Leading by serving

By Ruth Carol, contributing writer

People often choose a career in medicine to help others, so why not choose a leadership style that promotes serving others?

Leaders are considered servants first and leaders second in the servant leadership model. In the context of health care, physicians serve their patients first and foremost. They serve others on the health care team by fostering and nurturing them to perform at their optimal level. This model emphasizes a holistic approach, promoting humility and empathy, a sense of community, and the sharing of power in decision making.

Although this term was coined by American essayist Robert K. Greenleaf in the 1970s, it is as relevant today as the day he described it. If you don’t think so, consider what author and motivational speaker Simon Sinek says about leadership today: “Good leadership is not about being in charge, it’s about taking care of those in your charge.”

Servant leadership describes leaders who don’t promote themselves, but rather use their role to develop and promote those coming behind them, said Mary Maloney, MD, recipient of the AAD’s 2019 Advocate of the Year and Mentor of the Year award. Leadership models are important because they enable individuals to model healthy behaviors, she added.

During the COVID-19 pandemic, adopting this model of leadership was perhaps more important than ever, as the entire medical community rallied together to protect the health of the nation and the world. “When you serve others, everyone gets lifted,” noted David J. Mann, MD, who is in private practice in Buffalo Grove, Illinois.

An exemplary model

Servant leadership promotes a sustained perpetual growth cycle, in which everyone can succeed and thrive in “service” of a shared core mission, Dr. Mann explained. In the case of his practice, the mission is to heal others and help heal the world. In contrast, dictatorial leaders make life simpler, but morale becomes toxic under that kind of authority while laissez-faire leaders who believe in democracy at all costs end up having chaos in their organizations, he said.

Being a servant leader requires self-introspection, stated Seemal R. Desai, MD, who has a private practice in Plano, Texas, and serves on the Academy’s Board of Directors. “It’s not about being perfect, but rather about being a work in progress and willing to evolve,” Dr. Desai said. “That also makes you more relatable as a leader.”

A conscious commitment to self-awareness, self-care, and growth is a critical element in physicians’ ability to offer optimal service to others, Dr. Mann stressed. “We serve our patients by understanding and prioritizing their needs,” he said. “We treat everyone with dignity and respect, and we model these values for our patients and each other by our choices and actions.”

Ideally, servant leaders seize learning opportunities in every situation that arises, Dr. Mann noted. This creates an environment where people can keep growing personally and professionally, which, in turn creates a culture where thriving — not just surviving — can be sustained.

Benefits of this model

Regarding patients, practicing servant leadership could contribute to fewer medical errors as well as improved outcomes and patient satisfaction. The attributes associated with this approach (see sidebar) not only foster a positive physician-patient relationship, but overlap with patient-centered communication, which has been linked to better outcomes and improved patient satisfaction. Empowered people are more engaged and look to solve problems, so it makes sense that this leadership model would contribute to all the above, Dr. Maloney said.

Greater “ownership” among team members translates into better attention to detail and nuance, greater initiative, more valuable and meaningful interactions, better communications, improved outcomes (tangible and intangible), heightened patient satisfaction, and an enriched experience overall for all parties involved, Dr. Mann said. Of course, this doesn’t happen overnight. There are obstacles and learning curves to overcome. “Facing these difficulties by leaning in is a way of demonstrating that servant leadership is an everyday responsibility, and servant leaders are tested in big and little ways all the time...because that’s where the growth lies,” Dr. Mann added.

DermWorld>2020>June>Leading by serving>servant-leadership-quote

This model promotes more of a collaboration with patients, Dr. Desai said. “You don’t just tell patients what to do and send them on their way,” he added.

When patients feel like they are seen, heard, and understood that leads to improved patient care, Dr. Mann said. That may mean honoring their frustration at how long they’ve waited for test results or even to see their doctor on a particularly demanding day. “We try to be respectful of our patients’ time and communicate in a timely manner, taking full accountability for any issue we’ve contributed to, and never blaming the patient or using guilt to alleviate our stress,” he said.

It’s also about improving systems and processes to better serve patients. In response to Coronavirus Disease 2019 (COVID-19), for example, Dr. Mann introduced ahead of schedule a teledermatology platform that allows him to complete a virtual physical examination. He also worked with a digital media partner to better connect and reach out to patients as this volatile and disruptive time required new ways of communicating and coping.

Practicing servant leadership can also have a positive impact on physicians and members of the health care team. When leaders foster and nurture physicians, they help physicians reignite the joy they have in their work, Dr. Maloney said. That prevents burnout and increases retention because the physicians see themselves as growing, which also applies to their sense of pride and accomplishment.

Similarly, servant leaders engage with team members to ensure they are working in positions that fit their strengths as well as their aspirations. Sharing intellectual knowledge, such as understanding the burden of psoriasis, can help staff become more empathetic toward patients with the disease, she added.

