Abstract

Neurosurgeons may have multiple roles including clinician, educator, researcher, and administrator. Leaders in neurosurgery have the added responsibilities of setting a vision, communicating the vision, implementing a plan to achieve it, and gaining commitment from the team and other stakeholders. For success in the current era of U.S. health care, neurosurgical leaders must deliver despite challenges such as reduced resources, increased protocolized care, automation, and depersonalization. In this work, we describe five empowering strategies that can help leaders perform best. The steps include deepening self-awareness, leading with honesty, developing emotional intelligence, improving coaching skills, and becoming a better influencer. Leaders that take these steps to invest in their leadership skills will reap broad benefits.

Keywords: Coaching, Emotional intelligence, Health care, Leadership, Neurosurgery

INTRODUCTION

Neurosurgeons in leadership roles may have many additional responsibilities including clinical work, education, research, and administrative duties. As leaders, they are also responsible for crafting a vision and priorities, communicating the vision, and implementation of the plan. Leadership in the current health-care environment presents unique challenges. Examples of current health-care challenges include a mandate for cost reduction, demand for superior outcomes, need for greater practice transparency, a workforce with shifting priorities, rapid development and integration of technology, increased automation and protocolized care, and depersonalization. To overcome these challenges, deliver needed neurosurgical care, and accomplish other goals, robust leadership has never been needed more. Volumes have been written about the different facets needed for strong leadership. However, some of the softer, “human” aspects of leadership have not been emphasized in prior descriptions of neurosurgical leaders.[ 4 , 5 ] In this manuscript, we discuss personal qualities and learnable, interpersonal skills that can empower leaders in neurosurgery.

DEEPEN SELF-AWARENESS

Regardless of career stage, leaders in neurosurgery benefit from the development of self-awareness. Leaders should strive to clarify their values, priorities, skills, strengths, and weaknesses. Reflection on factors that have shaped their management styles, such as mentors and prior successes or failures, is insightful and may present opportunities for improvement.

Another strategy to deepen self-awareness is to study one’s unique personality traits. Commercially available personality inventories such as the Revised NEO™ Personality Inventory (NEO PI-R) can provide objective feedback on personality traits that influence management style. This feedback can help leaders be more effective in their current positions and prepared for future opportunities. For example, a leader with lower extraversion may need to make greater effort to socialize, build relationships, and display an energetic disposition.

Feedback from peers also presents an opportunity for growth. Honest feedback should be solicited periodically from multiple coworkers, preferably 360° reviews, and followed up, ideally, with executive or peer coaching.[ 26 ] Another source of feedback is peer coaching. With peer coaching, a neurosurgical leader seeks out a colleague with comparable experience and hierarchical status. The colleagues then enter a reciprocal relationship where ideas and feedback are exchanged. In the relationship, both leaders enhance self-awareness, which can lead to improved professional performance.[ 16 ]

Good leaders also recognize that coaching is relevant, regardless of one’s career stage. Professional life never becomes effortless because individuals change, organizations change, and environments change. To have continued success, neurosurgical leaders must be open to change, coaching, and evolution of leadership style throughout their careers.[ 13 ]

FOCUS ON HONESTY: A KEY ATTRIBUTE FOR LEADERS

Different leaders have unique characteristics, and there is no single set of characteristics a leader must possess. However, good leaders have core attributes that transcend generations and changing environmental conditions. Experts in leadership, Jim Kouzes and Barry Posner, have conducted over three decades of research to determine the most important characteristics of respected and admired leaders. They collected and analyzed more than 75,000 surveys from people around the globe. They determined that the most admired leaders are honest, forward-looking, inspiring, and competent. These qualities have persisted across time and geographies.[ 22 ]

Based on their research, Kouzes and Posner also pointed out that honesty is selected as the single most important quality in virtually every survey since 1980, regardless of geographical region, population interviewed, or organization.[ 22 ] For leaders in neurosurgery, honesty must be the foundation for building trust and confidence. When selecting neurosurgical trainees, honesty is recognized as one of the most important qualities.[ 25 ] Honesty is also an obligatory quality for strong leaders in neurosurgery.

