Leadership in Medicine: Playing to Your Strengths to Maximize Your Potential with Dr. Rik Nemanick

Dr. Rik Nemanick discusses how playing to your strengths as a leader in medicine can help you to maximize your potential.

“When someone does get that first leadership position as a physician, a lot of times they’re like ‘I don’t know what to do!’”

-Dr. Rik Nemanick, Principal Consultant and Founder of Nemanick Leadership Consulting and Author

All physicians are leaders. And effective leadership is key to being a successful physician. On DocWorking: The Whole Physician Podcast, Cohost and Lead Coach Jill Farmer meets with Dr. Rik Nemanick to discuss how physicians can continue to develop their leadership potential. As the founder of Nemanick Leadership Consulting, Dr. Nemanick is able to offer physicians highly valuable advice on how to create a team-oriented mentality and work ethic. How can you be a leader as a part of a team? How can you make those around you successful? What culture do you want to create? In today’s podcast, Dr. Nemanick acknowledges the common barriers that hinder physicians from becoming leaders and proposes to resolve them by calling attention to the importance of practicing 360-degree feedback. Together, Jill and Dr. Nemanick put forth their expert advice on how to best practice introspective techniques to kickstart your leadership habits. Listen today as a step towards becoming a successful physician. 

Books by Dr. Rik Nemanick:

The Mentor’s Way: Eight Rules for Bringing Out the Best in Others- https://www.amazon.com/Mentors-Way-Rik-Nemanick-dp-113818991X/dp/113818991X/ref=mt_other?_encoding=UTF8&me=&qid=

Rik is principal consultant and founder of Nemanick Leadership Consulting. He helps clients maximize their leadership talent through executive coaching, leadership education, and mentoring programs. He has worked with healthcare organizations like Massachusetts General Hospital, BJC HealthCare, Catholic Health Initiatives, and Esse Health. Rik is the author of the book The Mentor’s Way, which describes his approach to mentoring. He is an adjunct faculty of executive education at Washington University. He is a Board Certified Coach and earned his doctorate in organizational psychology from Saint Louis University. He can be found at Nemanick.com

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Please enjoy the full transcript below

 

Dr. Rik: When someone does get that first leadership position as a physician, a lot of times they’re like, “I don’t know what to do.”

[DocWorking theme]

Jill: Hi, everyone, we’re so glad you’re here at DocWorking: The Whole Physician Podcast. I’m Jill Farmer, lead coach at DocWorking and cohost of the podcast. And today, I’m really excited to be talking to you about physician mentorship and leadership. But first, remember, we’re always brought to you by oDocWorking Thrive, Our program where you can get some leadership training, individual coaching, peer mentorship, all kinds of ways to support you and your practice in life, so that you can thrive at work and at home.

And today, we are really lucky to be joined by Dr. Rik Nemanick. He is a principal consultant and founder of The Nemanick Leadership Consulting. He has his doctorate in organizational psychology and he helps clients maximize their leadership talent through executive coaching, leadership education, and mentorship programs. He has worked with healthcare organizations like Mass General Hospital, BJC HealthCare, Catholic Health Initiatives, and LC Health. He is the author of the book, The Mentor’s Way, which describes his approach to mentoring. And he is an adjunct professor as well, at Washington University in St. Louis. Rik, thank you so much for joining us today.

Dr. Rik: Jill, I’m so glad to get to spend this time with you and I want to sign up for your program. [laughs]

Jill: It’s a good one if I do say so myself. You and I have talked about this, the fact that we’re both passionate about leaders and good leaders, empowering, inspiring, and helping to make everyone in their world potentially leaders in their own life. I think with physicians, one of the things that a lot of people don’t recognize is, there’s so much emphasis, of course, on the technical aspects of education, as it should be in medical education. And healthcare systems traditionally have promoted based on technical skills related to the delivery of healthcare services, which of course is good, right? You want your leaders to be proficient and even excellent at what it is they’re doing as it relates to patient care and as it relates to their work as physicians. And a lot of times people get promoted into leadership positions without having any training, expertise, or understanding of actually how to lead, how to inspire, how to empower. What are your thoughts on that?

Dr. Rik: Well, that’s a great observation. I find that physicians have that in common with a lot of other really well-trained professionals – attorneys, accountants, actuaries. And there’s not a lot of education, while you’re getting certified in those skill sets, in how to be a leader. Part of it is just because there’s so much technical education to jam in your head. But also, I find is, a lot of times, when you do try to teach that stuff at that level, it really just becomes theoretical, because I’m not practicing it right away versus all your technical skills you are practicing, put into what you’re doing and get some feedback on how that’s going. And so, I think that a lot of organizations, a lot of medical schools and law schools, don’t put a lot of emphasis on it. Some are doing more and I think that’s really great. But it’s something that I think is really lacking. 

