Essentials of Leadership in the Field of Physical Medicine and Rehabilitation—A Personal Perspective

Kristjan T. Ragnarsson

8: Essentials of Leadership in the Field of Physical Medicine and Rehabilitation—A Personal Perspective

OBJECTIVES

1. Discuss characteristics of leadership based upon personal observations and experience.

2. Describe qualities of effective leaders.

Several years ago, I was asked to discuss the essentials of leadership in the field of Physical Medicine and Rehabilitation (PM&R) with a group of young academic physiatrists. In this regard, I was asked by the group’s leader to describe my own leadership style and how it has changed over time, name the qualities that I believe are important for a leader to possess, and describe skills that are essential to acquire to be an effective leader.

To describe one’s own leadership style is difficult, since your own views are likely to be very different from the opinions of those you are supposed to lead. Frankly, your own views of your leadership style matter less than what others think. To capture what others think of one’s leadership style, one should ask others about the characteristics of excellent leaders with whom they have directly worked and whose leadership they have directly observed, followed by the same for your colleagues’ perceptions of your leadership style. Therefore, I asked a couple of my faculty members’ opinion of my leadership style. I was pleasantly surprised, although I realized that they would carefully avoid describing the negative aspects of my style! Nonetheless, I will humbly include some of their observations below, which I can only hope are correct!

One of my associates described my leadership style in the following ways: You bring in the people you trust, you give them authority, and you stay out of their way while their performance is good. You keep an open-door policy, so you are easy to approach to listen to my concerns and give me advice. You don’t rush to make a decision, but rather try first to get all essential information in order to eliminate bias and then you make a sound decision.

Another one, in less than 5 minutes, wrote up the following: You have a spotless international reputation; you command respect and have multiple levels of involvement in the field of PM&R and within our own academic institution. You do not put people in a position they don’t want to be in, which plays to the satisfaction of those working for you. For example, you allowed me to develop my interest in medical education, which has kept my job interesting for me and helped me in my career. You work as hard as or harder than those around you. You give credit to those working for you and you share your success with your associates, even your personal success, such as when you receive awards. You are willing to make changes in your own performance based on feedback of coworkers; for example, you increased the time you spend with our residents when they complained that they did not interact enough with you. You provide mentorship and make relevant suggestions to your faculty and staff in order to enhance their performance.

My third associate wrote the following: You listen to all staff and appropriately act on their concerns. You lead by example. You are a visionary thinker. You believe in the mission of rehabilitation medicine and you have created one of the best rehabilitation centers in the country (world) in an academic center where rehabilitation medicine was barely known before. You continue to make the center even better, despite the excellent reputation that it enjoys, which is a major reason why key staff members stay. You are an analytical thinker who also thinks “outside the box.” You develop novel solutions to difficult problems. You carefully select your staff, guide their development, and help maximize their potential. You are a highly skilled physician, which is essential for a successful physician leader. You are always willing to share or even give up the spotlight to others. You set the highest ethical standards and you adhere to them yourself. You are reliable, easy to respect and trust, which is fundamental.

Has my leadership style changed over time? I don’t think so, but it is hard for me to judge. I would have to evaluate by using reliable leadership style assessment tools over time in order to track and monitor changes in my leadership style. What happens over time is that your credibility and influence increases if your performance has been consistent and significant. People listen to you more carefully, which also means that you must be more careful in what you say and do. Your words may have a surprising influence, for better or for worse!

These observations of many of the leadership traits identified by my associates parallel the literature on leadership characteristics from distinguished thinkers and contributors such as Peter Senge, Warren Bennis, Tom Peters, Jack Welch, and Steve Covey.

QUALITIES THAT LEADERS MUST HAVE

The broadest definitions of leadership are “roles played by key individuals to facilitate change.” Leadership competencies include (a) vision, (b) focus, (c) direction, (d) communication, and (e) mentorship. Some core traits of a good leader include drive, motivation, honesty/integrity, self-confidence, intelligence, and knowing the business. Being considerate of others as individuals is also a key characteristic of effective leaders. True to the mission of your organization, good leaders are proficient in clarifying, defining or framing issues, setting goals, and coordinating action steps. Leadership is all about being mentored and mentoring others.

