We see this forward-leaning and focus on improvement in a statement made by Edward Bope, MD (Family Physician, Residency Program Director) (McKenna and Pugno, 2006, p. 156): “Leadership requires time, patience, confidence, and the belief that things can be better. With those commitments, a great deal can be accomplished?” It is also a vision that is centered on care and the reformation of healthcare to provide better care. As Peter Geerlofs, MD (Family Physician, Chief Medical Office, Allscripts Healthcare Solutions, Inc.) noted (McKenna and Pugno, 2006, p. 16):
What makes physician leaders effective? Many of the same attributes that drive people to become physicians in the first place. Caring about the healthcare system and what happens to it, caring about and advocating for patience: an insider’s knowledge of what is wrong with healthcare and what could work to transform it.
While Sandstrom also emphasizes the commitment to care-oriented values (concern for the other), she tends to emphasize consistency and integration of vision and values with current practices. She promotes the role of leader as guardian and the engagement of strategies that consistently reinforce organizational vision and values. Jeannine Sandstrom would probably agree with Tim Munzing, MD (Family Physician, Kaiser Permanente, Orange County). As one of McKenna and Pugno (2006, p. 161) physician leaders, Dr. Munzing advocated the following: “Keep your goals, vision and mission in mind when planning and evaluating opportunities.”
McKenna and Pugno would probably also agree with Dr. Munzing since goals, vision and mission are kept in mind on behalf of looking into the future. While Dr. Sandstrom would agree with Drs. Munzing, McKenna and Pugno regarding the important role played by this first set of leadership competencies and attitude, she would be concerned about too great an emphasis on looking into the future to expand and updating the vision and value–potentially at the expense of consistent integration of existing vision and values with ongoing responsibilities and practices.
I agree with Sandstrom that effective leadership in a challenging healthcare environment filled with VUCA-Plus conditions requires a firm (consistent) commitment to an important set of values that align with a compelling vision. Consistency of mission is critical when faced with volatility, uncertainty, complexity, ambiguity, turbulence, and contradiction. However, I also agree with McKenna and Pugno. Effective mid-21st Century physician leadership in a VUCA-Plus environment also requires a consistent look forward and outward.
This broader perspective helps to guide inevitable adjustments to an organization’s vision and values. For physician leaders, “just-in-time” learning is required if current engagements of perspectives and practices are aligned with fundamental values. There must be assurance that these engagements consistently advance a sustainable vision (Sandstrom: LL). However, this is not enough. “Just-in-time” learning must join with Otto Scharmer’s (2009) “learning from [and into] the future” so that agile alignment is prevalent in all of the healthcare system’s operations (McKenna and Pugno, 2006).
