So Now You’re a Leader; First Steps in Your New Role

Elaine Schulte MD, MPH

Vice Chair, Staff Development

Dept Chair, General Pediatrics

Cleveland Clinic Children’s

November 18, 2015

Acknowledgements

• Content for this presentation was adapted from leadership presentations with the AAP’s Pediatric Leadership Alliance and from a workshop done with Drs. Luanne Thorndyke (UMass) and Martha Grayson (Einstein).

• Additional content was provided by Benard Dreyer MD (NYU), Maryellen E. Gusic MD (AAMC) and Peter Szilagyi MD, MPH (UCLA)

Introductions

• Name

• Department

• Years experience

• Leadership position?

After participating in this session, you will be able to:

• Identify the strengths and weaknesses of different leadership styles and strategies to avoid typical pitfalls for new leaders

• Diagnose new situations and develop appropriate strategies to tackle challenging situations

• Build effective collaborations and promote teamwork to accomplish one’s goals as a leader

New leaders in academic medicine: who are we and what are our

challenges?

Background – Old leaders

• Medicine was an art

• Worked tirelessly – alone

• Patient-focused, not finance-focused (accidental administrators)

• Don’t like change

• Content with revenue under existing payment system

Old culture/new culture

• Old culture

– Individualistic

– Autonomous

– Expert-centered

– Competitive

– Hierarchical

• New Culture

– Collaborative transparent

– Outcomes-focused

– Mutually accountable team-based

– Service-oriented

– Patient-centered

Emerging leaders

• Women - medical students/residents

• May have some leadership training (FLEX, AAMC, ELAM) or MD-MBA combined program experience

– 1993 – 6 programs

– 2015 – over 6.4 million Google hits for “leadership training programs for physicians”

Examples of new business programs for healthcare leaders

• Harvard Business School’s managing Health Care Delivery – new in 2009

• Penn Medicine Leadership Forum through Wharton School of Business

• Vanderbilt University’s Owen School of Management

• Dartmouth College’s Tuck School of Business

Leadership development programs for physicians

• Many established LD programs

• Reported outcomes: – greater acceptance of the demands of leadership

– improved attitudes toward time management, goal priorities, and interprofessional relationship building

– increased motivation to get involved in professional activities inside and outside organization

• Future research should include well defined targeted populations (eg dept chairs)

Acad Med 88 (5), 2013

Some of our challenges

• Unlike other industries, academic institutions lack infrastructure to innovate and change

• Dept chairs are not typically groomed to be leaders

• No business skills

• Poor personnel management skills

Am J Med 2002

More challenges

• Doctors now have access to growing body of performance data

• Most physicians are now salaried, working for hospital systems

More challenges

• Financial challenges are biggest dilemmas amongst medical school deans – Decline in resources following an era of

abundance

• Building alignment – structural, cultural, role

• Staffing problems

• Morale

Acad Med 81(1), 2006

Lessons from business industry

• 5 essentials for success – CEOs share and look for in hires

Passionate Curiosity

Battle-hardened confidence

Team smarts

Simple mind-set

Fearlessness

Adam Bryant, “The Corner Office”

“Leadership is not something that you learn once and for all. It is an ever-evolving pattern of skills, talents, and ideas that grow and change as you do.”

Sheila Murray Bethel

Before you get started, let’s examine what you “bring to the table”…

Five practices of exemplary leadership

1. Model the Way Find your voice and set the example

2. Inspire a Shared Vision Envision the future Enlist others in your vision

3. Challenge the process Search for opportunities Experiment/take risks

4. Enable Others to Act Foster collaboration and strengthen others

5. Encourage the heart Recognize contributions and celebrate values and victories

Kouzes JM, Posner BZ. (2008) 4th ed. San Francisco: Jossey-Bass

Leadership Styles

• Emotional intelligence underlies leadership styles

• Situational: repertory of leadership styles

• Transformational vs. transactional

• Servant leadership

• Fitting it all Together: Synergy of leadership styles

Emotional Intelligence

• Self-Awareness:

– Know Thyself! (γνωθι σεαυτόν)

• Self-Management

• Social Awareness

• Social Skill

Relationships between Aspects of Emotional Intelligence

Self-Awareness

Self-Management

Social Awareness

Relationship Management

How Much Does Leadership Matter?

