The traits of effective medical leadership

As physicians we are trained to assimilate data, analyze and interpret findings, and make the correct decision — every single time.  Often these tasks must be performed very quickly and in emergency settings.  For those who perform invasive procedures, decisions are often made “on the fly” and can have significant consequences.

In addition to our clinical duties, physicians are now thrust into executive roles as well.  Managing practices, budgets, government mandates and regulations have now become part of everyday clinical life for many practitioners.  The concept of the physician executive is now commonplace — and for many doctors and practices — a key to survival in an unstable and volatile health care market.  Improving skills in both decision making and communication can be critical to success in the new world of health care.  Learning to lead is critical to providing outstanding care for our patients every single day.

Recently in the Wall Street Journal, author Andrew Blackman explores the inner workings of a business executive’s brain — exactly how the brain functions when making effective decisions in the world of business.  Researchers evaluated how executives make decisions under a variety of circumstances. They localized the biologic processes that occur in the brain via advanced neurologic imaging techniques.  From a biological standpoint, this research provides great insight into how successful decision makers formulate plans and solve problems.  In addition, the research provides insight into how leaders can make more effective decisions when under duress.  Using complex imaging to map the electrical connections in the brain when decisions are made, researchers are able to better quantify — biologically — what makes some leaders better than others.

By shedding light on how our brain functions when making good decisions, we may be able to one day “train” our brains to utilize particular regions during specific tasks.  For now, much of what Mr. Blackman reports concerning optimal conditions for making decisions is applicable to physicians and other leaders in medicine in one way or another.

According to the Wall Street Journal, there are several things to consider when making important decisions:

1. Deadlines and time pressures may limit creativity and innovation. In medicine, every day is a deadline.  Schedules of patients packed into the office or procedure list remain a reality.  Making decisions under pressure is a big part of what physicians do on a daily basis.  However, the recent neuroimaging research indicates that often the deadline pressure may stifle creativity and lead to poor decisions.  Stress induces more activity from the area of the brain associated with “task completion” and less activity in the areas responsible for new and creative idea generation.  According to Harvard researchers, one way to potentially combat this change in thought centers during times of stress may be to train workers and leaders to become more self aware and use “mini meditation” to help the mind wonder.

Although in medicine, we are trained to react to acute situations, it may be that while we react, we can also work to explore other creative centers of our brains in the process.  By combining both quick reaction and creative thought, we may not only be able to stabilize a critically ill patient but also provide a unique treatment plan going forward.

2. Worry and uncertainty can lead to bad predictions and poor decisions. I have been accused of being Chicken Little on more than one occasion.   Uncertainty is something that is commonplace in medicine yet it makes most of us uncomfortable.  As physicians we rely on data to make good decisions.  However, uncertainty remains a significant part of what we do in medicine on a daily basis.  We often deal with limited data and must make a decision based on the best available evidence.  Clinical trials bring us some level of certainty  but our patients are biologic organisms, each with potential differing responses to treatments and disease.

According to researchers, the areas in the brain that are activated when you are working on problems that are cause you worry are often associated with anxiety and disgust.  Many poor decisions are made due to the worst case scenario line of thought.  While worry and uncertainty can never be completely avoided, psychologists argue that the way to avoid poor decisions during these times, is to learn to accept uncertainty and control the things that you can control.  No decision is ever final — even in medicine there are opportunities to act, refocus and change directions if necessary.

3. Good decision makers may look past the facts and incorporate gut instinct. Many decisions in medicine are made by considering the best available data and incorporating clinical judgement and instinct in order to make a determination as to the best course of action.  Interestingly, when MRI scans were performed on the brains of very successful business executives who were involved in making difficult decisions, the areas of the brain responsible for emotion and social thinking began to light up more than the purely analytical areas.

Researchers concluded that those leaders who relied not just on facts but on gut instinct and emotion tended to be more successful.  Social thinking — in simple terms — is the ability to look at a problem from numerous angles.  Seeing the potential impact of a potential decision from multiple points of view can provide invaluable insight and may lead to better decisions in the long run.  In medicine, involving other team members — nurses, technicians, and support personnel — in the care and formulation of the patient’s treatment plan may actually help a physician leader to make better decisions.

4. Effective leaders must stay positive and inspire teams. When leaders begin to inspire teams of people and lead with passion, certain other areas are activated in the brain — particularly those areas associated with positive emotions and social thinking.  Along with involving other team members in the care of the patient, it is essential for an effective leader and decision maker to incorporate praise, encouragement and rewards when motivating teams to perform at a high level.  Creating an emotional bond among members of a medical team can be as simple as asking for input from all involved parties and recognizing outstanding contributions to patient care.

The bottom line

Business executives are adept at making determinations that affect millions (if not billions) of dollars and these decisions can move markets.  In medicine, we must make decisions every single day. While some decisions may be trivial, others may permanently impact the lives of our patients and their families.  Moreover, from a business standpoint, the management of a medical practice in today’s market requires impassioned leadership and great skill in order to remain viable.

The work that is done with neurologic mapping in decision making may have provide us with guidance in the future as we develop new leaders.  It may be that through practice and coaching, we will one day be able to activate specific areas of the brain when we are working to make tough decisions.  The strategies and skills that we are able to glean from these types of research activity will allow us to be more effective physicians, leaders and executives in the years to come.

Kevin R. Campbell is a cardiac electrophysiologist who blogs at his self-titled site, Dr. Kevin R. Campbell, MD.

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  • SteveCaley

    Few physicians will be operating in business at an executive level, though. There is a bit of a “glass ceiling” in higher levels of management. Far more physicians operate at middle-manager rank.

  • kkinase

    Dr. Campbell,

    How would you advise the new interns that will be starting July that are interested in healthcare management/leadership as a long-term career goal? Join hospital committees? Get an MBA/MHA?

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