Developing Competent Physician Leaders: Maximizing Talent to Boost Operating Results

The Conscious Competence Ladder

The Conscious Competence Ladder (the “Ladder”) is a theoretical model initially developed by Noel Burch at Gordon Training International in the 1970s. The framework is also called the “four stages of learning,” where the four stages correlate to the levels of awareness and competence relative to any specific skill. The Ladder is intended to demonstrate an evolutionary process where people become aware of and then become proficient at a new skill, with the ultimate goal of an individual being able to perform the function with little to no thought. The first step is Unconscious Incompetence (or Ignorance); most people start here. The individual may not understand or even recognize their incompetence. Acceptance of this deficit is necessary to move on to the next step.The second step is Conscious Incompetence (or Awareness). At this point, the individual has accepted that they do not have a full understanding but see value in learning a new skill.The third step is Conscious Competence (or Learning). The individual recognizes and can demonstrate the new skill; however, they must engage in significant concentration when using the skill. This stage requires considerable time  to hone the skill.Unconscious Competence (or Mastery) is the fourth step. At this stage, the individual has a critical level of understanding of the skill and can teach others, as it has become second nature to them.

Applications for the Conscious Competence Ladder in Healthcare In applying the Ladder to healthcare, physician clinical skill development provides an excellent example, as the figure shows.

What may be more challenging, however, is knowing how to apply the Ladder to leadership development. It is essential to understand that a leader's effectiveness is established by organizational culture, situational factors, leadership style, and leadership aptitude during any given situation. For the most positive outcome when generating new leadership prospects, the leader should be reflective of the workforce for the organization and its patient population. Effective and engaged leadership is critical because:

  • Quality and cost performance are imperatives, and committed leaders are crucial to achieving those results.
  • The organization suffers when all staff doesn’t actively participate in improvement and strategic planning initiatives.
  • Leadership must hold providers and staff accountable for performance pertaining to clinical and service quality, productivity, and financial viability.
  • Value-based care requires significantly more input and analysis from all staff. Leadership must be engaged and supportive of the initiative.

Organizations should work to identify potential leaders and emerging talent within their organization. The process of development should be a formal program that seeks to further the impact of leaders throughout the organization. The end-goal should be to have successful, results-driven leaders propelling initiatives throughout the organization, with a pipeline of new talent continuously in development. This will not only improve overall results within the organization, but it will also increase morale and buy-in to the organization.

Coker follows the Ladder’s four steps in building leaders effectively within healthcare organizations:

  1. Identify potential leaders and begin evaluating leadership styles and determining areas of improvement.
  2. Give people a reason to want to change while also addressing the challenges that exist.
  3. Incorporate physicians into a formal training process, including a feedback loop, mentorship program, and peer review functions.
  4. Establish physician leadership roles and empower them with actual decision-making abilities while also developing and implementing a collaborative leadership structure to improve transparency and trust. Continually invest in new talent and create an organizational culture of leadership development.
Common Pitfalls on the Road to Success

There are several common mistakes made in developing physician leaders. These include:

  • Distraction: Healthcare leaders are pulled in different, often emergent, directions. Staying focused on specific development programs and ensuring they are followed is difficult to sustain, especially for clinical leaders. Therefore, priorities must be set and clearly communicated, to avoid distraction on issues of less importance.
  • Identifying New Talent: In all organizations, the Pareto Principle tells us that there will be a relatively small number of people who do the bulk of the work– volunteering for committees or working on special projects, for example. Healthcare organizations can struggle to identify new talent to bring to the table, resulting in the same people being placed in leadership positions repeatedly. Thus, it is critical not to focus on the same set of people who “do everything,” but rather to look for and support new or emerging talent.
  • Burnout: 73% of healthcare leaders feel at least some degree of burnout (MGMA, June 2018). For physicians and nurses that are taking on leadership roles, this can be even more challenging and leads to decreased motivation to remain dedicated to a leadership program.
  • Compensation: One of the best ways to ensure people seek leadership positions is to compensate them for their time. However, sometimes, hospitals may struggle to find the resources to support leadership development efforts.

Near-constant changes within the healthcare industry have placed a spotlight on the need for stronger physician leaders for healthcare organizations to remain high-quality, patient-focused, financially solvent, and competitive in their market. While successful and effective physician leadership requires an investment of time and resources, a significant opportunity is available for organizations that develop, establish, and continuously support physician leaders. Healthcare organizations should actively support these initiatives but empower physicians to be true leaders who drive change at the front line of healthcare delivery as well as in the Board room.

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