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In this episode, neurosurgeon Leon Moores delves into his book, All Physicians Lead: Redefining Physician Leadership for Better Patient Outcomes. He challenges the traditional view of physician leadership as limited to formal titles, exploring how physicians influence patient care, guide health care teams, and mentor the next generation of doctors every day. Leon emphasizes the vital leadership role all physicians play, from the moment they put on the white coat, and shares insights on how redefining leadership can lead to better patient outcomes.

Leon Moores is a neurosurgeon.

He discusses his book, All Physicians Lead: Redefining Physician Leadership for Better Patient Outcomes.

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome Leon Moores. He’s a neurosurgeon, and as you can see on the video he got called in, he’s coming at us from his car. He’s the author of All Physicians Lead: Redefining Physician Leadership for Better Patient Outcomes. Leon, welcome to the show.

Leon Moores: Thank you very much for the invitation. It’s great to be here, Kevin.

Kevin Pho: So you are a neurosurgeon, and you also recently came out with your book All Physicians Lead. So tell us the events that led you to write this book.

Leon Moores: Yeah, it’s interesting. If you look at a standard definition of leadership, it’s influencing behavior to achieve a desired result. And in health care we have a tendency to think of a physician leader as someone who’s a little bit more senior, has a position in an organizational chart, a medical director, chief medical officer, chairman, something like that.

When I think we’re missing out on the fact that as soon as you put on the long white coat you are leading, you are influencing behavior to achieve a desired result. Whether that’s leading a small health care team in the OR, in the ICU, in clinic, or even influencing a patient to stop smoking, take their medicine, lose weight, exercise.

And because we’re not explicit with doctors that they’re engaging in leadership events every day, we may not be aware of that with the intent to improve. So hoping to influence that and get at physicians very early in their training, rather than waiting until they’re 40 or 50 years old to say, oh, now I have to learn leadership.

Kevin Pho: Why is it so important for physicians to take ownership of that leadership role, especially so early on in their careers?

Leon Moores: Yeah, physicians have influence within the health care team, and we’re a much more team oriented environment than we were 30 years ago, for instance. But still doctors have some increased psychological size, we have impact. If the doctor comes into clinic or the OR and they’re not necessarily in a great mood, or they’re acting in a way that doesn’t generate a good environment of care, that impacts the sense that the other team members have, engagement, and it actually in extreme circumstances can lead to increased errors.

So ultimately recognizing that as a physician you have this impact on the health care team and ultimately on the patient, hopefully suggests that improving those leadership skills, particularly leading under the highly stressful occasions that physicians are frequently called to work within, will improve that environment of care, improve the patient experience, improve compliance, and ultimately improve patient outcomes.

And it’s interesting, because we do a lot of focus on training senior health care leaders, physicians who are going into these organizational chart positions, where they don’t necessarily have the degree of influence at the patient level. I’ve been a CEO in health care systems, and my ability to impact patient care by putting out a CEO message is somewhat limited. But all of our doctors every day that are taking care of patients in our clinics, our ORs, our ICUs, ERs, are directly impacting that environment of care and ultimately patient care.

Kevin Pho: So in terms of the clinicians that you’re seeing on the ground, do you feel that they need to be cajoled a little bit and make them realize that they have that intrinsic ability to lead?

Leon Moores: I think physicians want to take great care of patients, and so here’s where I’m trying to draw the straight line between your leadership behavior, your ability to influence behavior of the entire team, to achieve that result of patient outcome.

I don’t think we’ve done a great job in medicine saying, hey, you are a leader day one as a doctor. I sometimes say that we call them doctor’s orders, not doctor’s suggestions, for a reason. And that influence that you have is there whether you are conscious of it or not. And the real question is, do you want to be the best you can be at influencing that care team, influencing that patient and family?

And there are great methods for doing that. The good news is we don’t have to reinvent that in health care. Leadership is leadership in any genre, in any environment. And so improving your skills in successfully, in a sustainable way, to lead and influence behavior, there are templates out there all over the place.

The other thing that physicians I think may have a little bit of aversion to the term is that as we’re brought up as clinicians we think, I’m a surgeon and I’m a clinical doctor, I don’t necessarily want to be one of those quote physician leaders. I don’t want to go into admin, I don’t want to work in carpet land, I don’t want to go away from patients. And so there’s a little bit of cultural reluctance to say, no, I’m a leader.

And hopefully we can overcome that by pointing out again that you’re influencing that team, and probably have more influence on the care environment in the trenches than I would in the C-suite.

