Thought leadership

Five “To Do’s” and Five “Taboos” for Success

Five “To Do’s” and Five “Taboos” for Success

Our recent studies of physician leadership surfaced practical insights of what to do and what to avoid in order to optimize physician leader effectiveness and we are now incorporating these insights into our work to help clients develop and refine their “Physician Leadership Academies”.  Physicians motivated to enhance the effectiveness of their clinics, hospitals, health plans or health departments should discuss and refine the five “do’s and taboo’s” for more effective physician leadership. To see the one we did with Oakwood-Beaumont, click here.

Not all physician leaders succeed

Our interviews indicate that physician leaders fare well when they evolve into, rather than jump cold into a senior role with a nice title and business card. Some try to run the race too fast and without enough training or preparation. Some thought they had all the answers, but found they were for other questions or wrong. Some forgot that to be a leader, you need followers.

Longer lasting success and less negative resistance from colleagues is usually seen by carefully designing and managing a transition from physician clinician to physician leader through such roles as: quality project team leader; compensation committee chair; clinical department chair; member of board of directors; clinical service line developer/manager; vice president and then CEO. Most indicated that they found it helpful, at least initially, to retain some frontline patient activities as they made their transition into various leadership roles; both to retain credibility with their colleagues, but also to stay connected with the frontline wisdom about what was really needed, and what might best work or not for enhanced clinic or hospital performance.

Why do physicians move into leadership roles?

Physicians are more receptive to shifting their commitment to serve others in new leader roles partially out of frustration with their inability to control key facets of their practices and careers, but mostly they are driven by a desire to leverage their understanding of the unique art and science of medical care in order to make a bigger difference in the health and quality of care for more patients and communities.

There are also more intriguing leadership roles available to physicians from Clinical Department Chair to CEO to Television Health Anchor. Regional physician leaders interviewed for this article acknowledge that the diversity of these new ways to make a difference are a seductive draw on physicians, particularly in their fragile years of personal and professional introspection, in their 40s to their late 50s. 

The decisions to move into leadership roles, however, are not made easier by physician colleagues who hold back support or openly resist the new leader’s overtures for collaboration and change.  Physician leaders acknowledge that colleagues have occasionally turned on them by “joking”: “he/she abandoned us to go over to the dark-side with the suits.” There is an often unstated assumption that “when you leave us, you leave our values. You will too soon not be patient centered.” By becoming guarded around the new leaders, and holding them to higher standards of results than other leaders, physician colleagues may unwittingly cause a self-fulfilling prophecy of physician leader failure.

While this skepticism about their motivation and capabilities to work in the administrative or systems side of health care may have been more prevalent in the early days of physicians moving into new hospital based roles, it was, and is considerably different in physician owned and controlled organizations, like clinics or fully integrated health systems.

Great Leaders Need Followers

Physician leaders from the Kaiser Permanente Medical Group exchanged experiences in a roundtable discussion regarding how physician leaders are viewed by other physicians and staff. 1 Insights distilled from the discussions highlight three key conclusions:

  1. Physicians are perceived as “leaders”, whether they want to be or not, and therefore must consciously cultivate effective leader attributes.
  1. Physicians determine a majority of the pace of workflow. It is imperative for physician leaders to learn more about the skills and tools of group process, but not abandon recognition of the centrality of the physician-patient encounter interaction.
  2. Physician leaders will be significantly more effective, and rekindle the fun of medicine, if they more actively and creatively cultivate physicians as colleagues, i.e. earn physician followers.

I would like to reference one of the most powerful insights into the essential focus of effective leaders that was shared with me, not from an accomplished, street smart entrepreneur, nor from a leadership guru, but from the leader of a small rural women’s coop selling chickens in rural Zimbabwe.  From local dialect to Swahili to English she observed . . .

“If you want to get the work done with and through others, you must touch their spirit or hearts, then they will move their minds.  If you move both their hearts and minds, their hands and feet will follow.”

