Top 10 Leadership Lessons that I have Learned as a Dean of a Medical School
This year marks my 20th year in medical education and my 25th continuous year of having some type of leadership position (nearly all related to medicine or medical education). I have been reflecting on the lessons that I have learned related to leadership. My favorite quote from Mark Twain is, “good judgement is the result of experience and experience the result of bad judgement.” Indeed, I believe that this is true when it comes to leadership.
I am also a strong believer that an expert is a master of the basics. I think this is true in medicine where a master physician is one that is incredibly skilled at their history-taking skills and their physical examination skills - skills that are taught to every first-year medical student, but take a career to perfect. I am also convinced that a masterful leader is an expert in basic leadership skills, such as those I included in my article around basic leadership skills for physicians.
Physicians are expected to be leaders of the healthcare team. Unfortunately, medical schools traditionally have had very little leadership training in their curriculum. That is now changing and I am inspired that we have the opportunity to train better physician leaders than any previous generation of physicians graduating from medical schools.
As a dean of a medical school (a relatively rare job in America) and as the Dean of the nation’s newest medical school, I have had the pleasure of working with a number of leaders over the years and I see common areas of leadership growth. In this blog, I list the top 10 leadership skills that I have learned over the years here with my perspective with the hope that it may be helpful to readers on their leadership trajectories, wherever they may be.
Communication is Important
In my favorite biography of Walt Disney, by Neil Gabler, the author talks about how Walt Disney was a strong believer that communication was central to his management style and also his conflict resolution skills.
It is important to have clear, transparent, and honest communication as a leader. It also takes an inordinate amount of my time, but it is also one of the most important things that I do.
When folks get into positions of leadership, I think that many realize how important it is. Through past experiences and different roles, I have learned to hardwire a number of different communication pathways into my leadership. These include the following: monthly newsletters to all employees and students, quarterly newsletters to clinical faculty, a podcast series, a blog, all-hounds employee meetings, detailed reports to the board, weekly 1:1s with all of my reports (this is evidenced-based management), active social media accounts, and dedicated report-out style meetings with my leadership team. I believe that communication is one of the most important aspects of my job (and takes the most amount of my time).
French and Ravens described the 6 bases of power. These areas of power are methods by which individuals gain opportunities for influence on others. One of those areas is information. This dynamic sets up the possibility of individuals within an organization to hoard information or knowledge and this can cause inequity within a group or organization. The antidote for this is to have ubiquitous and transparent information across an organization and foster an environment where information is broadly shared, as appropriate. It creates a level playing field and has the opportunity to improve the lives of others through the sharing of information.
2. Process is Important
Another area that is sometimes underappreciated with new leaders is process. They often see that some processes are obstructive to efficiency and think that through persuasion, they can create more efficient pathways. I am convinced that process is important to excellent leadership.
One of my favorite examples of process and how it can positively impact an organization is with Robert’s Rules of Order. Originally developed in the 19th century, Robert’s Rules of Order is a structured set of parliamentary rules that are easily adapted in formal meetings. At OCOM, we have hardwired them to be the way we conduct all formal, standing meetings for good reason - they create a very democratic process where everyone has a voice and is heard. They also minimize gaming within a meeting and maximize a fair distribution of voice within a group.
Additionally, I have learned that the wisdom of a group is usually pretty darn good. A group nearly always comes to the best solution, when given the proper information, opportunity, and voice. Also, all of our meetings have a structured agenda circulated in advance, and under Robert’s Rules of Order, it must be approved by the group at the beginning of each meeting. We also have detailed minutes of all standing meetings that are transparently viewable by all employees, with few exceptions (e.g., meetings that involve personal information of students).
It is also important that there is a structured process for policy. Without such, a fiat power process can ensue. By having a transparent policy on policies, there is a structured process where rules are established.
3. Integrity
One definition of integrity is to do what you say you are doing.
I think it is important for physicians to have integrity. Likewise, I think it is important for organizations (especially medical schools to have integrity). This is also an area that I see many early-career leaders struggle (especially those that have difficulty saying no or struggle to deliver on the things they promise).
I am convinced that every organization and human being would live better lives if they would improve on their commitment to integrity.
4. Continuous Improvement
I am a strong believer that excellence is not a state of being, but rather it is a state of becoming. If you were doing something that was excellent five or ten years ago, it may not be excellent any longer. Status quo bias is a very real thing and it can creep into all of our lives and every organization very easily.
In biology, if you are not growing, you are dying. I think the same is true with all of us as human beings with our personal growth. Continuous improvement and innovation is a value that can be incredibly important for each of us and an ideal for every organization.
