Invited Perspective
Lessons Learned Through Leadership Bruce M. Gans, MD There was no plan in my head when I realized that I had turned my career pathway down the road toward one of being a leader. It just happened. I will take credit for being selfaware enough to be conscious of the fact that I was actually making a career choice, but it was circumstantial, not the result of a grand plan.
LESSONS LEARNED FROM MY CAREER PATH Lesson 1 “See the world as you want it to be and try to make it happen.” In college, as an electrical engineering major, I realized I also wanted to be a physician and to combine the 2 roles. This led me to create a unique curriculum for myself at Union College, the small school I attended, to essentially minor as a premed student. When searching for schools with graduate programs in both medicine and biomedical engineering, the University of Pennsylvania was the school that saw things my way and offered me admission to both schools.
Lesson 2 “Stay open to new and unanticipated possibilities.” Then came my accidental discovery of physical medicine and rehabilitation (PM&R) (I was heading down the neurology and biomedical engineering pathway until then), and it became clear that I could combine my interests in applying engineering principles to the patients cared for by physiatry. When I literally bumped into Frank Bonner (then a resident in PM&R), and he showed me what “those people” were doing in the rehabilitation ward on which he worked, I immediately knew I had to change my plan and pursue physiatry.
Lesson 3 “Seek mentors when you need help deciding what to do.” Fast forward to picking a residency in my newly chosen field. How to make this choice was my next challenge. I sought out someone smarter and wiser to mentor me through this process, and William Erdman, MD, shaped my future with his guidance to head west to Seattle (as one of several choices to be explored).
Lesson 4 “Sometimes you have to take the bad with the good and deal with both.” Once you have chosen a residency program (or fellowship program these days), it starts getting harder to make subsequent career choices because there are fewer constraints on your options. In my case, I turned out to really like living in Seattle and loved taking care of disabled children. No training programs existed then for pediatric rehabilitation, so once again, I had to go down the “do-it-yourself” pathway and convince the University of Washington to let me do focused time at the children’s hospital. So when I was offered a faculty position at the University of Washington, details to be determined at a subsequent time, I took a leap of faith that things would work out. Sure enough, the leadership position at the Children’s Orthopedic Hospital and Medical Center opened up unexpectedly. Because it was the only pediatric rehabilitation faculty position, I had to accept not only PM&R 1934-1482/14/$36.00 Printed in U.S.A.
B.M.G. Kessler Institute for Rehabilitation, 1199 Pleasant Valley Way, West Orange, NJ 07052. Address correspondence to: B.M.G.; e-mail: [email protected] Disclosure: nothing to disclose
ª 2014 by the American Academy of Physical Medicine and Rehabilitation Vol. 6, 205-208, March 2014 http://dx.doi.org/10.1016/j.pmrj.2014.01.015
205
206
Gans
the clinical role I wanted but also the leadership role that the position required. Friday afternoon I was the resident on-service, and Monday morning, I was director of the department. So while honing my clinical, research, and teaching skills through self-discovery, I also found myself to have some talents in directing and leading others. It turned out that what I had thought was the “bad” (leadership), turned out not to be so bad after all. In fact, I kind of liked what I found myself doing.
Lesson 5 “It helps to write things down.” Then came the turning point. I was approached to become associate chairman at Tufts in Boston. I had to decide if I was going to pursue the leadership pathway or stay focused on clinical care, teaching, and research. Up until that point, I had known that I might need to make this choice, but I had assumed that I would need to take the initiative and that it would be several years hence. Instead, here was the initiative forcing me to confront my future. After much soul searching, I examined my recent experiences and tried to envision my future in each of these pathways, and I made a list of pros and cons. When contemplating that list, I made my choice to move to Boston and consciously embrace a career with leadership in the forefront.
