Too Much of a Good Thing Sinks Leaders

If you're a physician leader, it's well worth reading Stop Overdoing Your Strengths, by Robert E. Kaplan and Robert B. Kaiser, which appeared in the February 2009 issue of Harvard Business Review. It may give you some pause. In this iconoclastic piece, Kaplan and Kaiser make a good case for eschewing the conventional wisdom of "playing to your strengths" in order to offset your weaknesses as a leader. Rather, the authors present a thesis that "[d]ividing qualities into 'strengths' and 'weaknesses' implicitly ignores strengths overdone." Using examples of individual leadership (im)balance within a broad style framework of "operational v. strategic" and "forceful v. enabling" leadership the authors stimulate plenty of self-reflection.

Clinicians increasingly play to their strengths. In an environment of health care knowledge and procedural complexity that are increasing exponentially, sub and sub-sub specialization has increased. Clinical consultants with esoteric strengths are frequently used to inform situations and decisions that in the past would have been made by generalist physicians with a broader comfort level. Which is not necessarily a bad thing for patients. Take orthopedic surgery as an example. Twenty years ago, many orthopedic surgeons were reasonably comfortable across the spectrum of hips, shoulders, and knees and orthopedic trauma, including with taking general ED call for orthopedics. Today it's not uncommon for a "hip guy" to demur on an ankle injury which would be best managed by a "foot and ankle" or sports orthopedics specialist. Each is playing to his strengths.

But this clinical example is somewhat beside the point - while it raises its own dilemma about the perils of clinical specialization, I used it here to illustrate that physician leaders, in particular, are likely to come from an original clinical experience where playing to one's strengths is an invaluable asset. And when they rise on these strengths to positions of leadership as heads of Divisions, Departments, programs, service lines, or medical staffs, reliance on them doesn't magically disappear. I've coached scores of physician leaders who have found that playing to the personal strengths that made them excellent clinicians isn't the recipe for getting the leadership job done.

Consider the three "A's" that contribute to clinical practice success (Ability, Availability, and Affability). Overused, they may prevent the development of other valuable leadership skills actually impede leadership success. As seen through the Kaplan/Kaiser framework, over-reliance on ability (deep content or process knowledge about areas of health care in which he or she has practiced) can result in a physician leader who is overly focused on operations at the expense of strategy. It's hard to see the forest and the trees at the same time. Availability is a clinician's strength which I have seen trap many physician executives when relied upon too heavily as a leadership asset. Excessive personal availability rarely traps the clinician, for whom "being there" means serving the patient promptly and personally. As a program or organizational leader, it's a recipe for drowning and risks leaders who develop in the forceful rather than the enabling direction in Kaplan/Kaiser parlance. It's also hard to grow and distribute leadership in an organization if the top leader is always available to solve problems. Similarly over reliance on affability may not be compatible with the tough decisions and positions that may face physician leaders. Underdeveloped alternatives to affability risks pushing leaders too far towards the enabling and potentially indecisive end of the Kaplan/Kaiser spectrum. Consensus is good but not the path to leadership success in all situations.

It's all about balance. But the challenge for physician executives who earned success by attention to the A's is not to earn F's as leaders by sticking to the same plan.

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