Volume 9 no 1

ADVICE: Leadership lessons and observations

Nicole Boutilier, MD



Back to Index

ADVICE: Leadership lessons and observations

Nicole Boutilier, MD


Boutilier N. Leadership lessons and observations. Can J Physician Leadersh 2023;9(1):9-11



My 17 years in physician leadership have come with lots of lessons. Hard ones, ones that had to be repeated, ones that I’ll never forget, ones that gave me hope and ones that shattered my confidence.


Leadership is a journey, not a destination. With many curving roads, pit stops, and refueling, you are sometimes headed down a well-trodden road and other times creating a path as you venture into new terrain. The experiences you will have and the training you will receive will only tell part of your story. The leadership skills you attain and your lived experiences will shape you as a leader, but you will also be forced to take a hard look at your purpose, your values, and your resilience. The people you lead and the people who lead you will be formative in establishing a solid foundation that will allow you to grow, fail, and grow again.


Here are 17 observations that you may want to consider (one for each year in which I held a formal leadership position).


1. Be authentic

People want to hear from the real you. What you think, what you say, and what you do matter. Let them know you — the person you try to be and the gap when you don’t meet your own expectations. Share your successes, but also share your failures. Be the leader you would want to lead you. Work at it every day. Be humble and honest to all (but most of all to yourself).


2. Listen, listen, and listen again

Physicians are taught in medical school how to listen actively. You know how to mirror body language and tone and to paraphrase the speaker’s words. But are you listening for understanding or are you simply waiting for the person to stop so that you can jump in with your own thoughts? The next time you are in a meeting, practise not letting your thoughts be the only thing on your mind. Be curious about others’ perspectives and give careful consideration to their ideas.


3. You are not an imposter

You may be new to leadership or you may be experienced and have feelings of inadequacy. You feel like someone is going to realize that you aren’t the right person for the role, situation or solution. And you are right, there is no perfect person for every scenario that a leader will face. But you are there and that is enough. You can use powerful questions to get to the root of an issue. Can you tell me more? What can I do to support you? What ideas do you have to solve this problem?


4. No telling, just coaching

The longer you are a leader, the more you may be called upon to use your wisdom and insight. Sometimes it is for problems with which you have had experience and you are an expert at solving. But guess what? An old or recurring problem can be solved with a fresh perspective and in a variety of ways. Telling people what to do does not build capacity or allow for new thinking or innovation. I eventually formalized my coach training as a key component of my leadership style. This helps me focus on giving my team the confidence to solve their own problems and transform the system with the knowledge, skills, and abilities that they possess. As practised in the coaching world, you hold them fully capable.


5. Vulnerability

There is the good, the bad and the ugly. Share it all. Let your team know how you are feeling and when you think you weren’t at your best. Most of all, share what you learned and what you want them to know. Sharing your stories builds trust. Let your team share their stories and how they are feeling. Be compassionate and cultivate belonging. Connecting in this way, while awkward for some team members, creates psychological safety for people to see the humanity all leaders bring when they take their whole selves to work.


6. Know your blind spots

Consider feedback as a gift. Ask others what you could do better. What do they notice about you and your leadership style? Invite people to share their observations about you even when they are hard to hear. Be open to the perceptions of others and check in with your team regularly. As in different cars, different blind spots can arise with new situations. Hire and work with people who complement your strengths and help narrow the gaps. Self-awareness is key.


7. Always be learning and growing

There is no such thing as too much development. Design a plan for yourself for this year, the next 5 years and the next 10 years. Be expansive in your vision of your leadership in terms of values, impact and people. Worry less about titles and recognition. Know what gets you up in the morning and into the flow. If something scares you, that’s what you should do next.


8. Borrow unabashedly from your mentors

If you experience or witness mastery by a leader, incorporate those skills into your own toolbox. Ask them questions, understand their process and how they achieve their success as a leader. The more tools you use and develop, the more diverse and versatile you will become as a leader. Mentors can be formal or informal leaders, people you know in your community or even people you read about or whose books you buy. They can be younger, older, in other professions or someone in your organization at a different level of leadership. Look in every direction for inspiration and guidance.