Honesty is an actionable endeavor. According to Merriam-Webster, honesty is defined as “adherence to facts” and “fairness and straightforwardness of conduct.” In the article, “Are you a Good Boss – Or a Great One?” From the Harvard Business Review, Hill and Lineback counsel leaders “Every day those people [who you lead] examine every interaction with you, your every word and deed, to uncover your intentions. They ask themselves, ‘Can I trust this person?’ How hard they work, their level of personal commitment, their willingness to accept your influence, will depend in a large part on the qualities they see in you.”[ 20 ] With honest and fair conduct, neurosurgical leaders construct a robust foundation, on which to develop a committed and effective team.

Credibility is another term that is interrelated with honesty. As defined by Merriam-Webster, credibility is “the quality of being trusted or believed in.” While honesty is an essential component of credibility, credibility is a broader term encompassing other traits such as competence. Across medical disciplines, credibility is recognized as a critical leadership trait.[ 2 , 6 - 9 , 11 , 12 ] A recent systematic review on physician leaders in the hospital setting determined that credibility among medical peers is the most important factor for effective leadership.[ 2 ]

This importance of honesty and fair conduct, although seemingly obvious, cannot be overemphasized for leaders. Honesty is also an essential ingredient for leaders to be perceived as credible.

DEVELOP AND DISPLAY EMOTIONAL INTELLIGENCE (EI)

EI has become a “buzz term” in popular psychological literature. Originally proposed in 1990,[ 28 ] EI refers to “a person’s ability to recognize, discriminate, and label their own emotions and those of others.”[ 27 ] EI also involves the “ability to express one’s emotions and to handle interpersonal relationships judiciously and empathetically.”[ 1 ] The five main components of EI include self-awareness, self-regulation, motivation, empathy, and social skill.[ 28 ]

Understanding, developing, and displaying EI have countless benefits for neurosurgical leaders. EI has been associated with improved job satisfaction in numerous industries, including healthcare.[ 21 ] Emotionally intelligent neurosurgical leaders can expect greater job satisfaction, as higher EI has been inversely related to lower rates of burnout and job dissatisfaction among surgeons.[ 10 , 14 , 23 ]

EI also benefits the surgeon-patient relationship for neurosurgical leaders with patient care responsibilities.

Empathy, a component, of EI has been shown to have a positive effect on patients’ satisfaction with their surgeons and improve health outcomes.[ 30 ] EI is also an important component of the framework for an effective teaching environment. Faculty, competent with EI, will serve as best role models and effective educators of residents. Finally, leaders also need to stay in touch with the emotional state of coworkers and peers. In the article, “Why Should Anyone Be Led By You,” authors Goffee and Jones advised leaders to be “sensors” and hone the abilities “to collect and interpret subtle interpersonal clues, detecting what’s going on [in the work unit] without someone spelling it out.”[ 15 ] Using EI, neurosurgical leaders can work to maintain strong relationships within the team and navigate challenging interpersonal situations with emotional equanimity.

Although EI is now being incorporated into medical curricula for many trainees,[ 29 ] most neurosurgeons have not had formal training in EI. Aspects of EI may be intuitive to surgeons, and other aspects can be learned on the job. Nonetheless, a neurosurgical leader should take a formal or informal self-inventory of his or her EI. The leader may wish to take a self-assessment using a commercially available product such as the EI Appraisal^®. Self- and social awareness and management skills can be developed using texts such as EI 2.0,[ 3 ] seminars, or with executive coaching.

The job description for a neurosurgical leader is complex and multifaceted. A critical facet of the job is the “Human factor.” The “soft skills” of EI benefit the leader, patients, trainees, coworkers, and peers.

