. For their patients and their colleagues, doctors must be leaders.

Dhruv Khullar was a 2012 Medical Fellow. He is a physician at New York-Presbyterian Hospital and an assistant professor in the Weill Cornell Department of Healthcare Policy and Research.