Effective Physician Leadership Notes

In today's podcast episode, I present my take on things the CMO should never say to the CEO. 

These admonitions apply to anybody in management, not just the CMO. For reference purposes, the term “senior management team” refers to the CEO and all the CEO's direct reports. This includes the CNO, the senior VP for HR, the CFO, the COO, and other senior-level positions.

The principles I learned apply to any highly functional senior management team. Whether you’re an executive in a hospital, pharma company, insurance company, or other large corporation, these leadership concepts apply.

Many nonclinical positions involve management from the very start. But others (e.g., physician advisor, medical writer, or medical director) may not involve management at first. But it is quite common for physicians to move into management positions quickly because they are seen as leaders by others.

As a result, learning these principles can be useful for almost any physician, and other clinicians in alternative careers.

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4 Things the CMO Should Never Say

There are probably many more. But here are things the CMO should never say because they reflect negatively on accountability and commitment to the success of the organization.

“We’ve tried that before and it has never worked.”

This is a common refrain of those who are unwilling to revisit old goals.  But leaders need to accept the fact that goals that were formerly unattainable might now be possible with new technology, new ways of doing things or renewed energy and enthusiasm. 

“I completed my assignments, but somebody else dropped the ball.”

This is a comment that would make us cringe. The COO, CNO, CFO, and CMO should never say these words.

A team member fails to complete an assignment and the plan does not come together as hoped. While that comment may be accurate, it demonstrates that the person making it is not a true leader. A leader is going to take the bull by the horns and get it done, even if it means taking on more responsibility or monitoring the other team members' progress and assisting them when needed.

It's not that you need to babysit everybody. The point is to get the project done. And a leader is generally the most proactive in helping others to meet their commitments.

“I disagree with the decision on this and I cannot support moving in that direction.”

The way it works on a good team, the leader of the team gives everybody a chance to chime in, and share their input. However, organizations are not led by consensus. Once everyone is heard, a decision will be made by the CEO or whoever is in charge of the project.

Then, even if you didn't strongly support it, or vehemently argued against it, once the decision is made, you must fully get behind the decision. And everybody should then work together to accomplish the goals of the project. If it fails, the team can revisit the other recommendations later.

“I’m sorry IF…” 

There are apologies for doing something wrong, and apologies for making mistakes, but we're talking here about apologies for not doing what you said you would do. Everybody on a senior management team needs to be 100% accountable for doing what they said they would do, when they said they would, the way they said they would.

There should not be any contingency in an apology such as “I'm sorry if you don't believe that I did this properly,” or “I'm sorry if things didn't turn out okay.” That's not an apology. The word “if” should never be used. You must take ownership.

It should be, “Look, I'm sorry. I dropped the ball on this.” Admit that you made a mistake. Then, “I commit to correcting this and I will come back in one week and have everything that I committed to accomplished.” And finally, “This won't happen again.”

Apologize appropriately and keep your word.


There are certain things that any leader including the CMO should never say to the CEO.

If you're in a leadership position, you can undermine your standing by making one of these four blunders. It can be career-ending.

On the other hand, if you demonstrate integrity and accountability by not making excuses, not blaming others, not being defensive, and by apologizing appropriately, you'll be well on your way to being an exemplary leader.

NOTE: Look below for a transcript of today's episode.

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Transcription PNC Podcast Episode 251

4 Things the CMO Should Never Say to the CEO

John: Now this week, I'd like to present a topic in what I'm calling my effective physician leadership series. I've done several other solo episodes where I talk specifically about leadership. So, I'm giving it a bit of a moniker here as an effective physician leadership series or effective physician leadership notes.

But I learned a fair amount about working in a complex management environment as chief medical officer for a 300-bed nonprofit standalone hospital, which I did for 14 years. And we spent a lot of time honing our skills as a team together to develop trust and to build a team that could really effectively run that hospital.

And I learned a lot. We had coaching. Our CEO had a coach. We as members of the senior's team had the same coach. And we did receive coaching as a group together. So, I did learn a lot that I think would be helpful to share with you. Many of you are in leadership positions or will be in leadership positions. Now pursuing a management or leadership career itself is a nonclinical or a nontraditional career for physicians, although many physicians do become leaders. I think also even if you start as a medical writer, an editor, or something in utilization management or any other alternative type of career, you will have opportunities to take management and leadership positions. And so, you should probably learn these principles if you don't already know them.

Now, whether you're a CMO in a hospital, pharma company, insurance company, or other large corporation, these concepts will definitely apply. But even if you're not, if you're running a smaller organization, if you're an entrepreneur and you're trying to grow your business, you're going to need these kinds of skills. And if you're in a lower management position such as a medical director, by demonstrating these leadership skills that will lead to you being recognized and considered for more of a leadership position. So, you have to demonstrate these kinds of skills early in your career. And that's what enables you to move up. Because in violating these leadership principles, you will be passed over because it'll be obvious that you're not ready for that kind of a position.

And when I decide to address a topic like this, sometimes it's more fun and instructive to look at it from the perspective of what not to do. I know I've done a presentation on eight big mistakes to avoid while pursuing a nonclinical career. That's one example, but it can be useful to do it from the perspective of things not to do, the common mistakes to avoid. And so, with that, let me describe the four things the CMO should never say to the CEO.

Before I get into the four things, I want to remind you of a couple of things. First, these apply to anybody in senior management. So, it's not just the CMO. It could be the CNO. It could be the senior VP for HR. It could be any of a number of senior-level positions, but these are the things that you don't want to say or express even to the rest of the team because it'll show that your leadership is failing.

Now, let me define what a senior management team is. And basically, when I use the term, I'm referring to the CEO and all the CEO's direct reports. So, I'll use a hospital as an example. In a small hospital, such a team may consist of the CEO, the CFO who sometimes also serves as a COO, the VP for HR, maybe the chief nursing officer, and there might be a VP for ancillary services who covers all of the lab testing and respiratory testing and imaging because it's a small organization. So, there might be five or six in that senior management team.

A larger hospital might have those positions, plus the chief operating officer, plus a VP for strategy or strategic initiatives, maybe a VP for post-acute services, and a CMO. And then the larger organizations might have those plus others like the chief legal officer, or the chief academic officer if it's an academic institution. The chief medical information officer might be a separate position and or a chief quality officer. But you get the idea.

The senior management team will consist of 6 to 12 members setting the vision and strategic direction of the organization under the leadership of the CEO and the direction of the board of directors or trustees, depending on if it's for profit or not for profit. And so, the execution of the strategic and management plans that are developed by the senior management team is done at the level of the directors and the managers, and the frontline employees. They're the ones that actually run the hospital per se day to day. But the role of the senior team is to be certain that each of the component parts does its job, follows its budget, and coordinates with the other components to meet its mission.

And the other thing I want to comment on here is counter to what some may believe. Each senior management member should be committed to the success of the organization as a whole, and not just the success of his or her own division. That's really one of the highlights or the hallmarks of a truly effective senior management team. You don't consider the people reporting to you to be your primary team. It's your team, but your primary team is the team that you work with on a day-to-day basis to coordinate all of the functioning of that organization, meaning your senior management team. And you'll sometimes have to give up certain resources to help the other parts of the team succeed so that the organization can succeed, even though it may take a little bit away from your part, your division, let's say. So, I wanted to mention that.

Given all that, here are four things, there are probably many more, but there are four things the CEO does not want to hear from any member of the leadership team.

One is this. "We've tried that before, and it has never worked." This is something I heard a lot when I was CMO, but it was usually from team leaders, managers, and physicians. And it's a way to try to stall things. It's a way to get stuck. Sometimes it's due to a fear of change, fear of doing things in a different way. Sometimes it might be that people really actually believe that, but it's usually because the stakeholders, whoever's in that group, again, whether it's a department or a part of a department, they don't want to try something new. They don't want to change the way things are done now because they've got it down, it's routine, they can handle it and it's not challenging.

I'll give you an example. We knew at our hospital at some point that several new things were coming down the road. For example, hospitalists. We knew that was a type of service that ultimately would be coming to our hospital because it was growing across the country and there were good reasons why it was growing.

Another was the institution of an observation bed unit. And the fact that the observation unit should be staffed by dedicated physicians. So, let me take that one. We, for several years, tried to create an observation unit because with Medicare changing its rules, it was saying that it would not accept having certain patients admitted to the hospital, particularly if they weren't going to be staying for more than a day or two. That by definition, meant they should be an outpatient.

And so, we tried several different ways over several years to make that happen. And we constantly would hear that "Oh, we tried that two years ago and it didn't work. The patients weren't treated well or the outcomes weren't good or the physicians were losing patients." There are lots of reasons, but this is a common thing that you hear when you're rolling out something new. It's that "We've tried that before and it's never worked." This is something that if I heard one of my directors say, it just drove me nuts, because look, there's a reason we're discussing this. There's a need that exists. And we are here as leaders of this organization to find out how to come up with a plan to discover how, or to make it happen, that this has to be addressed.

And in the observation situation, we had a lot of denials and we were actually writing off a lot of care because we would just keep patients in the hospital. And then we would after the fact change, convert the inpatient to an outpatient and not charge anybody anything, because patients weren't really being told that that's what was going to happen. The bottom line was, ultimately, we had to come up with a plan. We had to work together and make it happen.

And when you heard that comment, "We've tried that before, and it's never worked." That is basically looked at by the CEO and the other senior management team members as just dragging your feet. We can acknowledge that that's true, but that means we just didn't implement it the way we should, or we need to come up with a new way to implement it. So, that's the first, this is probably not the biggest one of the four I'm going to discuss, but it's an important one.

Now, by the way, these kinds of comments usually come up in the following setting, at least in my experience. Organizations generally have regular meetings of the senior executive team. That's one way they become a team is because they're constantly communicating directly and working together. Now they might meet by Zoom call more than they did before, but our team met in person at least weekly. And we would have a two-to-three-hour meeting. And some of them were devoted to strategic issues and some were devoted to operational issues and sometimes they would overlap. But we were face to face addressing these issues and hearing these comments sometimes maybe when we shouldn't have, but that's when they would be called out and then we'd learn. At those meetings, we're constantly planning and tracking our progress forward on management goals that we had set at the beginning of the year. That always meant that there were multiple people getting together that reported to us to work together to get these different projects going and completed.

So, this is a comment that we sometimes heard that would make us cringe. And that is on reporting back on their project, which we usually had a team working together. One of our members would come back and say, "Well, I completed my assignments, but it's still not done because somebody else dropped the ball."

This is one of those comments where you're assigning blame to somebody else because something didn't happen. I had managers and directors that would say this. Again, it would just kind of drive me crazy and I'd have to call them on it because it could be phrased in a different way.

But being phrased that way just doesn't sound good to the CEO or anybody in charge for that matter. And it doesn't sound good to the board if the CEO uses that comment. And a good CEO, never would. Even though I might be on a team as a monitor or maybe even chairing the committee. Let's say we're putting in place something like a new service line. And we have people from the lab and we have people from the pharmacy and we have people from nursing and people from credentialing all together. And one of my directors might come back to me after we had gone through a great planning process and we have these Gantt charts that tell us when things are supposed to happen and what each person is supposed to do.

And one of my directors would come back to me and would say, "Well, I had all my work done last Thursday and I knew we were getting back together early this week but somebody else dropped the ball. If it hadn't been for so and so, well, this whole thing would've been done by now. I just don't see why they can't do their job." Then I might ask my director, "Well, did you do any kind of follow up or did you reach out to find out what was happening along the way? Maybe you could provide them with some support." And then the director's comment would be something like, "Well, no. We each had our own work to do. I'm not their supervisor and I'm not their babysitter."

I think these things happen all the time because somebody drops the ball and then things fall through the cracks. While those comments are basically accurate, what that shows in that person is a great lack of leadership because the leader in this group, whether they're a chair or not, is going to take the bull by the horn and they're going to say, "Look, I've got my part done. I'm reaching out to the other members of this team. Hey Mary, did you get your part done? And if not, how can I help you? Joe, did you get your part done? Because I want to go back. We're all getting back together in a few days and I want to make sure that my VP is pleased and that we've done our job as a subcommittee on this team to get this part done."

I can tell you that there are employees that will argue at this point to the end of the Earth saying that as long as they're doing their job and they're part of the job, then they're a good employee. But that is a person who's going to be in that management position forever because they're never going to advance to be a leader. And so, that's why I'm telling you that I should never hear that from you if you're in a potential position to be looked at as a leader.

So, it's not that you need to babysit everybody. The point is to get the project done. It's not really important who does what work per se, but it'll become apparent who does what work and the people that are doing the most work and taking the most leadership, which means being the most proactive in getting things done, it will get advanced in that organization. If you want to just be someone punching a clock and making widgets, then so be it. But if you want to be a good manager and a good leader, then you need to be proactive. And when the project doesn't happen, it doesn't matter whether you did all your part, the project didn't happen. You are part of the team and you failed the team.

All right, the next one. Now this one, you don't hear a lot, but every once in a while, you might hear someone say something to this effect. "I disagree with the decision on this and I cannot support us moving in that direction." In other words, I bring this up because there's a situation, an understanding that when you're a member of a senior management team, you have to understand that sometimes decisions are made that are not going to be the exact decision that you would make in that situation.

But the way it works is that in a good team, the CEO or whoever's leading the particular team gives everybody a chance to chime in. And generally, to make that happen, you have to be proactive and you have to elicit responses from everybody in the room. Because you can make a situation where the team doesn't work cohesively because only two or three people pipe up. We always had people on our team that were very vocal. They were very extroverted. They always had opinions. They could hear something and then within three seconds they had an opinion.

Now I'm the type of person that needs to think about things. So, I would come back a week later sometimes with a really serious consideration on a topic we were discussing. And I always felt bad that I couldn't be more spontaneous, but that's just the way my brain works. I need to think about things and then come back with my thoughts rather than just my knee-jerk reaction, which may or may not be valid.

But we definitely had people on a team who always had an opinion and that's fine. But the CEO was pretty good about saying, "Okay, now I want to hear from Pete and now I want to hear from Sarah. And now I want to hear from everybody." And that's another sign of a good leader by the way. A leader will elicit input from everybody, even those who are not naturally expressive about their opinions.

So, the point on this is that none of these organizations are run by consensus. None of them are really a democracy depending on how you define that. Somebody has to make the final decision ultimately. Now sometimes you all may come to the same conclusion on your senior management team and say, "Yeah, this is fantastic. We came up with a great plan. Let's do it."

But a lot of times you're going to have disagreements about the best approach or when you're selecting a strategic initiative you might have to choose from among two or three, and you're going to be fond of one and somebody's going to be fond of the other. They're feeling it's the best thing to do, but it can't all happen. You have a budget. You can only spend so much this year. So, one thing's going to have to be put aside. And when you're in a team like the ones I'm talking about, everybody has to fall in line once a decision is made.

We assume that the decision, whether it's a board decision or a CEO decision, that the decision is made for the best of the organization. And it's not always a hundred percent clear, which is the best way to go. But the thing is with a team in order to trust one another and to work collaboratively going forward, what the CEO is going to demand, what the board is going to demand is that everybody gets on board with the plan.

Even if you didn't strongly support it, and even if you vehemently argued against it, that's fine. And everybody should have that input on that senior management team. That's what that team is for. To inform the CEO, to challenge the CEO. The CEO is usually going to have an idea of what they want to do and why it's the best approach. Just like the chair of any committee or team is going to have their opinion. They're going to come to a meeting and ask your opinion and your input, but they're going to have what they think is the best approach to take.

But the thing is until they hear from everybody on that team on that committee or on that senior management team, they don't really know everything. And that's why they need to be challenged because they may be working off assumptions that aren't a hundred percent accurate or that might be missing something. Again, the idea here is not that you can't disagree, you can, but it's the second part of the statement stating "I cannot support moving in that direction." The whole statement is "I disagree with the decision on this and I cannot support moving in that direction" or something similar.

