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Dr. Pate’s Prescription for Change

St. Luke’s Health System’s Journey to Transform Health Care

St. Luke’s Dr. David Pate: Leadership and the hard job of ‘soft’ skills, part 2

Dr. Pate
By Dr. David C. Pate, News and Community
September 17, 2019

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 second of a two-part series of reflections that framed that conversation.

- David C. Pate, M.D., J.D.

Last week, I wrote about some of the ‘soft’ skills that I think are critical for successful leadership. Following are my thoughts on other important soft skills.

Emotional intelligence

Feelings of frustration, impatience and inadequacy can be signals when it comes to emotional intelligence, and I work at getting these emotions in check, having come to understand that ambitious efforts must be done in stages.

Usually, these emotions are precipitated by a current challenge and an overreaction to the magnitude of that challenge. When these emotions are getting out of balance, I try to pause, find peace and quiet for a few minutes and simply get perspective. I like to sit back, think about how far the health system has come since I first got here and allow myself to be amazed for a few minutes. I go back to the challenge, which then doesn’t seem so overwhelming.

To do the important work, and to ensure that all members of the team are equipped for the journey, it is critical that leaders review members of their teams. This is leadership assessment. Any organization’s success is dependent upon having the right team, and it may go without saying that every member of the team’s success hinges on everyone else’s. Here is where the emotional intelligence of a leader is brought to bear.

It is the honest thing to do, and sometimes the most challenging, to share with team members what their performance issues may be, what needs to change and what is expected. It can certainly be difficult, but I have found that strong leaders want honest feedback so that they can become even better leaders.

At the same time, it is incumbent on the leader to ensure that resources are available to help direct reports improve their performance where improvement is called for, and that a timeline for improvement is clearly articulated. The emotionally intelligent leader will follow up with their direct report, provide feedback and guidance, and provide praise for progress or consequences for the lack of improvement.

It may be the case in an organization that those in leadership positions have not received the benefit of thorough, thoughtful performance appraisals; many may not have clear goals.

Goals should be set prior to the beginning of the fiscal year. They should be challenging, and not everyone will hit all of their goals every year.

Failure to achieve a goal does not make someone a bad person. And appreciation for what team members do and how valuable they are, clearly, consistently and regularly expressed, goes hand in hand with the rest of the emotional intelligence that needs to be brought to bear by leaders. Suggestions for growth and development and markers of progress are a leader’s responsibility when it comes to team members. Taking the time to develop those benchmarks is evidence that a leader takes team members seriously and values them.

And then you turn the tables.

The team should have the opportunity to evaluate you. They should be encouraged to be open and honest, and assured of their anonymity. The tone you set in being honest will allow others to be honest with you.

Prepare to receive a mixed bag of feedback. Prepare also to mine this opportunity. Build goodwill, by taking the results back to the team and sharing the good and the bad. Acknowledge the times you have not performed well and the opportunities you have for improvement. Express appreciation for the feedback. I have found from my own experience that your credibility will increase when you not only share the results with the team and your plans to address opportunities for improvement, but follow through and change as indicated.


Vision, to me, is integrally connected to the ability to build, develop and lead teams. To truly lead an organization, there must be a vision, and that vision must be embraced by the team charged with steering the ship. Given the fact that most industries are in a time of upheaval, and that health care may well be at the eye of the disruptive storm, the team also should understand the urgency for change.

This is when you retreat to advance. Retreats get a bad rap, but there is no better mechanism by which to forge a team and embed a vision that I know of.

Some leaders will think retreats are a waste of time. Others will wish they could have the time to work. Still others will be all in.

Leadership retreats should include significant time developing and coming to agreement on vision and strategy. It may take a long time to bring everyone along, but you will get to the place of alignment, where team members are truly invested in the vision and consistent in their understanding of what it will take to achieve the vision.


Leaders talk about job one, whatever it may be, at every meeting. They articulate the why of the matter. They ensure that everyone gets credit for the win and no one person takes the fall. Shortcomings have to do with systems, and the lack of systems; failure is rarely one individual’s result.

Transparency and honesty must be woven into the fabric of these conversations. And what comes of this, setting a clear vision, discussing it at every turn and being transparent with missteps, is that others inside and outside the organization begin to assimilate the vision and become ambassadors for it.

This, perversely, can be a double-edged sword. Prepare for adversity. Just because you are doing the right thing does not mean that everybody likes you. You are not told, when you assume leadership, that it will be a lonely job at times. You will not enjoy being second-guessed. I don’t know where resiliency comes from; there have been times that I didn’t even know that I had it and yet, there it was.

If you have built your team, if you have listened, if you have spent considerable time discussing your vision and strategy, commitment will remain and finger-pointing will be kept to a minimum.

Leading through influence

No matter how many ‘soft’ skills are brought to bear, there are likely to be holdouts. It is never the case that everyone will be willing to support your movement in the direction of substantial change.

This is often a matter of fear; it is human nature to want to hang on to what you know, what you can control, what you can predict. Often the ‘soft’ skill that can be tapped in such instances is the ability to lead through influence.

You may look to partners outside your normal sphere of influence. This can signal, among other things, that you are serious about a particular transformation. Stakeholders, who are always watching much more closely than you may realize, may come on board after a period of time and observation.

In the case of big bets, this can be very risky. When you decide to jump in the deep end, you will have done so because merely testing the waters has not gotten the attention of your stakeholders. Presumably, most of them are aligned with your vision and want to see the right thing done, but need to be tilted in a direction. Outside validation can provide the needed push.

Health care organizations, including St. Luke’s, have to learn, and they have to learn fast. Lots of organizations, including those in health care, retreat from transformation. This is a mistake. When leadership waivers, management resists. When that happens, boards get cold feet. Great team members leave. You are now officially launched on a death spiral.  

This is not St. Luke’s story. We have not completed our transformation, but we are well on our way. The credit for this goes to the fantastic team of executives I get to work with, a very supportive board, thousands of dedicated employees and our amazing physician partners. Here’s what I have learned from all of them:

  • Most leaders have mastered most of the ‘hard’ skills – operations, finance, etc.
  • When leaders do not succeed, it is due to the absence of ‘soft’ skills.
  • Transformational leadership is the hardest of all forms of leadership, unless the house is on fire. Change takes time.
  • Getting people to change requires being able to set out a clear vision, a case for urgency, an outline of how to get there and communication, communication, communication. You must be prepared to tell the story over and over, and in different ways. Most of the mistakes I have made can be tied back to communication.
  • Trust, hard work and relationships are essential to success. People have to trust you, and you have to work hard to develop and maintain relationships. They are what you will fall back on when times get tough.
  • Board and executive team alignment are critical.

In my opinion, the ‘soft’ skills are the differentiators between satisfactory leaders and great leaders. I think you can teach them to some extent, but young leaders need to see them role modelled and have an opportunity to practice them. Learning the ‘soft’ skills comes through practice and experience.

I am hopeful that, in pointing out successes and failures and describing the role and benefits of the ‘soft’ skills – communication, holding others and oneself accountable, the ability to build, develop and lead teams, emotional intelligence, vision, the ability to inspire others, integrity, empathy, listening, the ability to lead people through influence and not authority, etc. – I have provided a structure that might serve as a blueprint for leaders, and for leaders wanting to grow leaders.

I’m not an expert on leadership; I am learning every day.

About The Author

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.