Physician leadership is crucial for success in the Canadian health care system. However, LEADS in a caring environment, CanMEDS 2015, and other competency-based frameworks related to physician leadership development have, thus far, failed to create measurable and perceivable outcomes. Current frameworks do not properly address the complexity of the environment, are neither proven nor designed to create effective leaders, lack direction in the acquisition and tangibility of these skills for physician leadership, and fail to provide physician leaders with effective foundational skills. In this paper, we explore the political skills inventory and argue that this new competency framework provides four clear, foundational competencies needed by all physicians to be effective: social astuteness, apparent sincerity, interpersonal influence, and networking ability. The integration of these skills into the training of physicians, at any point in their career, would provide physician leaders with the skills they need to effect change in their complex environment.

 

Key words: Canada, political skills, health care, physicians, effective leadership

 

Context

 

The Canadian health care system suffers from a lack of effective physician leadership. The Health Association of Nova Scotia1 notes that the health care system and health outcome standards are not being met and points to diminished leadership capacity as a key factor. Top

 

Competency- and curriculum-based leadership frameworks and their lengthy lists of competencies and skills form the basis for most physician leadership development programs, yet they have shown limited success because of a lack of focus. Nova Scotia and other provinces that employ these frameworks are experiencing insufficient physician leadership capacity.1 LEADS in a caring environment — used by the Canadian Medical Association’s Physician Leadership Institute and other health authorities across Canada2 — and CanMEDS 2015’s competency framework for the roles of leaders3 do not provide a clear path for the acquisition of these skills or a deadline or timeframe for when the skills are acquired. Most important, they have not proven effective in building physician leadership. Top

 

These frameworks focus on individual competencies, but fail to provide measurable outcomes in a complex environment, provide a set of foundational leadership skills to physicians, or lay out an effective path for attaining these proficiencies. The solution to effective physician leadership development may not be found in a diverse array of leadership skills or more competency frameworks, but rather in very specific competencies, such as the political skills inventory (PSI).4 We propose that a more concerted focus, specifically on political skills as foundational leadership skills for all physicians, may hold some of the answers to the question of how to achieve more effective physician leadership. Top

 

This paper is an exploration of the potential benefits of incorporating a specific, foundational set of four skills that:

 

• have been assessed and proven to make leaders effective
• provide a clear process for development of these skills at any time in a physician’s career
• provide physicians with skills they currently lack
• are finite and understandable
• craft leaders who lead effectively in a complex environment Top

 

These five factors support the contention that political skills are useful for physicians in their increasingly complex environment and help them provide effective leadership.

 

Political skills

 

The PSI differs from traditional competency frameworks, as it includes a set of four, foundational, focused competencies that aim to increase effectiveness. According to Ahearn et al.5 political skills are the “ability to effectively understand others at work, and to use such knowledge to influence others to act in ways that enhance one’s personal and/or organizational objectives” (p. 311). As such, politically skilled individuals combine four key competencies4: social astuteness, apparent sincerity, interpersonal influence, and networking ability (Table 1). Top

 

Social astuteness

This political skill combines the expertise and perception skills of, in this context, physicians. This links to serving patients by reading their language and non-verbal cues and also by building relations with others to achieve the highest possible level of patient care. In a leadership context, physicians with this skill are able to build meaningful and genuine relations with their non-physician and physician colleagues. This allows politically skilled, socially astute physicians to craft the outcomes they desire through leadership of a diverse range of actors, at the systemic level, and in their interactions with patients. Top

 

Apparent sincerity

Apparent sincerity is crucial for leaders, as it is at the crux of successfully influencing others without ruining relationships or giving offence. The sincerity, honesty, and integrity of leaders with apparent sincerity enable them to effectively influence within their organization, across professional boundaries, and outwardly in a public-facing capacity without being perceived as power hungry, manipulative, or having other negative characteristics.6 This skill enables leaders to lead effectively while still being perceived as genuine and without ulterior motive.

