Kiki relaxing with one of her many charges
Last year my family adopted a seven-year-old great Pyrenees from a local rescue. This dog has been a spirited and welcome addition to our family. For those that are unfamiliar with the breed, the Great Pyrenees is a livestock guardian. It is often used as a working dog on farms and has the instinctual tendency to alert to potential threats. As house pets, Great Pyrenees often adopt small children and other animals in the house as their “flock.” Whether in the mountains where they take their origin, on farms or in our family’s backyard, their instincts remain strong.
We live on a golf course. So there are a lot of “threats” to our “flock.” We spent the entire spring, summer and fall listening to the sturdy bark of our new pet as golfers and maintenance workers make their way down the path along our back fence. This can be irritating. It is particularly irritating to my wife who spends more time at home than I do.
The other day she was wondering what steps we could take to quell the barking. While annoying, especially at 3am, it is the dog’s instinct to alert to potential threats and I don’t think that she should be punished for that. We knew what we were getting into when we adopted this dog and we have to accept these traits as they are even if they are somewhat disruptive.
This made me think about management in the healthcare realm and in particular, physician leadership. Too often we select individuals for leadership and management positions based upon their performance as workers. However, all too often very traits that propel somebody to the front of the pack can be undesirable in the board room.
As physicians, we are often bred/trained to act decisively and quickly assimilating large amounts of complex data and making decisions independently in order to protect our patients’ health and/or life. I have seen physician leaders, myself included, admonished for failing to consider all aspects of the situation before making a decision. What many people don’t understand about doctors is that we are trained to do this. When a patient is crashing in the ICU, there’s no time to assemble a task force or hold a committee meeting. A leader needs to step forward and ACT. Act quickly. Act decisively. Act independently. Few decisions that the physician leader makes on an administrative level have that kind of urgency; however, it is sometimes difficult to turn off that ‘fight or flight response’ we developed throughout our medical training.
So how do we mitigate this instinct to act independently and sometimes rashly when confronted with a difficult decision? Short of formal training or education in the business leadership or administrative disciplines this instinct is usually tempered over time. The physician leader will make a few mistakes, hopefully not catastrophic, and learn from those experiences. We are, after all, exceptional students. However, not all physician leaders are ‘retrievers.’ By retrievers I mean friendly, malleable and easily realigned. Some, many, are more like the Great Pyrenees- intelligent, bold, stubborn but fiercely loyal.
One of the things we learned about the Great Pyrenees breed before we adopted was that they require a strong master. Does this mean that physician leaders need a strong ‘master’ as well. Well, not exactly, but they can benefit from good partnership and mentoring.
Our organization utilizes a ‘dyad’ leadership structure that pairs a physician leader with an administrative leader. While the strength of any dyad partnership is dependent on the individuals involved, for me, it has been extremely advantageous. My administrative partner helps to temper some of the aggressiveness, boldness and sometimes impulsiveness that I have been rewarded for throughout my years as a medical student and physician. When properly constructed, dyad partnerships are more than just complementary but rather synergistic with the value of the pair being greater than the sum of its parts. Ideally, dyads will evolve into their respective roles together, each taking on the more desirable traits of their partners in exchange for the abatement of less functional attributes.
We must understand what we are dealing with when we elevate physicians to leadership positions. Any healthcare organization will benefit greatly with strong physician leadership; however, it is important that the tools and processes are in place to ensure that the proper choice is made initially and ongoing development is fostered. Dyad leadership is not the answer for every organization but it can be a very powerful tool to keep physicians engaged in high levels of organizational leadership while ensuring that administrative leaders have the clinical data and expertise to make appropriate decisions.