Earlier this year, I had the opportunity to address a joint session of the American College of Healthcare Executives and the Association of University Programs in Health Administration. I was asked to speak about leadership and the importance of soft skills. This is the first of a two-part series of reflections that framed that conversation.
- David C. Pate, M.D., J.D.
In the context of health care, ‘hard’ skills primarily refer to proficiency in core curriculum subjects of business school that then become the stuff of the day-to-day work of running, in my case, a health system – finance, accounting, marketing, operations, business law, human resources, mergers and acquisitions, etc.
‘Soft’ skills, I have come to believe, are far more important, and they are not usually taught to health-care administrators. In fact, they are the difference between being a mediocre leader and a great leader, or sometimes between being a successful leader and an unsuccessful one.
Communication; holding others and oneself accountable; the ability to build, develop and lead teams; emotional intelligence; vision; the ability to inspire others; integrity and empathy; listening; the ability to lead people through influence and not authority, etc. These are not abilities that are easily taught.
But they are telling. Whether a hospital, a health system or any other organization is helmed by leaders with or without the competencies of these soft skills is often apparent to those they lead.
I have seen it from all sides over the past three decades and in multiple settings, in multiple parts of the country. I have seen leaders lacking in the soft skills who have nearly driven their organizations to ruin, with tremendous turnover in their leadership ranks and little insight into their own failings. I have also seen, and learned from, leaders with a command of the soft skills, like Jack Lynch, a CEO I was privileged to work for, who assembled great teams of leaders and took their organizations to great heights. I can often judge the strength of a leader by the strength and longevity of their leadership team.
Over the years as well, I’ve tripped up. In almost every case, it is because I did not successfully apply these soft skills.
Here are a few of my observations from the trenches.
You can tell a great deal from a person’s writing, and the care and attention put into written communication – spelling, punctuation, grammar, sentence construction, etc. It is relatively easy to see whether someone did the minimum necessary or put a lot of effort into it.
Verbal communication is also essential. Is the leader capable of clear communication? Inspiring? Can she paint and communicate a vision of where the organization needs to go?
Communication with the board must be open and honest. It must be clear, and the leader must communicate not only the opportunities, but the challenges and the risks. And because communication is a two-way street, the leader must be willing to listen to her board, understand and address concerns and keep the board updated.
Communication with staff members must be sincere. A leader should always be honest with her staff and employees. It is not always appropriate to share certain information, but the leader should always be honest about the information she does share.
In most of the instances where I failed to exercise my best leadership, it was because of lack of communication – not fully thinking out who would be impacted by a decision I was making and ensuring that I engaged those people in the decision-making.
Accountability must be role modelled. If a leader is not accountable, then it is likely her subordinates will not be either.
And it starts with clear expectations. The leader must ensure that the person to be held accountable is clear about timelines and has the necessary resources to deliver on the accountabilities. Finally, there must be consequences. When leaders miss deadlines, do not take the work seriously or provide information in a haphazard manner, these are signals that strengthening a leadership team is called for.
Timeliness is another tell. When a meeting is scheduled for 8 a.m. and attendees gradually assemble between 8 and 8:15 a.m., accountability is the diagnosis. Leaders who take accountability, those with a grasp of this soft skill, start meetings on time and are in their seats ready to go. I have found that, by front-loading agendas and placing announcements and critical information at the start of meetings, meetings can become vehicles for accountability.
There is often the opportunity to improve accountability to transform an organization without losing the good parts of the culture, and it can be done in stages, first with personal accountability, then team accountability and then cross-functional accountability.
Ultimately, organizational accountability is the desired end-state, though I have only seen this in cases of crisis, such as natural disasters. Organizational accountability is when everyone understands what their job is, how it contributes to delivering on the mission and strategy and that they are willing to do whatever it takes, even if something is not technically their job. At St. Luke’s, we have come a long way over the past nine years, and we are now achieving cross-functional accountability.
Leaders support leaders; leaders do not emerge fully formed. So there has to be leadership training and development. We are famous in health care for taking our best clinicians and making them leaders, believing that because they are great in their profession, they will be great leaders, when in fact, the competencies are quite different; and, in the case of physicians, often what we learned from our training is antithetical to best leadership practices.
And there is the fundamental matter of whether a group of employees is, in fact, a team. No organization will succeed if those designated as leaders have not coalesced as a team. None can succeed alone; leaders need to be able to depend on and trust one another. Therefore, we have to make time for team-building.
In Houston, I witnessed the Enron debacle. It was a formative experience, to say the least, and I have been intent on ensuring that the care model and business model that St. Luke’s is embarked on would stay true to our foundational culture, starting with our values of integrity, compassion, accountability, respect and excellence.
No one cares much about values when everything is going well. It is pretty easy to act according to values when things are good. The real test is when things get tough – and they will. That is when you better know what your values are, bring them quickly to mind and measure them against the options you are being asked to consider.
At St. Luke’s, we went through a process to come up with the most important values that we could all agree should guide every decision we make. My chief operating officer, Chris Roth, taught me something very valuable. There was a time that I was wrestling with a very difficult and weighty decision. Chris asked me which of two options would “add the most to the employee trust bank,” and it was amazing how clear the answer became when I used that lens to solve the problem.
Teams are fragile things. And while you can communicate as a leader, and you can take and build accountability, and spend time strengthening your team, and approach the work from a values-focused position with integrity, you will stumble at times. Quite often, it’s likely to have to do with listening, and reading the environment.
I have at times and in different leadership roles become frustrated that we were not moving fast enough. I have sometimes jumped the gun, and prescribed what needs to be done ASAP.
There is nothing that stalls the momentum like dictating, rather than listening. It will distract you from the business you have planned. It will change the atmosphere from one in which you are operating as an inclusive team to one that is authoritarian, and a dynamic in which team members follow orders, rather than asking healthy questions.
At this point, it is time to admit the mistake, reconvene the team and apologize, which is exactly what I did after committing this faux pas in a management meeting about nine years ago. Realize, and say, that you cannot go faster than the team is ready. Understand that to be most successful, the team must be able to provide input and guidance.
Here is the silver lining: The team will respect a leader who is able to be vulnerable and contrite.
Impatience, I believe, is somewhat linked to vision, another of the ‘soft’ skills. I, for example, have very strong feelings regarding what must change about health care, and despite my sense of urgency for change, I have learned to pair listening with vision to build success over time; that particular combination seems especially to support a third “soft” skill, that having to do with team-building.
David C. Pate, M.D., J.D., previously served as president and CEO of St. Luke's Health System, based in Boise, Idaho. Dr. Pate joined the System in 2009 and retired in 2020. He received his medical degree from Baylor College of Medicine in Houston and his law degree from the University of Houston Law Center.