Leadership Interview

Roberta Hines, MD, is chair of the Department of Anesthesiology and the Nicholas M. Greene Professor of Anesthesiology. We spoke with her recently about her leadership philosophy. She shared stories about mentors and leaders who have inspired her, and what she has learned about leadership in her own career.

Tell us about the first time you saw someone displaying leadership skills and what it meant to you. What did you take away from the experience?

Growing up in rural New Hampshire, one of my earliest exposures to leadership and its impact occurred as a member of the local 4-H Club. Ester Christy served as the leader of the local girls 4-H Club chapter. She was an amazing and dynamic woman—one of the few women I knew at that time who had graduated from college. She and her family maintained a working farm, and she was the mother of three children. She demonstrated a true ability to master “work/life balance” before this term became fashionable.

She instilled in me, and all the other young women in our 4-H Club, that we could and more importantly should focus on our future, that we need not be constrained by traditional roles or boundaries. She made sure we were exposed to a broad range of opportunities, cultures and experiences. She gently but constantly raised the bar for all of us and provided a strong and supportive network in which to accomplish our goals.

From this early experience, I saw that commitment and dedication to one’s beliefs and goals, combined with a passion for success, were essential traits of a successful leader. As I reflected upon the characteristics Esther exemplified, I learned the importance of “leading by example.”

Please tell us about a traditional leader you observed during your career, the positive and negative aspects of this person’s style, and how they helped to crystallize your leadership practice.

After completing my undergraduate training, I had the good fortune to work in the laboratory of Dr. Gilbert Mudge at Dartmouth Medical School. Dr. Mudge was a former dean of the school of medicine and an internationally renowned researcher in renal physiology. He had the reputation for being a tough taskmaster. As you might imagine, I was a bit intimidated as well as intrigued by the opportunity to work with him.

During my time in his laboratory, I had the opportunity to experience many aspects of his leadership style. I was impressed with the ease with which he adapted his style and approach depending on the circumstances. His ability to read people and to gauge their reaction was something I had never witnessed before and one that clearly made a lasting impression on me. After getting to know him, I gathered the courage to ask him if he knew that people often described him in a somewhat unflattering way. His response was one that I still often think of today. He said there are always people who can only see the glass half full; for them it is not about what they have accomplished, but what opportunities they missed. To this day, I remain focused on seeing the glass half full. Thank you, Dr. Mudge.

What was your first leadership role, and what did you do right, and what would you do differently?

My first formal leadership role was as medical director of the cardiothoracic intensive care unit at Yale-New Haven Hospital. As a new faculty member fresh out of fellowship, I approached the role with a mixture of excitement and fear. This was the first time the institution had a dedicated CT-ICU, and as such, I was the unit’s first medical director. I quickly learned the value of active listening and consensus-building while synthesizing with the input of many and sometimes opposing constituencies. My nursing colleagues in the ICU were always available to lend emotional and intellectual guidance, all the while convincing me that it was “my idea in the first place.” Their support was invaluable in allowing me to develop confidence and the strength that I needed to care for the patients, educate the house staff, and advance my academic career.

Similarly, my cardiac surgical colleagues were exceedingly trusting as they allowed me to participate in the care of some of the most ill patients in the hospital. This experience taught me the value of collaboration and relationship-building in a multidisciplinary environment.

As I reflect upon this amazing leadership experience, one aspect of my leadership role that I would have done differently is that of developing a formal succession plan. One of the roles of effective leadership is to ensure that there is someone who is capable of succeeding you because you will eventually move on.

Please tell us about an experience where you found leadership in an unexpected place, and what you gained from that experience. Is there an uncommon experience you can think of that helped form your leadership practice?

Several years ago I was skiing in Vail, Colorado. As I rounded the corner, I saw a gentleman unconscious lying in the snow with the ski patrol performing CPR. As you can imagine this was quite a chaotic scene, filled with a mass of other skiers, as well as various members of the ski patrol working on several different tasks simultaneously. It was clear that while everyone was focused on performing their specific duties, no one was orchestrating the entire process. By quickly assessing the situation and rapidly developing a rapport with the members of the ski patrol on site, I was able to oversee and participate in the care of the patient, while having other skiers direct traffic around the area.

The leadership skills that I have learned earlier in my career, including communication, engaging others and the ability to quickly access situations as well as individuals, were invaluable in this most unexpected situation. When the resuscitation was complete—the patient survived and was airlifted to Denver, where he received a pacemaker—I was caught off guard as several onlookers came over to compliment me on my ability to quickly engage and lead in this chaotic situation. I was quite flattered, but most importantly thankful for all of the opportunities given to me to attain these skills in a more traditional venue and how applicable they are even in the most unusual circumstances.

Tell us about an experience that transformed your understanding of what good leadership can accomplish?

Throughout my career, I have been impressed and inspired by patients and their families who have dealt with the consequences of medical errors. So many of these individuals and families have made a conscientious effort to turn these personal misfortunes into opportunities to challenge us as physicians to do better. Instead of dwelling on the negative aspects and assigning blame, these extraordinary individuals have demonstrated courage and leadership as they have lead successful campaigns to increase our awareness and activities related to patient safety. They serve as role models for all of us.

What are the first things you consider when leading colleagues through a major transformation?

First and foremost, you must believe in the value of this transformation. Communication and transparency are essential throughout the process. You must be able to be articulate in your vision and be visible, as your hands-on leadership will be vital during the transition period. Any successful transformation can only be accomplished through a combination of vision and an implementation strategy. This strategy requires the engagement of a talented and trusted leadership team that will be vital in helping to communicate, as well as building consensus among the various constituents impacted by the transformation. It is essential that you provide the venues in which those being affected by the transformation can communicate their ideas and concerns openly and constructively. You must also be prepared to accept that not everyone will embrace this transition and have a strategy in place early for these individuals.

What part of your career fuels your growth and development as a leader?

There are so many aspects of my career that continue to energize me; it is difficult to highlight any one specific element. If I were to select one aspect that I particularly enjoy, it would be the privilege of training and mentoring the next generation of physician scientists and physician leaders. Coupled with the ability to interact with amazing and talented faculty, I am constantly challenged to be a more effective and impactful leader.

Do you have helpful thoughts to share for early career, developing leaders?

While many aspiring leaders have the desire, drive and intellect, they often lack the essential “tools” to become effective leaders. We have all spent many years—as undergraduates, graduates, students, residents, fellows—developing the skills necessary for us to become highly skilled physicians and scientists. But the attributes needed to transition into leadership are not part of the traditional medical school curriculum. I believe it is essential that future leaders acquire the necessary tools and skills long before actually assuming any leadership role. Many times, talented physicians and scientists who have spent years developing expertise in their respective disciplines believe that they will acquire leadership skills as part of “on-the-job training.” This is certainly not the way successful leaders in other disciplines are developed and nurtured. We need to take a page from our colleagues in the business world who are constantly identifying key individuals for leadership roles and providing these individuals with a structured approach to development. I would encourage anyone interested in a leadership role to identify a mentor early in this process and to utilize this mentor to develop a timeline approach for obtaining the appropriate skills.

For me, the process of continuing to embellish my leadership skills has included traditional coursework coupled with engaging a personal coach. In addition, I also strongly encourage others to develop a very small but trusted network of advisers. These should be individuals currently in leadership positions who can serve as a sounding board, and who should be empowered to challenge you when necessary. I enthusiastically encourage faculty to embark on a path to leadership roles. The future of medicine will depend upon these talents and our commitment to training leaders.