When someone does get that first leadership position as a physician, a lot of times they’re like, “I don’t know what to do” and then they start thinking about, “All right, well, who are the good leaders I’ve had? who are the ones I look up to where I respect, I really admire, and I’m going to try to be like that person?” or sometimes, they think, “Oh, God, I’ve had this awful leader and I’m not going to be like her. She was terrible and I’m going to be the opposite of that.” But other than that, they’re winging it.

Jill: Yeah, and I think that is a great place to start. We talk about that in one of the short courses that we have in DocWorking Thrive about, it is important to identify yourself and not think of it as either ‘I’m a leader’, ‘I’m not a leader’, in that fixed mindset way or ‘I have this fixed way of being and so the kind of leader I am is ingrained’, or ‘I’ve been born into it’, instead, as you said, identifying in that game of warmer and colder in life, who do we want to be more like and follow and then who do we want to say no, that was really ineffective. Notice the impact it had on you to have ineffective leadership and look for ways to move away from that. 

Another great point you made obviously is, yeah, some of the training, if you can say, there needs to be more training in medical education, that would be great, but it also would be in some cases training in a vacuum, so the reality is, once you get into real life situations, that’s where you get to emphasize the knowledge and practice, right, to improve leadership skills. So, how does somebody gain knowledge and practice, so that they can become better leaders as they move into leadership opportunities?

Dr. Rik: One thing is to get feedback on a pretty regular basis. Once you’re in a leadership position, don’t be afraid to get feedback. Ask for feedback, make it easy for people to give you feedback. So, find out early on, “Hey, I’m just trying this out. I’m just winging it.” and here’s the tough thing is, you have people whose job relies on them to be an expert and be really good at something, and the people that they’re leading look at them in a clinical sense and expect them to have the answers and know what they’re doing and be awesome, and then it’s difficult for that same person to, on the leadership side say, “I’m actually faking my way through this. So, I’m going to need you all to give me some feedback” and that creates a dichotomy in the feedback giver’s mind because, on the one hand, they’re used to this person whom,”I give that, that person feedback, they’re the physician, they’re the ones who are in charge of whatever we’re doing here”, and on the other hand, it’s like, “But you’re not really necessarily an expert leader, so, it is okay for me to give you feedback there.” And so, I think one thing that some physicians have figured out, not many, is, how to make it safe for the people that work with to give them feedback on their leadership.

Jill: Yep, that’s right, because there’s a lot of still, I find compared to other industries I work in and have worked in doing training through the years, time and stress management training across a variety of sectors, that there is still some old school hierarchical stuff going on in medicine that has really worked its way out of a lot of other industries in the same way. And so, I want you to say a little bit more about making it safe to give and receive feedback and why that hasn’t necessarily been available in the past, but why it’s important for that to change?

Dr. Rik: Well, one thing is because 360-degree feedback instruments and tools have been used mostly by big corporations for professional leadership programs. And so, it’s something that hasn’t been used a lot in medicine and it does get used on the administrative side of medicine a bit. The folks who come in with a more administrative background, they are getting 360s, but they don’t often think to have the physician leader get to 360. The tools are coming into the space and becoming more available, but I think the experience with them is still not quite as deep as in other areas of leadership. 

I think when you think about making it safe, one is, creating a channel for someone to give you feedback confidentially and anonymously like that. But the other way is to really lower the bar and to just demonstrate some humility and say, “I know I’m in charge of this clinic, I’m in charge of this department if I’m in an academic setting. And I am supposed to be really good clinically, but I’m trying to figure this leadership stuff out. And so, I do need to know, what am I doing that’s getting in your way? What can I do to make you be more successful?” And I think a lot of times, leaders in general don’t think about that. They don’t think about their job is to make the people they are leading be more successful. And so, that’s one question that can really open things up is, what can I do to make you more successful, what can I do to make your job easier, what can I do to help you, help our group, or help what we’re doing here? And so, I think asking the question– 

Then when people do give you feedback, fighting the temptation to argue with them and get defensive. I think a lot of times, and this is not just who are physicians, that a lot of leaders when they start getting feedback, they know they should ask for it. But when they start getting it, they’re like, “Well, let me explain something to you. Let me tell you why that is or I’m not really sure I see it the same way as you.” Like you said, we already have a hierarchic difference. There’s already a power differential. Now, imagine that person, you’re trying to give some feedback to and they showed a little bit of humility saying, I’d like some, and then you give some, and they shut you down. How likely are you to want to do that the next time and so, you’re teaching people how you want to take feedback by the way you take feedback.

