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Physician Leadership in a VUCA World

Physicians live in a VUCA world.  What’s that you ask?  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) of 2010 and the Medicare Access and Chip Reauthorization Act (MACRA) of 2015, VUCA has come to perfectly describe the environment physicians now face.  Moreover, the challenges are magnified by the fact that while doctors have been well-trained to practice the art and science of medicine, they have had little preparation for managing and leading change, particularly in a complex, unsettled environment. 

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 issue is who will lead the effort.  The answer has to be physician leaders.  

Medicine has traditionally been organized as a craft-based industry in which individual physicians, organized around their practice specialization, create a customized plan for each patient.   What it’s being transformed into is a team-based activity, 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 requires 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.  

Accomplishing this requires 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 greatly matters.  

The Army conveys the 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 roles, as well as, positional roles that challenge one’s character and competencies.  The Army’s development of a seasoned combat leader is a 10- 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 military 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 that you want to BE, and then develop a long-term plan that will bring that BE to life.

We’ll have more to say about using the Army’s template to develop your personal leadership capabilities in upcoming blogs. 

Keith Thurgood, PhD
Major General, USA Ret.