Bridging the Leadership Development Gap

In Reply: Health care is fortunate to have physician leaders such as Dr. Verma and Dr. Bohnen and institutional leaders such as the University of Toronto and the Mayo Clinic, who are seriously embarking on the training of physician leaders. There are many definitions of leadership; I view it as the ability to help people solve problems that make the world better. Leadership training can focus on the behaviors and skills needed to accomplish this goal, such as convening, listening, managing conflict, influencing, decision making, consensus-building, leading change, and building skills through an understanding of theory and deliberate practice. These leadership behaviors and skills are the same ones needed to practice team-based care, to provide high-quality care, and to establish a health care system that learns, all of which are sorely needed.1 As such, basic leadership training should be for all physicians, not just those aspiring to seek formal leadership positions. Too often, medical students lack leadership skills. During my patient safety course, for example, second-year medical students have to identify a safety risk and mitigate the impact on patients. When I ask how they would approach getting “buy in” to implement the change, they go blank. While they all could tell me about Virchow’s triad of factors that contribute to thrombosis, they had never heard about Kotter’s model for leading change.2 When I graduated from medical school, my view of teamwork was that I give an order and the nurse takes it. Too many physicians have this view of leadership, where efforts to improve care are done over rather than with others, resulting in interventions that are less effective and less likely to be implemented. Let’s hope that tomorrow’s physicians graduate with the leadership skills needed to deliver high-value, patient-centered care. Health care is changing rapidly, and physicians need to help lead the way. Peter J. Pronovost, MD, PhD Johns Hopkins Medicine senior vice president, director, the Armstrong Institute for Patient Safety and Quality, and professor, Department of Anesthesiology and Critical Care Medicine, Surgery, and Health Policy and Management, Johns Hopkins University, Baltimore, Maryland; [email protected]

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