It’s a stereotype with a grain of truth: leaders are often promoted for past performance, not future potential. That notion certainly rings true in health care, considering how many clinicians are regularly promoted to positions of leadership because of their clinical skills. When things don’t work out, though, it’s less often about their clinical performance and more often about shortcomings in their ability to connect, navigate conflict and instill confidence and loyalty in others. They’re hired for their skills and fired for their humanity, in other words.
To quote leadership expert Marshall Goldsmith, “What got you here won’t get you there.” Clinicians usually operate from a highly detailed, scientific mindset—it’s what led them to success in the first place, argues Ted Witherell, faculty member in the Department of Health Policy and Management, program director for Conflict Feedback and Negotiation for Physician Leaders at the Harvard T.H. Chan School of Public Health, and former Senior Director of Talent Management for the Mass General Brigham health care system.
He explains their cognitive dissonance in a leadership role thusly: “‘As a clinician, I’ve grown up in this hierarchical, structured environment. The letters after my name mean something in terms of what I can and can’t do. In a new leadership role, though, I have to influence.’ That’s a journey, and it trips up some folks.”
So why is influence such a different but critically important skill set for health care leaders and—more importantly—how do they develop it?
Understanding the Unique Challenges of Moving From Clinician to Leader
Health systems are usually organized hierarchically; clinicians are trained to make definitive diagnoses and give clear direction to other medical professionals. In a position of leadership, however, a person may not be able to make decisions unilaterally. Working in a nuanced way with other administrators, experts, colleagues, and subordinates, particularly in negotiation and conflict management, is a completely different skill set.
“It’s a skill that’s as valuable—and, if clinicians want to move their agenda forward, more valuable—than the clinical skills. Those ‘hard’ skills got them to the table but won’t get them to the next place,” says Witherell.
In research on how physicians learn, the concept of “confidently held misinformation” is also common, in which physicians may be incorrect about a particular fact, but have total confidence that they’re right. This is a common mindset that they must unlearn in order to be effective leaders. The shift from answers with no room for indecision to inquiry, reflection and collaborative problem solving is key to medical leaders’ success.
Influence: What It Is and What It Means for Medical Leaders
Witherell begins class discussion about conflict management with a simple premise: that conflict is inevitable, and that there is nothing we do not negotiate over. It’s not conflict “resolution,” because the problem may not have a solution. Instead, influence involves bringing together disparate viewpoints and advocating without dictating.
“Influence in this context is a way of thinking about power with more nuance—ways it can show up that are more dynamic than the way you’ve known it in the past,” he says. Put more bluntly, it’s “getting people over whom you have no authority to do stuff.”
The three elements to cultivate effective influence, as Witherell defines it, are as follows:
- Conflict: working through disagreement in a way that solves the problem at hand and maintains or enhances the relationship with the other person.
- Feedback: having difficult conversations around thorny issues like performance and change—which can be significantly harder than just avoiding the conversation or giving commands.
- Negotiation: approaching conversations with a win-win mindset, i.e., instead of advocating for your slice of the pie, engaging with the other person to make a bigger, better pie together
That last bullet point is relevant to leadership in all its forms. Known as interest-based bargaining, it is a mindset that involves getting away from a “mine” mentality and towards an “ours” mentality, even in scenarios where money, responsibility or other critical issues may be at stake.
What Medical Leaders Can Do to Cultivate Influence
All of this can, obviously, be challenging for a medical leader. Understanding that there is something to learn, and stepping back to learn it, can be a process in itself. Witherell describes the initial process like this: “In learning we move from a state of unconscious incompetence—ignorance is bliss—to conscious incompetence, which is very uncomfortable.” Witherell says that when students begin to process this in class and internalize new ways of thinking, it leads to a sort of rebalancing and renewed confidence.
Fortunately, most clinicians have seen effective leadership even if they themselves have not yet lived it. And the work to improve begins simply: by having difficult conversations, over and over again. A few important points to remember during that learning process:
- Influence requires empathy for the other person or people—and, as an associated skill, the willingness to not be right 100% of the time.
- Solving from the top level of conflict instead of the basement (i.e., using one’s prefrontal cortex instead of the emotion-driven limbic system), as noted by Harvard faculty Leonard Marcus, is a skill in and of itself. Another aspect of conflict management is helping the other person stay at the top level, too.
- An interest-based mindset is all about “getting to yes,” or as Witherell says, “getting all those viewpoints on the table and seeing where we have moments of agreement.” It’s important to remember that, especially in moments of tension.
- Developing better leadership skills can pose unique challenges for each person. Thus, the learning process will also be unique. “Watch for the triggers: the kinds of things that push your buttons, that you’re willing to go to battle over,” says Witherell.
Throughout the process, Witherell underscores that conflict is borne of passion—generally, we disagree over things we care deeply about—and clinicians care about patients already.
“It’s a fallacy to assume that conflict is a battle to see who cares more. It’s really just different viewpoints about ways to care,” he says. “And there’s no wrong way to care.”