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Health Care Ethics USA Principles for Physician Leadership in the Health Care Community Hospital administrators, fellow physicians, and those involved in drafting health care policies need the unique input supplied by physician leaders. Unfortunately, many doctors are so wrapped up in the daily demands of practice and/or research that they find little time and energy to devote to broader community issues. Although medical practice typically deals with concerns and problems of individuals, a physician's responsibility to the community is also vitally important. The medical profession historically has recognized that obligation. For example, Principle VII of the American Medical Association Principles of Medical Ethics reads, "A physician shall recognize a responsibility to participate in activities contributing to an improved community." Certain aspects of this responsibility are even clearer for the Christian physician. This article discusses principles that frame the notion of Christian physician leadership, describes qualities of leaders applicable to different settings, and gives suggestions as to how physicians can be encouraged to take on leadership roles. Principles Stewardship The call to service for Christian physicians can be based on three principles: a responsibility to others, a call to instill Christian values in a pluralistic society, and a mission to become a prophetic witness for justice and a powerful voice against injustice.1 As leaders, they access the traditional role of a steward by serving as instruments of God's grace to the communities they serve. Words like "responsibility," "call," and "prophetic witness" foster an environment in which self-reliance is not the central value. Physician leaders, as good stewards, are persons of hope for patients, families, and communities that encounter suffering. Subsidiarity Although this principle has mainly come to light in the 20th century as a crucial norm of Catholic Social Teaching, subsidiarity was traditionally used to describe relationships between communities and individuals. It served to protect those who were most vulnerable. The traditional sense of the principle becomes a dynamic tool to articulate the proper role of the leader within the community. Physician leaders serve the organization and the greater good of society-always in the context of patients, colleagues, and localized communities. Preferential Option for the Poor Discussion In order to provide a context for this discussion we offer the following hypothetical situation. A new hospital joins a system. Flowing from the system's mission, a desire for physician leadership is necessary so that the hospital and physicians can transition smoothly to the new system leadership. However, animosity regarding re-application for privileges, poor staffing ratios, and lack of communication between administration and physicians all contribute to a "less than smooth transition." Rather than becoming discouraged, a physician within the hospital develops a mentoring program designed to seek out physician leaders who can mentor those granted new privileges. As a result, leadership abilities are no longer assumed in those hired into key positions where physician leadership is necessary. Rather, leadership ability is nurtured and fostered within the spirit of community relations and the calling of Christian physician leadership. How physicians view their relationship to the community has a powerful impact on how they delineate their obligations. The ability to share responsibility between the community and the physician is a necessary obligation of the community in fostering the leadership of its physicians. Mahoney clearly realizes as well that the "sharing of responsibility injects dignity into the relationship…this indeed, may be the major role of the leader-to make self-worth and dignity possible in others."3 Looking more closely at leadership one notes its inherent social dynamic. That is to say, in order to lead one must have followers. A responsibility to serve the common good of the institution and the members involved is demanded of the effective leader. In sharing this role the leader motivates and cultivates an environment that participates in its social nature through shared resources. This type of physician leadership is a response to a call involving: service to the community, a spirit of respect, advocacy for the marginalized, a concern for responsible stewardship, and a witness to faith.4 It is important to understand these concepts more clearly in order to live the mission of a physician leader. Mission's call is to serve the community by providing for those who are in need, as it is guided by hope and a need to be witnesses to the Christian faith. This service is to be provided within a spirit of respect by serving with compassion, being sensitive to vulnerability, and realizing that the patient is a member of a family and society. Leaders are called to be advocates on behalf of those who are marginalized and powerless because all are unique persons worthy of care. In this same breath we must be attentive to use resources wisely and responsibly, and be good stewards of the gifts granted to those who have by providing for those who have not. Living attentively to this mission, in solidarity, gives witness to our faith by providing a space for leadership in a community through an inculcation of Christian values in society and the greater medical community. Christian physician leaders can be important witnesses to the power of the Gospel of Jesus Christ. It has been said by various authors that effective leaders model the way, encourage the heart, enable others to act, think about the future, align people to a shared goal, and are focused on producing change. All in positions of authority need assistance in becoming more effective leaders. As demonstrated by the system in our hypothetical situation, Christian health care communities can empower physicians to lead in the following ways:
Conclusion A nurturing environment often precipitates a "fleshing out" of good leaders. Therefore, it is important to establish boundaries as well as outline leadership characteristics specific to each environment. Notions of leadership are not easily defined, as leaders exhibit dynamic characteristics in each unique situation. However, there are overarching characteristics of leadership that are essential to all settings. We believe this grounding can be found at the roots of how our Christian identity frames that notion of leadership. As we discussed physician leadership in health care, we looked to the qualities found in principles of ethics in order to "re-plant" those essential roots in the solid foundations of Catholic Social Teaching and the Biblical tradition. This solid foundation then sprouts growth that can be lived out in the vital mission of being conduits of our Lord's healing care to the community.
Suggested Readings James M. Kouzes and Barry Z. Posner, The Leadership Challenge: How To Keep Getting Extraordinary Things Done in Organizations (San Francisco: Jossey-Bass, 1995). Michael K. Magill, "Becoming an Effective Physician Leader," Family Practice Management (May 1999): 35-37. James L. Reinertsen, "Physicians as Leaders in the Improvement of Health Care Systems," Annals of Internal Medicine 128 (May 15, 1998): 833-38. Richard W. Schwartz and Caroline Pogge, "Physician Leadership: Essential Skills in a Changing Environment," American Journal of Surgery 180 (September 2000): 187-92. Questions for Discussion
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