In bringing together the insights of McKenna and Pugno with those of Sandstrom (LL), I find that a particularly strong foundation is being built when you bring together these two sets of perspectives concerning advocacy. Sandstrom has brought in an appropriate advocacy-focused list of roles and competencies that includes serving as a champion (advocating for individuals or causes), uniter, and community-minded leader. Competencies include being a connoisseur of talent, building teams with diverse approaches and capabilities, and promoting inter-departmental collaboration. An additional competency is identified by one of McKenna and Pugno’s (2006, p. 117) physician leaders. William Jessee, MD, FACMPE (Pediatric, Preventative and Emergency Medicine Physician, President, Medical Group Management Association) identifies the knowledge base that physician leaders must acquire if they are to be effective advocates:
“To be a persuasive advocate for any cause or constituency, physicians must not only be articulate and insightful, we must do our homework and have a thorough knowledge of the issues at hand. This is vital. Otherwise, we will be discounted, or worse, discredited. Our country needs evidence-based health policy, evidence-based medicine, and evidence-based management of health services delivery. Physicians are ideally positioned and equipped to gather and share the evidence—if we’re willing to invest the time and effort required.”
McKenna and Pugno have added their own insights regarding differences and community. They brought in what my colleague, Marybeth O’Neill (2007), calls the “backbone and heart”. More than has been the case with the previous three leadership practices, this fourth practice seems to require a large amount of character (backbone) (e.g. behave honestly, persist despite obstacles and setbacks) along with a cluster of competencies (head) that Jeannine Sandstrom has identified.
We can expand this list. We find that relationships should once again be brought into our analysis of effective physician leadership—though this time it is brought in by McKenna and Pugno (rather than Jeannine Sandstrom). They provide a detailed list of the relationship-based competencies (e.g., listen attentively, ask questions, encourage discussion and debate) that are required if a physician leader is to be effective as an advocate. One of their physician leaders who is often quoted puts it this way: “To be an effective leader requires skills in listening, speaking, and writing. Physician leaders need to be good communicators as well as idea people.” (Peter Geerlofs, MD, Family Physician, Chief Medical Officer, Allscripts Healthcare Solutions, Inc.) (McKenna and Pugno,2006, p. 154)
I propose that these communication skills are particularly important when advocating for Sandstrom’s “differences and community.” I would push even further than McKenna and Pugno, suggesting that for effective relationships to be established under conditions of advocacy one must not only be a good communicator but must also know how to manage conflicts—for disagreements and resistance are inevitable when one is promoting differences and community (Bergquist, 2003).
