As the practice grows, the leader of that practice must grow with it

SURGEONS FACE A COMMON CONUNDRUM — the more successful they become, the larger their practice and staff grow and the more they must reach for skills that have little to do with surgery and everything to do with leading a successful, sometimes multi-million dollar business.

Assistants, office managers, accountants and nurses may keep the day-to-day operations of a surgical practice afloat, but the surgeon, as captain of the ship, needs to possess strong leadership skills to maintain everything from smooth communications and organization to staff morale and, ultimately, the best quality of patient care.

The situation raises the issue of what mix of traits or practices make the best surgeon-leaders and how surgeons acquire them. In looking to the corporate world, one intriguing study offers some seemingly counterintuitive insights about successful leaders, suggesting they possess not the classic, larger-than-life style of Lee Iacocca or Donald Trump, but operate somewhat under the radar, with a strong sense of humility and quiet commitment to succeed. The study looked at 11 companies that stood out from 1,435 Fortune 500 companies by having achieved "sustained greatness" — defined by stock returns at least three times the market's for 15 years after a major transition period.

Instead of being extravagant, some of the leaders tended to border on shyness, combining a certain mix of "humility, will, ferocious resolve and the tendency to give credit to others while assigning blame to themselves."

Those traits would certainly lend themselves well to any setting, medical or management. But, as another study points out, in the daily grind of decision making, surgeons can find themselves grappling with the directly competing interests of giving patients the best care possible while keeping office operations running smoothly. The struggle between these "healing versus corporate" mindsets, albeit on a much larger scale, can be seen played out most acutely among conflicting parties in medical institutions.

TAKING THE LONG VIEW "The executive's focus is (or should be) on positioning the organization for the future, so their time frame of action is middle- to long-term. Physicians have a more short -erm time frame, arising from the necessity of meeting the immediate needs of patients," say the study authors.

"Executives...view...resources as limited and [are] highly aware of the need to allocate scarce resources effectively. Conversely, physicians...consider resources as critical for serving their own patients and maximizing the quality of care." Not surprisingly, the study finds that these contrasting "global versus granular" views extend to patient care itself.

"Executives consider service to patients within the organization and also providing services and programs to the greater community as being highly important. Physicians' patient focus is...much narrower — on their individual patients."

"Clearly, physicians and executives have different world views and professional identities, and their professional identities are based in different professional values," the study, published last Fall in the Journal of Health and Human Services Administration, notes.

The challenge for the cosmetic surgeon-CEO in private practice is that these seeming yin and yan viewpoints must be held in balance in order to succeed. With such bipolar priorities needing to be considered, the surgeon's best bet is to establish a clearly defined value system for the practice behind which staff can become aligned and all members in the practice share, the study authors assert.

"Possessing strong or inspiring values is increasingly considered to be a key quality of successful leaders... Organizational values contribute to the culture and ultimate success of organizations," David Graber, Ph.D., M.P.H., co-author of the study and Associate Professor at the Medical University of South Carolina, tells Cosmetic Surgery Times .

'THIS I BELIEVE' Examples of some shared values include anything from empathy and quality of care to fiscal soundness and efficiency, and Dr. Graber suggests tapping into the values of all team members to make sure it reflects the enduring beliefs of everyone in the practice. "Although the [physician] may always have the most influence in setting the values, if the nurses, business managers, and other staff had meaningful input, they would feel recognized and lead to a culture that everyone could 'buy into'," he notes.