Last week, we discussed empathy and how we as doctors can be empathetic to our patients. This week, we carry on in our series of 7 Skills We Wish Were Taught at Medical College and delve into leadership.
Doctors as Leaders and Managers
As we continue in our study on 7 Skills We Wish Were Taught at Medical College, I now want to focus on a key set of competencies that are clubbed under the umbrella of Leadership skills. Let’s begin by asking a fundamental but important question:
Are doctors leaders?
In order to derive an effective and complete answer to this question, it is important to define and understand leadership. So, who is a leader?
There are a number of theories on Leadership that have evolved over time. From the idea in the late 40s that leaders are born and not made, (the Trait Theory or Great Man of Leadership) there was a shift in the 60s to the Behavioural Theory of Leadership. The early 80s saw the rise of the idea that leadership depended on the situation (Situational Theory of Leadership). To my mind, if leadership traits were inherited and could not be acquired, then leadership would never have been taught successfully, and it would not have been made a key module in universities and management schools across the globe. Currently, the central idea is that leaders need to exhibit vision, charisma, participation, collaboration and empathy, and also that leading and managing are different.
I have a very simple approach to leadership: All Leaders must have followers to lead. Hence, all characteristics that will induce people to follow are components of Leadership traits/skills. In brief, leadership is about influencing others and thereby creating followers to lead.
As our roles as physicians require people to follow and place their trust in us, we ARE leaders whether we like it or not, accept it or not.
We have the opportunity to powerfully influence our patients, the people we work with and the society at large. Therefore, we are de facto leaders by virtue of our profession.
Are Doctors Good Leaders?
Having settled the question that doctors are leaders, we progress to questioning whether doctors are good leaders.
The answer is not simple, and there is wide variation among doctors, but as a community, most doctors struggle with exhibiting good leadership skills. I believe that there are valid reasons that prevent the complete evolution and exhibition of leadership potential of doctors. A lot of this can be attributed to the way we are taught and mentored in our graduate and post-graduate studies. I have listed four major reasons below that I believe are responsible for the lack of maturity of our leadership skills:
We are brought up in a highly competitive environment right from our school days and continue to compete throughout our life. This invariably means that we are less inclined to work in teams and have a tendency to be lone rangers. This is one of the major reasons for our failure to develop as leaders.
- Individualistic Approach
Doctors are used to working as individuals. We rarely work as teams, and hence guard our independence jealously. We value autonomy, and that is the antithesis of leadership, which is all about working with others.
- Command and Control Style
Doctors are used to telling patients what to do rather than inspiring or empowering them, which leads them to be less effective leaders. This command-and-control style of behaviours does not gel well with the current environment of empowerment, freedom and knowledge. We can no longer awe people by sheer knowledge alone.
- Lack of Good Role Models
Doctors in India rarely have the right models to follow in their graduate and post-graduate days, and hence emulate the style of leadership displayed by seniors, who had learnt the same from their seniors. And thus the cycle continues unbroken.
I vividly remember one of my first days in medical college. We were being introduced to anatomy by one of the most respected and feared professors in the department. He took a piece of chalk, broke it in half and after throwing it on the floor, crushed it with his shoe. He then pointed to the crushed chalk and said dramatically, “This is what I can do to you!” It was an awesome display of power and arrogance, which my class and I never completely forgot. After all, we were 18-19 year old students who had just entered medical college.
What was the need to intimidate us when we were already overwhelmed freshers, eager to learn and please? This incident happened almost 40 years ago but is a vivid memory for me even today. These were the role models for us, and we picked up the same dysfunctional top-down arrogant leadership styles and continue to perpetuate them, much to our folly.
Are Doctors Good Managers?
As leadership is about influencing people so that they follow, management is about “controlling” people and getting them to do things. Management is hierarchical, where there is an organized structure with well-defined positions,
“Management is about arranging and telling. Leadership is about nurturing and enhancing” Tom Peters
job profiles and authority to ensure that processes are followed and things function smoothly. While leaders inspire people to get work done, managers use their position and authority to accomplish organised process driven tasks.
In order to further understand the difference between leaders and managers, I have listed some key differences in the table below:
Leadership vs. Management: Splitting Hairs or Is There a Difference?
The Focus of a
- On the future
- On broad purposes and directions
- On commitment
- On the product
- On effectiveness
- On the present
- On details
- On control
- On the process
- On efficiency
The bottom line is: The main difference between leaders and managers is that leaders have people who follow them while managers have people who work for them.
“I start with the premise that the function of leadership is to produce more leaders, not more followers” Ralph Nader
I believe that our education system makes doctors better managers than leaders. But unfortunately, we still have a long way to go on honing our managerial competencies, as we are not taught these systematically.
However, in practice, it is not enough to just exhibit only leadership competencies while ignoring development of managerial skills and vice versa – a successful physician leader needs to develop both Leadership and Managerial skills. They then need to acquire the fine art of balancing both competencies, depending on the situation, to get their team on board with their vision of success.
Going forward in the series, we will focus on the most important leadership competencies, define them and then deep dive and study them individually with special reference to the healthcare world.
There are a number of theories, models and concepts on Leadership and the skills that go into making a good leader, and without getting into the merits of each of those, I have devised and listed four major heads under which most of these competencies are covered. In my subsequent articles, I will attempt to unfold each head and build a more complete understanding of Leadership while maintaining focus on healthcare. The four broad competencies that go into the making of exemplary Leaders are as follows:
Next time, we will discuss “Vision and Purpose” the first competency that is necessary for becoming exemplary leaders.