October 18, 2017 | Sawan Jalnapurkar, MD
Career Development

From leading bedside rounds to representing the medical community in Congress, from medical school to being a practicing physician, we wear the dual hat of a leader and a physician. Paradoxically, leadership training has not been part of most official fellowship curricula. It could very well be one of the reasons for underrepresentation of physicians in leadership roles, as only five percent of hospital CEOs have a clinical background, which may lead to health policies that are cumbersome to implement in real world settings.

It is important to make the distinction between leader and manager. A leader is a person with a goal and vision for the organization, and skill set to achieve them. A manager, on the other hand, is a guru of operational aspects of an organization. There are five main leadership styles based on the involvement of the team in decision-making.

• Directive: Leader makes decisions unilaterally without consultation from the team. This type of leadership can be useful in clinical settings when you are setting clear objectives and rules for the team. However, it can sometimes be dysfunctional to do when the decision is going to affect the entire team.
• Consultative: Leader seeks counsel from the whole team before making a decision and considers each of team member's opinions. This style is helpful to gain the trust of the participants.
• Participative: The team is more involved in this style of leadership. The leader seeks suggestions from the team on possible solutions and decisions. Compared to a consultative leader, the participative leader not only involves team members in decision-making but also incorporates their suggestions. This style encourages team members to be more proactive, creative and innovative.
• Negotiative: The leader incentivizes his team to arrive at certain decisions by reinforcing the team's behavior or action in certain desired directions.
• Delegative: The leader will guide the team to make the decisions and provide his or her opinion. This type is the least authoritative of all leadership styles.

Which one are you? A good leader uses a combination of the above-mentioned styles to fit the given situation. Irrespective of styles, a good leader must possess these qualities:

• Listening: It allows people on your team to be heard, actively involved and appreciated, resulting in better job satisfaction. The team will thus feel responsible for their work and be more likely to make sincere efforts towards improvement. As per Epictetus, that is why we have two ears and one mouth, so that we may hear from others twice as much as we speak.
• Defining expectations: Employees – resident, medical student or another physician – who have a clear understanding of what is expected of them and how to meet those goals have a sense of purpose and accomplishment.
• Nurture creativity: This is particularly important in medicine today, being in the setting of dynamic healthcare policies to which we must adapt. In my opinion, no ideas are bad ideas – they may be underdeveloped ideas. When you lead with this notion, you will be surprised how creative a person can be, and your encouragement of this behavior will make you realize it is not difficult to develop a trusting relationship with your team.
• No one to blame? When we work in a system, it is crucial to identify when errors are due to a process rather than one individual. This helps improve the process, and strengthen team dynamics. When we adopt this culture, teams will be more willing to share the information on errors and there will be effective communication with more transparency. Team members will be more likely to feel secure and will have a positive outlook resulting in reduced number of errors. On the other hand, when we blame an individual for each error, it causes more fear in the team, which can lead to more cover-ups and a vicious cycle of errors.
• Be the leader you wish to follow: A simplest answer to what makes a good leader or how to become a good leader is to follow everything that you would expect from your own leaders to do. Placing yourself in the shoes of your team will provide you with an empathetic point of view and cause you to be more likely to understand their side and help them, in turn helping your team grow.

As a physician, you are at the front line of the patient care and education, and you can make a difference by working together with managers, nurses and administrators. Physicians and managers both play significant roles in the healthcare team. Physicians can identify the problem, seek information and recommend optimal medical therapy with alternatives. Managers, on the other hand, work towards implementation of the plan, in and outside the office, by creating specific policies and successful health care facilities where administrator and physician work hand in hand. In order to have more clinically relevant, patient-centered policies, we must be the part of change. As we know, prevention is better than cure – it is easier to participate in aligning incentives with patient-centered care rather than to change policies after they have been implemented.

The ACC has recognized the need for development of future leaders in medicine. In addition to sessions at the annual meeting and faculty development courses, the ACC established the Leadership Academy for FITS and Early Career Section members in 2014. It provides leadership development, skill-building and mentorship from peers and senior ACC staff.

Other opportunities to learn about strengthening your leadership and managerial skills and to understand the business aspect of medicine include: attending ACC's CV Summit, participating in ACC state and national committees, and enrolling into an executive MBA program specifically designed for physicians. You can also choose to gain practical experience by joining a leadership committee in your hospital, medical school or state and national chapter of the ACC. I have been pursuing all the above options in order to gain key leadership skills and learn how to implement them. It has been an incredible experience and has provided me with a different perspective in managing my patients. These experiences have certainly fostered my growth both personally and professionally.

In a nutshell, you should first ask yourself which leadership style you most often use: directive, consultative, participative, negotiative or delegative. Then, think about which style is best suited for which situation, and practice the styles that you are less comfortable with. In my opinion, the ideal leadership style would be the one that is selected and executed for a specific situation!

This article was authored by Sawan Jalnapurkar, MD, Fellow in Training (FIT) at University of California, Riverside.