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Secrets of management success.

Secrets of Management Success

Research has shown that certain characteristics set successful managers apart from their less successful colleagues. Research that is just beginning shows that most of those characteristics also set successful physician executives apart. This article is based on presentations at the College's 1989 National Conference in Washington, D.C., and introduces concepts that will be reported on in more detail in upcoming issues of Physician Executive.

My direct experience with the medical profession has been as limited as that of most consumers. I remember very fondly my pediatrician. She was one of the special people in my life, and I would probably still be going to her if she were still alive and if I hadn't gone through adolescent shyness that drove me elsewhere. Last year I watched my father die and worked with one of the most marvelous individuals I ever had the privilege to encounter. His general practitioner physician stuck with him through years of a progressive blood disease and shared the family's grief when he died. While I know a bit about corporate executives, I didn't know much about physician executives until recently. Medicine and the health care field are in the news these days, so I was anxious to learn more about a profession that had somehow created an alliance against it among government, industry, insurers and consumers. Some years ago I reviewed the literature on the leadership of scientists and engineers, (1) and I believe the situation with doctors is quite similar. The more academic and research-oriented doctors are like scientists, and the practitioners are more like engineers. One of my findings still seems to hold; if you are competent enough, you can be a real S.O.B. and get away with it. You can lead a group, and it will follow you because of your expertise. But it is not an especially healthy thing for an organization, and it doesn't work at higher levels. What is healthy, and needed, is leadership that builds effective organizations and draws out the talent in its human resources. The need for executive leadership of the kind that is found in some of America's corporations is stronger for the health care field than it has ever been. If the medical profession does not generate this leadership, somebody else will. I think that is already happening. The wolves are at the door. A recent Conference Board report has identified the problem. (2) "Runaway [health care] costs are an unaffordable drag on American productivity and competitiveness." Corporations have a deep distrust of the medical establishment. They also have concluded that the first round of cost containment has now ended with very little success. For instance, Goodyear has a $200.7 million annual cost for health care that adds $3.40 to every tire. Its plant in Lawton, Okla., has a medical center operated under contract. It "serves 7,000 company employees at roughly half the cost that prevails in the community. A similar center is soon to be opened in Akron, Ohio, and is expected to save Goodyear $800,000 a year." More such leadership can be expected from companies in the absence of action from the medical profession. But there is good news. My contacts with physician executives and my reading of the health care literature tell me that the potential for leadership is great in the profession. What will be required for that leadership to take shape and then to begin to shape the health care field is conscious attention to and development of the successful characteristics of leadership. The characteristics that follow come from an analysis of highly regarded leaders in U.S. industry, (3) but there is no reason to suspect that the same characteristics will not prove successful in health care. In studies of successful senior level executives, we have asked them about the kinds of experiences they have had in their careers and what they have learned from those experiences. What we have learned is that there are characteristics that these leaders have in common. These are actually 34 kinds of things that these senior executives learned, developed, and practiced as they grew in their careers. In this article, I will concentrate on six general characteristics of successful leaders.


The first quality of the leader is the ability to set and implement agendas. That means having a vision of what might be and making it happen. There is a hero myth around leadership that says that leadership is inspiring people. There is certainly something to that, but leadership involves a lot more than charisma. A lot of what we do is based on how our organizations are structured and what the reward systems are. Sometimes we spend our time and our money rewarding people for counter-productive behavior. (4) Bennis put it well when he said leadership is managing attention. (5) People pay attention to what is rewarded. People pay attention to the structural relationships that guide their daily lives. Effective leadership, then, involves deft use of reward systems and organizational design in addition to personal persuasion. The ability to set agendas is really an ability to manage change. The biggest mistakes American corporations made involved the belief that they didn't have to change. There are three fundamentals considerations in setting and implementing agendas or visions--quality, customers, and employees. Quality has been a major issue in corporate America for a long time. It has become a compelling issue in recent years in health care. I won't deal with it here because the subject of health care quality has already been dealt with at length in the health care and health care management literature. Customer service, however, has received less attention, and here corporate experience is useful. SAS Airlines was in trouble when Jan Carlzon took over. He discovered that what customers thought of SAS was determined by 50 million moments of truth every year: every time a customer comes in contact with somebody who works for the airline, usually in a 15-second interaction. (6) Carlzon redesigned the company, giving the people on the front line the authority to act on customer problems without hassles. It's at the point of contact that the consumer judges your leadership, and it may not be the doctor who has the most significant moments of truth with customers. So I would be looking for evidence in leaders of the ability to see how the institution is working, to think a level up, to see the larger picture, and to see how things relate to one another. The leader has to understand how issues and events are connected in order to set and implement a vision.

Handling Relationships

In moving to management, physician executives moved from being in control and giving orders to selling and persuading, a totally different orientation. Scientists, engineers, and, I suspect, medical professionals are used to telling people the facts and expecting people to do something. People do not always respond to logic, or their logic may be different than yours. Many physicians have already moved from being and working alone to working for someone. The move to management is another shock. But the successful leader will understand that achieving goals means working with people--all kinds of people who make the organization work and who supply it or use it or run it. The ability to set and implement agendas involves not only having a vision, but also being able to make it happen. The leader makes it happen by being able to handle relationships, by being able to persuade and nudge and cajole as well as command, by understanding other people's points of view and acting accordingly, and by knowing how to use authority without abusing it.


