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Leading in a Large Medical Organization

Welcome! This article is part of a Medscape Physician Business Academy course, . Visit the Course Page to take the full course and receive a certificate.


Whether you've migrated from an independent practice environment or have decided to start your physician career as an employee, practicing medicine in a large hospital or health system may be quite different from what you're used to or what you expected. Although you can probably count on more constraints and more bureaucracy, larger organizations also offer more opportunities to lead.

What's more, because you'll be working in an environment that serves more patients and more community needs, your leadership can have a bigger impact. You'll also have the chance to positively influence the lives of your organization's employees—including your physician colleagues.

Thinking Differently About Your Role

Physicians' medical training does not focus on important traits of leadership and staff management, and may even be contrary to them. Physicians often bear sole responsibility for the biggest patient care decisions. The pressure to be accurate and accountable is intense. These aspects of your profession understandably contribute to perfectionism; independent decision-making; and sometimes resistance to team-building, which is an important component of being a successful leader.

However, because team-based medicine is now emphasized in virtually every healthcare environment, developing more collaborative skills and overcoming the instinct to carry the entire burden yourself will make you a much more valuable physician.

Even if you have a natural inclination toward teamwork, you may feel unprepared to take the lead. Medical schools typically still don't offer leadership or business training, giving you limited opportunity to develop these skills. If you were involved with team sports, a supervisory job, or the military before becoming a physician, that experience might give you a head start.

If you don't have prior experience and are committed to building a management resume, an advanced degree (eg, an MBA or MHA) can help you quickly learn many of the skills you need. Another advantage of employment with a large system or hospital is the potential availability of financial assistance for pursuing a management degree. In addition, many universities now offer programs that are tailored for the needs of working physicians.

Even if you're not prepared to pursue an academic credential like an MBA, you can develop leadership skills on the job—and you will probably have many opportunities to do so. And if you're planning to pursue a management degree in the future, experimenting with being in charge on the job can help you be ready to get the most from that academic experience.

Leading Others by Learning From Them

Learning from leaders whom you respect can help you gain essential management skills. You can begin developing your leadership skills by simply asking questions. For example, if you notice that a process seems inefficient, asking why it's done that way—in a respectful manner—can be the first step to improving efficiency.

The "respectful" part is as important as the questions themselves. Often, processes that seem obviously inefficient evolved from a series of entirely logical decisions. When trying to encourage positive change in large organizations, it is wise to consider the parable of Chesterton's fence—the idea that before taking down a fence, you should be sure you know why it was erected in the first place. Inertia may not be the only reason that seemingly inefficient or outdated processes remain in place.

Without the support of the people at all levels—those who keep the workflow humming—change will be impossible, regardless of how much better your ideas are.

Keeping this in mind is not just important to avoid mistakes. It also helps minimize the risk of demotivating people who are responsible for the many less visible jobs in your organization. Without the support of the people at all levels—those who keep the workflow humming—change will be impossible, regardless of how much better your ideas are. One way to think about this is to recognize that if you're to be a leader, people must be willing to follow!

By respectfully asking, "Have we ever considered this approach? Do you think it might be more effective? Why or why not?" can be an effective way to suggest changes. The idea is to make suggestions without overtly criticizing or offending others on the team—and with genuine interest in others' feedback.

As a physician, you have been trained to believe in your own decision-making capability. It's essential, of course, for you to have that confidence in your clinical practice. But others who work in your organization may have more knowledge and experience in their fields than you do. When you encourage them to work side-by-side with you on making improvements, rather than viewing the process as a top-down one, you can learn what they know that you don't, and you will gain important insight.

One reason this is so important is that clinical and administrative staff often have a natural tendency to be intimidated by physicians. This can lead employees to hold back opinions that are contrary to ideas you propose or be annoyed by a suggestion you make but remain silent. In the moment, their not speaking up may feel like respect—or like everyone agrees with your ideas. But if employees hold back important information because they are afraid to contradict you or are annoyed, that can lead to bad decisions.

By consciously asking questions and recognizing that employees have valuable information to share, you help create a more team-oriented culture—and help ensure that all your team's collective wisdom is harnessed.

Managing Up, Down, and Across

This approach of respectful questioning is not only useful for working with staff. It can help you work better with those above you in your organization as well. In business training, there is a well-understood idea that organizational leaders need to understand how to manage up, down, and across—meaning that in order to be effective, leaders must be able to influence the people they manage, the person who manages them, and their peers and colleagues in the organization. True leaders get things done not just with formal authority, but through their relationships and influence.

Influence in a large organization starts with becoming a trustworthy leader, mastering skills, and internalizing norms, such as:

Putting yourself in others' shoes. What is important to them? For example, when managing upward, it's essential to appreciate your boss's priorities. How will what you want to do make him or her be more successful? It's not much different when attempting to guide change that affects those below you in the organization—has your plan considered the impact on their jobs, and how to make the transition manageable for them? Making the effort to get to know people at multiple levels of your organization can help you learn about the challenges and priorities of their roles and shows that you respect and value the work they do. Certainly, this offers a compelling reason to embrace the concept.

