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What does it take to be a good leader?
Effective leaders can be bred, not born
by Tammy Worth



Published in the February 2008 issue of Today's Hospitalist

At a session on leadership presented during a hospital medicine conference last fall, baseball provided an example of what does—and doesn’t—define leadership.

As the session presenter, Aaron Gottesman, MD, pointed out, successful teams need more than superstars to win. He noted that while New York Yankee Alex Rodriguez had led his league last year in homeruns, runs scored and (astronomical) salary earned, he had not taken his team to the series.

“The superstars like the A-Rods of this world can help their team with great statistics,” said Dr. Gottesman during the conference, which was
“Loneliness is a sentiment frequently used to characterize new leadership.”

–Aaron Gottesman, MD
Staten Island University Hospital

held by the World Research Group. “But if the team is not cohesive, it becomes dysfunctional.”

Having superstars on your bench is very different from having effective leaders, said Dr. Gottesman, director of hospitalist services and associate director of the internal medicine residency program at Staten Island University Hospital in Staten Island, N.Y. While he said that superstars—think nocturnists in hospital medicine—are important team members, it is a manager’s ability to lead the entire group that counts.

And achieving success as a leader takes skills that are rarely part of physician training, Dr. Gottesman pointed out. Unfortunately, he added, leaders in hospital medicine—like those in many other fields—are put in positions without guidelines or support, and often harbor major misconceptions about how they should feel and act.

As a result, he said, most leaders find themselves in the same position he did when he became director of his program five years ago. “When I was first appointed,” he told the audience, “I was absolutely clueless as to how to run my group.”

The superstar myth
According to data Dr. Gottesman cited, the average hospitalist group consists of between seven to eight full-time equivalents. With the number of hospitalists projected to hit 50,000 in the next 20 years, literally thousands of physicians will find themselves in leadership roles in terms of group, committee or hospital management.

What that means, he explained, is that hospital medicine, which is a relatively new field, will be rife with young and untested managers. Those managers will be particularly vulnerable to common leadership myths.

One myth is that leaders are the “superstars” of the field, larger-than-life personalities who head the pack, answer to no one and look out for only themselves. In reality, Dr. Gottesman said, effective leaders rely on standards and data, not charisma. And they are extremely dependent on those around them.

“The perception is that leadership is defined by being an authoritative individual,” he said. “The reality is that it is more of an interdependent position.”

Clinging to the misperception that you need to be a lone-wolf leader will only exacerbate what Dr. Gottesman said are typical (and typically unmentioned) reactions to becoming a boss. “Along with being disoriented, confused and suffering from the occasional panic attack,” he said, “loneliness is a sentiment frequently used to characterize new leadership.”

Born or bred?
Another common myth: Authority comes with the territory, something Dr. Gottesman characterized as the myth of “positional power.”

“Once we have been appointed to this leadership capacity,” he pointed out, “there is some sense that we magically become leaders.” Instead, power comes from being able to drive, not dominate, decision-making and to foster interdependence within the group. Instead of trying to become the chief expert, he said, leaders should aim to be the chief facilitator.

But what if you don’t have some essential leadership skills, like the social skills to manage relationships?

“The reality is that leadership is more of a bred phenomenon than a born phenomenon,” he claimed. “Through deliberate practice, even coaching if necessary, you can actually change your skill set and become a leader.”

Personality conflicts
Along with figuring out what new personal and operational skills they need, leaders have to be tuned into their own emotional and psychological triggers, Dr. Gottesman said.

“Before you can conduct and control the group, you need to control yourself more than anything else,” he said. “Watch your words and your winks.” Even insignificant comments or actions can play a major role in perceptions of favoritism and can affect your capacity to lead.

But even when leaders have that self-control, they’ll often run into another problem they’re unprepared for: personality conflicts.

“Physicians are trained to manage diseases and patients,” Dr. Gottesman said, “not other physicians who, like any other group of people, can be depressed, suspicious, narcissistic or think the grass is greener somewhere else.”

Unfortunately, many young leaders managing difficult staff begin to voluntarily shoulder those problems instead of dealing with them head-on. In such situations, the leader becomes what one article cited by Dr. Gottesman from the Harvard Business Review called a “toxic handler.”

Leaders who find themselves in that position often don’t know where to turn for help. According to Dr. Gottesman, facilities need to learn to acknowledge the existence of toxic handlers and offer remedies to help them decompress.