Lesson 6 “Perseverance can win the day.” Nine years later, my telephone rang. It was from Detroit; I was asked if I would consider becoming president of a large rehabilitation hospital, chair of the department at Wayne State University, and senior vice president for rehabilitation and postacute services at the Detroit Medical Center. With great certainty, I told them that I was quite content leading my department as chairman at Tufts and certainly would never even remotely consider moving to Michigan, let alone Detroit. After what can only be described as being the subject of one of the most aggressive recruitment processes imaginable, I was amazed to hear myself accept the position, and even more amazed to hear my family support the choice.
Lesson 7 “Managing expectations can be as important as achieving results.” Everyone knew my new job was impossible. It, after all, was really 3 full-time positions, each reporting to a different entity and with many apparent conflicts. But that was the most fun part of it all for me. To not be irrevocably conflicted myself, I had to first internalize and resolve the conflicts of the organizations, and then lead each of them
LESSONS LEARNED THROUGH LEADERSHIP
simultaneously down the common path of shared mutual interests, and because everyone knew I could not be expected to succeed, they all had lowered their expectations of what I would accomplish. When I surprised everyone by exceeding those expectations, it started working and working very well indeed.
Lesson 8 “People need to believe there is a problem before they will be willing to accept change.” A few months into my tenure, a grave economic crisis unfolded at my hospital. Disastrous billing problems were discovered that threatened the solvency of the organization. A turn-around of the hospital’s operations needed to be quickly achieved. Worse, no one had seen it coming, and, in fact, some of the board members were unwilling to accept that a crisis was at hand and that drastic actions were required. I found out that, before you can fix something, you need to believe that it is broken. I had to work on a communication plan not at first focused on the fix, but instead convincing people that there was a problem.
Lessons 9 and 10 “People respond better to a message of hope and desire than one of loss and failure.” “Effective communication is essential for successful leadership.” So, presentation after presentation, one-on-one meeting after another, I communicated to groups large and small what the problem was, how it had occurred, and what was needed to fix it, to the point that some folks got sick and tired of my story. They started reacting negatively not to the circumstances but to the message. It was time to stop selling the problem and to start selling the solution.
Lesson 11 “Sometimes self-sacrifice is a part of leadership.” Around my ninth year in office in Detroit, things were going badly for the system, which resulted in rounds of layoffs and fiscal cuts, along with a temporary management team being brought in to fix it all. Although my hospital was functioning well, it was part of an ailing system, and the needs of the greater good seemed to be all consuming. I determined that the organization needed a change of leaders to give someone new a chance to accept the challenges of making the changes that the circumstances required. I was too close to the decisions that I had made and the people I worked with and felt that I could not be as objective as the challenge required. So I terminated myself by accepting a new position that offered me a fresh challenge in a new community. Painful as it was to leave all I had achieved, it
PM&R
seemed best for the organization and would set an expectation that change was the new order of the day.
Vol. 6, Iss. 3, 2014
207
During all theses years of professional growth and development in which people actually paid me to do things, there also was all the volunteer service that I became involved with for the field of PM&R. The 3 major professional organizations I have served for our specialty have been the Academy (American Academy of PM&R), the Association of Academic Physiatrists, and the American Board of PM&R. In each case, I started by volunteering (sometimes also by being recommended by mentors) to do something. In each case, my work was noticed, and I was offered higher levels of responsibility and was eventually elected to leadership roles. In the Academy, I was given the opportunity to serve on the Health Policy and Legislation Committee. This gave me the chance, over the years, to develop close working relationships with our Washington lobbyists, to meet and engage in dialogue with elected members of Congress and their staff, to work with members of the Executive Branch in Washington DC and Baltimore (Health Care Finance Administration [HCFA], later to be renamed Centers for Medicare and Medicaid Services [CMS]), and to see “how the sausage is made” for advocacy and legislation. I discovered that I was pretty good at policy thinking (not politics, policy) and that one could make a difference. Whether testifying to the House Ways and Means Committee about research funding or the Senate Committee on Veterans Affairs about services for soldiers with brain injury, our system of government welcomes experts and their opinions.
