Leadership, Engagement, and Well Being

When I arrived with my husband Dave and daughter Claire in Orlando in June of 2013, I was suppressing my anxiety and awareness that I didn’t have a manual called “How to Be a Division Chief” at a free-standing children’s hospital.

I joined the largest pediatric health system without much knowledge or understanding of the realities of healthcare access in the fourth most populous state and perhaps the one with the most underserved children and families for decades. As I reflect on the past five and a half years, I am in awe at what my incredible team and I have been able to achieve, and at the level of care delivered despite all of the challenges we have faced internally and externally. Since September of 2016, I have also assumed the role of surgeon-in-chief for our hospital. Writing my own job description and vision for what I believed necessary and what a physician leader in this role should and could accomplish was daunting and surreal. 

As I have lived and breathed challenges from both leadership roles, I am even more grateful I have been grounded only by my clinic and OR days, like all my front-line colleagues. The countless issues, big or small, simple or complex, made it necessary and, frankly, self-preserving, to gain a new perspective as a physician on both “leadership” and “engagement.” I must give credit to Kari Granger, my external coach for this past year (an investment in me from my organization), for helping me discover my new perspective and self-awareness. I want to share some key points about leadership and engagement because, it turns out, both directly influence physician well-being and the degree of burnout experienced by physicians.

Impact of Leadership on Burnout

Of the many publications by Tait Shanafelt, MD, an expert in physician wellness and currently Stanford Medicine’s chief wellness officer, I find one of high relevance for physician well-being: “Impact of organizational leadership on physician burnout and satisfaction” (Mayo Clin Proc. 2015;90(4):432-440). This study used a survey to assess burnout in physicians and scientists working at Mayo Clinic in 2013, but what was unique was that physicians also rated the leadership qualities of their immediate supervisor in 12 specific dimensions. Supervisor scores in each leadership dimension and composite leadership score strongly correlated with the burnout and satisfaction scores of individual physicians (all P<.001).

On multivariate analysis, adjusting for age, sex, duration of employment, and specialty, each 1-point increase in composite leadership score was associated with a 3.3% decrease in the likelihood of burnout (P<.001) and a 9.0% increase in the likelihood of satisfaction (P<.001) of the physicians supervised. The mean composite leadership rating of each division/department chair (n=128) also correlated with the prevalence of burnout (correlation=-0.330; r(2)=0.11; P<.001) and satisfaction (correlation=0.684; r(2)=0.47; P<.001) at the division/department level. This is why developing our own competency as a leader and having an organization focus on the competency of those who are in leadership positions is critical as we hope to not only survive but thrive in the face of the burnout epidemic.

What this all points to is that being a successful leader in our specialty, societies, and organization mandates relational leadership, which physicians have never been formally or informally taught. Relational leadership is a perspective on leadership focused on the idea that leadership effectiveness has to do with the ability of the leader to create positive relationships within an organization. Having individual expertise based on clinical or research excellence in a niche or particular domain is still recognized but is no longer enough to lead an entire “army” of fatigued and wounded physician workforce. This applies not only to physicians, but also is equally critical for non-physicians in administrative leadership roles.