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Intensivist Cristin Mount and business operations lead Steve Lettrich from All Levels Leadership discuss their article “A 6-step framework for new health care leaders.” The authors address the common challenge where clinicians step into leadership roles with little formal training. They outline a practical framework designed to help new leaders navigate complex organizational webs. The conversation details six critical steps: understanding organizational priorities, building relationships with stakeholders, defining goals through needs assessment, categorizing challenges by timeline, developing 90-day action plans, and remaining adaptable. Cristin and Steve emphasize that success relies on aligning departmental goals with the broader mission to secure necessary resources and support.
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Transcript
Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome Cristin Mount and Steve Lettrich. Steve is the business operations lead at All Levels Leadership. Cristin is an intensivist also affiliated with All Levels Leadership. Their KevinMD article is “A 6-step framework for new health care leaders.” Cristin and Steve, welcome to the show.
Cristin Mount: Thank you very much.
Kevin Pho: All right, so I am going to ask each of you just to briefly share your story and then we will jump right into the article. Cristin, why don’t you go first?
Cristin Mount: I spent 24 years in the Army, all of it in health care. Over the years, as you do in the Army, you progress in leadership roles. I never quite lost that sense of overwhelm in the first couple of weeks to months, depending on the magnitude of the job that I did. One of the things that I noticed is that the initial period in a new leadership role can cause a lot of anxiety. There is a lot coming at you. That was certainly my experience and I certainly made a lot of mistakes. So my goal is to help prevent other physician leaders and health care leaders new to leadership roles from making the same mistakes I did.
Kevin Pho: All right, Steve, you are the business operations lead at All Levels Leadership. Just briefly share your story and then jump right into the article that both you and Cristin wrote, and we will talk about that.
Steve Lettrich: I am the only member of All Levels Leadership who is not a physician by trade. My career has been in health care, though, both in the Army, the federal government, and in the private sector. In project management, I have had the opportunity to lead teams and be in academia. Process improvement and project management are really my passions. Like Cristin, I saw lots of new leaders stumbling. After a while, you start to see recurring patterns. Cristin gave this presentation at the Women in Medicine conference and I immediately thought this is such a great mindset and framework for new leaders. It felt just so universal to me. Being not a physician, I felt this also works for chief nurses. This would work for APP managers. It would work for business managers. This would have worked for so many people I worked with in my academic job. So when she asked if I wanted to contribute to it, I was very enthusiastic to participate.
Kevin Pho: For those that didn’t get a chance to read that article, just briefly tell us what it is about.
Steve Lettrich: We feel that there are two very counterproductive cliches or stereotypes that we see a lot of new health care leaders fall into. This is because health care leaders typically don’t receive a lot of leadership training before assuming a leadership role. You are typically good at your clinical or administrative job for a certain number of years, and then it is time to be in charge. We feel that these two negative cliches are “hit the ground running” and “the leader who has all the answers.” These are two recipes for disaster, especially if you do them at the same time. So we want to try to present a framework to directly counter those two counterproductive stereotypes. We spell out a lot of deliberate steps that new leaders often don’t feel comfortable taking the time to do, but we are trying to stress that you need to.
Kevin Pho: So what are those steps?
Steve Lettrich: The first step is that you have to really become familiar with the organizational goals of both your boss and your boss’s boss. That is about the maximum range that is really going to directly affect your decision-making, but you have to do the research. If the goals are not immediately available and well published, you have to ask the hard questions and pull their priorities out of them. Once you do that, you need to do a needs assessment. You take what you believe are your initial goals, and ask if you have the personnel and the resources to accomplish them.
The third step is going to be to reach out and make introductory contact with peer leaders at your level and key subject matter experts. This includes areas like information technology, legal, and human resources. We are not saying that you have to immediately develop a strategy, become besties with this person, and do lots of working lunches. But you do need to make the face-to-face meeting with them that will build that little social bridge and make it easier and more instinctive for you to reach out to them when you think you need help. Again, this avoids being the leader who has all the answers themselves.
Then in the article, we talk about our ways where we triage tasks using two different criteria. We consider both the resources required and whether it is a short, medium, or long-term goal. We talk about how you can use those to properly prioritize your tasks and maximize your most valuable resource, which is your time.