governance as well. I saw how repeated visits and meetings changed attitudes and how credibility and impact could grow with consistent and repeated meetings, and, I saw how impactful passionate and caring professionals could be in influencing the beliefs of others (not to mention the effect of actual patients who were willing to share their stories). During the period of my presidency for the Academy, a number of important issues were addressed. One great but unexpected challenge was the resignation of the executive director, Ron Henrichs. I suddenly had priority one established for me because of Ron’s great opportunity for growth in a new role. Although Ron made the recruitment process relatively easy by offering us candidates from his network of relationships, I took the challenge very personally. After all, the key staff position in the Academy would directly affect not only myself and the other board members but also all members and the Academy as a whole for years to come. Happily, we recruited a wonderful leader in his own right, Tom Stautzenbach, who has served the Academy very well for more years than we had the right to expect. Organizational relationships were my second priority. How the Academy related to the American Board of PM&R, the American Congress of Rehabilitation Medicine, and the Association of Academic Physiatrists were all very important. I viewed the Academy as needing to form stronger alliances with each, for varying strategic reasons, to most successfully provide leadership as an organization for our members, physicians who practice PM&R. Along the way, it became clear that the Academy needed to publish its own journal on an independent basis as part of the overall strategy for best serving members and the field. Hence, the process of creating a new journal, PM&R, was launched on my watch.
Lesson 12
FUTURE ISSUES FOR PM&R
LESSONS LEARNED FROM MY SERVICE TO THE ACADEMY
“Who you know can be as important as what you know.”
Lesson 13 “Relationships are built over time and require active effort to be developed and maintained.”
Lesson 14 “Relationship-based leadership is cumulative in its effect, and one needs to be patient and see the broad view to judge its success.” I also learned that facts are not enough. Especially in Washington, it seems that stories and personal relationships can be as impactful as scientific studies. Although we have all seen the “naysayer” about rehabilitation hospitals do a complete turn around when it becomes personal to him or her, I came to appreciate that personal relationships can drive
The above review of my past and some of the issues I dealt with as president now lead me to put forward a few thoughts about our future. I cannot help myself as a leader and visionary (I actually do have a crystal ball on my desk) but to put forward the following observations. Tomorrow’s world of health care will be much more interconnected and interdependent than today’s world. PM&R as a specialty is ideally suited to help be the glue that connects many disparate parts of the “system” that we work in with our patients. As clinicians, we enjoy long-term relationships with our patients and are comfortable with the delayed gratification that we experience from seeing patients improve or live their lives more successfully over weeks, months, or years (compared with microseconds, minutes, and hours for most other medical specialties). This means we have the patience to work with emerging and evolving systems of care for the greater good.
208
Gans
I predict that the role of the physiatrist who is involved in caring for persons with disabling conditions will more and more involve helping to navigate the system of health care and to practice in all the current and future settings yet to evolve. For some it will be practice in the intensive care unit and emergency department to help prevent long-term complications and to promote appropriate transitions in a timely manner to nonacute care hospital settings. For others, it will be coordinating specialized primary care as part of a medical home or medical neighborhood. For yet others, it will be managing musculoskeletal conditions in a more costeffective manner, helping to sort patients who need conservative care from those who need interventional care and those who require surgery.
LESSONS LEARNED THROUGH LEADERSHIP
What is common to each of these scenarios is that the role of the physiatrist will be one of leadership: leading informal or formal teams, leading systems of care, leading teams of physicians, and leading patients and their families to make the right choices. So every lesson I have learned and articulated above about “leadership” can have meaning to individual clinicians and the roles that they serve when treating one patient at a time as well as the organizations and systems that are to come. The lessons I have learned through leadership should have an impact on our field and on our patients. I share them with you all in the hope that you will use those lessons that resonate with you and make each day a better day for your patients and our field.