Showing respect for reporting lines, expertise, and boundaries. Large organizations rely on structure to function efficiently. Employees need to know who they take direction from and what their job requirements are. Respecting these sorts of organizational boundaries is essential to becoming a trusted leader and colleague. So, for example, when concerns arise about an employee or function that does not report to you, addressing them with the correct manager helps build trust and avoid unnecessary conflicts.

Developing a reputation for reliability and integrity. Your reputation for honesty and for being a reliable coworker and a team player is an essential ingredient to building influence. Keeping your commitments and not losing sight of today's priorities in favor of tomorrow's plans will help cement your reputation for getting things done. If your motivation and intentions support the organization's core value and principles, you gain support and maintain respect.

Understanding organizational norms and culture. Every organization has its own culture—the unwritten norms that help everyone understand how things get done. It can take some time to understand what the culture of an organization is, and what that means for making changes and leading new initiatives. It certainly will take longer to understand these influences in a larger organization than it does in a smaller practice model with less structure. Regardless, it's essential to take the necessary time to learn about the culture and understand the organizational norms, because not doing so can doom even the best ideas to failure.

Motivating Staff Who Don't Report to You

In larger organizations, physicians are more likely to interact with lay staff members in situations where they know little about those employees' actual reporting responsibilities. This can present challenges when a physician leader needs staff support to get something taken care of.

Also, clinic administrative staff often feel removed from the physicians. So, when you make a request or seek their help, it may be an interruption and not necessarily a part of their job. For this reason, even though you're not their boss, it is important to recognize what staffs' role is and find effective ways to engage and motivate them.

Asking instead of telling [staff] to do something shifts the message from an order to a request, and being thankful will make it a far more welcoming message.

How well you communicate—in both attitude and words—will influence how much cooperation you get and the result. Be thoughtful and respectful when giving staff a directive or making a request. Asking instead of telling them to do something shifts the message from an order to a request, and being thankful will make it a far more welcoming message.

This method of leading shows that you care, and that together you are part of the same team. Expressing appreciation for staff support sends a strong message that encourages staff cooperation while strengthening the relationship in a meaningful way.

Balancing Practice and Leadership Opportunities

Physicians who are very focused on their practices and their patients may find the prospect of adding a committee role or even a department chair role daunting. When time already seems too constrained, taking on extra responsibilities may seem like a bad decision.

However, it's crucial to all physicians in the organization that their peers take advantage of these leadership opportunities. This is what ensures that physicians' voices are heard.

What's more, these roles are preparation for bigger roles in the future—perhaps eventually achieving the highest level of leadership. If you're hoping to move your career in this direction, these early experiences can be invaluable for building your resume. (And they can help you confirm whether you want to move from clinical work to management at some point.) Participating in committees can be a way to explore and advance specific clinical and business passions as well.

One way to manage the time constraints is to plan ahead. Build yourself a road map of when and how you'd like to get more involved in management work. Start researching what paths might take you to the leadership role you hope to fill later in your career.

Find Mentors, Be a Mentor

Mentors can be invaluable to the process of planning your leadership path and be instrumental in guiding your management success. Sometimes—but not always—your direct manager will become a mentor. More likely, you will need to seek out physician mentors that you respect, who are further along in their career, and who are following a path that interests you.

Becoming a mentor is a great way to build relationships with coworkers coming up behind you. Although younger physicians may naturally seek your advice, remember that nonphysicians may benefit from your help, too—and this is an excellent way to build your leadership at the same time.

For example, in any large health organization, you'll find nurses or other clinical staff who aspire to try a different specialty or advance their careers with further training, such as a physician assistant program or technical certification. You probably have a lot of valuable experience to share—whether it is about how to push through organic chemistry or what the culture is like in a different part of the hospital.

Helping the careers of those following in your footsteps (or working alongside you) sends a message that you are approachable, helpful, and interested in your teammates and their success—another valuable leadership trait.

Some people have a personality that leads to being more natural when it comes to learning how to be a good manager. They are outgoing, more open, and attract other people to them. However, not everyone is a natural leader, and for those that aren't, developing management is more difficult. Don't let this result in shying away from doors of opportunity. You can arrive at the same destination as those who seem more natural at honing these if you are intent on and passionate about learning and strengthening leadership.

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Welcome! This article is part of a Medscape Physician Business Academy course, . Visit the Course Page to take the full course and receive a certificate.


Judy Capko

| Disclosures | January 01, 2019

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Judy Capko

Healthcare Practice Management Consultant, Capko & Morgan, San Francisco, California

Disclosure: Judy Capko has disclosed no relevant financial relationships.