Physician Leadership in a VUCA World

By Keith Thurgood, PhD – Prista Board of Directors

We live in a VUCA world. Developed as an operational construct by the United States Army in the late 1990s, VUCA describes the world in four adjectives:  volatile, uncertain, complex, ambiguous.

Since the Affordable Care Act (ACA) was signed into law in 2010, VUCA, as it relates to healthcare, has taken on new meaning with deeply imbedded dilemmas.  Moreover these dilemmas are magnified by the fact that while doctors have been well-trained trained to practice the art and science of medicine, they have had little preparation for managing and leading change.

Healthcare enterprises are increasingly focused on transforming all aspects of care delivery, including cost structure, clinical quality, data transparency, patient experience and the overall efficiency and effectiveness of care delivered. There is no argument that these need to be addressed, but there is a question about who will lead these efforts. The answer has to be physician leaders.

Medicine has traditionally been organized as a craft-based industry where individual physicians, organized around their practice specialization, create a customized plan for each patient. What it’s being transformed into is a team-based practice, organized around patient or disease state, where groups of peers, treating similar patients in a shared setting, execute coordinated care delivery processes using agreed upon clinical guidelines and protocols. To drive and sustain this change, we need physician leaders who understand how to lead change and create alignment, and who don’t confuse being a leader with simply being given a leadership title. We need engaged, adaptive and collaborative leaders at every level of the organization. In short, we need to turn doctors into leaders.

To accomplish this, we need a radically new approach to leadership development. For guidance, we can look to one of the world’s premiere leadership development organizations, the U.S. military. No other institution devotes more time, energy and money to developing the character and competence of its future leaders. The military focuses on character and competence because how leaders get results matters.

The Army conveys this developmental message with the phrase, “Be, Know, Do.”

  • Character, underpinned by values, describes what leaders should “BE.” Your value system drives behaviors, and you demonstrate your character by the way you behave.
  • The skills a leader needs are the basis of what a leader must “KNOW.” These include interpersonal skills, conceptual skills, and technical and tactical skills.
  • Finally, leaders must have a bias for action to deliver results—the “DO.” This includes influencing, making decisions, accomplishing the mission and continuous self-improvement.

This framework encourages developing leaders by leveraging a variety of educational experiences, planning, and staff and positional roles, that challenge one’s character and competencies. The Army’s development of a seasoned combat leader is a 15-year journey supported by a progressive set of experiences that stretch the thinking, innovation and application of key ideas and concepts. The most effective leaders are developed over a long period of time.

Where do we start in healthcare? Rather than reading the latest book or signing up for another class or workshop, aspiring physician leaders should start their leadership development journey at the beginning: by first looking at one’s self. It’s difficult to do because it requires looking in the mirror, not out the window. Start by clearly identifying the type of future leader you want to be, and then develop a plan to bring that to life.

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About the Author Faris Islam


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