Lessons Learned Through Leadership Bruce M. Gans, MD There was no plan in my head when I realized that I had turned my career pathway down the road toward one of being a leader. It just happened. I will take credit for being selfaware enough to be conscious of the fact that I was actually making a career choice, but it was circumstantial, not the result of a grand plan.
LESSONS LEARNED FROM MY CAREER PATH Lesson 1 “See the world as you want it to be and try to make it happen.” In college, as an electrical engineering major, I realized I also wanted to be a physician and to combine the 2 roles. This led me to create a unique curriculum for myself at Union College, the small school I attended, to essentially minor as a premed student. When searching for schools with graduate programs in both medicine and biomedical engineering, the University of Pennsylvania was the school that saw things my way and offered me admission to both schools.
Lesson 2 “Stay open to new and unanticipated possibilities.” Then came my accidental discovery of physical medicine and rehabilitation (PM&R) (I was heading down the neurology and biomedical engineering pathway until then), and it became clear that I could combine my interests in applying engineering principles to the patients cared for by physiatry. When I literally bumped into Frank Bonner (then a resident in PM&R), and he showed me what “those people” were doing in the rehabilitation ward on which he worked, I immediately knew I had to change my plan and pursue physiatry.
Lesson 3 “Seek mentors when you need help deciding what to do.” Fast forward to picking a residency in my newly chosen field. How to make this choice was my next challenge. I sought out someone smarter and wiser to mentor me through this process, and William Erdman, MD, shaped my future with his guidance to head west to Seattle (as one of several choices to be explored).
Lesson 4 “Sometimes you have to take the bad with the good and deal with both.” Once you have chosen a residency program (or fellowship program these days), it starts getting harder to make subsequent career choices because there are fewer constraints on your options. In my case, I turned out to really like living in Seattle and loved taking care of disabled children. No training programs existed then for pediatric rehabilitation, so once again, I had to go down the “do-it-yourself” pathway and convince the University of Washington to let me do focused time at the children’s hospital. So when I was offered a faculty position at the University of Washington, details to be determined at a subsequent time, I took a leap of faith that things would work out. Sure enough, the leadership position at the Children’s Orthopedic Hospital and Medical Center opened up unexpectedly. Because it was the only pediatric rehabilitation faculty position, I had to accept not only PM&R 1934-1482/14/$36.00 Printed in U.S.A.
B.M.G. Kessler Institute for Rehabilitation, 1199 Pleasant Valley Way, West Orange, NJ 07052. Address correspondence to: B.M.G.; e-mail: [email protected] Disclosure: nothing to disclose
ª 2014 by the American Academy of Physical Medicine and Rehabilitation Vol. 6, 205-208, March 2014 http://dx.doi.org/10.1016/j.pmrj.2014.01.015
205
206
Gans
the clinical role I wanted but also the leadership role that the position required. Friday afternoon I was the resident on-service, and Monday morning, I was director of the department. So while honing my clinical, research, and teaching skills through self-discovery, I also found myself to have some talents in directing and leading others. It turned out that what I had thought was the “bad” (leadership), turned out not to be so bad after all. In fact, I kind of liked what I found myself doing.
Lesson 5 “It helps to write things down.” Then came the turning point. I was approached to become associate chairman at Tufts in Boston. I had to decide if I was going to pursue the leadership pathway or stay focused on clinical care, teaching, and research. Up until that point, I had known that I might need to make this choice, but I had assumed that I would need to take the initiative and that it would be several years hence. Instead, here was the initiative forcing me to confront my future. After much soul searching, I examined my recent experiences and tried to envision my future in each of these pathways, and I made a list of pros and cons. When contemplating that list, I made my choice to move to Boston and consciously embrace a career with leadership in the forefront.