Jill: Very powerful. I recently interviewed Ryan Niemiec, who is one of the leaders in the idea of strengths, putting values and strengths in action. He talked about the idea that humility is often underutilized in workplace settings, but one of the ones that makes people feel most connected and to see each other as humans. He said, “One of the most simple ways that we could put humility into action is by listening better.” And so, I love how you reminded us that being better listeners as leaders makes us better leaders. Showing how experty we are isn’t always the best way for us to really do what needs to happen here. I want to also follow up with something else you said, the idea of being able to take feedback without getting defensive. It’s a skill. 

Dr. Rik: Oh, yeah.

Jill: It’s going to take some practice. You’re going to have to listen to some of our other podcasts on emotional agility on how to process your emotion before you react or say something. I know that’s not something you’re supposed to be perfect at but be aware of, right?

Dr. Rik: I’ll add one more thing to that is, thank people for giving me feedback, even if it was hard to hear, even if you don’t necessarily agree with all of it. Think about the fact that that person had to climb over a big power differential in order to tell you what they would like to see more of or less of from you. And even if you don’t get defensive, you know, if you manage that, make sure you do thank them, so that the next time, it’s easier for them and more likely they want to do it. 

Jill: Beautifully said. Another thing I want to workshop, an actual case that came up with a physician leader recently and they are getting better at listening to feedback and taking in feedback. But they were a little flummoxed by the idea that one physician that they’re leading gave them one set of feedback about their leadership style and someone else said something different. They said, “What am I supposed to do?” I said, “Well, you individualize your leadership for the needs of the people you’re leading.” I want to hear you say more about that.

Dr. Rik: That’s exactly right that different people you interact with are going to experience you and your leadership very differently. And so, if you have someone maybe who is maybe more junior in the role, more learning, you may be a little more directive with how you lead them. And someone more senior, someone more experienced, you may need to be a little more hands off, a little more setting general direction than getting too specific. If you give them both the exact same type of leadership, then the one person is going to say, “Hey, that was great” and the other person’s going to say, “Either A, you’re a micromanager. Get out of my business,” if the person has more experiences or if they’re less experienced and you’re staying at that, “No, no, you got this. Here’s the general direction you should go in.” They’re going to say, “This person doesn’t care or doesn’t really want to help me succeed. They’re treating me like sink or swim.” And so, I can get two very different pieces of feedback from two different people. 

I think also, when you think about the different roles you play as a physician, you’re going in and out of roles all day. You think about I am now with a patient, let’s say, and sitting across from someone and they’re looking at the physician with a white lab coat, and I’m playing one very specific role with them, and then as soon as I leave that clinic, a room with that patient, I’m now interacting with some of the staff and I have a different role relative to them, and I’m going in and out of those roles all day. 

I had a physician I did some feedback with a number of years ago. One of the pieces of feedback was that she was low on a dimension that is on an instrument called the Hogan of Agreeableness, which is the extent to which you want to make people like you and want to be someone that people like to interact with. She was pretty low on that and she did not like hearing that. I said, “Well, what makes you say that?”  “Well, with my patients, I am very nice and I listen to them a lot and really make them feel heard and appreciated.” and I said, “If I were to go talk to the staff, what would they say about that?” And she didn’t talk. She said, “Oh, okay, I guess I see that.” Because you’re playing a role with the patients, that is something that you’re trying on, you’re putting on, and it works for you and it’s great. But when you’re back with the staff, you’re a very different person and not necessarily the same person that patients are seeing. So, it’s very easy to get conflicting feedback based on the roles you’re playing.

Jill: Thank you for those kinds of tactical, practical ways of thinking about that. I think that’s extremely helpful for us. I want to go back to something you said earlier because I know it’s a term that you and I are familiar with, especially in that corporate setting. But you talked about a 360. When we’re talking about feedback, we’re talking about a 360, and I’m not sure everybody and our audience is going to be totally familiar with what that is or how it could be utilized as a tool in their own leadership development.

