The Exec: Secrets of Success in Clinical Care Leadership

Ivor Douglas shares perspectives on critical care leadership, recruiting physicians to serve in leadership roles, and mentorship.

There are several elements to success in critical care leadership, including an understanding that critical care requires a team approach, the new director of the Department of Medicine at Westchester Medical Center Health Network says.

In June, Ivor Douglas, MD, will become the director of the Department of Medicine at Westchester Medical Center Health Network and chair of the Department of Medicine at New York Medical College. He currently serves as professor of medicine at the University of Colorado as well as chief of pulmonary and critical medicine at Denver Health Medical Center, where he has directed the medical intensive care unit since 2002.

"There must be a recognition that critical care is a team sport and that leaders who are going to succeed in critical care need to understand the imperative that leadership is about both servant leadership in being a member of a multidisciplinary team and transformational leadership," Douglas says. "This is a discipline that is high-risk and expensive, which at times requires leaders to shift leadership style in a way that can transform the practice of the field."

Critical care leaders need to strike a subtle balance between subject matter expertise and high levels of self-regulation and emotional intelligence, with the willingness to step forward to lead a team when needed, according to Douglas.

"You need to have a full spectrum of leadership skills that are developed over time," Douglas says.

Douglas explains that there are three primary elements of physician leadership development in critical care: equanimity, humility, and altruism.

"Equanimity is important in its most reductionist sense that you have grace under fire, but it is a lot more than that," Douglas says. "I sometimes talk about the 'metronome effect' for my fellows and trainees, which is the recognition that to function when things are slow or things are fast, you must self-regulate and be cognizant of the things that get your metronome out of speed. When your metronome wobbles, the risk of error becomes high."

For physician leaders in critical care, humility includes the ability to speak to error, own error, and acknowledge that building redundancies in systems is important to manage error and harm risk, Douglas says. Altruism is also critical for leadership.

"We don't speak about altruism enough when we talk about emulating or role-modeling behaviors," Douglas says. "People come to medicine for a particular set of reasons, and they come to critical care leadership or physician practice a lot because of an altruistic drive."

Ivor Douglas, MD, has been named director of the Department of Medicine at Westchester Medical Center Health Network and chair of the Department of Medicine at New York Medical College. Photo courtesy of Westchester Medical Center Health Network.

Recruiting physicians to serve in leadership roles

For CMOs and other clinical leaders, the biggest vulnerability in recruiting physicians to serve in leadership roles is the tendency to advance people who look like them or behave like them, according to Douglas.

"There is a large and dominant practice in the professions that has weakened our ability to achieve workforce efficiency and diversity," Douglas says. "This practice says, 'I am successful; these are my behaviors and skills, therefore, the people I want to recruit to be leaders need to look like me, behave like me, and emulate my practices.'"

Recruitment of physician leaders should be based on hard-wiring principles such as diversity, equity, inclusiveness, and belonging, Douglas explains.

"These principles should be the strength of our healthcare system," Douglas says. "The imperative in academic leadership particularly involves the ability to ensure workforce effectiveness and resilience."

When they are recruiting physician leaders, CMOs and other clinical leaders should try to identify candidates who possess the skill sets and aptitudes that will ensure fulfillment of the organization's mission, Douglas says.

Qualities of successful physician leaders

The most successful physician leaders have endured adversity and survived professionally, according to Douglas.

"There is a lot to be said of folks who have demonstrated resilience and have learned and grown through the process of career development," Douglas says.

The best physician leaders are willing to acknowledge their mistakes and to learn from them, Douglas explains.

"The ability to speak coherently, humbly, and honestly about past failures is revealing about an individual leader's capability for adaptability and resilience as well as the individual's ability to step into a role where emotional intelligence and maturity must be demonstrated," Douglas says.

Keys to success in mentoring

Mentoring relationships between leaders and physicians should be bi-directional, according to Douglas.

"The most valuable mentoring experiences I have had involved the recognition that the mentoring interaction was as valuable to me as the mentor coaching and exploring as it was for the mentee," Douglas says. "Uni-directional relationships exist; but almost universally, when we look at performance assessments in uni-directional mentoring experiences, they are far less satisfying and durable than bi-directional experiences."

Mentoring relationships should also have a contractual element, Douglas explains.

"A mentoring relationship needs to be one where the roles and expectations are established formally," Douglas says. "The expectations for functional mentoring and the benchmarks must be clear between the mentor and the mentee."