Lesson 6 “Perseverance can win the day.” Nine years later, my telephone rang. It was from Detroit; I was asked if I would consider becoming president of a large rehabilitation hospital, chair of the department at Wayne State University, and senior vice president for rehabilitation and postacute services at the Detroit Medical Center. With great certainty, I told them that I was quite content leading my department as chairman at Tufts and certainly would never even remotely consider moving to Michigan, let alone Detroit. After what can only be described as being the subject of one of the most aggressive recruitment processes imaginable, I was amazed to hear myself accept the position, and even more amazed to hear my family support the choice.
Lesson 7 “Managing expectations can be as important as achieving results.” Everyone knew my new job was impossible. It, after all, was really 3 full-time positions, each reporting to a different entity and with many apparent conflicts. But that was the most fun part of it all for me. To not be irrevocably conflicted myself, I had to first internalize and resolve the conflicts of the organizations, and then lead each of them
LESSONS LEARNED THROUGH LEADERSHIP
simultaneously down the common path of shared mutual interests, and because everyone knew I could not be expected to succeed, they all had lowered their expectations of what I would accomplish. When I surprised everyone by exceeding those expectations, it started working and working very well indeed.
Lesson 8 “People need to believe there is a problem before they will be willing to accept change.” A few months into my tenure, a grave economic crisis unfolded at my hospital. Disastrous billing problems were discovered that threatened the solvency of the organization. A turn-around of the hospital’s operations needed to be quickly achieved. Worse, no one had seen it coming, and, in fact, some of the board members were unwilling to accept that a crisis was at hand and that drastic actions were required. I found out that, before you can fix something, you need to believe that it is broken. I had to work on a communication plan not at first focused on the fix, but instead convincing people that there was a problem.
Lessons 9 and 10 “People respond better to a message of hope and desire than one of loss and failure.” “Effective communication is essential for successful leadership.” So, presentation after presentation, one-on-one meeting after another, I communicated to groups large and small what the problem was, how it had occurred, and what was needed to fix it, to the point that some folks got sick and tired of my story. They started reacting negatively not to the circumstances but to the message. It was time to stop selling the problem and to start selling the solution.
Lesson 11 “Sometimes self-sacrifice is a part of leadership.” Around my ninth year in office in Detroit, things were going badly for the system, which resulted in rounds of layoffs and fiscal cuts, along with a temporary management team being brought in to fix it all. Although my hospital was functioning well, it was part of an ailing system, and the needs of the greater good seemed to be all consuming. I determined that the organization needed a change of leaders to give someone new a chance to accept the challenges of making the changes that the circumstances required. I was too close to the decisions that I had made and the people I worked with and felt that I could not be as objective as the challenge required. So I terminated myself by accepting a new position that offered me a fresh challenge in a new community. Painful as it was to leave all I had achieved, it
PM&R
seemed best for the organization and would set an expectation that change was the new order of the day.
Vol. 6, Iss. 3, 2014
207
During all theses years of professional growth and development in which people actually paid me to do things, there also was all the volunteer service that I became involved with for the field of PM&R. The 3 major professional organizations I have served for our specialty have been the Academy (American Academy of PM&R), the Association of Academic Physiatrists, and the American Board of PM&R. In each case, I started by volunteering (sometimes also by being recommended by mentors) to do something. In each case, my work was noticed, and I was offered higher levels of responsibility and was eventually elected to leadership roles. In the Academy, I was given the opportunity to serve on the Health Policy and Legislation Committee. This gave me the chance, over the years, to develop close working relationships with our Washington lobbyists, to meet and engage in dialogue with elected members of Congress and their staff, to work with members of the Executive Branch in Washington DC and Baltimore (Health Care Finance Administration [HCFA], later to be renamed Centers for Medicare and Medicaid Services [CMS]), and to see “how the sausage is made” for advocacy and legislation. I discovered that I was pretty good at policy thinking (not politics, policy) and that one could make a difference. Whether testifying to the House Ways and Means Committee about research funding or the Senate Committee on Veterans Affairs about services for soldiers with brain injury, our system of government welcomes experts and their opinions.
