Healers in Need of Healing Cannot Heal

Herdley O. Paolini, PhD; Mark H. Greenawald, MD


May 20, 2016

In This Article

Leading from Within

Ultimately, we believe that the goals of excellence in healthcare and the transformation necessary to achieve it will not be possible without a re-examination of who is leading the transformation and how we are preparing them and supporting them on their leadership journey. So how is this transformative leadership, this "leading from within," really developed? To begin with, we must acknowledge that leader development is not an "event" that takes place over a weekend conference or even a yearlong program. Leader development is an ongoing formation process that requires deliberate, consistent, and explicit implementation and dedicated organizational support and is continually grounded in the who and the why of leadership. It involves a commitment to the inner work of leadership—creating regular space for reflection, contemplation, developmental dialogue, and feedback.

These leaders are invited and supported to seek their ongoing personal wellness as an ethical imperative and take a holistic view of wellness that includes not only the physical but also the mental, emotional, spiritual, relational, and communal. They cultivate a high degree of self-awareness and awareness of others, engage often in open and honest questions and deep listening, hold tension in ways that respect a diversity of realities, and inspire trust by their integrity. Their development involves a commitment to a purposeful process that is more than a classroom or educational program or formal curriculum, though each of these can be components of this process.

The process should be developed, implemented, and facilitated by an interdisciplinary team that understands the physician worldview, principles of adult learning, and dynamics of behavioral science. It should be highly experiential, take advantage of small-group dynamics and collegial relationships, incorporate the physician's individual context into the process, create a safe space for learning that acknowledges the vulnerability involved in transformative learning, and provide ongoing mentoring and professional coaching. It must focus on the emotional wellbeing and personal integration of individual physicians as a foundation from the very start. The important management aspects of the business, structure, finance, and regulatory environment of healthcare can be taught in parallel to this process but should not be viewed as more important than true leadership development.

We realize that this is not a minor tweak of the first generation of physician leadership development. It is a major advancement over what is presently being offered. Implementing such a process will require true vision on the part of the present group of senior physician and healthcare leaders. To do otherwise will mean that achieving the triple aim will likely continue to exist more as an aspiration than reality; and the blind search for this Holy Grail will set up patients, clinicians, and leaders for frustration and disappointment.

To contact the author, email Dr Paolini at


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.