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One of the most important lessons for surgeons is learning how to build commit-
ment to goals—not requesting commitment from their colleagues. This process
takes 3–4 months, and it begins with deep engagement of all the relevant people in
all the technical centers and key care processes in the organization. If leaders build
commitment, people believe that the goal and the plan are not only important and
attractive, but also attainable. Research shows that people will work hard to achieve
the goals even in the face of setbacks and disruptive events.
The leader visits with people inside the organization and asks 2 simple ques-
tion—(1) Why are we in this situtation? and (2) How can we fix this situation? As
the leader listens and aligns the stakeholders, they must put something in front of
people that is significant and that they would feel proud to achieve. When solutions
come from inside the organization, and not from consultants, there is a perception
of fair process. There is deeper engagement, an understanding of the rationale used
to make the decision, clearer roles, responsibilities, and expectations. It allows the
leader to align the internal stakeholders, so everyone becomes willing to sacrifice
some of their self-interest, and the buy-in is 100%. The people become willing fol-
lowers, who want to go through painful situations in order to fix the organization.
I argue in this chapter that the case method is useful both for teaching leadership
and doing research. Good cases not only bring organizational situations, critical
events, cultural facets, and “reality models” in the classroom, they require systemic
diagnosis that evokes wide-ranging perceptions of cause and effect, sharpening and
enlarging debates and discussions. Finally, cases can accomplish deeper learning
objectives—e.g., underscoring the importance of having more than one theoretical
lens, discovering an emotional response as an intervening variable in decision-mak-
ing, failing to separate facts from assumptions, or discovering personal biases in the
use of heuristics or rules of thumb when making decisions.
Medical professionalism is fundamental to medicine [ 52 ]. When surgeons adopt
and embrace their role as leaders, medical professionalism can be strengthened and
supported. If the purposes of an organization support medical professionalism, sur-
gical leaders have the potential to build commitment to patient-centered care,
safety and quality, efficient use of resources, improved access to care, professional
competence, better coordination, and scientific knowledge that advances social
justice.
When physicians practice good leadership, they can make a significant differ-
ence in health-care performance in terms of technical outcomes, patient experience,
and decision-making efficiency and costs. As one surgeon leader has said: “In the
long run, the best care is always the lowest cost care.” Having dozens of surgeons
pursuing this idea in hospitals could have a significant effect on performance.
Clinical leadership is an overdue imperative, and yet we remain somewhat
ambivalent about whether we should train physicians to take significant leadership
roles. In the end, it is up to surgeons to want to take the lead and to commit to
becoming a leader capable of managing serious clinical problems such as patient
safety, poor quality, clinical inefficiency, poor coordination, incompetence, or the
prevalence of disruptive physicians.
J.A. Chilingerian