governance as well. I saw how repeated visits and meetings changed attitudes and how credibility and impact could grow with consistent and repeated meetings, and, I saw how impactful passionate and caring professionals could be in influencing the beliefs of others (not to mention the effect of actual patients who were willing to share their stories). During the period of my presidency for the Academy, a number of important issues were addressed. One great but unexpected challenge was the resignation of the executive director, Ron Henrichs. I suddenly had priority one established for me because of Ron’s great opportunity for growth in a new role. Although Ron made the recruitment process relatively easy by offering us candidates from his network of relationships, I took the challenge very personally. After all, the key staff position in the Academy would directly affect not only myself and the other board members but also all members and the Academy as a whole for years to come. Happily, we recruited a wonderful leader in his own right, Tom Stautzenbach, who has served the Academy very well for more years than we had the right to expect. Organizational relationships were my second priority. How the Academy related to the American Board of PM&R, the American Congress of Rehabilitation Medicine, and the Association of Academic Physiatrists were all very important. I viewed the Academy as needing to form stronger alliances with each, for varying strategic reasons, to most successfully provide leadership as an organization for our members, physicians who practice PM&R. Along the way, it became clear that the Academy needed to publish its own journal on an independent basis as part of the overall strategy for best serving members and the field. Hence, the process of creating a new journal, PM&R, was launched on my watch.
Lesson 12
FUTURE ISSUES FOR PM&R
LESSONS LEARNED FROM MY SERVICE TO THE ACADEMY
“Who you know can be as important as what you know.”
Lesson 13 “Relationships are built over time and require active effort to be developed and maintained.”
Lesson 14 “Relationship-based leadership is cumulative in its effect, and one needs to be patient and see the broad view to judge its success.” I also learned that facts are not enough. Especially in Washington, it seems that stories and personal relationships can be as impactful as scientific studies. Although we have all seen the “naysayer” about rehabilitation hospitals do a complete turn around when it becomes personal to him or her, I came to appreciate that personal relationships can drive
The above review of my past and some of the issues I dealt with as president now lead me to put forward a few thoughts about our future. I cannot help myself as a leader and visionary (I actually do have a crystal ball on my desk) but to put forward the following observations. Tomorrow’s world of health care will be much more interconnected and interdependent than today’s world. PM&R as a specialty is ideally suited to help be the glue that connects many disparate parts of the “system” that we work in with our patients. As clinicians, we enjoy long-term relationships with our patients and are comfortable with the delayed gratification that we experience from seeing patients improve or live their lives more successfully over weeks, months, or years (compared with microseconds, minutes, and hours for most other medical specialties). This means we have the patience to work with emerging and evolving systems of care for the greater good.
208
Gans
I predict that the role of the physiatrist who is involved in caring for persons with disabling conditions will more and more involve helping to navigate the system of health care and to practice in all the current and future settings yet to evolve. For some it will be practice in the intensive care unit and emergency department to help prevent long-term complications and to promote appropriate transitions in a timely manner to nonacute care hospital settings. For others, it will be coordinating specialized primary care as part of a medical home or medical neighborhood. For yet others, it will be managing musculoskeletal conditions in a more costeffective manner, helping to sort patients who need conservative care from those who need interventional care and those who require surgery.
LESSONS LEARNED THROUGH LEADERSHIP
What is common to each of these scenarios is that the role of the physiatrist will be one of leadership: leading informal or formal teams, leading systems of care, leading teams of physicians, and leading patients and their families to make the right choices. So every lesson I have learned and articulated above about “leadership” can have meaning to individual clinicians and the roles that they serve when treating one patient at a time as well as the organizations and systems that are to come. The lessons I have learned through leadership should have an impact on our field and on our patients. I share them with you all in the hope that you will use those lessons that resonate with you and make each day a better day for your patients and our field.
