Principles of Leadership in Healthcare

"Leaders are people who are able to express themselves fully...they know who they are, what their strengths and weaknesses are, and how to fully deploy their strengths and compensate for their weaknesses. They also know what they want, why they want it, and how to communicate what they want to others in order to gain their cooperation and support. Finally they know how to achieve their goals" (Ingram, 2004).

Leadership is a difficult task, by which a person impacts others to accomplish an objective. While this is a challenging situation in any field, it is of extreme significance in the healthcare setting, where quality of service, trust, and ultimately people's lives are dependant. In addition, leadership-- whether it be positive or negative-- will have a direct implication on staff interactions, continuous quality improvement, and risk management. Thus the ability to establish oneself as an effective leader involves a process of successfully employing characteristics such as communication, trust, guiding vision, knowledge, equity, and ethics.

The first characteristic a leader should apply is communication. Communication is the transmission of information and views from one person to another. The ability to communicate a vision ranks among the key tasks of a leader, and all organizations depend on the existence of shared meaning and interpretations of reality to facilitate coordinated action (Leadership Advisory Commission, 2003). The act of communication begins with a thought within the intellect of the transmitter. This idea is then conveyed to a recipient through actions or statements. The recipient then interprets these actions and statements into an abstract idea. Listening is the key to communication and the information is useless if it is not expressed in the right manner, making the ability to communicate a clear and shared vision is an essential task of a leader. The combination of a compelling vision and effective communication skills inspires people to take action (Leadership Advisory Commission, 2003).

Trust is another component of effective leadership, and is built on consistency, dependability, and reliability. "If people are going to follow someone willingly, whether it be into battle or into the boardroom, they first want to assure themselves that the person is worthy of trust" (Leadership Advisory Commission, 2003). People may be enticed to a vision, persuaded by operating communication, but they must trust a leader to uphold their dedication to a system or a task. Without the establishment of honesty and follow-up, it is impossible for a leader to maintain a functional level of commitment to an organization or project (Leadership Advisory Commission, 2003).

Leaders must also be able to provide the members of their team with a guiding vision, a purpose for what they are doing and strength in adversity (Ingram, 2004). Their vision is a distinct view of the team's intention and the implementation of well communicated objectives that connect to this vision. Leaders need to express a "target that beckons", and for an association to develop the leader needs to think outside the box and break the mold (Leadership Advisory Commission, 2003). The leader needs to constantly have a clear view of the group's purpose and develop mutually agreed upon and challenging goals that clearly relate to this vision (Leadership Advisory Commission, 2003).

Another necessary component of leadership is knowledge, which includes acknowledgement of one's own strengths and weaknesses. An effective leader should be willing to take risks and recognize that errors are a chance for learning (Leadership Advisory Commission, 2003). Knowledge does not just refer to problem solving and clinical skills, but to possessing the ability to motivate oneself, accept responsibility and exhibiting emotional maturity (Leadership Advisory Commission, 2003). In the demonstration of all of these features, knowledge is constantly being attained on a personal level, and is also being relayed and encouraged to the members of the team.

In order for a leader to maintain cohesion and loyalty within an organization, they must employ the qualities of fairness and equality. Treating everyone without prejudice will decrease animosity amongst team members, and allow everyone to work at their best ability. A leader should be fair and open-minded to diversity especially in a world where individuals come from different cultural backgrounds, and have diverse religious backgrounds. Leaders must be able accept these individuals for their positive attributes, as "diversity has proven valuable in all types of organizations in generating innovative ideas; broadening the appeal of the organization; expanding its network of donors and volunteers; and making it more open, flexible, and responsible" (Leadership Advisory Commission, 2003).

Finally, leaders must maintain an ethical orientation if they are going to successfully lead their team. Leaders are responsible for the ethical standards that govern the behavior of individuals in their organization, and they set the moral tone (Jurkiewicz & Brown, 2000). In addition, while organizations allow for a diverse range of evaluative rules and standards for people employed there, success is defined by adherence to an organization's overriding ethic and effective leadership is inextricably tied to a concern for the nature of that ethic (Jurkiewicz & Brown, 2000).

Unfortunately, effective leadership in today's healthcare setting is parallel to ineffective leadership. Not all practitioners fit the mold of an effective leader, and although this continues to be a problem in healthcare, we as physician assistants have an obligation not only to our patients but to our colleagues as well. The impaired practitioner should not go unnoticed and it is our obligation to ensure that this doesn't occur.

Our responsibility as physician assistants is to protect patients and the public by identifying and assisting impaired colleagues who are unable to practice with reasonable skill and safety to patients. This could include physical or mental illness, due to loss of motor skill, the aging process as well as excessive use or abuse of drugs, including alcohol (American Academy of Physician Assistants, 2000). The impaired colleague also includes one with an infectious disease, such as hepatitis, a physical disability or even inappropriate sexual behavior.

In order for physician assistants or any healthcare practitioner to be able to provide quality care to their patients and to maintain a stable working environment with colleagues, one must be able to identify the "red flags" of ineffective leadership. Some examples which are cause to be reported for professional misconduct include practicing fraudulently, practicing