As physicians, whether or not we hold a formal position of power or leadership, we are all informal leaders in our daily practices. We guide our patients and their often-complicated treatment plans. We lead our team of nurses and medical assistants. We direct the development and implementation of clinical trials. In emergency situations, we lead by running a code to resuscitate a patient. In the operating room and emergency room, we lead teams to implement effective patient care. We guide the next generation of physicians through training, mentorship, and education. Physicians are meant to be leaders. In order for healthcare to grow and flourish, doctors must be effective from positions of both formal and informal authority. Unfortunately, in our decades of training to become excellent clinicians, one key component is often lacking: we are not taught how to be effective leaders and agents of change. How effective we are in having strong physician leaders will be the difference between a health system that is flourishing versus floundering.

A good leader is someone who is able to execute someone else’s vision well. A great leader is someone who has a vision and is able to excite and motivate those around them to work toward implementation of that vision. A good leader is able to delegate, a great leader is able to motivate. Traditional leadership was associated with a title or a formal authoritative position. In the modern era with social media and the rise of the influential “thought leaders,” a leader can be effective with formal or informal authority.

Being an agent of significant change in healthcare can be a challenge. Our healthcare system can be unwieldy, and it can feel impossible to have an impact that is transformative. But there are those who are able to affect change on a large scale in a meaningful way. One excellent example is the United Kingdom’s National Health Service (NHS), a large government-run institution that is embedded in tradition and hierarchy. Julie Battilana, PhD, a professor of business administration at Harvard Business School, and Tiziana Casciaro, PhD, a professor of organizational behavior at the University of Toronto, identified some predictors of success when the NHS attempted a quality improvement initiative. They discovered the key to success boiled down to interpersonal relationships within the network. The people who had the greatest success at becoming change agents were central in the organization’s network, and their level of impact was not based on the individual holding a formal leadership position. They also found individuals who created interrelationships and connections between otherwise disconnected groups were the most successful at implementing major changes. They discovered that developing relationships with the “fence-sitters” was always helpful. However, it was also noted that developing close ties with those who resisted change could be counter-productive, or if it was helpful, may only have been beneficial for implementing minor changes. They concluded that these three points are essential to being an effective leader, with or without formal authority.

Several other key components are essential to being an effective change agent, and in this piece, I share some effective strategies physicians can utilize.

Define Your Vision

To be effective, you will need a vision. A vision should be limitless. Think outside the box and without restrictions. When implementing change, compromises may eventually be necessary, but the initial vision should be developed as if boundaries do not exist.


Create the Right Type of Network

The type of people within your network matter. As Drs. Battilana and Casciaro have highlighted in their work, there are two types of informal networks that exist within an organization. In a bridging network, an individual links people who would not otherwise be connected to each other. It is important to be able to interact across organizational boundaries, and in doing so, access diverse and novel information. In a cohesive network, all members have ties to each other.  This level of social connection typically leads to trust and a high level of support. People from this type of network are sought out for their advice and trusted for their judgment because of their interpersonal relationships. Both network types have their own benefits. If the goal is to make dramatic or divergent changes as a leader where the current system will likely be disrupted, a bridging network may be more useful to bring about different ideas and solutions. Resistors who do not have personal relationships or social connections are also less likely to band together. This network also allows for delivery of a tailored message of the vision and plan to each individual. This message can be modified to satisfy each person’s needs. However, a cohesive network may be a better choice if the purpose is to implement change and lead by building on established practices, especially if a similar goal or vision is shared by the rest of the network.


Bridge the Gap Between Supporters & Skeptics

Dr. Battilana and colleagues describe three types of people who appear when discussions begin about change: Endorsers, who may share your vision and are excited about change; resistors, who are against the change; and fence-sitters, who are either ambivalent or can see both sides of the coin. Their research highlighted that developing deep relationships with endorsers would not make them more likely to support your goals, although it is always beneficial to enlist the help of some champions to further your cause. By developing closer relationships with those on the fence, it is more likely there will be a shift in your favor as they are less likely to want to let down someone they see as a friend. Those who fall in the resistor category could go either way, and their support often depends on how drastic the change is, whether the change will directly impact them, and how intensely they oppose the change. They also suggest it would be wise to be cautious when interacting with those who fall in this category. Listen to their concerns and thoughts, but do not be disappointed if the resistor does not change their mind. Try to understand their viewpoint and make modifications if appropriate, but do not get frustrated if you cannot bring them to your side.


Create an Effective Network; Surround Yourself With Great & Diverse People

The greatest leaders realize early that they will be the most successful by surrounding themselves with diverse individuals. Simply having a formal leadership title does not make one an effective leader. It is essential to work with a network that includes individuals with informal authority who are entrenched within the organization. An individual who is trusted and respected within the system, who is a known entity but without formal authority, can be a formal leader’s greatest ally. Dr. Battilana’s study showed that centrally positioned individuals make successful change agents by using informal connections to further the cause. These relationships can be more powerful than a formal leadership title when attempting to affect change. Titles and formal leadership positions and authority can give the illusion of power, but without the influencers within the network who lead with informal authority, change will be challenging.


The Importance of Emotional Intelligence (EI)

Psychologist Daniel Goleman, PhD, described five key components to emotional intelligence: self-awareness, self-regulation, motivation (defined as a passion for work that goes beyond money and status), empathy, and social skills (such as proficiency in managing relationships and building networks). Dr. Goleman explored the contagious nature of emotions at work and the link between leaders’ emotional states and their companies’ financial successes. He applies advances in neuroscience research to explain how leaders can increase each element of EI by understanding and improving the ways they focus their attention. To be most effective, leaders must be self-reflective and understand how their actions and emotions will affect those around them. The most effective leaders are self-aware, empathic, and introspective.


Prioritize, Delegate, Motivate; Coach and Sponsor Others

To be an effective leader, it is important to identify the strengths and weaknesses in others, and help each team member fulfill tasks that are best suited to their skill sets.


Find a Leadership Style

Quite a few categories of leadership styles have been defined in the literature. Dr. Goleman proposed six styles of leadership based on a sample of approximately 4,000 executives worldwide: coercive/commanding, authoritative/visionary, affiliative, democratic, pacesetting, and coaching. Many healthcare leaders are adopting management techniques and tools used in other industries, specifically lean leadership versus servant leadership. Lean leadership is a philosophy on improving processes and eliminating waste to add value and calls for holistic changes in style and culture. Greenleaf’s theory of servant leadership is based on an idea that leaders should serve their followers. These styles will be covered in a separate, upcoming piece.


Make Your Team Feel Valued

One of the most important things that great leaders do is make the people around them feel valued. Regular performance reviews with objective data are essential in promoting and improving effectiveness within a team. Team members will be motivated to improve, their strengths and weaknesses will be clearer, and these assessments set well-defined goals and responsibilities for each individual. It can also help the team member identify their purpose in the greater plan. Setting specific goals and targets as a leader can help with opportunities for development and open communication. Transparency can go a long way in improving team members’ overall satisfaction. This will then reflect in their productivity levels. Reinforcing the importance of each member of the team’s contributions can go far when asking a colleague to go the extra mile on a project that may keep them late at work. People intrinsically take pride in their work, and when their work is appreciated, they are more likely to continue to try and exceed expectations. Recognize successes, publicize achievements, and praise success and you will develop a team that is focused on exceeding expectations.