Lecture on the imperative for strong leadership in medicine

1. PHYSICIANS
MUST LEAD:
HERE’S WHY
Elliot R Goodman MD

3. The best hospitals are run by
doctors: USNWR ratings:
#1 Mayo Clinic
#2 Cleveland Clinic
Both physician run for 100 years

4. Effective medical CEOs produce:
● Better patient care - lower morbidity, mortality,
medical error rates
● Better patient satisfaction scores
● Better economic outcomes
● Better physician retention rates, lower burn-out rates

5. Advantages of medical leadership:
● 2011 study of CEOs of top 100 USNWR hospitals - physician led
hospitals scored on average 25% better on clinical quality
metrics than those run by non-clinical CEOs
● Similar study showed that proportion of hospital
leaders/managers with MD degrees positively correlated with
good hospital practice and performance
● Dr Toby Cosgrove (ex-CEO, Cleveland Clinic) - BIGGEST
ADVANTAGE - physician leaders possess peer-to-peer
credibility (they have walked the walk, not just talked the talk)
● Both the Mayo and the Cleveland Clinic allow physicians safe
space to experiment, innovate, succeed (CABG, 1960’s
Cleveland Clinic) and sometimes fail

7. Sisyphus: King of
Ephyra

8. Medical Sisyphus:

11. Effects of physician burn-out:
● Reduced clinical efficiency and increased rate of
medical error
● Physician depersonalization - exacerbated by reduced
face-to-face interaction with patients due to EHR
● Low personal accomplishment
● Poor patient experience, satisfaction scores and
outcomes

13. Medscape Physician
Compensation Report, 2018:
1983: 24% employed, 76%
self-employed

18. Leadership:
which is it?

21. Thomas Carlysle: 1840 -
lecture series on Great Man
theory of leadership

22. Carlysle:
“The history of the world is but
the biography of great men" -
heroes shape history through
both their personal attributes
and divine inspiration.

35. The heroic leader, the charismatic,
goal-scoring superstar who
doesn’t mind carrying the team on
his back, is out. Enter the post-
heroic leader, the quieter,
engaging team player who brings
every player into the decision-
making process.
True leaders are not heroes. True leaders create heroes.
Great leaders don’t create a state of dependency.

38. Leadership roles:

46. Training clinical leaders:
● Traditionally medical education produced autocratic/heroic lone healers
who in general were self-employed and who expected the activity of a
hospital to center around them. Remember Sir Lancelot Spratt.
● Nowadays, healthcare is more patient-centric, team-based. Physicians
are now more likely to be employees of large entities. They are now
much more accountable to these organizations, to patients, to insurers
and to the government for the quality and cost of their care.
● Clinical leaders must be trained to fit into this new reality.

47. Examples of training programs:
● Yale - Executive MBA for physicians with significant leadership
potential.
● Cleveland Clinic - internal leadership courses teaching
Emotional Intelligence skills, team-leading, conflict resolution
and coaching. 43% of the graduates of this course become
senior clinical leaders at the Clinic.

48. How to become an effective clinical leader:
● Leadership recognized both by AAMC and ACGME as
a core competence for doctors-in-training
● Assess your own leadership abilities (?personal
strengths and weaknesses)
● Find yourself a mentor (leadership style template)
● Develop your own style of leadership (be prepared to
change it as the situation requires)
● Learn to build a strong team underneath you

49. Building effective teams:
● Define team objectives clearly
● Delegate clearly
● Define the supervisory structure
● Define expectations - “what does excellence look like?”
● Incentivize
● Empower
● Address conflict without delay
● Accept different viewpoints
● Encourage free communication
● Minimize negative competition between team members

52. Leadership tips from the Navy SEALS:
● Take ownership of everything (esp. failure)
● There are no bad teams, only bad leaders
● Believe in the mission
● Check your ego at the door
● The team is everything - protect it
SEALS priorities:
#1 MISSION
#2 TEAM
#3 SELF