Dr. Rik: That’s a great question. The 360 is something that was pioneered a very long time ago. I’m trying to think of when I first came across it, but the whole concept of it is to get some feedback, some perspective from the people who report to you. If you’re a physician, the staff who work in your clinic, and then you think about from your peers or your partners you work alongside of, if you have a supervisor, so whoever is your boss, and then you have to rate yourself and they are rating you on your leadership attributes. The way the 360 works is, it usually takes the form of a survey that goes out electronically and it’s got closed ended responses, ‘strongly agree’, all the way down to ‘strongly disagree’ for a whole bunch of leadership competencies.

Sometimes, and I’ve done this a bit as well is, instead of doing an electronic survey, is an interview with all those people. But the whole idea is, let’s pull together a bunch of feedback. It’s segregated by the person’s position relative to you. So subordinate, peer, boss, because like we just said, the feedback may be different because your role and relationship with each of those different groups is different. And so, as you think about how to understand the feedback, it helps us say, “Well, my subordinates are saying one thing that’s different than my peers that might be different than my boss, because I’m operating with them all differently and they’re receiving me differently.” 

It’s a really powerful way to get feedback from people because it’s confidential. Usually, the way it works is the feedback from the subordinates and peers groups are blended together, so you can’t pick out. “Well, Jill said this about me and I’m going to let her have it.” It creates a little bit of safety for people to give feedback. But also, I like it, because it’s black and white, it’s right there in front of you, and a lot of times, it’s numeric, so, you can then start comparing across questions and across individuals when you’re the coach coming in to say, “Well, you’re actually below your peer group here or your boss is reading you lower here than you are and let’s talk about that.” It gives me as a leadership coach a lot of great stuff to work with.

Jill: Can you give us an example of what kinds of things show up in that kind of feedback that you’re able to coach somebody on that really helps them improve their leadership right away?

Dr. Rik: Usually, it’s organized by competencies. Within the competencies, there are going to be dimensions that you’re good at. Let’s say, one of the dimensions that you might get, Dr. Jill, we’re just going to say you are my client here, is gives regular feedback or gives me positive feedback to her subordinates. I might see that I say, “Well, it looks like that your subordinates are actually reading you pretty low there and you gave yourself a higher rating, you gave yourself a four, they’re averaging like a 2.8.” I coach from a perspective of asking questions. And so, the starting place is, “Jill, what do you think is going on there? What do you think is causing them to rate you lower than yourself? What are you seeing or not seeing?”

Jill: I might say something like, “Well, am I being aspirational? This is how I want to be, but the actual situation is that the people are experiencing me differently. So, how do I improve the way that I solicit feedback from my subordinates in a way that makes them feel seen and connected to.”

Dr. Rik: Right. Then I would say, “Well, what is it that you’re doing or not doing? What do you think that they’re seeing or not seeing? What is making it easier or harder for them?” Because you’re right. A lot of times, the self-rating is how I’d like to see myself versus how I actually see myself. There’s a little bit of that emotional intelligence and self-awareness that sometimes is a gap.

Jill: Right. And I had a situation came up like that with the client and they were like, “I say to him every time as I’m walking by. Everything good, all good with a thumbs up.” [laughs] But they realized is that, for some people, that was fine. That was the feedback mechanism loop that worked. But for other people, it felt it was sort of, “I’m going to tell you that all is good. I’m not really here to listen to what you need to tell me in a given situation” and it was really enlightening to understand that. Well, the intention was there to get feedback and feel that was meaningful communication. That’s not how the other staff members, and support staff, and nursing team was experiencing it. 

Dr. Rik: Well, exactly. If you ask a closed ended question like that, “Is everything good?” And you say, it kind of in passing, the message you’re saying is, “I don’t really care what your answer is, because I got to move on to the next thing.” But I do want to have a positive interaction with you. I’m going to say words to you that might make you feel good, but really are just words I’m saying at you as I’m going by.” And so, I might think, “Hey, I’m doing a good job” and they might think, “That person does not care about me.”

Jill: We’ve talked briefly about some of the mistakes that can be made in leadership. One is, not getting feedback, making assumptions, and not taking that feedback in and making a difference. Another is, getting defensive about feedback as it comes in. What are some other mistakes that you see people making as physician leaders that they might want to think differently or shift their perspective on that will support their leadership and help them embody better leadership?

Dr. Rik: One thing that comes up a bit is, a lot of times, they don’t think of this because it becomes kind of part of the environment I don’t really think about, is, what kind of vision do I have for my leadership, what kind of leader do I want to come across as, being intentional around it, and what kind of culture do I want to support around me? What kind of culture do I want the people who report to me who work with me to experience? Because you do have an outsized influence on other people and their jobs whenever you’re in a leadership role, and the higher up you go, those things become more important. 