Then we just say that you need to continuously go back, revise the list, and adapt. We give you a way to start. As you grow more into the job, you are going to realize that you missed things in your first go-around. Just make it iterative and set deliberate time to go back and go through our process of analysis again, say every six months or every year. Just make sure that you are still on track with the organizational goals. Identify anyone new coming to the organization that you need to go out and meet personally and develop a working relationship with. Make sure you have a system to constantly prioritize your tasks rather than just developing a huge task list and determining what looks good that day.
Kevin Pho: I love this framework because as we all know, physicians don’t get a lot of training, if any, on leadership. Like you said, “hit the ground running” is very common when it comes to physicians. So having some type of systematic approach would definitely increase their chances of success as a leader. Cristin, in your story when you first introduced yourself, you said that you made some mistakes as you transitioned into a health care leader. Can you share one of those mistakes and tell me what the biggest thing is that you have learned from some of the things that you did when you initially went into leadership?
Cristin Mount: There are so many mistakes to choose from. I think the one that sticks out as the most cringe-worthy was right out of critical care fellowship. I was made the critical care director for the medical center that I was assigned to. I found that everybody was coming into my office with a list of complaints when I was the new person on the block. I felt the need to fix those immediately. I would go out and try to fix one thing without really having the whole picture. Then that would lead to three more people coming into my office upset because this one thing had changed. I created a real chain reaction of chaos in the entire section.
It was humbling when a great mentor pulled me aside and said: “Let’s slow down here. Let’s go back to the beginning. How did you approach this?” They really coached me through some of those initial steps that we built into our framework. Each time I moved into a new job with a larger chunk of responsibility, ultimately finishing in charge of all of the non-surgical medical care for the Army’s major medical system up here in the Pacific Northwest, I would feel that overwhelm. People were coming at me with things that needed to be done or they wanted done. If I fell back onto this framework, it at least gave me some space to stop and think before I acted.
Kevin Pho: So I am going to encourage all listeners to go back and read the article and framework to really get more details, more so than we could do in this short podcast. So, Cristin, for those other physicians who are thrown into leadership positions as you were when you just came out of fellowship, tell me what the first step is. I know that there are six steps, but what is the first thing that that new physician leader should do?
Cristin Mount: I think the most important thing for me that I really made sure I took time to do was to understand where I sat in the larger organization. Ask exactly what your piece of this organization does and what actual physical space you own. Ask what your relationships are to your peers. Consider if the nurses in the ICU are under your supervision and mentorship or if that is someone else. Just taking time to stop and look around and figure out how your piece relates and interlocks with everybody else around you is going to really be effective. It helps in terms of understanding how you need to triage when everyone comes in and asks you to do things. It also helps you see how you can help the organization move forward towards their strategic goals. I think of all of the steps that we outlined, for me the key was always just to fit in and really figure out how I work here. I asked how I am providing patient care and how that affects the people around me. I asked where that fits in the organization. It is different every time.
Kevin Pho: Steve, you mentioned that you observed so many physicians as they transition into leadership. What are some of the red flags? What are some of the biggest mistakes that you have seen that you are going to warn physicians listening to this podcast not to do as they transition to leadership?
Steve Lettrich: The first thing that I am going to warn them not to do is to assume that because they are excellent at patient care, they can also figure out the implications of legal issues, human resources, and information technology. You asked Cristin what her greatest mistake was. My greatest mistake falls in this way, and that is why I often push developing stakeholder relationships so much. When I went to the hospital in Fort Campbell and I was put in charge of the emergency preparedness plan, mass casualties, and natural disasters, I did not do a good enough job in this completely new environment. I did not go out and aggressively meet all the subject matter experts in communications, safety, and medical logistics. I was much less effective for my first six months as I had embarrassing learning curves in my meetings.
That would be the main thing. I would encourage them to go out and robustly interact with the subject matter experts. When in doubt, ask the question. Swallow your pride and get it right the first time rather than starting down a path and then finding out you can’t do that for some reason and having to go back and do rework. It will save you time. It will improve the morale of your team if they are not going back and fixing mistakes.
Kevin Pho: So Steve, where can physicians get resources in terms of becoming better leaders? Obviously I know you work for the organization All Levels Leadership, but short of the organization where can they find mentors? Where can they find people within their local organization to better help them transition into that leadership role?
