Several reviews of the literature on leadership training programs have appeared, 5 , 6 but few describe the major national, comprehensive health care leadership training opportunities. Programs for women both comprehensive and specialty-specific 9 — 11 were among the first to appear in an attempt to increase the ranks of senior women leaders in the health sciences. A leader must be able to engage the various interprofessional communities within the hospital, academic affiliate, or health care system.
Leadership training for students and medical residents is a rising topic of discussion, 2 with some programs implementing short leadership retreats for rising senior or chief residents 4 , 16 and others incorporating leadership training in their regular trainee curriculum.
If uniformly implemented, these early career programs would be of great value in developing a pipeline of leaders for the future. Early career programs would likely be insufficient to create the leadership skills necessary for senior career opportunities but may establish the foundation for continued development. More development programs are needed to make comprehensive leadership training more widely accessible. Better coordination among disciplines, and expanded availability of comprehensive leadership development opportunities, would result not only in better prepared senior health care leaders but also in improved interactions between hospital administrators, practicing professionals, and academicians, with a culture of true collaborative or shared leadership.
This definition has evolved over time, and today, we recognize different styles of leadership, each with their own definitions. In health care, three of these types are prevalent and most identified: Transactional leaders, who work within the boundaries and the existing standards of the organization. They are usually not risk takers, but focus on efficiency, control, stability, and predictability.
Transformational leaders, who raise one another to higher levels of motivation, making changes and shaping the future. Servant leaders, who focus on the service aspect first as they have a natural tendency to help others. Each of these types has its place in health care, but transformational and servant leaders are more likely to help the institution advance, while transactional leaders are most qualified to maintain the status quo.
Relationship behaviors involve the ability to interact with peers and subordinates in a way that all feel comfortable with themselves, with each other, and their specific setting.
Therefore, individuals are, by necessity, becoming more aware of their own leadership styles and the way they communicate, usually through feedback from others. Physicians, for example, are not usually trained to concentrate on leadership or think about their own behavioral style. Yet, leadership is an intrinsic part of the practice of medicine, even in the interactions with patients and their families.
Gabel 22 examined how all physicians take on leadership roles at some time in their careers, whether formally or informally. He discussed the characteristics of formal and informal leaders and concluded that it is important to expand the scope of leadership training so that both types of leaders are included.
Different health care leaders may arrive at their positions via different personal paths. Rogers 19 published an analysis of the communication and leadership styles of health care leaders in each major area within an academic health center, that is, medicine, nursing, and administration. She studied the importance of linking leadership styles to individual professions.
She concluded that physicians, nurses, and administrators must have an increased awareness of self and individual leadership style and that each of these health care leaders must be engaged in practices of reflection. In nursing, reaching a leadership role is often an expectation or at least an aspiration for a large number of individuals.
It should therefore be no surprise that the nursing profession has embraced leadership training earlier than others in health care. They likely have managerial experience, so the transition to leadership is fairly natural, as long as they are able to also have vision in addition to their managerial skills.
One cannot, however, assume that these individuals possess all the traits that will make them effective leaders in a large and complex health care system: the development of integrated leadership processes throughout health care delivery systems is needed. For physicians, the transition to becoming true modern leaders is a major accomplishment, 25 often requiring a move outside their comfort zone.
In fact, many cringe at the thought of having to be a leader. Arroliga et al state that failure to train our healthcare leaders could have a long-term negative impact on society. He argues that the traditional means of selecting leaders by virtue of age, productivity or other academic skills was inadequate, as these individuals simply emulated their predecessors, but had no formal development of the personal and professional qualities and skills required by a leader.
Thankfully, this may be changing as educational standards for trainees evolve. In , the Accreditation Council on Graduate Medical Education ACGME launched their outcomes project, a competency initiative that included six core competencies that residency programs use to evaluate their residents. One of these is systems-based practice.
These competencies, now included in the ACGME accreditation system as performance milestones, 26 began the task of introducing this topic into medical education, albeit at the graduate level. As a result, many medical schools have elected to incorporate these skills in their medical student curriculum as well.
Hopefully, the trend of investing in the leadership growth of physicians from their earliest development will allow them to acquire the skills to become better collaborative leaders, with a vision for the entire realm of health care. Stoller 27 observed that health care leaders must also possess commitment, integrity, altruism, and authenticity. He listed some of the skills and traits that physician leaders, in particular, must have or acquire.
These include a technical knowledge of insurance and reimbursement issues, how to balance expense with quality of patient care, health care regulations including the Affordable Care Act , legal issues in health care and public policy, problem-solving skills, communication skills, emotional intelligence, and a commitment to lifelong learning.
In his editorial in the American Journal of Medicine , Alpert 28 defines qualities that are important for leaders. These include commonly mentioned themes such as equity, justice, role modeling, work ethic, balancing work and personal life, organization, and prioritization. Developing all these skills may be a challenge for many individuals.
In the early years of recognition that health care professionals required some form of leadership training, degree programs such as MPH and MBA were thought to be the solution. But experience has shown that these additional degrees do not necessarily turn an individual into a leader.