A lot of times it’s a skill that we’re not selecting for when we’re lower in the organization, so even if you’re moving into your first leadership position, we’re not necessarily selecting for developing the ability to create a vision or the ability to pay attention to the culture that you’re creating around you. But as leaders move up in the organization, those things become more critical. Like I said, when you’re in your first roles in the organization as a technical contributor or as a first line leader, those feel like atmospherics, they just feel part of the atmosphere I’m not really conscious of, but what’s going on if people above you are doing a good job of it is they are laying out a vision, they’re communicating about the vision, and a vision is kind of seeping into your brain, and that’s something you’re signing up for and you are sharing, same thing with the culture, they’re expressing and they’re reinforcing value sets down in the organization that you’ve adapted to and you’ve incorporated some extent, and you don’t think about, “Well, how did that get there and why is it that I’m actually listening to that and believing in that stuff?” And so, I think that’s a skill set around creating vision and creating culture that the more senior the leader is, the less experience they have building that.

Jill: That’s how you change cultures and make workplaces where people want to be for the long term to serve the highest goods. So, I love how you framed that for us. Any other mistakes that come to mind? 

Dr. Rik: Yes, one big one. Tolerating jerks. Tolerating people. No, tolerating leaders, and not even leaders, but just physicians who do a great job clinically, maybe if they’re in an academic setting, they bring in a lot of money through grants and things like that, or if they’re just a really great physician and they start amassing some power, tolerating some of their bad behaviors and forgiving them for it rather than helping them deal with those derailers early, because A, those derailers now are going to make the culture around that person really terrible. And it’s going to lead to turnover and really negative culture. But also, that derailer will catch up with that leader someday. And by giving him a pass and forgiving him for it early and not really holding them accountable for developing it is going to be doing them a disservice down the road.

Jill: I have seen that happen over and over again, and see excellent physicians leaving workplaces where they’re otherwise satisfied, because that bad behavior or derailing behavior as you described it has just made it intolerable for other colleagues. So, it is something that we really have to understand and take seriously. Finally, let’s look back. We’ve been talking about some of the big picture and as you get higher up the leadership chain in terms of the impact and decision making that you can do. Let’s talk now to maybe some of the residents who are in our audience or people who are new in their career. What are some things that you would advise them to do, to think, about if they want to build some leadership skills as they move into leadership and feel they do have some readiness as they’re moving into leadership possibilities?

Dr. Rik: Well, so, actually, one piece of advice comes from one of my coaching clients. He is an academic department chair. He said one of the things that really helped him get some taste of leadership when he was coming out of residency through his fellowship was volunteering to help out with things. Asking what is a chair or department director? What does that person need help with? What are some things that would allow you to get some experience with something beyond your skill set and also get some experience on the running of a department or of a clinic or something like that, so volunteer to help out? But also recognize that you’re successful, because the people around you are helping you to be successful. What can you do to repay that, what can you do to be a part of a team with other people? 

They’re looking at you, like you said earlier, hierarchically, as the physician who tends to be at the top of the pyramid in terms of clinically making decisions and things like that. Everyone defers to your opinion. But when you are part of a team, you have to really see, I’m just one member of this team, and they’re the other members, and they’re here to make me successful. And so, I want to say, how can I help make them successful, too? You can do that when you are in residency, coming out of residency. Your first job to look at the people around you, the other physicians, and the staff around you and say, “What can I do to make them more successful too?” And that will get paid back.

Jill: Dr. Rik Nemanick, I could talk to you about this all day. Thank you so much for sharing your wisdom. Thank you for making this so interesting and just empowering all of us to think about how we can make a change to be even better leaders moving forward. It was really great to have you here. 

Dr. Rik: Jill, thank you so much. I really enjoyed it.

Jill: If you want to check out more of Rik Nemanick’s work, Dr. Nemanick can be found at nemanick.com and I’m going to spell it for you. It’s N-E-M-A-N-I-C-K dotcom. There’ll be a link in our show notes as well as more information about the great work that he does in the world. Remember, go to docworking.com right now to check out all of the wonderful things. We have leadership support, communication for the win for physicians, stress and time management support, group coaching, individual coaching, and peer support, all there at DocWorking Thrive. Go to docworking.com today to find out more. Until next time, I’m Jill Farmer.

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