Kevin Pho: So give us a specific example or story where, in an ideal situation, that physician centered leadership can directly lead to improved patient outcomes. What would be your ideal example of that, either from the book or something that you’ve seen in the past?

Leon Moores: Yeah, absolutely, thanks for that question. If you take just for an example the uncomfortable interaction that occasionally we all have. So you’re a physician, you’re in the clinic or you’re in the ICU, and a staff member, a team member, a nurse, an administrator, and you kind of mix it up a little bit.

If you don’t recognize that you’re influencing that environment, you don’t recognize that you’re a leader, you may walk away and just shake your head and say, ah, you know, what a jerk, and let it go. Or maybe lose some sleep over it, because you’re still upset at the interaction.

If on the other hand you say, hey, I am a leader in this environment, my behaviors that I’m modeling make a difference, my emotions and my attitude make a difference, they impact that team’s sense of how this health care team is working every day, then what you’re probably going to do is say, oh boy, I could have done better. At the very least you’re going to reflect upon that incident with the intent to improve next time.

You may go back to that individual and say, hey, let’s talk about that, I wasn’t at my best, I want to do better, how did we get there, let’s do better next time. And in fact you may even go to that small team that was observing that event and try to improve their view of you as a leader, both now and in the future, by saying, here’s a mea culpa, wasn’t at my best, we’ll try to do better, tell me how this made you feel.

And looking at it through that leadership lens, you’re going to dissect out that encounter much more than if you just walk away because you’re just one of the team and your impact doesn’t matter.

Kevin Pho: Now without giving away everything in your book, what are some key ways where physicians who don’t normally label themselves as a leader, how can they themselves lead and improve patient outcomes? What are some key things that they should do?

Leon Moores: I think one of the great episodes in movie history is the Apollo 13 movie. And so if you recall, in that scene, or some of the listeners may have lived through this and watched it live, there’s a ship traveling through space, it’s blowing up, certain death is imminent for the crew, and the commander of that team picks up the microphone and just says very calmly, Houston, we have a problem.

And when as a physician you are overworked, because we all are, you’re under stress, because we all are, you’re struggling with the EMR, because we all are, and something perturbs your day, it’s difficult to just say, you know, Houston, we have a problem, let’s try to work this out. Human nature tells us to react.

And if you’re constantly thinking my reactions have an effect, for better or for worse, on this team, if things are going awry and you sit back and say, hey team, looks like things aren’t going quite right here, let’s all get together, let’s talk about everybody’s view on this, how can we make this run smoother for the next three hours, five hours, week, that’s going to send a very clear message that you value the team members, that you value their experience, that you value their input, and that you care about everybody on that team.

And so from a very nuts and bolts standpoint, leadership of self, a center of several concentric circles of leadership theory and education and training, is critically important. And if you do nothing else, just recognizing again that you have that impact, and saying, OK, I’m going to take a deep breath, I’m going to count to 10 next time I feel the temperature rising inside me, my emotions starting to come out, I’m going to think about whether that’s the most appropriate way to handle the situation, and maybe do it a little bit differently with that insight.

Kevin Pho: Now you’re a practicing neurosurgeon, and obviously you have a lot of interaction with young physicians, fellows, and residents. How do you teach leadership along with all the clinical things that you have to teach them?

Leon Moores: Yeah, I think it starts with modeling behaviors. I am not perfect at it, I don’t think any of us are, and it’s a constant learning engagement until retirement and then beyond probably.

So that when I make a mistake, if I do get on that edge of emotion, saying, OK, hey, sorry everybody in the OR for instance, got a little excited there, appreciate everybody’s work, let’s dial it back. Having residents and medical students see somebody with gray hair, and very little hair actually for me, do something like that, I think is a great way to help them learn and realize that they can be a little vulnerable like that and lead in that way.

And then of course, catching people doing something right. We have a tendency to correct our junior trainees, because we’re stressed, because there’s a lot of time pressure, mostly for the negative things that they do. So before we’ll pull a resident or a medical student aside and say, hey, hey, don’t act like that, they typically have to be two or three standard deviations beyond what we would expect as good leadership behavior or professionalism, or whatever cultural competency terms that you want to use. Ultimately it’s all leadership in my opinion.