 

Interpersonal influence

Leaders with interpersonal influence are able to create coalitions and appeal upwardly (i.e., to superiors) by exercising their will to adapt their behaviour and appeal to the audience to “elicit particular responses from others.”4 For physicians, this would take the form of leading physician and non-physician colleagues (including internal administrators and external agents) in a context-sensitive way to accomplish their goals (i.e., better patient outcomes). Top

 

Networking ability

This skill enables leaders to build a diverse network of colleagues and leverage it to achieve their goals. Leaders with networking ability are often seen as “highly skilled negotiators and deal makers, and adept at conflict management”4 — skills that physician leaders have noted as crucial for their position but that have not been recognized in the current leadership frameworks.7 These networks are necessary in an increasingly complex health care environment that calls for alliances between physicians and non-physicians to meet such health challenges as an aging population and more prevalent chronic disease. These complex problems call for physicians to work together and across professional boundaries with other stakeholders, such as administrators and government agencies. Stronger networks are essential to achieving positive outcomes in the current context.

 

Taking a political skills approach is innovative because of its focus on four key skill areas that enable physician leaders to be effective in influencing change in the diverse, systemic networks of health care. The PSI is focused on effectiveness; thus, these skills enable leaders to maximize and leverage their relationships to get things done effectively.6 Considerable research has examined organizational politics, but a serious omission has been the failure to evaluate the political skills of the influencer, which leaves a knowledge gap when trying to understand the “how” of the leadership process.6 Top

 

The PSI is a multi-dimensional construct that addresses this “how” and has been shown to be associated with effective leaders.6,8,9 As an example of the measurability of the PSI, Douglas and Ammeter9 examined a leader’s political skills and their effect on ratings of leadership effectiveness for public school administrators and supervisors, while Ferris et al.6 studied political skills at work and their impact on work effectiveness in managerial or administrative positions at a large university. Braddy and Campbell8 asked approximately 200 leaders in mid- and upper-level management to rate the extent to which they used each of the four political skills in their own leadership roles. Collectively, these studies showed that political skills permit leaders to exert greater influence on others and help teams increase their efficiency and productivity. This emphasizes the fact that political skills — unlike those of the competency frameworks used in the physician-leadership world — have proven to be effective in impacting the complex organizational network in which physicians exist; they are designed for effectiveness, are measurable, and are perceivable. These skills are grounded in solving problems and guiding organizations, small or large, in complex environments. Top

 

The PSI presents a multi-faceted, network-based set of competencies designed for effectiveness in a complex environment. Unlike other methods of leadership development that currently exist in the physician-leadership world, political skills are proven to craft effective leaders in these environments. This is fundamental, as a framework ought to be developed for and aligned with the environment in which it is operating. Aligning framework with environment is likely to ensure that the leaders acquiring these competencies will be most effective. Top

 

The emphasis on measurable effectiveness of these competencies sets PSI apart from other leadership development frameworks. Neither CanMEDS 2015 nor LEADS has proven to be effective nor were these frameworks designed with effectiveness in mind. PSI, however, is both designed and proven to create effective leaders in a diverse, complex, and multi-faceted environment.6 In addition, political skills are finite, specific, and fundamental and can be developed at any stage in a physician’s career (preferably throughout their career). Top

 

Acquiring political skills at any career stage

 

Political skills may be acquired in three steps: self-assessment and understanding; facilitated learning; and evaluation and feedback.10 For leaders, a strong sense of self is driven by a deep understanding of one’s own personality and how one is perceived by others. Personality tests (such as Myers-Briggs Type Indicator, the Five-Factor Model, or the Sixteen Personality Factor Questionnaire) serve as instruments for leaders to self-assess and understand how they work, which political skills they need to focus on, and what skills they are most likely to have a predisposition for.6 Also, 360-degree reviews help leaders understand the perceptions of those above, below, and around them in their professional world. This helps them determine what skills they already possess or what ought to be the focus for future professional development. Top

 

The development of political skills comes through various facilitated learning exercises. Experiential learning (e.g., role-playing in a difficult health care situation), case analysis (e.g., evaluation of a scenario depicting someone using — or failing to use — political skills), vicarious learning (e.g., observing/shadowing someone else), general communication skills, or even dramaturgy (teaching the skills of theatre and how to display emotions and execute roles) are all ways in which political skills can be cultivated and acquired.10

