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What Defines A True Leader in Healthcare?

Leadership matters. There is zero chance of any business actually achieving its goals without the benefit of great leaders. This is especially true in the healthcare industry, according to the Joint Commission, because healthcare organizations represent a system of processes, people, and other resources that must be led effectively to achieve the desired outcome of high-quality, safe patient care. When organizations have a significant number of skilled leaders, innovation, quality, and productivity tend to flourish, and a culture is created in which employees are more likely to feel motivated, empowered, and supported.1But not all of us are truly effective leaders, despite our best intentions. What is it that makes certain professionals stand out when it comes to leadership? What can organizations do to encourage leadership development among their stakeholders?

This article will help individual healthcare providers and their organizations answer these two fundamental questions.

CHARACTERISTICS OF LEADERSHIP

Great leaders do many things well that make a difference in their places of employment. For purposes of this article, four traits will be discussed: envisioning a desired future, fostering innovation and change, building effective teams, and creating a positive working culture. 

1. Leaders envision a desired future. 

Having a vision for the optimal working environment is a critical part of leadership. When leaders espouse a powerful vision that other people agree with and want to be part of, followers are more motivated to act.2,3Of note, leaders must “paint a grand picture of what it is that we’re all trying to achieve, this destination that we’re all trying to reach. But just as important — and also more time consuming and requiring even more investment — is that [leaders] communicate about how each employee in the organization can get a sense of how [his/her] work connects to the organization’s mission or vision.”4Vision gives a team direction and helps people to focus on understanding what it really takes to perform a particular job well. Vision also helps to inspire and allows for all involved to have a consistent understanding of how management expects to attain certain goals.4 

2. Leaders foster innovation and change.

Some of the forces driving change in contemporary healthcare include rising costs, declining reimbursement, workforce shortages, emerging technologies, and a growing elderly population.5Also, most contemporary healthcare organizations are undergoing continual change directed at organizational restructuring, quality improvement, and employee retention. Today’s healthcare leaders are challenged to think in new ways, adjust to change, and lead that change while carving out new models of care.6In a 2015 study of more than 50 identified leaders in the healthcare industry, a top challenge that many interviewees discussed was “effectively dealing with rapid change while being tasked with leading more complex organizations.” Meeting this challenge was also seen as an integral part of leadership competency.7 

What often differentiates a successful change effort from an unsuccessful one is the ability of the change agent — a leader who is skilled in the theory and implementation of planned change — to deal appropriately with conflicted human emotions and to connect and balance all aspects of the organization that will be affected by that change.5Unfortunately, change often begins with a few people who meet to discuss their dissatisfaction with the status quo, and an inadequate effort is made to talk with anyone else in the organization. This approach virtually guarantees the change effort will fail because “people abhor information vacuums, and when there is no ongoing conversation about the change process, gossip usually fills the void. These rumors are generally much more negative than anything that is actually happening.”5Leaders then must ensure that anyone who will be affected by a change will be included in the planning for it. Change agents and the “elements” of the system (ie, the people or groups within it) must openly develop goals and strategies together. All must have the opportunity to define their interests in the intended change, as well as their expectation of the change’s outcome and their ideas on strategies for achieving said change. When change agents fail to communicate, they prevent others from understanding the principles that guided the change, what has been learned from prior experiences, and why compromises have been made. Likewise, stakeholders affected by change should thoroughly understand the change and the impacts that will likely result. Effective, open communication throughout the process can reduce resistance.5

3. Leaders build effective teams.

The Agency for Healthcare Research and Quality suggests that, although the concept of leadership has traditionally been used to refer to the top rungs of an organization, frontline workers and their immediate supervisors play
crucial leadership roles in acting as change agents and promoting patient-centered care.8Teambuilding, which incorporates a shared mission and vision of all stakeholders, is then critical to meeting organizational goals. The leader’s role in building that team is fundamental. In teambuilding, the leader must recognize the skills and capabilities of all team members and empower them to work to their full potential. The most effective teams include talented individuals who possess complementary areas of expertise and who are comfortable expressing their opinions.9
Leaders should trust their team members and challenge them with new learning opportunities. When difficult decisions are required, leaders and their teams should be able to demonstrate a high degree of emotional intelligence and the courage to make the right decisions for the organization. Leaders should also successfully encourage team members to communicate collaboratively so that they can work well together and learn from each another. 