Integrity, Which Will Inspire Trust

I believe reliance on mutual trust and respect is fundamental and most important of all qualities. A person without integrity cannot be trusted and should never be selected to a leadership position at any level.

A leader must be honest, truthful, and consistent. Your word should be as good as your signature. My mentor, Howard A. Rusk, MD, used to say, “Always tell the truth, then you will never have to remember what you said!” However, this is only one reason of many why you should always tell the truth if you say anything at all.

There should be no surprises in your behavior. Your constituents must always be able to figure you out. Inconsistent reactions and behavior will make it difficult for your faculty and staff to tolerate you.

A leader must never exploit one’s people or one’s constituents. An example of such exploitation occurred a decade ago when the president of Enron told his staff to buy the company’s stock, when he himself was selling his own stock in anticipation of the company’s implosion. The leader must never manipulate his constituents by not giving them the full story. A leader must be trusted as the best advocate for his or her constituents. The leader must try to protect his constituents from difficult and threatening situations in order to allow them to do their job in peace and without fear.

As a leader, you must know yourself, be candid about yourself, and have the capacity to self-disclose, at least to an extent. You must admit to your own mistakes, at least when they are obvious to others. You don’t always have to try to have the last word in order to make your opinion prevail, especially when others on your staff are unconvinced.

If you are able to inspire trust in your constituents, there is a wonderful payback (i.e., you will also be able to trust the people who report to you). This is fundamental for a strong leadership (i.e., mutual trust).

Unfortunately, I do not believe that integrity can be learned, although it can and must be practiced by what we think and do in our daily lives. Integrity is a quality a leader must have. Integrity cannot be acquired on the job.

Competency

Of course, a leader must be competent. Expertise is an essential component of leadership. You have to know what you are doing. In selecting leaders, competency can usually be judged quite easily by examining the track record of the applicant and speaking directly with those listed as references.

If you are to lead an interdisciplinary rehabilitation team, a PM&R practice, or an academic department, you have to know and thoroughly understand what each member of your faculty and staff does and is capable of doing. You also need to know what you as the leader need to do in order to succeed.

Competency is something you cannot acquire after you obtain a leadership position. You must have it before.

Energy and Endurance

A leader must be able to work hard and not just in spurts, but consistently over long periods of time, even for years or decades. As a leader, you must be ready to come in early, leave late, work on weekends, and delay or cancel vacations and trips, when your effort is needed within your organization.

You have to be able to adhere to deadlines and consistently deliver on time. Answer e-mail, telephone calls, and so on, at once or as soon as possible. If there will be a delay, let the sender know. Those who develop a reputation for being unresponsive or slow to respond are often rejected as candidates for leadership positions. Being too busy is not a good excuse, because we all are. Similarly, it is important to be punctual and not keep your constituents waiting. Their time is valuable, just like yours. By consistently being punctual as a leader, you send a strong message for others to act likewise.

By being the hardest worker, you will serve as a role model for your constituents. This should be fairly natural for most leaders, because it is by hard work that most got to the top (i.e., it is more by perspiration than by inspiration). Paradoxically, you don’t have to be driven all the time. You must be able to relax in between. More than a century ago, John Ruskin (1819–1900) wrote: “In order that people may be happy in their work, these three things are needed: they must be fit for it, they must not do too much of it and they must have a sense of success in it.” You must be able to handle stress well, be able to smile and laugh, even when things are tough.

Energy and endurance can hardly be acquired on the job once you are in a leadership position. On the other hand, there are certain things that can be practiced.

Establish good work habits. Come to work early and tackle first those things that you least want to do.

Try to thrive on pressure (i.e., if nobody demands top performance of you, demand it of yourself).

Try never to let up. If it appears that you have succeeded, you should be aware that there is no status quo. The environment changes and failure may lurk just around the corner. Therefore, try to retain a sense of urgency.