For physician leaders to succeed, they, like all leaders, must earn their followers.  This is unlikely to be done with spreadsheets and org charts. To earn your followers, embrace the wisdom of the coop leader... engage their hearts and minds if you need their hands and feet to help you accomplish the strategies you know will enhance your organization’s performance. In all industries, it has become clear that the real leaders master the softer variables of group process, motivations, communications, trust building, and listening. Several of the interviewees acknowledged that “physician leaders must listen to learn, and learn to listen. Just like we were taught in early history and physical exams.”

In contrast to physician leaders, however, not much is known about “physician followers”.  Much is written in physician journals and discussed in the physician’s lounge of hospitals and clinics about the scope and nature of physicians who have moved from physician as clinician to physician as leader, but more insight is needed about physicians who are moved to resist or follow the physician leader. Physician followership is an important but under-examined aspect in the chase for continuously improving organizational performance.

Here are the Five Do’s and Five Taboo’s for Successful Physician Leaders to earn followers and make the biggest impact. 

5 Do’s

5 Taboos


1.     Be self-aware: open to new ideas and new vulnerabilities, but always be honest and trustworthy

2.     Enhance mentoring: find one and be one Learn leadership like medicine, by “leadership grand rounds”

3.     Master situational leadership styles: a team is not always needed, but often essential for sustained change

4.     Build and cultivate teams with “principles of engagement”. Master the art of asking good questions and new tools for group process management.

5.     Stay connected to front line clinicians and staff:  listen to learn, and learn to listen


1.     Jump in with your one right answer

2.     Assume you can’t make a difference

3.     Focus on managing the numbers and spreadsheets more than the emotions of change or process improvement

4.     Ignore the need for earned followers

5.     Forget the power of the physician-patient encounter


In any given year, in any given day, we are all called on to lead and to follow in a variety of formal and informal ways.  Situations change.  Problems solving skills vary. Roles change. Situations require different leadership styles.  But all leaders require followers. Embracing the five do’s and taboo’s can help earn followers.

The leader-follower partnership also requires something from those in the follower role. Physicians moving through the follower role should keep in mind these 5 attributes in their leadership transition:

1.         The Benefit of the Doubt: Assume they really do still care about patients and physicians, bud have taken on new accountabilities and scope that encompasses what is best for the long-term vitality of the system or enterprise as well as the patient or physician group;

2.         Open Mindedness: Be receptive to getting engaged to help frame the problems and explore ways to resolve the problems.  Avoid joking about . . . “going over to the dark side” . . . or “not one of us now, but one of the suits”.

3.         Critical Thinking: Be supportive, however, challenge the leaders by asking tough but fair questions about their plans, projects and progress.

4.         Mindful Actions: Continue the mastery of the soft motivational and emotional dimensions of leadership through physician work.

5.         Opportunistic: Don’t resist opportunities to be an effective, situational leader yourself. 

Remember that while situations change and require differing tones in certain situations,  physicians that treat colleagues and staff with respect and dignity, will find it infectious.  Informal physician leaders can be at least as effective as physicians in formal positions of authority.

Modern physician leaders need to earn their followers. Earning followers requires more than charismatic visionaries. They must also engage their colleagues and staff in the enthusiastic pursuit of measurable results that advance their organization’s enhanced services for patients and communities. Engaging people in a pursuit of peak performance means listening to all stakeholders to better understand their needs, their capabilities, their ideas for process improvements, and their observations about obstacles to success and how best to overcome such obstacles. Effective physician leaders should also remember that to move followers’ hands and feet toward a desired vision, we must move their minds, which requires us to connect with and move their spirits and emotions. Moving mountains requires moving hearts and minds.


James A. Rice

Jim Rice, PhD, FACHE is the Managing Director & Practice Leader with the Governance & Leadership service line of Gallagher’s Human Resources & Compensation Consulting practice. He focuses his consulting work on strategic governance structures and systems for high performing, tax-exempt nonprofit, credit union and health sector organizations and integrated care systems; visioning for large and small not-for-profit organizations; and leadership development for Boards and C-Suite Senior Leaders. 

Dr. Rice holds masters and doctoral degrees in ...

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