Continuous improvement is easier said than done. It takes a conscious effort to always be looking for ways to improve and avoid slipping into an easier way just because we are more comfortable doing so.
One aspect of continuous improvement (and professionalism) is embracing feedback. We have all experienced painful feedback, but the negative feedback are opportunities for some of the most growth. One of the biggest challenges for early-career leaders (including myself when I started my leadership journey) is to be able to take and learn from negative feedback, even when it is coming from a non-constructive source. It seems to me that the best way to grow and embrace feedback is to do so often.
5. Dealing with Conflict
Conflict resolution is another important skill for all leaders, but also one that can be very challenging.
The 3 C’s of conflict resolution are communication, collaboration, and compromise. I have found these to be more challenging than they appear on face value when there is significant conflict between two parties. One of my dearest mentors was the erstwhile Marc Morganstine, DO, FAODME, who was one of the longest standing GME leaders in the nation when he passed away about a decade ago. He taught me from his experience of working years with residents to bring the two parties into the room together and work through the 3 C’s (although he didn’t consciously call them that at the time). I have found this to often be a seemingly magical solution in many, but not all cases. I have also learned that it is possible to have trust “bankruptcy” between two individuals and there are conflict areas that are not (or at least not easily) fixable.
6. Being Effective with the Self-Limiting Beliefs of Yourself and Others
One of the most valuable skills that I have learned in leading others is understanding false-limiting beliefs. Probably all humans have some false-limiting beliefs. These are often the inner voice inside that tells some people that “they are not good enough”, “they are not smart enough”, or “they are not loved enough.” There is a tendency for folks to spend their lives disproving their false-limiting beliefs. For myself, my false-limiting belief was that I am not loved enough, which I believe is a common one for physicians (probably the reason why they get into a service-related profession and frequently enjoy the positive accolades from patients and nurses).
As a tool for positive and ethical leadership, I think it is helpful to recognize the false-limiting beliefs of others as a way to see how their motivations work and to use those as a means for positive changes. It is also helpful for us all to identify what our false-limiting beliefs are and to see if there are growth opportunities for each of us to advance beyond them or work more effectively while living with them.
7. Relationships
I believe that Esther Perel was accurate when she said, “The quality of your life ultimately depends on the quality of your relationships.” I also believe that the quality of a leader and the quality of an organization is dependent on the quality of their relationships.
Relationships take significant and conscious effort and work and they don’t happen by accident. One of the most important things that I do with my job is to try to advance relationships within and external to the organization and to try to heal those relationships that are not doing well and to try to create positive relationships where I can. I sometimes get questions from folks about my tours and meeting with external folks, but I am convinced that they are incredibly important, even if there are obvious advantages for the organization (make friends when you don’t need them).
I explore this topic in more detail in my February 2025 blog post.
8. Avoiding Defensiveness
One aspect of leadership that I see often with physicians is defensiveness. I think that the training of physicians often lends itself to defensiveness. For example, medical students and residents are often asked to defend their impression about a patient regarding a diagnosis or treatment with a belief that a physician can never be wrong.
The antidote for defensiveness is curiosity. If we find ourselves reacting defensively, curiosity can be an important tool and can help de-escalate a situation. It also sets us up for success by being better listeners and seeking to understand the other point of view and can lead to personal growth and learning.
9. Servant Leadership Style
I have studied the various leadership styles (autocratic, bureaucratic, laissez-faire, transformative, etc.) and I am convinced that Servant Leadership is likely one of the most evidenced based and group-satisfying styles of leadership. There are a number of challenges with Servant Leadership (lack of universal definition, hard work for the leader, etc.), but I think it is an ideal leadership style.
Technically, Servant Leadership is a type of democratic leadership. Democratic Leadership has the advantage of giving everyone a voice through a shared governance model. Of course, we have all experienced elections where we have seen all of the voters having a voice, but they are not always happy with the outcomes. Also, democratic leadership can potentially be gamed through various communication and lobbying initiatives.
10. Public Speaking Skills are Important
One of the most valuable skills that I have focused on over the years are public-speaking skills. Nancy Duarte, the famous public-speaking consultant for some of the top organizations in the world commonly says that, “presentations have the ability to change the world” and I couldn't agree more. I think it is important for every leader to grow and further develop this skill. I have written an article on this topic. I had the incredible opportunity to give the first in-person faculty development session at OCOM and I chose public speaking for that topic. Here is the link to my slideshow. Here is the link to a handout for that session.
I hope that these lessons that I have learned present some value to the reader. Please contact me if you have any questions or comments at rhasty@ocom.org.