Some people believe that corporate executives don't have any values, and recent shenanigans on Wall Street might lend support to that idea. But the executives we studied were highly principled and held strong beliefs about their responsibilities as managers and about how people should be treated in an organization. These values can be reduced to a series of personal statements. * I will do what I say. * I will do it when I say I will do it. * If I can't do it, I will warn you. * I will act with integrity. * I will live up to my duties to give

feedback and to be responsible for the

development of others. At the simplest level, managerial values boil down to treating people with basic human respect, regardless of their titles or jobs. My work with physician executives suggests that the move from clinical practice to management involves developing a value system that will work in a new setting and a new set of relationships.


There are as few great managers as there are great runners or surgeons. Most people aren't cut out to be good managers. They are temperamentally unable to survive in the environment that a manager faces. Managers develop a comfort with ambiguity. They are cool under stress, like the doctor in the operating room, but now in an organizational environment characterized by ambiguity, delayed feedback, and uncertainty on how they are doing. Managers have an ability to roll with the punches and persevere. They are pragmatic and problem-oriented.


The fifth characteristic is self-awareness. Successful executives have an awareness of themselves and of their limits, and an ability to admit their weaknesses and work around them. Above all, they learn from their mistakes. To admit a mistake, and to grow from it, requires a strong sense of self-confidence and a realistic understanding of one's strenths and weaknesses. Likewise, it takes a strong sense of self and considerable self-awareness to help employees learn to act on their own. One of the hardest things successful managers have to learn is to give up part of their power and give it to other people. But they have to learn it because they become "ignorant." They can no longer stay on top of all the technology and everything else that they have to manage. To manage things they know nothing about, they have to rely on the expertise of employees.

Learning from Experience

The final characteristic of the successful leader, and one that I would certainly look for if I were trying to breed a new generation of leaders, is the ability to learn from experience. Effective executives are avid learners, always wanting to know how things work and why things happen. Even when they do well, they strive to know how to do better. Less successful managers don't do that. What kinds of experiences do successful managers have that give them a chance to learn leadership and management skills? Our studies identified 16 different experiences, ranging from job assignments to extraordinary bosses to hardships and setbacks. (3) As we study physicians, it is increasingly clear that exposure to these kinds of developmental experiences is relatively rare. It will take a major effort to provide physicians with opportunities to develop leadership skills on a par with their clinical and scientific training. Learning to be an effective leader is, in short, a difficult and time-consuming process. The point is that the executives we studied did indeed learn it. And practice it. And they made mistakes and learned some more. Apparently this process was identified in ancient times, and can be described in four stages of learning and growth: Unconscious incompetence. At this stage, the manager is unaware that he or she is not very good at management. It is the starting point of a manager. The person has been promoted, was really good at the previous job, and is convinced that he or she is going to be good at management. Conscious incompetence. This stage comes in many executive careers very shortly after entry into management, when they start discovering that people don't automatically do what you tell them to do. They become aware that they are not very good at management. At this stage they are very receptive to learning management techniques and start to seek help. Conscience competence. Learning how to manage or lead is not easy, and at first the skills seem awkward or even phony. It is a very self-conscious, awkward stage, requiring practice, error, practice. Unconscious competence. When the skills have been learned, they are no longer conscious but flow naturally. Senior physician executives that we have studied work hard to be good at what they do. They went through a lot of pain and agony to become good physicians. That pain and agony was repeated to become a good leader and a good manager. One of biggest challenges of the leader/manager in to construct a conscious, deliberate strategy to identify and develop employees with the potential for leadership. The goal should be to provide them with the opportunities that you haven't had and the kinds of experiences that you had to catch by the boot straps. Otherwise, leadership will occur by accident, as it did, regrettably, in corporate America for a while. I don't think leadership in the health care field can be allowed to be an accident. Current leaders have got to be more selective about who enters management and more demanding of leadership as opposed to technical skills. Closer tabs must be kept on the development and growth of identified managers and evidence of the learning of new skills must be sought. But there are all manner of ways to acquire this learning and some of the basic lessons were learned very long ago. They only need to be dredged from our memories. In fact, a recent best-seller by Robert Fulghum suggests that all we really need to know we learned in kindergarten. (7) "Wisdom was not at the top of the graduate-school mountain," he says, "but there is the sandpile at Sunday school." An organization and its leaders could do worse than remember Fulghum's schoolyard advice, which includes: * Play fair. * Don't hit people. * Put things back where you found them. * Clean up your own mess. * Don't take things that aren't yours. * When you go out into the world, watch

out for the traffic, hold hands, and

stick together.

References [1]McCall, M. "Leadership and the Professional." In Scientists, Engineers and Organizations. Monterey, Calif.: Brooks/Cole, 1983, pp. 328-45. [2]"Management Briefing: Human Resources." The Conference Board 5(4):, April 1989. [3]McCall, M., and others. The Lessons of Experience: How Successful Executive Develop on the job. Lexington, Mass.: Lexington Books, 1988. [4]Kerr, S. "On the Folly of Rewarding A, While Hoping for B." Academy of Management Journal 18(4):769-83, Dec. 1975. [5]Bennis, W., and Nanus, B. Leaders: Strategies for Taking Charge. New York City: Harper and Row, 1985. [6]Carlzon, J. Moments of Truth. Cambridge, Mass.: Balinger Publishing Co., 1987. [7]Fulghum, R. All I Really Need to Know I learned in Kindergarten: Uncommon Thoughts on Common Things. New York City: Villard Books, 1989.

Morgan W. McCall Jr., PhD, is Senior Research Scientist and Visiting Professor, Center for Effective Organizations, Graduate School of Business Administration, University of Southern California, Los Angeles.
COPYRIGHT 1989 American College of Physician Executives
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Title Annotation:medical management
Author:McCall, Morgan W., Jr.
Publication:Physician Executive
Date:Nov 1, 1989
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