So doing that earlier, once again, if you think, hey, I’m a leader as a faculty member, my behaviors have impact, and if I see a resident doing something that’s really great, a piece of equipment wasn’t working in the operating room, you did a really nice job with that, you were very calm, you said, you know, this instrument isn’t working, can we please get another one up, you waited patiently, you weren’t sighing or stomping your feet or throwing your gloves in the wastebasket and walking out. All of those things can be very, very helpful. Again, catch them doing something right, and if they’re moving maybe one standard deviation beyond what you would like to see, catch that earlier instead of just correcting when the behavior’s egregious.

Kevin Pho: So other than reading your book of course, any other resources or courses? Or do physicians even need to take a course to develop and improve their leadership skills?

Leon Moores: The nice thing is that these leadership skills translate across disciplines. There’s so much work out there, both in the practitioner literature, leadership books, and in empiric literature, heavily in the business world. But there’s a lot of empiric literature in the health care field if you’re interested in diving into data-driven psychological work that talks about leadership behaviors and their impact on organizations.

What I would suggest is, if folks are interested in this, really just grab something off the shelf. I’m pretty agnostic about what to read, but look at some leadership books. Google, look on your favorite bookstore and say, give me some books on leadership, grab one or two that are appealing, read them.

A couple things are going to happen. You’re either going to say, oh wow, that’s really important, I didn’t know that, I’m going to learn from it. Or it’ll reinforce behaviors you already have, and then you may say, oh, I like this kind of path, and I’m going to continue reading and learning on that path. Or you may say, I kind of know that, and I’m going to research and look somewhere else.

But if you’re willing to start out literally by saying, what are some of the leadership of self books that are out there that can inform me of potentially gaps in my knowledge, my insight, and my ability to lead, that’s a really great start.

In the book I describe one model that says starting with leading yourself, expanding a concentric circle to leading one other, dyadic relationship, there’s a lot of literature in that, and then leading teams and then leading organizations as it goes out. So that’s a construct that people can put in their heads and say, oh OK, first I need to learn how to lead myself, what my strengths and weaknesses are, what my tendencies are both in stressful and non-stressful environments, and then go from there.

Kevin Pho: So you’re a practicing physician and of course have experience as a CEO, so you’re in both the clinical world and the executive world. The current trends in health care, there’s a lot of business influence, right? You have private equity buying up all these practices, and there’s a perception among clinicians that these business influences are suppressing the urge for physicians to become leaders. Is that an accurate assessment, and if so, what do you think about that perception?

Leon Moores: Well, if you look at the very top levels, very few hospitals in the U.S. have a physician chief executive officer. So at that level that’s true statistically, three, four, five percent are helmed by physicians.

I think there is a very serious push in health care, a recognition throughout though, that physician voices at senior leader tables are very important. There’s good data that supports that. And most health care systems are saying, look, even if we don’t have the CEO as a physician, at those boardroom levels, at the senior executive tables, we need to have physician voices, and we need to have nursing voices, and we need to have administrator voices. All of those tend to give better, more robust input. But that lens that the physicians have is widely recognized in U.S. medicine as important for making big decisions.

If you dial that all the way down to the chief of a small clinic, or just a physician in our health system in Northern Virginia, we have 1,200 plus physicians that are employed, and several thousand that work in our health care systems. Every one of them is impacting the culture and the environment of care much more than the senior leaders are or possibly can. Not because they aren’t interested in impacting the culture and the environment, but they’re just not there every day with all of our other team members.

So two levels to that, and I think recognizing that level where all the physicians are out there doing the work every day, meeting with our other team members, is a critical enabler of health care system performance.

Kevin Pho: We’re talking to Leon Moores. He’s a neurosurgeon and author of the book All Physicians Lead: Redefining Physician Leadership for Better Patient Outcomes. Leon, we’ll end with some of your take-home messages that you’d like to leave with the KevinMD audience.

Leon Moores: Thanks very much. I think that most people who’ve worked for more than a decade or so recognize that leadership matters. If you’ve had good leaders, if you’ve had less than good leaders, you know that that environment changes based upon the leadership characteristics of that individual.

As physicians you’re one of those individuals. You impact the health care environment, you impact the team every day, no matter what environment you’re in, clinic, OR, ER, ICU. And all of us can be better. So you are in fact leading, you have influence, you have impact, and there are ways to get even better at that. And if you get better, it’s going to ultimately impact patients, engage with your system and how compliant they are with their therapy, and ultimately patient outcomes. So better physician leadership makes better outcomes.

Kevin Pho: Leon, thank you so much for sharing your perspective and insight, and thanks again for coming on the show.

Leon Moores: Thank you Kevin. Appreciate it.