Physicians are frequently called upon to take on leadership roles. These roles can come in various forms, ranging from academic leadership roles (eg, division or department chief or chair) to educational leadership roles (eg, clerkship or residency program director) to leadership roles in a practice setting (eg, director of a practice group). Although some of the desired skills and competencies for the leader may be specific to particular roles and responsibilities, others are more generic and applicable to any of these leadership positions. In this chapter, I will concentrate initially on the generic aspects of leadership and conclude by discussing some of the challenges that are more specific to hospitalists and to the hospital environment. In addition, instead of trying to review the voluminous leadership literature, I will present a personal perspective, based upon my own experiences in a variety of leadership positions over many years. I will divide the discussion of leadership into four components: the personal attributes that a leader should demonstrate, the skills that should be acquired, a suggested approach for trying to reach a goal, and leadership challenges for hospitalists in the hospital environment.

Before considering the important attributes of a leader, it is worthwhile to understand the distinction between a leader and a manager. Much has been written about these differences, which can be readily summarized and understood by any of several descriptions or aphorisms:

• Leaders have followers; managers have subordinates. Individuals voluntarily follow a leader because of the qualities of the leader; subordinates work for managers because of the reporting relationship and the organizational authority vested in the manager.
  
• Leaders lead people; managers manage tasks.
  
• Leadership is doing the right thing; management is doing things right.
  
• Managers focus on tactics and tasks; leaders focus on strategy and direction.

In fact, however, these distinctions often blur in the setting of actual roles and responsibilities in the workplace. The individuals who are most successful in assuming roles with greater authority and responsibility are those who are both effective leaders and effective managers. A leader who does not have good management skills can generate visionary ideas but be unable to implement or operationalize them. A manager who does not have good leadership skills will be unable to mobilize and motivate a supportive team.

Some activities and responsibilities of a physician leading a group of hospitalists can readily illustrate the differences between leadership and management. “Managing” the group means assuring that the patients are covered, that transitions of care are effectively handled, that chart and billing documentation is complete and accurate, and that teaching responsibilities are assigned and well integrated with patient care responsibilities. In contrast, “leading” the group means exploring and developing ideas for improving the system and its productivity, improving quality of care, developing the skills of the team, and facilitating the professional development of the team members.

For the purposes of this chapter, I will primarily use the terms “leadership” and “leadership skills,” recognizing, however, that we are really considering both leadership and management skills. In the medical leadership positions that are likely to be assumed by readers of this chapter, success will hinge upon both leadership and managerial qualities and the importance of each in reinforcing the other. Therefore, my approach to discussing leadership and management qualities will be one of lumping rather than splitting.

It should go without saying that a leader must demonstrate professional integrity, including honesty. High standards of integrity and honesty are a prerequisite for obtaining the respect of colleagues, superiors, and subordinates. The leader sets the model of behavior for the rest of the team, and lack of professional integrity exhibited by the leader will soon be mirrored by cracks in professionalism among others.

The leader needs to be an effective communicator; openness and transparency in communicating to all constituencies assure that everyone is on the same page. A commonly held perception of a talented leader is often someone who can communicate both values and vision, including a set of goals and how those goals might be achieved. However, that is only part of the communication equation, which also involves establishing and transmitting expectations for others. It is critical that subordinates, trainees, and team members understand the expectations being placed on them, including how and on what basis they are being judged.

Communication must also occur on a two-way street, ie, the leader must be an excellent listener as well. If the leader is unable or unwilling to hear what others have to say, he or she will be doomed to failure. Without ideas and feedback from others, the leader will invariably make mistakes of both commission and omission that can be avoided by hearing the ideas and opinions of others and considering all perspectives when making important decisions.