COACH PEERS

Understanding and providing coaching is an important skill utilized by the best neurosurgical leaders. As a coach, a neurosurgical leader can help develop professional peers. It is important that coaching is distinguished from other activities often associated with negative connotations such as micromanaging and mandating behaviors. Coaching also differs from teaching and mentoring. According to Sir John Whitmore, a leading figure in executive coaching, the definition of coaching is “unlocking a person’s potential to maximize their own performance. It is helping them to learn rather than teaching them.”[ 24 ]

Several authors have described various skills that are necessary for effective coaching. Coaches need to listen actively and ask questions for discovery. Questioning can help provoke thinking, shift perspective, check assumptions, and challenge beliefs. Coaches can help identify blind spots and weaknesses, highlight hidden strengths, provide structure and feedback, and assist with goal setting. Ultimately, a coach should help guide a coach to arrive at their own forward-looking, solution-based approach.[ 19 , 24 ]

It is important to note that coaching requires dedication and investment to be effective. Coaches must contribute time and demonstrate sincerity and empathy to establish rapport with those they coach. Through investment and team development, a coach will reap diverse benefits. A neurosurgical leader that coaches effectively will build a stronger team, become a magnet for talent, and develop a sustained network of support with those he/she leads.[ 19 ]

BECOME GOOD INFLUENCER

Good leaders are good influencers. To achieve desired goals, neurosurgical leaders need to influence others, including those who are outside their direct hierarchy. To exert influence, relationship building is necessary. Understanding and adapting to the working or social styles of others may facilitate relationship building. For example, timing and form of communication may need to be tailored for different employees. Another team building strategy involves team work. A leader who is a selfless team player will build relationships and capital, making it easier to exert influence later. A final influencing strategy involves coupling goals to institutional priorities.[ 18 ]

Influencing others are an important component of change management, a framework used by leaders to deliver transformative, sustainable change. Leaders must be able to influence and align key stakeholders to support the proposed plan for change.

Influencing also refers to a strategy where “vital” specific behaviors are identified and changed to solve problems. In the book, Influencer: The New Science of Leading Change, the authors describe the study of positive deviance. The authors present an example of a hospital with 13 months of declining service scores. A quality project examined the “vital” behaviors in outlier departments and teams with the highest customer satisfaction scores. They identified five “vital” behaviors associated with positive deviance including smiling, making eye contact, identification, explanation of role and actions, and ending every interaction by asking if anything else is needed. The leadership rolled out a robust training program for all 4000 employees in the organization. Remarkably, after enacting those five basic behaviors, service quality scores stopped declining and actually improved for 12 months in a row.[ 17 ] Neurosurgical leaders that can identify and influence the adoption of high leverage behaviors can overcome major obstacles.

CONCLUSION

Leadership in neurosurgery is challenging, especially in the evolving milieu of health care. We assert that neurosurgical leaders who invest in themselves and their team will have the greatest success. Leaders benefit from introspection and self-knowledge about their leadership style. Leaders should also be open to feedback and willing to evolve leadership styles to meet the environment and needs of those they lead. Extensive research has shown that individuals value honesty and fairness in their leaders, and therefore, it is important for neurosurgical leaders to demonstrate those traits.

Interpersonal skills and relationships are also necessary for successful leadership. The best neurosurgical leaders recognize true leadership is not an assigned title, but an attributed phenomenon. This concept was articulated well by leadership experts, Kouzes and Posner, who stated that “leadership is a relationship between those who aspire to lead and those who choose to follow.”[ 22 ] Leaders who develop and utilize EI will be more attuned to the team’s esprit de corps and effectively manage conflict with emotional equanimity. Developing rapport and coaching peers will allow leaders to enhance the dedication, capabilities, and sustainability of the team. In addition, leaders with healthy personal relationships are more effective influencers and drivers of positive change.

While there is no protocol or formula for best leadership in neurosurgery, the leaders that invest in the “human” skills will be empowered and have greater success achieving their aspirations.

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