Managers, administrators, and leaders are not one and the same. While an individual may encompass all three of these descriptors, often that is not the case. As described by Curtis et al, 29 managers administer, maintain, control, have a short-term view, and initiate.
Other managerial roles include planning and budgeting, organizing resources, and problem solving. Kotterman 30 defines management as dealing with procedures, practices, and complexity and leadership as dealing with change. Souba 32 discussed the changes that have occurred in health care leadership over the years.
Business and administrative acumen, a foreign concept for a clinical leader of the past, is now a necessity. The ability to engage others in creating a common vision and building teamwork is in stark contrast with the old image of the leader as a despot, commanding from above. Strong communication skills were always appreciated but are often lacking in the leader: lack of communication today is likely to derail a leader.
The concepts of awareness and authenticity have gained wide acceptance. Empathy and the ability to develop others through mentoring and coaching are, today, among the traits that truly differentiate a leader from the rest. This may include rules, laws, governance, or the personal competencies that are not innate in all. Leaders who believe that they can do it without any formal training often succeed for some time but eventually will encounter critical situations that they are not prepared to handle alone.
Then they urgently seek the resources to help them succeed, often too late to salvage a career. We need a pipeline of emerging leaders, both in the purely clinical health care realm and in academia, who have already mastered the additional skills through formal experiential training and will have greater odds of success when asked to step into a new leadership role.
It would be preferable for all if training in the key knowledge and skills were more easily accessible and therefore acquired before a major institutional and career failure dictate the need for more education.
These needs are global: the Foundation for Advancement of International Medical Education and Research FAIMER , 33 based on the ELAM model 10 and cofounded by the Founding Director of ELAM, demonstrated that leadership and management can be taught across cultures and that this has enhanced the ability of the leaders in the served countries to maintain alignment with their local needs, developing trust in their own abilities and avoiding persistent dependency on other countries.
This is a unique example that appears to validate the principles of leadership training developed for American health care as they apply to the global health care community. Warren and Carnall 35 from the UK noted that their national health care system has also neglected leadership training for physicians.
They encouraged physicians to develop skills and a level of understanding that go beyond technical expertise in their specialty, including the ability to create and communicate their vision and set clear direction. They also concurred with the opinion that programs spanning longer periods of time, allow the participants to absorb and reflect on their new knowledge, and incorporate it in their daily activities. Because leadership development is needed for all the professions from which health care leaders emerge medical, dental, public health, nurses, allied health providers, and administrators , the ideal curriculum would be interdisciplinary and applicable to as many as possible of these groups.
Such a program should include essential and universal leadership skills conflict management, negotiation, financial skills, etc , as well as strategies to develop personal traits. Table 1 lists a compilation of the essential elements of leadership development and the competencies considered the most important skills to be developed in health care leaders. Some general concepts are universally important for leadership development.
For an effective program that will give leaders insight into themselves and others, pretesting for learning style and personality characteristics are a must. An ideal leadership development program would include a basic curriculum of general, comprehensive health care concepts, presented with diverse methodologies, including didactic teaching, mentorship and coaching, and experiential leadership opportunities.
Even more detailed specialty-specific topics may be appropriate, if feasible. For example, surgeons, operating room nurses, and allied health providers need to learn operating room-related leadership skills and information, whereas clinic nurses and outpatient-based physicians and pharmacists need to learn skills specific to their ambulatory setting. Basic researchers have an entirely different set of skills required to run a major research program, and educators need the proper tools to lead curriculum development, innovative practices in education, etc.
Training about leadership styles and situational leadership should be a component of the curriculum for emerging health care leaders, allowing them to understand and be able to interact with individuals with different styles from their own. Among the competencies that should be included in most comprehensive leadership curricula, the most significant include finances and economics, emerging issues and strategic planning, personal professional development, adaptive leadership, conflict management, time management, ethical considerations, and personal life balance.
In addition, developing a well-defined project that will have an impact on the institution provides a practical, on-the-job application of skills learned that are therefore more likely to become ingrained. Blumenthal et al 3 suggested that the common elements of effective leadership development programs include reinforcing or building a supportive culture, ensuring high-level involvement and mentorship, using a variety of learning methods, offering extended learning periods with sustained support, encouraging ownership of self-development, and committing to continuous improvement.
Leaders develop personal resilience through continual learning. Lifelong learning is essential to success as a professional. Adult learning includes discovering the personal meaning of ideas. Learning shared with a cohort of fellow learners enhances the discovery process: adults can learn as much from each other as they do from formal instruction.
Learning is also enhanced when participants share common work experiences. While learning is unique to each person, learners need consistent methods of reviewing and improving learning outcomes. Learning is reinforced by mentoring and coaching and becomes embedded when participants are able to utilize what they have learned in a timely manner.
Mentoring 36 deserves special attention. It is right-fully considered a key component of leadership training, especially at the emerging leader level. Mentors are not reserved for emerging leaders: one is never too old or too senior to benefit from good mentorship.