Steve Lettrich: This is where it is challenging. We would say that we need to challenge senior health care leaders and senior supervisors to culturally not just be managers and supervisors, but to be mentors to the junior people. It is a hundred percent sure that if you are in a senior leadership position in health care, you have stubbed your toe and embarrassed yourself a number of times. We need to develop the culture of when someone new comes on, proactively tell them things. Tell them to make sure they are familiar with this policy. Tell them to make sure they are familiar with this person. Tell them to make sure they are aware that these are external stakeholders as well as our internal stakeholders. These are the key members of the community that you will be interacting with, so go meet them and learn about them.
I wish I could say that you can go to a lot of the standard business books out there or magazines. But a lot of the things that you will currently see in the Harvard Business Review or in a lot of podcasts that work in business give people freedom to be creative and leave 20 percent for personal projects. Those simply aren’t available in the health care industry, which is driven by RVUs and best practices. So you have to really lean on the subject matter experts within the organization to find what you can and can’t do.
Cristin Mount: I would also remind listeners not to forget about your professional medical organizations. For example, I belong to the American College of Physicians and we have peer mentorship, we have peer coaching, and we have a leadership academy. The Women in Medicine Summit in Chicago is a fantastic meeting, but that organization also hosts a leadership academy. So I think the professional medical organizations that we already belong to also have mentorship, coaching, a wealth of knowledge, and sometimes individual programs that are available. Don’t forget those more national resources, especially if you are not finding that mentorship and coaching in your own organization, as Steve mentioned.
Kevin Pho: Cristin, as physicians go through training, they lead teams as senior residents, as fellows, and as attendings. Why don’t those leadership skills sometimes translate into the business environment?
Cristin Mount: That is a great question. I think they don’t translate into the business environment because as you are leading a clinical team with respect to individual patient care, the focus is the patient. It is about everything about the patient and their care, what brought them to you, where they are going from there, and how the rest of the team is interacting to care for that patient.
To make the analogy, when you are in a leadership position as we think of in terms of health care leadership and organization, you are no longer focusing your efforts on that one patient. You are focusing your efforts on many people and on a large section. That section is connected to every other piece of the organization. You have to not only continue to lead, but you have to learn to follow. We talk at All Levels Leadership a lot about followership. You have to transition into this mindset that you need to consider all of the other moving pieces that are attached to you as you are making your decisions and deciding what priorities are.
I think the innate skills of physician leadership that we recognize and that we get trained in just by virtue of residency and fellowship training are the core nucleus of what make physicians great leaders. You just need a little bit more to take that step into organizational leadership. Some of that is time and experience. Some of that is coaching and mentorship. Some of that is just taking a framework and jumping in and seeing what works and what doesn’t.
Kevin Pho: We are talking to Steve Lettrich and Cristin Mount, both with All Levels Leadership. Today’s KevinMD article is “A 6-step framework for new health care leaders.” Now we are going to end with just asking you to share some takeaway messages with the KevinMD audience. Steve, why don’t you go first?
Steve Lettrich: Kevin, you mentioned earlier that this is a lot to process in a short article and in a short interview. We agree. For folks that are interested in learning more about this, we are going to be hosting a webinar that is going to be available on our website starting in early March where we will go into this in much more detail, specifically the more complex issues such as triaging tasks. If you go to our free resources page, there is a free workbook you can download. That will help walk you through some of these steps and will really augment the webinar. We would encourage people to come to our website and find those resources. We also offer coaching engagements for this specific thing. But the main takeaway that I would say is if you only remember one thing from our article, it is to aggressively form those initial business relationships. They will pay off for years to come.
Kevin Pho: And Cristin, what are your take-home messages?
Cristin Mount: I have two quick take-home messages. The first is that this process that we have developed and this framework is scalable. This will work if you are a resident that has been put in charge of a performance improvement process. This will work if you are a health care leader that is moving into organizational type leadership across the entire spectrum. The second is that it takes practice. So practice, practice, practice. Practice doesn’t have to be large and grand and in public. Practice is small things every day. You could take this framework. I take this framework sometimes when my home management to-do list is exploding and I apply it there. So look for opportunities for micro practice and just remember that this framework is scalable to any leadership role wherever you are in your career.
Kevin Pho: Steve and Cristin, thank you so much for sharing your perspective and insight. Thanks again for coming on the show.
Steve Lettrich: Thank you.
Cristin Mount: Thank you, Kevin.