And the point here is that once you've all had your say, whoever's making the decision, makes a decision, and then everybody gets behind it 100%. Then one of several things can happen. It's going to go great and it's going to be wonderful and the outcome is going to be just like everybody wanted. And that's good. Or it's not going to work or it's going to partially work. And then you just learn from that. And then you redirect and, in the case where there are multiple competing projects, well, then next year we'll do your project once this one is going.

But you don't remain as a squeaky wheel or a thorn in the side going forward once a decision for one of these big plans is made and we're moving forward. So, let's say we decide we want to do a hospitalist program, and the CMO myself, or maybe the CMIO or some other advisor says, "I don't think it's a good idea. The doctors aren't going to like it. The patients aren't going to like it." Okay. Give us the information, the support, the evidence. We'll discuss it, we'll consider it. But if we decide to move forward with it, then you're going to need to help us institute this hospitalist program.

Enough on that. The last statement I would say, the last thing the CEO doesn't want to hear from the CMO or anybody else on the team is, well, here's the short version. "I'm sorry if..." This is really just a comment on how to be accountable and how to apologize.

Now there's apologies for doing something wrong, apologies for making mistakes, but I'm talking about really apologies for not doing what you said you were going to do. That's one of the things. You need to be accountable. You need to keep yourself accountable. Everybody on a senior management team needs to be one-hundred percent accountable. Now, we're human and things can fail and falter, but the expectation by the CEO and by all the other members of the team is that if you say you're going to do something, you're going to do what you said you were going to do in the timeframe you said you would do it, the way you said you were going to do it.

Now, most people don't care too much about the way that you do it. But again, you're in a meeting. You've got a big project going on. Each of you has your part of that project. Let's say that as a CMO, since the pharmacy reports to me, the part of the project that depends on the pharmacy and the pharmacy director then is my responsibility. And I'm in a meeting. And I said, "Yes, we were going to deliver this protocol and set up the use of this medication for let's say this new unit. And that will be ready to go when I report back here in two weeks."

Then let's say two weeks rolled around and I got sidetracked. I let the ball drop and then it's my time to be accountable. Part of that is admitting that I didn't do what I said I was going to do. And that's where the apology comes in. But this is true of any kind of apology. There should not be any contingency in the apology like "I'm sorry if you don't believe that I did this properly or I'm sorry if things didn't turn out okay." That's not an apology. The word "if" should never come in there. You have to take ownership.

In this case where I didn't deliver the pharmacy protocol and maybe get the meds and get things cleared by the pharmacy and therapeutics committee and all those other things, there should be no "if". It should be, "Look, I'm sorry. I dropped the ball on this." That's number one, admit that you made a mistake. Number two, "I commit to correcting this and I will come back in one week and will have everything that was expected of me for today. And it'll be in place and it'll be ready to go. By the way, this won't happen again."

That's really part of a good apology. And unless you know how to apologize appropriately, you can't be a good leader. So, you're going to accept what went wrong, that it was your responsibility, that you're going to correct it usually within a certain timeframe, and that it won't happen again. This is pretty concrete and becomes a way to identify those members of the team that need to be let go.

If there's a member of the team who simply cannot keep their word, continues to commit to things that they don't complete, then makes mistakes, and then doesn't apologize appropriately, then they're not really worthy of being an ongoing member of that team. And take the steps needed to eliminate that person from the organization. And that's true of working with people in any business. So, if you're an entrepreneur, if you're a consultant, whatever it might be, you definitely want to follow that process with people that are reporting to you.

Those are the four statements or four things that the CEO doesn't want to hear, or four things that the CMO should never say to the CEO or their senior management co-members.

If you have any questions, feel free to contact me by email at john.jurica.md@gmail.com. If you're in a leadership position, you can really undermine your standing by making one of the four big mistakes I mentioned today. On the other hand, if you demonstrate integrity and accountability by not making excuses, not blaming others, not being defensive, and by apologizing in the appropriate manner when it's warranted, you'll be well on your way to being an exemplary leader.


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