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leadership

Leadership in Our Profession

The Pediatrician as Leader in American Health Care

By Charles W. Callahan, DO, FAAP
Colonel (Retired) United States Army Medical Corps
Professor, Department of Pediatrics,
F. Edward Hébert School of Medicine "America's Medical School"
Uniformed Services University, Bethesda Maryland  - Henry F. Jackson Foundation

 

“Why now?”

Tami Hendriksz
Charles W. Callahan, DO, FAAP

Training in pediatrics was an integral part of earliest medical school curricula in the U.S. and Europe in the nineteenth and first decades of the twentieth centuries. It remains a mandatory component of medical school education.  Leadership unfortunately is not.

If leadership is essentially getting people to want to do what they don’t want to do and leaving them proud to have done it, then it is a core competency for physicians in their professional patient relationships. The importance of leadership development in medical student education is slowly achieving recognition. Leadership is a component of allopathic medical school faculty professional development. But neither the Liaison Committee for Medical Education (LCME) nor the Commission on Osteopathic College Accreditation (COCA) specifically requires leadership training for medical students.

Pediatric residency training recognizes the importance of physician leadership development. Residency programs must teach “leadership skills that enhance team function, the learning environment and/or the health care delivery system/environment with the ultimate intent of improving care for patients”. The need for physician leaders in American and international medicine is finally being recognized.

For example, the days when one physician could know all that was required for the care of a patient have long passed. Now, patients in the hospital and in the clinic require that multi- and inter-disciplinary care teams assure the highest outcomes. Leading these teams will require professionals who can seamlessly move back and forth from hierarchical to shared leadership roles during different aspects of patient care. Juggling to attain a balance between complex and dynamic care-team scenarios will require wise, discerning leadership.

America needs more, better trained physician leaders even as it increasingly cannot afford the system that trains the leaders and provides the nation’s care. Something has to change.

“Why me?”
Our culture venerates medicine.  For the past forty years, the Harris Poll has asked Americans about their confidence in national institutions. Medicine has ranked among the top groups inspiring confidence among those polled for as many years. In 2014, the medical doctor was considered the most prestigious occupation in the United States in another Harris poll. We attribute the statement “With great power comes great responsibility” to Uncle Ben from the 2002 Columbia Pictures adaptation of the Marvel Comic-Book story “Spiderman.” “To those who have been given much, much will be expected.” Physicians are expected to lead.

As an aside, the second most prestigious profession in America according to the 2014 Harris poll was the military officer (rated as “prestigious” by 78% of Americans) just behind doctor (88%). America has “a great deal” of confidence in military leadership according to both Harris and Gallup polls. In fact, military leadership as topped the Harris poll as the most confidence inspiring of all American institutions for every year but one since 1990. (“Much is expected…”). However, military medicine does not have the market cornered on medical leadership.

“So How?”
We use mental models to think and operate. Models can be useful to conceptualize leadership, and countless have been proposed. The best advice regarding any model is that of economist George E.F. Box who said “All models are wrong, but some are useful.” Box contends that models are “wrong” not because they are inaccurate, but because they are incomplete.

At the Uniformed Services University, we have developed the “FourC’s” Model of Leadership as a framework to understand, develop, and evaluate leadership. The four “C’s” we use in this model address aspects of the leader as a person, group processes that involve effective leadership, and the varied context in which leadership occurs. In our model the four “C’s” are character, competence, context and communication.

Character is personal. It’s responsibility, integrity, confidence, trustworthiness, optimism, empathy, accountability, and professional values. Competence includes both transcendent leadership skills including high emotional intelligence, critical and strategic thinking, leading by example, motivating and empowering others as well as the specific expertise determined by the role and specialty. Context is the consideration of physical, psychological, cultural, and social environments including leadership under stress. Communication is the verbal (oral and written) and nonverbal sending and receiving of information.

The first step of any leadership journey begins with self. And the first priority for any medical leader is to master the basic skill set: doctors need to be excellent doctors, nurses exceptional nurses, administrators and logisticians must know and excel at their craft. The same is true in any field. In the military for example, the combat infantry leader has to master first the common soldier skills. It is a challenge to maintain mastery in these skills as you move through leader positions over a career. But begin by establishing the solid foundation and reputation in your chosen field. Get whatever necessary certifications you need and maintain them.

Play to your strengths whatever the situation. Clinicians who become leaders must always remember that the single thing that best qualifies them to speak at the board table is the fact that they touch patients. The same is true regarding the credibility to speak about electronic medical records and provider productivity. With increasing administrative responsibility, leaders may be too quick to stop practicing their craft. It can only dilute a leader’s credibility and perspective. Surrender your core competency at your own peril.

Time, energy and focus are finite. You cannot add without subtracting. What should you stop doing, or not start doing so you can maintain your basic competency? The best way to approach this is to constantly ask and re-ask these questions: “What do I want to be doing in five, ten or twenty years?”  “What are the skills I will need when I get there?” The answer to the first question will almost certainly change over time, and it should drive the answer to the second.

There is a proverb that says, “The best time to plant a tree was twenty years ago. The next best time is today.” An investment in leadership development is the same. The best first step is “leader emergence:” to recognize your role as a leader in the office, with your staff, with patients and families, on the wards, in the unit. An investment in character comes next. Follow these four “B’s” to lay a foundation:

  1. Read the basics. Refer to a leadership reading list or start your own.
  2. Read biography. Emerson said that history is subjective, and so “there is properly no history; only biography”. In literature and in life, read the lives of others. Imitate what is noble. Discard what is not.
  3. Read what you believe. For some faith traditions it will be a book of Scriptures like the Bible, Torah or Koran. For others it may be a matter of philosophy or meditative practices. Whatever your foundation, “get meta” every day: devote at least ten or fifteen minutes of quiet, reflective time to your “metaphysical” philosophy or faith. It is the way a leader stays grounded. 4) Finally visit “the balcony.”  Look down on your life frequently, on events and feelings with a trusted colleague or mentor. Adjust where needed. Reinforce or abandon when you should. 

Abraham Lincoln said, “Character is like a tree and reputation is its shadow.  The shadow is what we think of; the tree is the real thing.” The character we strive for can be summarized by an additional four “Be’s:”

  1. “Be the man (or ma’am).” We have to be the men or women that we hope to lead. We have no right to expect from others what we don’t demonstrate ourselves. 
  2. “Be the one” (John Wesley). By being accessible, approachable and affable we are available to those whom we lead whenever they need us.
  3. “Be there” was the advice Gunther Gebel-Williams gave his son when he took over the lion taming business. Be present when you get into the cage and when you climb into the leader role.  Finally Gandhi’s famous words,
  4. “Be the change” reminds us that fixing the troubles we see in others usually starts with fixing us.
    Leadership is a matter of who we are much more than even what we do, “Common souls pay with what they do; nobler souls, with what they are” (Ralph Waldo Emerson). The leadership development journey begins with a small but significant realization. Having a future image of the self as a leader motivates and guides leadership development. It begins with seeing the face in the mirror as a leader.

American medicine will change. The changes will impact the lives and health of children.
As pediatricians we are challenged to decide:  Will we be the leaders or the led?

 

About the Author:
Dr. Callahan is a physician executive and academician with 30 years of experience who has served for the past decade at the hospital executive level as chief medical officer, chief operating officer and chief executive officer of five military hospitals and medical centers in the Washington D.C. area.

His first two decades were spent practicing academic general pediatrics, pediatric pulmonology and pediatric critical care. He has held the rank of Professor of Pediatrics since 2001 and has more than 100 publications, seven teaching awards and $2M in research grants. In addition to senior executive positions, he has served at every level of hospital administration including PICU Service Chief, Pediatric Residency Program Director, Pediatric Department Chief and Chief of Professional Services of a health system in combat. In 2014 he volunteered with Partners In Health and treated children and adults with Ebola in rural Sierra Leone. In November 2015, he will become the Vice President for Population Health, University of Maryland Medical Center, Baltimore MD.

Follow Dr. Callahan’s leadership blog at http://henryv43.wordpress.com/ and on Twitter @henryv4_3.

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