Those aligned with the Tangible Culture do offer a cautionary note: changes to be made must be carefully considered before being implemented. Furthermore, these changes must be introduced gradually in a manner that does not disrupt existing perspectives and practices that are “doing just fine.” Those physicians aligned with the Tangible Culture are particularly resistant to recommendations regarding change offered by those who reside “outside” the medical community. One of McKenna and Pugno’s (2006, p. 132) physicians put it this way:
“Docs want someone who understands our world and sets an example. We’re turned off by platitudes—like business management fads. For example—‘promoting excellence’ is receiving a lot of attention. Most docs feel excellence is core to their profession, so for an outsider to push it as a ‘new initiative’ seems silly to us. Physicians are pretty hard on themselves and our leaders. We expect a very high level of integrity.” [Randall Oates, MD, Family Physician, President of Doc, Inc.]
As is the case with those in the Tangible Culture (and Professional Culture) in many other sectors of mid-21st Century societies, there is not much tolerance for faddish notions introduced by “outsiders” regarding healthcare operations. It’s almost as if sacred space has been invaded!
Conclusions
A clear message regarding physician leadership is being conveyed by McKenna and Pugno. They focus on competencies, character, and culture. There are certain basic competencies that a physician needs if they are to be effective leaders – and these competencies are not necessarily the same as those required to be effective providers of medical services. The character of a physician leader also seems to be of great importance—especially given the trust that patients and the general public have traditionally placed in not only the competence of physicians but also their intentions.
Given the wrenching of healthcare priorities away from healing to profitability, physicians must remain committed to core values. This commitment must be sustained in the face of growing pressures to be accountable to a bottom line rather than patient welfare. This is where character comes to the fore. Words such as integrity, trustworthiness—and even courage—come to mind when considering the nature of effective physician leadership.
Then, there is the matter of culture. Leadership is not engaged in a vacuum. It occurs within and is strongly influenced by the culture(s) that influence (and even dictate) the perspective and practices of those working in this culture. Physicians are often the powerful carriers of culture in a healthcare organization. A physician leader can swim against the strong current of the dominant culture in the organization where they chose to lead; however, this oppositional physician leadership is exhausting and usually unsuccessful. A burned-out leader and alienated membership typically are left on the battlefield at the end of a contentious engagement.
I am not leaving behind the critical interface between leadership and culture as I move to the next essay in this series. I turn to physician leadership competencies and character as they relate to the five basic leadership practices identified by Jeannine Sandstrom and Lee Smith (Sandstrom and Smith, 2017). Each of these practices relates to specific leadership functions that often are required in certain sectors of a healthcare system—and are served most effectively in specific healthcare cultures.
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