Narcissism: what keeps a high-achiever from being a great leader

With the awareness of saying something stupid comes learning and even at times insight. This awareness doesn’t erase one’s stupidity, but it may make one smarter for the future. I was recently talking with a friend about physician leaders and out leaked an incorrect generalizing comment. I suggested that physicians who tend to be self-centric in their view if not narcissistic aren’t good leaders. What I meant to say was that a lack of broad perspective is a barrier to being an effective leader, however, it may not be a barrier to positive contributions to organizational learning and problem-solving, not to mention being a good physician.  Dogmatic views and attachment to narrow perspectives can interfere with good leadership in complex, diverse and uncertain environments. However, in certain situations those qualities can be helpful. Not being a good listener is a problem if your leading a diverse group through complex issues, but good listeners (aka good leaders) like people who will speak up, and that’s were physicians, even those who are somewhat self-serving can contribute facts, ideas and insights.

As I tried to recover from my stupidity, a thought popped into my head. Could narcissistic physician leaders start to lose their effectiveness the more broadly their leadership asks them to think and function? What if they contribute quite well until they get to the executive leadership level? In 2012 Justin Menkes wrote a short article for the Harvard Business Review entitled: “Narcissism: the difference between high achievers and leaders.” He suggested that high achievers who are also narcissists can do very well to a point, however, at the executive level they can sink your company. The narcissism just gets in the way.

In 2000 and 2004 in the Harvard Business Review, Michael MacCoby published “Narcissistic leaders: the incredible pros, the inevitable cons” where he suggested that narcissistic leaders do have the advantage in certain situations, specifically where there is chaos or opportunity for innovation. Implied but not specifically stated in his article is that you have to be really good at what you’re doing (e.g Bill Gates, Jack Welch, etc.). Healthcare may be going through a lot of change, and some would claim chaos, but at the heart of providing health care is the patient, a person who doesn’t need chaos or change, they need high-reliability. Narcissism won’t get you that at the micro- or macro-system levels. Even beyond health care delivery, narcissism is potentially dangerous in healthcare. Just consider the case of Theranos and Elizabeth Holmes. Narcissism, even if you think you’re doing a good and just thing, gets in the way.


Is Health Care a Business?

I haven’t entered a blog in over 4 months, primarily because I’ve been held hostage by a financial crisis.  We were successful in reversing the crisis, but not without some “damage”.  The biggest damage I’m learning has been staff morale.

In the last several months I’ve heard several front-line staff tell me that health care has become too much like a business with too much focus on RVUs and money.  Some have “attacked” me personally for being too focused on the business aspects.  Financial strength is critical for long-term success (i.e. staying in business), and action is necessary when it’s eroding.  And it’s not about the money, its about preserving the organization, the service it provides to the communities, and the people who provide the service.

This message was lost somewhere along the way.  I do admit that communication is hard and as hard as I tried to frame things in a balanced manner, the complete message didn’t always get across. The root of this seems to be the cascading of the message – the ability of middle and front-line managers to communicate the message as intended: “We need everyone to think about where and how we can be more productive and where and how we can be more efficient recognizing that not all areas will have the same focus or countermeasures,” becomes “We need to see more patients or we’re all going to lose our jobs!”  Hope is an important part of any message in a crisis and hope doesn’t appear to cascade.

Let’s make no mistake about it…health care is a business and it is the responsibility of management to keep it in business. Front-line people need to recognize that reality. However, management needs to face the reality that staff are emotionally attached to what they do, how they do it, and attached to their own personal finances whether they want to admit or not.   They are running a business at home, but don’t want to see their organization run like a business.

Celebrating early successes, thanking people, pointing out where we are excelling, and providing reminders that what we do is important to our patients and families…isn’t enough. Paying people the same amount and giving them a raise at the end of the year despite the huge challenges in making that happen isn’t appreciated nor is it enough. So, what is a leader to do?

Deming in his writings and speeches gave us a clue – the key processes and results of a business need to be constantly scrutinized for improvement and the improvement efforts need to include everyone.  So, when the crisis hits, everyone is already on the same page. These key processes and results rarely change – they are constant – regardless of any crisis.  Metrics of efficiency, which often include financial markers, are now included in the critical processes and results of healthcare.  If you’re in healthcare, expect to hear more and more about the importance of finances along side patient safety and the care experience.

Key financial metrics and other metrics of efficiency are results, outcomes, that if not constantly improved will put you out of “business”, out of “mission”.