The next step, which in my opinion should be a required component of senior leader development, is exposure to executive coaching. Coaching differs from mentoring in that it is directed at enhancing performance in specific areas. It is goal oriented and may be a relatively short-term process, although many successful leaders avail themselves of a coach for their entire careers.
It is their responsibility to assure that the topics of discussion are appropriate to their needs and address any feedback they may have received. The coach does not set the agenda, but is there to assure that it is developed properly. Finally, the environment in which the training occurs plays an important role. A long-term benefit of longer training programs, not to be underestimated, is the networking and peer mentoring that inevitably develops.
What emerge are life-long relationships and networks of trusted peers that can provide strong, safe, and valued support. Many programs have been developed to enhance culture- or situation-specific skills. Training may occur in different formats, ranging from self-directed to team training or formal curricula of variable duration.
Of the programs described in the literature, a large number are directed toward graduate medical education residencies , mostly in response to requirements by the accrediting body ACGME. Most of these programs have short and intense components eg, day-long retreats that may be followed by small elements disseminated throughout the training period. Devising a curriculum at the professional school level is a greater challenge: the curriculum is tightly planned; therefore, such early career programs are most successful when integrated in the core curriculum, over the course of the entire duration of the degree program or planned during breaks from school.
Other programs for health care students in medicine, dentistry, and nursing have been described. Institution-based leadership programs directed toward faculty usually at the junior level are emerging with increasing frequency.
In more recent years, a number of specialty organizations have also developed specialty-specific leadership programs. A few examples include the American College of Surgeons Leadership Course for Surgeons, 50 covering topics such as the attributes of a leader, aligning values and leading change, building and maintaining team effectiveness, and leading oneself. These types of targeted programs are important and play key roles in the development of students, trainees, junior faculty, and practitioners.
Nevertheless, there is a need for more national-level interdisciplinary and comprehensive leadership training programs: these are still relatively scarce as are leadership training opportunities for senior career individuals who have already attained administrative and leadership roles. National programs have access to a broader cohort of participants from diverse backgrounds and attract some of the best individuals in the country.
This enhances the experience as participants and faculty bring their diverse experiences to the program and the networking element is expanded to a broad area. These programs are intense and relatively short 1—2 weeks duration. Few comprehensive leadership programs have undergone formal evaluation. Now in its 20th year, ELAM is the most comprehensive national and international program available today, albeit specific to the academic sector, and open only to women.
ELAM enrolled its first class in and has to date trained almost senior-level women in academic medicine, dentistry, and public health. Evaluation has been an integral component of the program since its onset. Leadership skills and knowledge increase after participation; a greater proportion of ELAM alumnae advance to higher levels of academic leadership than do comparison groups; and medical and dental school deans view the ELAM program as having a positive impact both on their schools and on participants.
In fact, These included, at the time of publication, 14 of the 26 women deans at US accredited medical schools, seven of the eleven women deans at US dental schools, and one of the 13 women deans at US public health schools. Twenty-eight ELAM alumnae have held or currently hold positions of vice president, provost, or president of an academic institution of higher learning, and seven hold equivalent leadership positions in organizations outside academia foundations, pharmaceutical industry.
The documented outcomes from ELAM suggest that similar programs, open to a wider population of senior health care leaders, would help in resolving the deficiencies described by many reports in the literature. Over the past 20 years, we have made considerable progress in the field of leadership development.
Leadership is a common topic of conversation in health care today, and there is an increasing body of literature and awareness of leadership development needs and opportunities. As noted earlier, a very significant step forward is that outcomes of comprehensive leadership training programs are being evaluated both in the academic environment 10 and when the emphasis is on clinical providers.
Graduates of these development programs are highly recruited nationally, and their knowledge is spread to diverse geographic areas. As a consequence of the experience during a development program, there is greater acceptance of executive and leadership coaching. She had not discussed it with her boss, the medical school dean. Her coach reminded her that blindsiding a superior is never a good idea. The chair therefore shared her ideas with the dean before discussing them with the CEO and discovered that the dean had different ideas.
Given the impact of the reorganization, had she moved forward without first consulting the dean, it is likely that she would have been removed from her chair position. Formal leadership development resources are growing in number and quality: the benefits of formal training are many and usually evident, albeit not always documented with objective data.
Institutions and health care in general directly benefit by the increasing numbers of individuals already in leadership roles with formal training.
With the rise of programs for students and postgraduate residents and fellows, a pipeline of physicians, nurses, and administrators with some formal leadership training is being created: this bodes well for succession planning and sustained organizational success of our health care systems.
Significant individual benefits include personal growth, career satisfaction and advancement, and, very importantly, networking: participants who spend significant periods of time learning together often develop a special camaraderie, which encourages ongoing collaboration and synergy among colleagues and institutions.
Relying only on leadership training programs to develop new leaders is not free of risk to both the individual and the institution. First, not all leadership programs address the differentiating leadership competencies especially emotional intelligence that set true transformational and servant leaders apart, giving them the personal tools needed to move health care forward. Programs may not include key components that are covered by the more comprehensive curricula. What does it take to inspire others, promote a novel idea, or even have a difficult conversation?
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