First, individuals should be encouraged to share their experiences, possibly through an organizational leadership-support group. And managers can be reassigned to other areas to allow them to “detoxify.”

Leading the leaders
With new leadership beset by so many problems, the issue of finding a mentor becomes critical. But finding a mentor, particularly in larger hospitals, is difficult.

A chair of medicine trying to regularly mentor a new hospital leader, for instance, typically passes that responsibility to a lower-level individual, who is likewise frequently too busy.

Or politics leads to poor mentoring, said Dr. Gottesman. Some mentors fear that the mentee will make them look incompetent, leading those mentors to try to diminish the new leader’s role or accomplishments.

And senior managers—who often are appointed as mentors to new leaders, Dr. Gottesman said—may be “burned out or feel they have been passed over for promotions.” Such individuals can often have a negative effect on a newly hired leader.

“Those who are in leadership roles, who never experienced a good mentor, cannot pass the experience along to the next generation of leaders,” he said.

Look to nontraditional lessons
Dr. Gottesman also urged hospitalists to look to nontraditional sources for insights into how to lead. “You can learn a tremendous amount from sources that seem totally irrelevant to your primary source of business,” he said.

Consider, for instance, the international news from the Ukraine, where the political process apparently includes poisoning your opponent.

Even during that country’s recent upheavals, Dr. Gottesman said he was fascinated by the fact that foreign investment in the Ukraine tripled over the last several years, from just under $2 billion in 2004 to $6 billion in 2007.

The lesson that he took away for hospital medicine leaders? If you’re in a facility beset with political turmoil, focus on your own group’s goals and service lines, not on the in-fighting.

“Leave the big boys to fight it out,” he said. “That should be a separate issue from the concerns of customer service and quality care.”

Or consider the recruiting problems of the Cirque du Soleil, the famed troupe that entertains close to 10 million people. The circus, Dr. Gottesman explained, employs 24 giants, 466 contortionists, 23 whistlers, eight dislocation artists and 14 pickpockets.

The challenge? In staffing both circuses and hospitalist groups, “it becomes important to understand how we replace such unique people,” Dr. Gottesman said.

That dilemma hit home recently, Dr. Gottesman said, when two out of his four nocturnists suddenly became unavailable. One had a medical emergency while the other left for another position.

He said he dealt with this conundrum by meeting with his entire hospitalist staff and getting help from his departmental leaders. The solution? One of the remaining nocturnists covered several shifts; the nocturnist who was leaving agreed to stay on in a part-time capacity; and the rest of the hospitalist group absorbed the remaining shifts.

“When the team believes in the mission of the organization,” he pointed out, “transient challenges are more easily transcended.”

The summit syndrome
Even when they manage to avoid a bad mentor or difficult staff, successful leaders have another hurdle to clear: the summit syndrome. When leaders finally master a given role and have no new challenges to overcome, they find it hard to continue.

“You finally reach the peak and now you are bored, so where do you go?” Dr. Gottesman asked. “This can trigger all sorts of discomforting feelings.”

The cure, he said, is to recognize that the syndrome exists and to refocus your career. Fortunately, he said, hospitalists can now branch out into senior roles within hospital administration, quality improvement, research, education or public health.

In pursuing those new avenues, the same principles of effective leadership apply, he pointed out: Leaders need to admit their weaknesses and turn to others for help.

“And they need to get out of their own comfort zone,” he said. “Achieving a new status is fundamental to learning appropriate leadership skills.”

Tammy Worth is a freelance health care business writer who is based in Kansas City, Mo.

Stages of new leadership
Paraphrasing an article in the Harvard Business Review, Aaron Gottesman, MD, who is director of hospitalist services at Staten Island University Hospital in Staten Island, N.Y., said that new leaders go through the following stages as they grow into their new role:

  • Taking hold: For as long as several months, new leaders go through orientation and evaluation and make necessary corrective actions. Some hallmarks of this stage include understanding the new situation; developing initial priorities; developing expectations with key subordinates; and establishing effective working relationships.

  • Immersion: This period represents more developed, exploratory learning and management. Managers achieve a more thorough understanding of the organization and staff. They also learn to anticipate future problems, reassess their priorities and settle issues with key personnel.

  • Reshaping: This is when new managers act on their plans. They reconfigure the organization, deal with causes of residual issues and tackle problems that arise from new changes.

  • Consolidation: In this stage, new managers evaluate what they have learned, follow through on plans for change and make further corrective actions. They also deal with problems that arise from changes made during the reshaping phase.
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