When we examine the current medical care environment that is out of balance and patient well-being is not the priority, we believe that integral leaders are the only ones capable of restoring that balance. If we accept this, from where do the integral leaders emerge?
Logically, they would come from the care components in need of balance – doctors and senior executives from hospital administration, the insurance industry, universities and the medical industrial complex. But of these, which background best prepares individuals to lead the medical care environment, an effort that makes patient well-being the priority?
Medicine has been the beneficiary of many passionate and capable leaders. But in our current state, the field is largely led by non-physician leaders from the areas of hospital administration and the insurance industry. Many of these leaders are quite skilled and do a credible job. But can we expect medical care to change for the better when the caregivers, directly involved with medical care, answer to leaders who have never treated patients? Perhaps. But logic would suggest otherwise. Caregivers have a unique perspective, which seemingly better qualifies them to lead us in the right direction. They are the ones who have spent nights at the bedside of the critically ill; delivered difficult news to patients; shared in the joy and grief with families; and have made life and death decisions. Non-clinicians simply don’t have this experience. And they never will.
However, the converse is also true.
Most doctors have not been formally trained to lead. Medical school and residency training does not usually teach leadership as part of a curriculum. Accordingly, most doctors do not consider themselves leaders. That title belongs to hospital and insurance company executives. The “suits” who run healthcare. Terms like “integral leadership” mean very little to doctors. In fact, integral leadership is poorly understood overall, even among those who do aspire to lead. However, integral leadership is exactly what is needed to address the current medical care crisis. Integral leaders who understand medical care (defined as the interface of the patient and the medical care components, doctors, hospitals, payors and universities/medical industrial complex—, usually measured by the degree of availability, affability and ability). To solve the medical care crisis, we need physician chief executive officers (CEOs) that operate as integral leaders.
What is integral leadership? Integral leadership refers to Twentieth Century philosopher Ken Wilber’s integral theory of reality; leading from a worldview that considers all of reality—subjective, intersubjective and objective. For integral leaders, subjective reality or “moral purpose” is more than simply experiencing reality as “right vs. wrong.” It is their subjective relationship with “right vs. wrong,” where right and wrong become relative that “the opposite of their story is always as true or truer than their own.” Intersubjective reality, the shared beliefs which build relationships and a common culture, become an ecology of opposites where traditional competitors paradoxically come together to achieve mutually beneficial global advancement. Objective reality, measured as performance, is always directed at noble intentions which achieve noble results such as win-win solutions that produce outcomes beyond what can be accomplished individually.
Integral leaders “make one from many for the service of all.” Sometimes referred to as “servant leaders” or “conscious leaders,” integral leaders are among the elite. And they are uncommon.
They possess extraordinary self-awareness and situational awareness. They have a very sophisticated and broad worldview. In terms of the medical care crisis, integral leaders can objectively visualize the medical care environment from the perspective of each component—the doctor, hospital, payor and university/medical industrial complex—and can see paths that result in win-for-all solutions. That means paths that balance the medical care environment.
So, our goal is to create CEO physicians capable of integral leadership. Doctors that lead instead of simply manage. According to leadership expert John Kotter, leadership is about driving change (which differs from managing because that deals with navigating complexity). In other words, we are asking doctors to help change their patients for the better, not just episodically treat whatever malady seems to be present at the time. But physician leadership does not stop here. The physician CEO must also lead beyond the clinical arena, something many young doctors today feel unqualified to do. They must lead their business affiliations and their professional development as shown in the diagram below.
But what does it mean to “lead a patient?” How does that differ from “treating a patient?” What are the skills necessary to do so? How do physician integral leaders interact with their clinical teams—their physician extenders and support staff? How do physician integral leaders interact with their various business affiliations and specifically the business affairs of their practice? As integral leaders, what are their relationships with the hospitals and clinical facilities in which they practice? Finally, as integral leaders, how do doctors develop themselves and their profession in a way that maintains balance and prioritizes patient well-being?
Over the next weeks, we will be exploring these questions in detail as part of a special series on the physician CEO. If we are to restore balance among the care components—doctors, hospitals, payors and universities/medical industrial complex—and make patient well-being a priority, then physicians must step up and lead. They must become integral leaders.