After wrapping up the SHM annual meeting, I was left with a sense of security about hospital medicine’s future. This security I can summarize in a single word: leadership. SHM has long had a strong set of leaders, which are needed now more than ever. With explosive expansion in volume and scope, hospitalist practice is going to require tireless leadership in the coming years and decades to ensure our trajectory is strategic and viable.
Wikipedia describes leadership as “a process of social influence in which one person can enlist the aid and support of others in the accomplishment of a common task.” Notice a few key words in that definition? “Process,” which implies that it takes time, patience, and tenacity. It is not something that automatically happens without any time or effort. Also notice the word “influence,” which does not include “power” or “authority” or “pay grade”—all terms that are entirely overused and misused in the medical industry.
There is a wealth of literature describing what leadership is and what it takes to be a leader. There are an abundance of theories on what traits and characteristics make up a good leader, and an equal abundance of theories on how great leaders evolve. Some subscribe to the inherited theory, in which genetic makeup will at least partially dictate whether you will be a “natural-born” a leader. Others subscribe to the belief that leadership is more situational, whereby leaders are effective in some situations but ineffective in others. Still others believe leaders emerge as a mixture of nature and nurture, that most good leaders can lead in a variety of climates and situations, but that a perfect leadership situation might not emerge for any one leader. For other leaders, a perfect situational opportunity might emerge that suits their leadership style, and transformational change can occur under their direction.
The science of leadership has found that some personal traits are more commonly associated with leaders than nonleaders, including extraversion, self-efficacy, conscientiousness, intelligence, and openness to experience. However, absence of these characteristics does not guarantee a hopeless leadership void; equally true, the presence of them does not guarantee good leadership.
So one can go on for the length of an encyclopedia about the science of leadership, but what about the art of leadership? The ability of a leader to “read the audience,” to “take the pulse” of their staff, to strategize their next foray into new territory, or to say no to a new (seemingly exciting) opportunity. It is the art of leadership that is much more intriguing. I have had the good fortune of seeing a variety of incredible leaders at work, both within and outside of SHM, including their artful mastery of difficult situations.
There were plenty of these artful masters exemplified over the course of the three-day meeting worthy of mention. Three outgoing board members have long led the society down many strategic pathways with brilliance and ease. Lakshmi Halasyamani is wise, kind, and even-keeled. Eric Siegal is sharp-minded, sharp-witted, and sharp-tongued. Joe Li is authentic, energetic, and conscientious. Three oncoming members will bring vast experience and collective wisdom to the SHM board—Brad Sharpe, Patrick Torcson, and Howard Epstein.
In the brief session celebrating the past presidents, I was struck by the number of impressive names and faces who all have gone on to do an array of other jobs. Together, they represent a collective footprint of impressive magnitude. As past president Shaun Frost gave his thoughtful exit speech, and new president Eric Howell gave his lively, energetic, and humorous entry speech, I was reassured that we indeed are in good hands, with a foothold of grounded past leaders, and a wealth of talent on the launching board. Moreover, the introduction of three new Masters in Hospital Medicine—Scott Flanders, Jeff Wiese, and David Meltzer—adds to the collective wisdom and talent of SHM.
We were blessed at the meeting by the presence of other incredible leaders in health care, including Patrick Conway and David Feinberg. Dr. Conway, the CMO of Medicare, is a service-minded colleague determined to make CMS more transparent, easier to traverse, and more aligned with what its recipients really need. Dr. Feinberg is a genuinely compassionate physician who has transformed UCLA medical center from a Motel 6 to a Ritz-Carlton in customer service. I have seen him speak before and had quite a bit of respect for him to begin with, but to watch how he handled a flock of unwieldy and uninvited guests on the stage was more than what anyone could expect from a great leader.
The Art of the Science
As we continue this unwieldy and unpredictable journey that we call health care and hospital medicine, the need for effective leadership within the industry will continue to increase. And there is little need to argue about whether leaders are naturally born, because there are more leaders needed than there are natural-born. So either way, many of us have to figure out how to be leaders, whether of a small program, a newly formed group, or a large conglomerate. And whether your contribution is large or small, it will be a contribution nonetheless.
Just as Mother Teresa was once presented with a statement from a reporter about how her care for the poor and neglected was just a “drop in the bucket” on combating poverty and dispassion. She paused and agreed: “Yes, it is just a drop in the bucket but it’s my drop.”
Just as Dr. Feinberg recounted when he was first offered the CEO position at UCLA, as an interim and unlikely candidate, he didn’t know what to do, so he just started doing what he knew how to do best. He just started walking around the hospital seeing patients, listening, visiting, saying “hello,” and giving out his business cards (his drop in the bucket). He wasn’t trying to do anything terribly innovative or strategic at the time—at least, not that he admits to. And anyone who watches Larry Wellikson work a boardroom or a ballroom can learn something about the art of leadership.
So think of leadership not as a secret sauce, or set of skills that can only be relegated to those enshrined with the DNA of a Kennedy or an MBA from an Ivy League school. It is a willingness to try to get some drops in some buckets, and lead people in a common direction. It is about being unambiguously committed and completely authentic, with a little science, and a lot of art.
Dr. Scheurer is a hospitalist and chief quality officer at the Medical University of South Carolina in Charleston. She is physician editor of The Hospitalist. Email her at email@example.com.