In the past, physicians were assigned leadership roles based on clinical and academic accolades rather than any true leadership skills they might possess. These leaders often worked in a paternalistic fashion, with a steep hierarchy. Contemporary leaders, however, need to be more collaborative, team-oriented, and directionally strategic. They should be active listeners, demonstrate empathy and awareness, have a commitment to the organization, and exhibit skills in the areas of persuasion and foresight.¹ Leaders must align their interests with their organization’s mission and vision while keeping the big picture in mind. Communication leading to team building is essential.

In one study evaluating simulation and team performance, the authors found that “an effective leader both commands the team and values input from team members.”² These same skills are essential for obstetrics and gynecology (OB/GYN) hospitalists to accomplish vital objectives such as improving patient safety and quality of care. Leadership is so strongly valued, in fact, that the Society of OB/GYN Hospitalists (SOGH) has identified leadership development as a core competency in the field of OB/GYN hospital medicine.

One can define leadership as an interpersonal influence directed toward the achievement of goals. Leaders enable a group to work together in the process of developing, sharing, and moving into a collective vision and then helping to push it forward to successful completion.

Several healthcare leadership styles have been identified in the literature.^1,3 Transactional leaders usually maintain the status quo by accomplishing tasks and focusing on efficiency. They rarely serve as instigators of change, although they are very effective at completing short-term projects. Transformational leaders are motivating, encouraging, and strategic, and generally elevate the organization to new levels. They are seen as inspirational and principled, with strong communication skills and an ability to stimulate intellectual curiosity. However, they usually need detail-oriented team members to help implement their vision, so they need to know how to get the best out of these people. Finally, servant leaders generally prioritize the needs of others and are viewed as altruistic. They work collaboratively and can boost morale, but they also can be seen as lacking authority.

What makes a leader successful and effective? Some important traits that distinguish true leaders include honesty and integrity, self-confidence, ability to inspire and empower others, commitment and passion, strong decision-making and communication skills, accountability, creativity, and empathy, as well as in-depth technical knowledge in their area of responsibility. Gabel summarized the characteristics of formal and informal leaders in medicine, noting that both types of leaders possess these qualities.³ Table 12-1 lists these traits.

Leaders perform an important function in their organization: that of advocacy. In this role, they sponsor change, are willing to go first and model change, communicate and hold others accountable for their actions, build teams, and remove barriers.

It is important to distinguish managers from leaders.^1,4 Managers typically administer, organize, and accomplish tasks with a short-term goal in mind. Leaders, however, generally have a long-term vision, inspire others, are innovative, and motivate change. As Kotter stated, “Management is about coping with complexity,” while “[l]eadership is about coping with change.”⁵ Most organizations need a balance of strong managers and leaders to accomplish goals and succeed.

Table 12-2 differentiates between leadership and management in four domains: Creating an Agenda, Developing People, Execution, and Outcomes.⁶