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What Are We Looking for?

Bolwell, Brian J. MD, FACP

doi: 10.1097/01.COT.0000574908.62092.1d


My organizational role has recently expanded. I am now leading our executive physician leadership and development program. It's a nice opportunity to put some of my leadership learnings into practice.

One of my first tasks is to see if we can improve the search committee process. Search committees tend to depend on the views of the committee chair. The chair person filters candidates and is frequently heavy-handed about the direction of the committee based on his or her personal beliefs. As a result, there is not a lot of recruiting rigor around the process. We are taking a closer look at our entire search committee process with a goal of standardizing key issues such as:

  • What qualities are we looking for?
  • What type of experience is desirable?
  • How familiar should the candidates be about fundamental leadership qualities?
  • What evaluation tools and interview questions should we use to learn more about the candidate?

At first glance, it might seem that this should be a straightforward process. Of course, it is not. An initial step is to identify which leadership jobs require a search committee in the first place. High-level academic appointments require a search committee, yet frequently, hospital physician leadership roles do not. Instead, individuals are simply appointed to those leadership roles. I'm not sure that makes sense. Defining which leadership roles in medicine require a search committee is a pretty important initial step.

The next step might be to define the job. What do we expect leaders such as department chairs to actually do? Is their primary role to elevate the scientific presence of the department? To recruit great physicians? To mentor? How much operational responsibility will they have? Will they be responsible for financial results?

With these questions in mind, we wonder if we should develop a job description for our physician leaders. Job descriptions are universal in 99 percent of human resource work yet tend to not exist in academic leadership jobs. The entire idea of creating a job description for physician leaders is surprisingly controversial. Many believe that it is unnecessary, largely because we have operated just fine without job descriptions. My personal opinion is that defining the roles and responsibilities of a chairman at any leadership level is a good idea and worthy of the time and effort required to do it.

The next step might be to look at desired behavior. Our organization has in fact developed eight desired leadership behaviors:

  1. Inspire (earning the followership of others)
  2. Drive (achieving results through others)
  3. Influence (influencing others)
  4. Collaborate (produce stronger outcomes through partnerships)
  5. Set direction (provide vision)
  6. Account for results (generate value)
  7. Transform (drive change and innovation)
  8. Build talent (recruiting and talent development)

One advantage to this approach is that each pillar can be tailored to the leadership job. For example, tactics to inspire others will vary, as the tools used by a CEO to influence will be broader than those used by a manager. Thematic in these leadership behaviors is the ability to work with others. This should always be examined as you interview candidates for leadership positions. Many will have excellent individual success, but it is important to determine if they can work in a team environment.

What about previous job experience? Obviously this is important as you look for a physician leader. The candidate needs to be an expert in their field and be competent clinically, but what else? Increasingly, health care leadership jobs require a working knowledge of financial metrics. Can these be learned by a candidate, or should they bring such knowledge with them?

Managing physicians is essential to succeed at health care leadership. How much leadership experience, especially experience managing physicians, is required? And how important is the national reputation of the candidate? For some search committees, this, coupled with federal grant funding, is the primary criteria to evaluate a prospective leadership candidate. But how much weight does a national reputation bare? At the very least, the leader needs to be able to attract top talent, and unquestionably having a big name can help them do so. This is certainly not a black and white issue. In my mind, previous job experience is important, but not as important as trying to define the essence of the potential leader.

Assessing character traits is crucial when selecting a physician leader. These include integrity, cultural competency, emotional intelligence, passion, tenacity, motivation, empathy, cognitive ability, inclusion, innovation, teamwork, and many others. I had one person send me a list of character traits and included one entitled “cognitive load management.” I'll leave the definition of that one to each reader to decide.

For me, these are all important. But what I am really looking for when I evaluate any prospective recruit is to try to learn about their fundamental core. What are they really like? What do they really care about?

Therefore, I generally gravitate to personality traits when I am evaluating potential leaders. While all the traits listed above make sense, I would suggest that the following five are essential.

First is emotional intelligence. A leader needs to be able to listen and see things from the perspective of others. Does the candidate create a safe environment for people to speak up and disagree? Are they able to acknowledge when they are wrong, or do not have the answer, or simply messed up? Can they accept honest feedback?

Second is grit. Grit is a combination of passion and perseverance. Are they resilient? Do they get back up when they are knocked down and fail? Do they have a true passion for the work? I previously wrote about grit and referenced the work of Angela Duckworth (Oncology Times 2017;39(13):16,39).

Third is serving others. Can they work in a team environment? Do they lead with empathy? As I referenced last month, work is about developing relationships. To do so, you not only need to be able to work as a team member (ideally as a giver), but also to support others and have their back (Oncology Times 2018;40(22):24,38). Can they demonstrate loyalty?

Fourth is honesty. Do they tell the truth? Are they plain speaking, or are they masters at spin? Can they focus on issues that really matter, or do they avoid difficult topics and focus on the periphery? Do they create an environment of transparency? A corollary to honesty is self-awareness. Importantly, are they aware of unconscious bias and are they able to create and embrace diversity?

Finally, and possibly most importantly, is courage. Can they have difficult conversations? Can they clearly state what lines cannot be crossed? Will they be able to be the only person in a room to speak up when necessary? Will the person as a leader consistently do the right thing, even when it's hard to do, and even when it may be challenging to do so politically? Winston Churchill said “Courage is rightly esteemed the first of human qualities... because it is the quality which guarantees all others.” Always try to find a leader who is courageous.

As I dive into this work, I am keenly interested in learning more about evaluation tools that can assist one's ability to see if applicants possess these character traits. There is a whole world of talent evaluation that I am just beginning to learn about. I greatly enjoy it, as I enjoy learning about anything to do with leadership. People are complicated and, without question, evaluating candidates for leadership positions is far from easy or straightforward. But if you find somebody with high emotional intelligence who also has a fair amount of courage, you will probably be on the right track.

BRIAN J. BOLWELL, MD, FACP, is Chairman of the Taussig Cancer Institute and Professor of Medicine at the Cleveland Clinic Lerner School of Medicine. Cleveland Clinic is a top 10 cancer hospital according to U.S. News & World Report.

Brian J. Bolwell, MD, FACP

Brian J. Bolwell, MD, FACP

Straight Talk: Today's Cancer Centers

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