 

Although this is by no means an exhaustive list, it does illustrate the variety of ways in which these skills can be acquired and practised and, more important, that they can be cultivated at any point in a physician’s career. As these are foundational skills, physicians should learn them early and throughout their education and career. For example, medical schools and residency programs could incorporate political skills training and assessment into their programs. Continuing professional development offers another access point for training. Top

 

Finally, evaluation of physicians’ political skills and feedback form the third pillar of effective training. This comes in the form of a 360-degree formal and/or informal review of the individual by their supervisor, clients, colleagues, and/or other persons they interact with, to allow the leader to collect the perceptions of those around them and make adjustments or undertake new learning to strengthen their skills.10 Political skills are simple and perceivable, making the exercise of collecting feedback easier than in other existing models of physician development. Top

 

Conclusions

 

The current system of physician leadership development in health care is not as effective as it needs to be. A re-imagining of the competencies needed in all physicians is a first step in closing this leadership gap. The PSI presents a structured, foundational approach to providing physicians with key competencies that will help them navigate their complex environment. Namely, the PSI diverges from previous approaches because:

 

• it is focused on effectiveness
• it has been proven to craft effective leaders in a complex environment
• there is a clear process for the acquisition of these competencies and it can be done throughout a physician’s career
• these skills are finite and simple compared with those of other competency frameworks (there are only four competencies and they are simple to understand and explain)
• it provides structure and a solution for physicians who have determined that they lack certain integral skills to operate effectively

 

These five factors support the PSI as a means to equip physicians with the core competencies they need to effectively impact their environment and be successful leaders in the health care world. Top

 

References

1.Health Association Nova Scotia. Leadership in health care in Nova Scotia. Bedford, NS: HANS; 2012. 47 pp.

2.CCHL (Canadian College of Health Leaders). LEADS in a caring environment framework. Ottawa: CCHL; 2016. Available: http://tinyurl.com/j2fbqek

3.Frank JR, Snell L, Sherbino J (editors). CanMEDS 2015 physician competency framework. Ottawa: Royal College of Physicians and Surgeons of Canada; 2015.

4.Ferris GR, Treadway DC, Kolodinsky RW, Hochwarter WA, Kacmar CJ, Douglas C, Frink DD. Development and validation of the political skill inventory. J Manage 2005;31(1):126-52. Available: http://tinyurl.com/hsy3uvt

5. Ahearn KK, Ferris GR, Hochwarter WA, Douglas C, Ammeter AP. Leader political skill and team performance. J Manage 2004;30:309-27.

6.Ferris GR, Davidson SL, Perrewé PL. Political skill at work: impact on work effectiveness. Lanham, MD: Davies-Black; 2005.

7.Comber S, Wilson L, Crawford KC. Developing Canadian physicians: the quest for leadership effectiveness. Leadersh Health Serv 2016;29(3):282-99.

8.Braddy P, Campbell M. Using political skill to maximize and leverage work relationships (white paper). Greensboro, N.C.: Center for Creative Leadership; 2013. Available: http://tinyurl.com/zk2yww2

9.Douglas C, Ammeter AP. An examination of leader political skill and its effect on ratings of leader effectiveness. Leadersh Q 2004;15(4):537-50.

10.Ferris GR, Perrewé PL, Anthony WP, Gilmore DC. Political skill at work. Organ Dyn 2000;28(4):25-37. Available: http://tinyurl.com/grdq9xg

 

Authors

Scott Comber, PhD, is assistant professor at the Rowe School of Business, Dalhousie University, Halifax.

 

Liz Wilson, MMM, is an Interdisciplinary PhD candidate and research coordinator in the Rowe School of Business at Dalhousie University.

 

Kyle Crawford, MPA, is a research assistant in the Rowe School of Business at Dalhousie University.

 

Correspondence to: Scott.comber@dal.ca

 

This article has been reviewed by a panel of physician leaders.

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