This model inevitably heightens individual and team productivity and accountability, improves morale, grows conflict resolution and communications skills, and facilitates collaboration and cooperation, Dr. Mann noted. “All of this goes to the bottom line — since positively functioning, healthy teams contribute to healthy, happy, and loyal patients, and the cycle keeps going onward and upward,” he said.

Servant leadership in clinical practice

Creating a supportive infrastructure and culture is paramount to practicing servant leadership. Dr. Mann enlisted the help of an executive coach to conduct a self-assessment to determine his personality type, leadership style, personal/professional skills, limiting beliefs, goals, aspirations, etc. Dr. Mann found the experience so valuable that he has had sessions with the coach and his entire team to implement such tools as judgment-free brainstorming meetings where all ideas are offered and considered, constructive feedback sessions, and talking circles. All these sessions are designed to provide a safe space for people to speak openly and freely, which then impacts how the team relates to the patients. These sessions, which Dr. Mann admits can be uncomfortable at first, build trust over time.

Each quarter, the team engages in an experiential learning activity. The last one was at a horse stable where they learned about equine therapy for patients with autism. Focusing on the importance of non-verbal skills, including body language, they discussed how to apply these skills to better serve anxious patients.

On a busy clinic day overbooked with complicated patients and understaffed due to illness, practicing servant leadership requires Dr. Desai to be a calming influence and focused on helping his staff best serve the patients, even if it means pitching in on tasks usually done by other team members. “Especially during challenging times, it’s important to let staff know that they are an integral part of the team. I need their help more than they need mine,” he said, adding that servant leaders should never skimp on showing gratitude.

Servant leadership in academic settings

As in private practice, patients come first in the academic world, but right behind them are the trainees. Rachel Reynolds, MD, the AAD’s 2020 Advanced Leadership Forum chair, said her days as a program director epitomized the importance of servant leadership. “I had to put my own needs aside to focus on what was in the best interest of the residents,” she said. Dr. Reynolds learned firsthand about humility, teamwork, and how to accept feedback.

“Being a servant leader within academic medicine requires you to suspend your own career goals because your job is to bring those people up behind you,” Dr. Maloney said. That means making sure that their name appears first on a published paper, they give the talk that you know you could give in your sleep, they receive credit for an idea that you may have helped them formulate, and they are given opportunities to become leaders in their own right, she stated. Not everyone can be the department chair, but many could have a leadership role as a clinic director, surgery director, program director, research team leader, or department representative on various committees.

It also requires one to support the institution’s broader scope of initiatives, even if they do not align with those of the dermatology department. Dermatologists can find it difficult to embrace the bigger mission of an institution because the specialty is so small and doesn’t have inpatients, said Dr. Maloney, who is chair of the dermatology department at the University of Massachusetts in Worcester. “As a department chair, I have to sit in on meetings about the financial health of the entire organization and no longer worry about the financial health of dermatology because without the former, there won’t be the latter,” she said.

Servant leadership outside of practice

Dermatologists can practice servant leadership myriad ways within their communities. Through the AAD/A, they can participate in skin cancer screenings, Camp Discovery, AccessDerm, the Diversity Mentorship program, the Shade Structure Grant program, and international volunteerism. They also can volunteer at a free clinic or homeless shelter, and/or offer educational lectures about important health/dermatology topics for patients, the local garden club, or the public at large. In light of the COVID-19 pandemic, dermatologists can live-stream lectures or host a webinar, write a blog for their website, share informative/inspirational social media posts, and send video messages to help educate and support patients when social distancing is called for.

DermWorld>2020>June>Leading by serving>servant-leadership-quote2

Getting involved in advocacy efforts or professional societies at the local, state, or national level is another avenue for servant leadership. Advocate for patients by soliciting for more research and funding for skin diseases, the vast majority of which lack treatment(s) approved by the Food and Drug Administration (FDA), Dr. Desai said. “Be a true servant leader by taking care of your patients, but also trying to help an entire patient population suffering from a particular skin disease,” he added.

Serving as an appointee to the FDA’s Pharmacy Compounding Advisory Committee, which is currently addressing the safety of in-office compounding of lidocaine and epinephrine, is just one of the ways Dr. Desai advocates for dermatologists and their patients. Having served on the Chicago Dermatological Society for the past 10 years, Dr. Mann is now president elect.

Serving on an AAD/A committee, task force, or even the Board of Directors is another opportunity to serve the dermatology community. It’s important to get involved in such efforts because dermatology is such a small part of the house of medicine and the AAD/A represents all interests of dermatology, Dr. Desai said. Currently, he serves on the AAD’s board, was elected to the AAD Executive Committee, as the AAD alternative delegate to the AMA, as deputy chair of the Health Care Finance Committee, and an advisor to the AAD Leadership Development Steering Committee.

Serving on various AAD committees and on its board of directors has been very rewarding for Dr. Maloney. She helped launch the Leadership Steering Committee and Leadership Institute and takes a lot of pride in seeing how both have grown over the years. “As you move projects forward, it makes you feel like you’ve done something to give back to the profession, to patients, and maybe even to the world,” she said.

Is the servant leadership model right for you?