Crossing the leadership bridge.

Much has been written about what makes a leader successful. Few articles have mentioned what a physician leader must do in order to be successful--cross the leadership bridge from wanting to be popular to being respected.

Early in one's career, physicians who aspire to be effective must master many leadership competencies, including interpersonal, strategic and financial skills. One of the key physician executive competencies is building trust.

Stephen Covey wrote about the importance of building trust, based on character and competence, in The Speed of Trust. (1) He described the four cores of credibility as integrity, intent, capabilities, and results.

* Integrity asks the question: Are you congruent?

* Intent asks: What's your agenda?

* Capabilities ask: Are you relevant?

* Results ask: What is your track record?

A person may have integrity, but if he or she lacks the other three cores, then he or she will not be an effective leader. Covey (1) describes 13 behaviors that are necessary for building trust:

1. Talk straight

2. Demonstrate respect

3. Create transparency

4. Right wrongs

5. Show loyalty

6. Deliver results

7. Get better

8. Confront reality

9. Clarify expectations

10. Practice accountability

11. Listen first

12. Keep commitments

13. Extend trust

Interestingly, it is Covey's contention that leaders can build trust sooner than expected and can even rebuild trust when it has been violated stronger and more quickly than imagined by following these behaviors.

Not surprisingly, some of the behaviors that Covey recommends for building trust mirror negotiation principles advanced by Fisher and Ury in their work based on the Harvard Negotiation Project. (2), (3)

For example, focusing on interests rather than positions is at the heart of principle-based negotiation and requires a willingness to understand the other person's point of view. It requires a mature perspective and high emotional intelligence. Such an approach engenders trust, which is necessary for a mutually beneficial solution.

The behaviors outlined by Covey, in my view, also make it easier to have a crucial conversation with a colleague. (4) Building trust early in a relationship allows the physician leader to have difficult conversations and to separate the people from the problem.

There is a very strong urge for aspiring leaders to wish to be popular and liked. As a result some may be disliked by many and respected by none. This is a counterintuitive principle not easily embraced by physicians who have been enculturated to "go with the flow."

Crossing the bridge

Why don't physician leaders cross the leadership bridge? There are several crippling beliefs that inhibit leaders from crossing the leadership bridge:

* Fear of the wrath of colleagues when they are held accountable

* Fear of not being supported by higher authorities

* Reluctance to upset the status quo

* Unwillingness to be seen as a "suit"

* Perceived social isolation

* Inexperience in dealing with difficult colleagues

* Lack of previous mentoring by outstanding physician leaders

* Lack of conflict resolution and negotiation skills

* Unresolved personal feelings regarding authority

* Unrealistic expectations of the outcome of a crucial conversation

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What does the other side of the bridge look like? Contrary to earlier fears, I have not experienced many adverse effects, though I was reluctant to cross the bridge early in my career for many of the reasons listed. For me, the fear of crossing the bridge was worse than the reality.

When there are successes I have learned to look out the window at the team and to give others credit and to look in the mirror at myself when I have fallen short, as Covey recommended. (1)

Building the trust account has paid many dividends. When I have made inadvertent withdrawals from the trust account I have done my best to rebuild trust. This has become easier for me as I have tried to model the behavior of the leaders whom I try to emulate.

I have learned that if I imagine a virtual string, place it straight on the table and push it, then the results are predictable. On the other hand, if I place the virtual string on the table again, straighten it and then pull it, then I have had much more success. Invariably, when I meet resistance, I ask myself if I am pushing rather than pulling the string.

The most effective and respected leaders that I have observed over 23 years of practice have successfully crossed the leadership bridge from wanting to be popular and liked to earning the respect of both other physicians and administrative leaders on a daily basis. And I have learned quite a lot from both physician leaders and administrative leaders.

I have learned from other leaders to earn respect by modeling the expected behavior, honoring others, listening intently, verifying that others have been heard and taking my job, but not myself, seriously.

Early in my career I wished for three things--the love of my family, the companionship of my friends and the respect of my colleagues. It was a journey to fully realize that the first two wishes could help maintain my balance to succeed in pursuing the last and most difficult, earning the trust and respect of my colleagues on a daily basis.

References

(1.) Covey S. The Speed of Trust, Free Press, New York, NY, 2006.

(2.) Fisher R and Ury L. Getting to Yes, Negotiating Agreement Without Giving In, 2nd edition, Penguin Books, New York, NY, 1991.

(3.) Ury L, Getting Past No, Negotiating in Difficult Situations, Bantam Books, New York, NY, 2007.

(4.) Patterson K, Grenny J, and others, Crucial Conversations: Tools for Talking When Stakes are High, McGraw Hill, New York, NY, 2002.

James S. Hernandez, MD, MS

Medical director of Laboratories, Chair, Division of Clinical Pathology, Mayo Clinic Arizona

[e-mail]

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