Emotional Intelligence

Leadership Style*

Organizational Success

20-30% 70%

* One way leadership style effects organizational success is by changing the “climate” , the key factors that influence an organization’s environment.

Climate*: Organizational Environment

Organizational Climate 6 Key Factors

1. Flexibility: – how free staff feel to innovate

2. Responsibility: – how much staff have a sense of responsibility to the

organization

3. Standards: – how high are the standards of productivity and behavior

4. Rewards: – how accurate and fair are performance feedback and

rewards

5. Clarity: – how clear are folks about the mission, vision and values

6. Commitment: – How much the staff are committed to a common purpose

Leadership Styles

• Coercive: “Do what I tell you”

• Authoritative: “Come with me”

• Affiliative: “People come first”

• Democratic: “What do you think?”

• Pacesetting: “Do as I do, now!”

• Coaching: “Try this”

What Works….and What Doesn’t Coercive Authoritative Affiliative Democratic Pacesetting Coaching

Flexibility -.28 .32 .27 .28 -.07 .17

Responsibility -.37 .21 .16 .23 .04 .08

Standards .02 .38 .31 .22 -.27 .39

Rewards -.18 .54 .48 .42 -.29 .43

Clarity -.11 .44 .37 .35 -.28 .38

Commitment -.13 .35 .34 .26 -.20 .27

Overall impact on Climate

-.26 .54 .46 .43 -.25 .42

Goleman D. Leadership that gets results. Harvard Business Review, March-April 2000

Style is Situational

• Effective leaders use multiple styles depending on the “situation”, frequently several in one week.

• Emotional intelligence needed to move from style to style fluidly.

• Coercive and pacesetting styles used very sparingly if at all.

• Dominant style should be a mix of authoritative, affiliative, democratic, and coaching.

Transformational vs. Transactional

“Ask not what your country can do for you, ask what you can do for your country.”

• Transactional Leadership: – Dominant form in academic institutions – Mutual dependence; negotiation – Focus on “I” – Leaders followed because in the best interest of followers (if you do

what I say and allow me to lead, I will reward you….)

• Transformational Leadership – Inspire with vision – Stimulate employees to look beyond own self-interest – Provide individual consideration for employees needs – Intellectual stimulation – Focus on “you” and “we”, therefore empower – Energize employees to believe they CAN!

Servant Leadership

Servant Leadership primus inter pares….first among equals

• The great leader is a servant first • Servant leaders take care of their followers’

greatest needs first, therefore: – Followers become healthier, wiser, freer, more

autonomous, more likely to be servants to others

• The first step to leading others is the necessity of change within oneself

• Servant leaders build a community in the workplace, replacing power with collaboration

• Relationship between leader and follower is a mutual search for wholeness

Fitting it Together: Synergistic leadership styles that transform hierarchical

organizations into learning organizations

Schwartz RW, Tumblin TF. The power of servant leadership to transform health care organizations for the 21st century economy. Archives of Surgery. 137:1419-1427; Dec 2002

Assessing yourself as a leader: Individual exercise

Complete the

Leadership Self Assessment

Scoring exercise with reflection

• Score your leadership self assessment

Reflect on your results-Any surprises?

Avoid putting yourself before others and you can become a leader among men.