9. Beware of ignoring a persistent issue

As physicians, we all know that you never, ever, EVER ignore a nurse who is trying to tell you something. Leadership is the same. Is your admin or your peer or your direct report getting under your skin about an issue? That’s a clue — a clue that you aren’t paying attention and may be missing an important point or a need to find another solution. That irritation you feel is at yourself. Recognize your limitations and remedy the situation. Ask for help.


10. Pivot — course correct — pivot

As leaders, we have all had a lot of experience “pivoting” during the COVID-19 pandemic. We are better at it now than we have ever been. Don’t lose this! Use this “muscle” regularly, whether creating rapid plan-do-study-act cycles, pilot programs, sprints, or test and trys. Flexibility and nimbleness will help us jumpstart innovative and creative actions. Evaluate everything, and get ready to pivot if things aren’t producing the desired outcomes.


11. Extroverts vs introverts

You will have both on your team, and you will identify with one more than the other. Being one or the other does not make you a good leader. You must know who you are and lead anyway. The introverted leader may need to practise speaking up; the extroverted leader may need to take up less airtime and notice who isn’t speaking. Tailor your behaviour to suit the situation, even when it’s not your underlying preference.


12. The meetings before the meeting

Building consensus, strategic alignment, and action plans requires a lot of engagement with stakeholders, both internal and external. Understanding your common ground with others is essential to the success of many projects. You might not get everything you want — and neither may everyone else — but knowing where the “pain points” lie in advance can create momentum toward a solution. Preparation is key.


13. Responsiveness matters

Whether it’s email, text, phone calls, or face-to-face meetings, make an effort to respond to people in a timely, efficient manner. This builds a reserve of goodwill that you may need to draw on in the future. Practise advance access (leaving some unscheduled time available for arising issues) and provide same-day/next-day service while also setting boundaries for time of day, length of emails, and respecting your needed downtime. Make it simple — if a message requires more than two paragraphs, offer a conversation. If it’s between 10 p.m. and 7 a.m., don’t text. Be available if you are needed urgently. Reduce meeting length and frequency by making sure everyone comes prepared and solution oriented.


14. Equanimity is essential

For those who practise meditation, “equanimity” will be familiar. My own interpretation is that you accept things as they come. There will be highs and lows, there will be crises, and sometimes there will be a manufactured crisis. You will inevitably hear from someone who is unhappy or angry. Accept this and learn not to react. Calm, assertive energy is a steady state that allows you to breathe and focus. This is hard, but do it anyway. You will never regret not answering an email in haste or not reacting with anger or impulse.


15. Give people permission to fail and stand by them anyway

Let your team know you “have their back” when they try new things, when they are creative and innovative, and even when they make a mistake. You are accountable for their performance, and they need to know you are willing to take a chance on their ideas and plans. Protect them when others are judgemental. Encourage them to take calculated risks and be open and transparent when things don’t go as planned. Hold yourself to the same standard.


16. Be ready to go at 60–80% readiness

Perfection is not achievable, and too often the pursuit of a perfect solution prevents the good-enough solution from timely implementation. Be risk tolerant, not risk adverse. Change as you go. Evaluate your strategies, monitor your key performance indicators, debrief your learnings from failures, and spread and scale your successes.


17. Reflection

We all have that feeling in our gut that won’t go away and keeps us up at night. Take some time to reflect on the situation. If you practise reflection daily and practise with intent, you will feel better and sleep more. Recognize quickly when you need to circle back to someone and clarify, apologize or hear more. Be open to changing your mind, being wrong and considering other perspectives.


18. Gratitude (Bonus, as I am halfway through year 18)

Express your gratitude on paper daily. We are very lucky to have the privilege, every day, of being a physician and a physician leader. Remember to thank others for their contribution. Send notes, emails, cards, and make phone calls. Recognize good work in front of your team. Let people take credit for their work. Make sure your superiors know the dedicated members of your team. Action your gratitude by elevating your team with opportunities to present their work, for development and for formal recognition.


You spend a lot of time at work and with your team. Celebrate your successes together and know your team as people as well as co-workers. Laugh and have fun when the time is right and share sorrows and grief when appropriate. I have found physician leadership to be a challenging and meaningful career path.



Nicole Boutilier, MD, is a family physician, a certified executive coach, and a mother of three young adults. She is the VP medicine at Nova Scotia Health.


Correspondence to: