These may be the leaders to whom McKenna and Pugno often refer in their book on physician leadership. McKenna and Pugno (2006, p. 63) lead off one of their chapters with an appeal made in this regard by Randall Oates, MD (Family Physician Founder and President, Docs, Inc.): “It is tough to come up with names of widely recognized physician leaders. The fact that I can’t immediately list recognizable physician leaders is in itself telling. We physicians lack leaders who can influence, thus raising the bar for the profession. Leadership is needed – individual or through professional organizations.” Where are the sponsors and influencers in health care? Where are the leaders who run interference for doctors like Frist and Shumway who are seeking to bring an innovative idea to fruition in contemporary health care?
Closely related to this second cluster are those women and men who actively promote the innovation. These promoters neither have the money (funders) nor the formal institutional position of authority and credibility (sponsors) to bring about early adoption of the innovation. The promoters are like Johnny Appleseed—moving across the land planting seeds. They are likely to bring in credible endorsers who don’t plant the seeds; rather, the endorsers are eating the apples. The promoters make sure that other people see the endorsers eating the apples!
A fourth cluster of people who help move innovations to early adoption are those who bring order to the innovative process and identify how best to administer these innovations. These are the early managers who take over from the Innovators (who are often disorganized). Seymour Sarason (1972) identified the critical role played by these managers when describing the creation of new settings. From his perspective in the 1970s, Sarason noted that managers are often bringing concepts and practices from the old order into the new order. In this way, they could thwart the efforts of healthcare Innovators who are particularly involved in the creation and promotion of new products and processes rather than improved administrative or customer services). His insightful analysis still seems to hold true.
McKenna and Pugno (2006, p. 63) turn once more to insights offered by Dr. Geerlofs. An important distinction is drawn between those who leaders in healthcare who focus on project and those who focus on patients. Geerlofs then suggests that some project-oriented members of the healthcare community are the Innovative pioneers, while others, as Sarason suggests, are those who manage the innovations:
“Some of us are driven to improve the healthcare system. It’s hard to know where that motivation comes from. Others derive satisfaction from helping individual patients.
Pioneers don’t worry about status quo. They’re interested in what’s new that could make a difference – perhaps a new technology or financing innovation. Executives, on the other hand, are primarily responsible for helping their organizations be financially successful in the next quarter. So they’re under a lot of pressure to be conservative. But they, too, make an important contribution because they can help their organizations take bite-sized steps toward innovation and transformation. They are in a position to put the innovations into action.
Sometimes unrecognized as physician leaders are the ‘nuts and bolts’ action takers; those physicians (and others) who by themselves won’t change the world, but are open to taking the necessary small steps, one after another, to move us forward. Organizations would do well to identify these practical pioneers and find a way to mentor some of them into future leadership roles.”
In their role as “executive” or “nuts and bolts action taker,” the physician leader can make all the difference regarding the success of an innovative perspective or practice. I turn now to the various rules that the physician leader can take in this regard.