---Lao Tzu

Let’s use an actual case to ground our learning…

Case introduction: You have 10 minutes for this exercise

• Work in a group of 3 at your table

• Introduce yourself and briefly share a leadership challenge you are facing

• Choose one person’s challenge and invite this person to describe his/her challenge in more detail

Five practices of exemplary leadership

1. Model the Way Find your voice and set the example

2. Inspire a Shared Vision Envision the future Enlist others in your vision

3. Challenge the process Search for opportunities Experiment/take risks

4. Enable Others to Act Foster collaboration and strengthen others

5. Encourage the heart Recognize contributions; celebrate values & victories

Kouzes JM, Posner BZ. (2008) The Leadership Challenge, 4th edition. San Francisco: Jossey-Bass

Change is an opportunity to innovate, learn and grow

• Greatness = making a distinctive impact that has lasting endurance

– Delivering on your mission

– Making an unique contribution

– Managing change

Collins, J C. (2005) “Good to Great and the Social Sectors: A Monograph to Accompany Good to Great.” New York, NY.: Harper Collins

Diagnose the situation accurately using STARS;

clarify challenges & opportunities • S: Start up

• T: Turnaround

[a]: Accelerate your Learning

• R: Realignment

• S: Sustaining Success

Watkins, M. (2003) The first 90 days: critical success strategies for new leaders at all levels. Harvard Business Press

Determine where and how to focus your energies

Challenges Opportunities

Start up No framework/no boundaries

Everything is new-no status quo

Leader needs to move fast, take chances, realign as learn more Turnaround Quick and decisive

action is needed Everyone ready for change

Realignment Status quo is deeply engrained

Pockets of strength exist

Leader needs to understand culture, convince others of need for change Sustaining Success Getting others to

take it to “the next level”

People motivated to succeed

Small group exercise

1. Diagnose the challenge shared by your colleague

2. Clarify the challenges and opportunities

3. List the tasks that will need to be accomplished and identify the priority initiatives

Would a particular “leadership style” be helpful in addressing the challenge you discussed?

Five practices of exemplary leadership (Kouzes and Posner)

1. Model the Way

2. Inspire a Shared Vision

3. Challenge the process

4. Enable Others to Act

5. Encourage the heart

Early victories build credibility and create momentum

• Building personal credibility

– Define strategic intent

– Identify “A-item” priorities

– “Connect”—help people know who you are and what you stand for

Watkins, MD. Picking the Right Transition Strategy. Harvard Business Review (2007)

Achieve Small Wins

• Doable steps

• Keep momentum going

• Sustain commitment

• Accentuate intrinsic rewards

Actions speak louder than words… and foster trust

Genuine approach

• Listen First • Demonstrate

Respect • Talk Straight • Create Transparency • Right Wrongs • Show Loyalty

Outcomes - Driven

• Deliver Results • Get Better • Confront Reality • Clarify Expectations • Practice

Accountability • Keep Commitments

Individuals are motivated when they feel autonomous, competent and

related • Great leaders:

– Expect the best • Personal and authentic acknowledgement

• Provide a sense of accomplishment

– Recognize and appreciate individual and group achievements

– Celebrate values and victories • Build a spirit of community

• Nurture themselves and others

A leader is one who knows the way, goes the way and shows the way. --John C. Maxwell

Large group discussion

How do you avoid common pitfalls for new leaders?

Most common mistakes of sr executives during the 1st 100 days

• Failing to establish strategic priorities

• Cultural gaffes and/or political suicide

• Waiting too long to implement change

• Not enough face time w/subordinates

• Hesitating on tough personnel decisions

• Getting sidetracked by ‘fire drills’

with a short-term focus

Kornferry.com

Watch out for common pitfalls

• Failure to listen

• Providing your team with “the answer”

• Overreliance on strategies/strengths that worked in other situations

• Not being aware of your vulnerabilities

• Tyranny of the urgent

• Conspiracy of Interruptions

What must an executive do in the first 100 days in order to succeed?

• Assemble and solidify a team • Articulate vision and goals • Identify and address what’s most important • Understand the new culture • Identify metrics for success • Achieve several quick successes • Fix obvious problems quickly

Kornferry.com

Triad exercise

• Recall your current leadership challenge

• What can you start doing?

• What things you should continue doing?

• What things things you should stop doing?

• Share with your group

“Leadership and learning are indispensable to each other.” --John F. Kennedy