4. Leaders create positive work cultures.

The Joint Commission also suggests that successful leaders should establish an organization’s culture through their words, expectations for action, and behavior — and that the culture be such that high-quality, safe patient care is valued, there is responsible use of resources, and an expectation for community service and ethical behavior to be a goal. In other words, leadership “builds the platform of values in the organization.”10Leaders must set a good example because workers often model their attitudes after the organization’s leaders. Additionally,  a leader who “exhibits honesty and integrity in all activities, for instance, can serve as a role model for team members to ensure that they will act in a similar fashion.”11A leader who “admits a mistake and takes ownership of the situation can demonstrate the importance of acting with accountability to the rest of the team.”11

The Joint Commission also suggests that organizational leaders are the most powerful force in changing an organization’s culture and in eliminating intimidating behavior. True leaders do this through what they communicate to the organization’s staff; by modeling desired behavior (“walking the talk”); and by establishing policies that encourage, facilitate, and reward the desired changes in attitudes and behavior throughout the organization.1

ENCOURAGING LEADERSHIP: THE ORGANIZATION’S ROLE

Great organizations require great leaders, and the best organizations understand that cultivating leadership skills should be intentional.9By investing in current and future leadership, fostering effective communication, and promoting evidence-based leadership, achieving  quality outcomes and enhanced organ
-izational efficiency can be realized.12
It is also important to note that leadership skills, like any other skill, can be learned and improved.9The skillsets needed by healthcare leaders in the coming decade will be even more complex than they are today, and contemporary healthcare organizations must begin now to create the educational models and leadership-development programs necessary to prepare the next generation of leaders.5But the need for leadership development is not unique to managers and other appointed administrators. All members of the healthcare team should be exposed to leadership training for the sake of improving quality, eliminating errors, and creating an organizational culture that is dedicated to improvement and focuses resources on the structures, processes, and monitoring systems that will ensure patients receive the care they need while minimizing the risk of harm.13Specifically, physician engagement and leadership development has become increasingly paramount as hospitals and health systems navigate the transition from volume-based care to one driven by value.14Population health and performance improvement also continue to drive transformational change that must rely upon physician leadership to reach its goals. Today’s nurses are also increasingly challenged to demonstrate leadership competencies that meet current standards, including the ability to maintain a global perspective or mindset regarding healthcare and professional nursing issues; appropriate technology skills that facilitate mobility and portability of relationships, interactions, and operational processes; expert decision-making skills rooted in empirical science; cultures that permeate quality healthcare and patient/worker safety; team-building skills; and the ability to balance authenticity and performance expectations.4Specific leadership skills that all employees within a healthcare organization, regardless of formal authority or position, can benefit from include communication, delegation, flexibility, commitment, and engagement.15“Leadership is the result of habits, and good habits build skill. When organizations prioritize the development of leadership, they build unity, create a growth culture, and align stakeholders to produce high-quality work.”15 

Carol J. Huston is an international nursing leader, motivational speaker, and acclaimed nursing educator based in Chico, CA. She is a frequent speaker at healthcare conferences, has keynoted more than 300 presentations worldwide, has authored six books, and has published more than 100 articles. She may be reached at chuston@csuchico.edu.

References 

1. Schyve P. Leadership in healthcare organizations: a guide to joint commission leadership standards. The Governance Institute. 2009. Accessed online: www.jointcommission.org/assets/1/18/WP_leadership_standards.pdf

2. Huston CJ. The Road to Leadership. Indianapolis, IN: Sigma; 2017.

3. Meaningful work: what leaders can learn from NASA and the space race. The Wharton School. 2017. Accessed online: http://knowledge.wharton.upenn.edu/article/what-leaders-can-learn-from-nasa

4. Zate K. Steve Jobs & the importance of vision to leadership. Eyes On Sales. 2011. Accessed online: www.eyesonsales.com/content/article/steve_jobs_the_importance_of_vision_to_leadership

5. Marquis BL, Huston CJ. Leadership Roles and Management Functions in Nursing (9th ed). Philadelphia, PA: Wolters Kluwer Health; 2017.

6. Dixon P. Top 3 skills healthcare leaders need now. Healthcare IT News. 2014. Accessed online: www.healthcareitnews.com/news/top-3-skills-
healthcare-leaders-need-now

7. Larson JA. Strategy as planned change – setting the stage for change. LinkedIn. 2015. Accessed online: www.linkedin.com/pulse/strategy-planned-change-setting-stage-larson-fache-fhimss 

8. Leadership role in improving safety. AHRQ. 2018. Accessed online: https://psnet.ahrq.gov/primers/primer/32/leadership-role-in-improving-safety

9. Rihal CS. The importance of leadership to organizational success. NEJM Catalyst. 2017. Accessed online: https://catalyst.nejm.org/importance-leadership-skills-organizational-success

10. Caldwell S. 9 reasons why leadership is so important – part 2. Predictive People Analytics. Accessed online: https://predictivepeopleanalytics.com/9-reasons-why-leadership-is-so-important-part-2

11. Joseph C. Importance of leader in a team. Chron. 2018. Accessed online: https://smallbusiness.chron.com/importance-leader-team-52168.html

12. Blickenstaff S. The Compliance Guide to the Joint Commission’s Patient Safety Systems Chapter. Middleton, MA: HCPro; 2015. 

13. The healthcare executive’s role in ensuring quality and patient safety. ACHE. 2017. Accessed online: www.ache.org/policy/exec-ensure-patsafe.cfm

14. Morrissey J. The importance of physician leadership. Trustee. 2015. Accessed online: www.trusteemag.com/articles/864-the-importance-of-physician-leadership

15. Sharma M. Radical Transformational Leadership: Strategic Action for Change Agents. Berkeley, CA: North Atlantic Books; 2017.

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Carol J. Huston, MSN, DPA, FAAN
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