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Leading up is about setting an example and building influence so you can be more effective. It starts with these seven skills.

Fam Pract Manag. 2017;24(6):6-9

Author disclosure: no relevant financial affiliations disclosed.

As more physicians become employed rather than joining or opening an independent practice, they are finding themselves in large organizations with a well-defined chain of command. Maneuvering in this hierarchy can be difficult for physicians, who are accustomed to being “captain of the ship” when making clinical decisions, but it's an essential skill for garnering the resources and support we need to do our jobs well.

“Leading up,” a concept popularized in the book by Michael Useem,1 is the ability to influence decisions made by those at higher levels in the organization, especially your direct supervisor. All physicians are leaders at some level, whether or not they have supervisory roles. Using our leadership skills to influence our colleagues and those in positions of authority enables everyone in the organization to be more successful.


  1. Develop emotional intelligence.

  2. Use power and politics for good.

  3. Choose being effective over being right.

  4. Be intentional and prepared.

  5. Help your supervisor.

  6. Disagree without being disagreeable.

  7. Don't expect credit.

It is common for physicians to express concerns about the leadership skills of their leaders. We need to recognize that those placed in positions of authority are not always (or even often) chosen for their leadership skills. They may be good administrators or managers, they may have been “next in line,” or they may have not stepped backward quickly enough when a volunteer was sought for a job no one else wanted. While focusing on the flaws in our leaders is easy, it's not usually effective or healthy. Instead, one of the best ways to influence the organization is to develop our own leadership skills and use them in a positive way. Here are seven ways to do that.

1. Develop emotional intelligence

A major component of being an effective leader at any level is emotional intelligence (EI).2 Although some people come by the attribute of EI naturally, others don't. Fortunately, this key element of leadership can, with effort and intent, be developed over time. EI is the ability to monitor one's own and other people's emotions, discriminate between different emotions, label them appropriately, and use this information to guide thinking and behavior.3 (A full discussion of EI is beyond the scope of this article but can be found in the book referenced.2)

Monitoring our emotions and how they affect others is vitally important. Our feelings happen without much cognitive control, and if we react to them without slowing down and allowing our cognitive self to process our emotions, we often end up with leadership and interpersonal problems. Just think of the damage we can do when we fire off a poorly worded, angry email. We can inflict the same kind of damage on those around us if we are not self-aware and do not slow down our reactions to strong emotions before we respond verbally (and even nonverbally). We can also damage our reputations if we aren't careful. For example, by showing frustration too easily, we can be labeled as reactionary or negative, which will weaken our influence.

A great way to slow down our response to emotional stimuli is to develop the self-awareness to know when our emotional buttons are being activated. Then, once we are aware of emotions that might lead us to behaviors that negatively affect our relationships, we must hit the mental “pause button.”3 Taking a deep breath, tapping our lips (as if telling ourselves to be silent), or even saying to the other person, “Tell me more,” can slow down the knee-jerk reaction we often have to our emotions and help us respond in a way that will help build the relationship rather than harm it The catharsis of an emotional tirade or angry email is short-lived, but being in control of our emotions and choosing how we respond will have long-term benefits.

2. Use power and politics for good

The words “power” and “politics” often have negative connotations in our culture. We tend to focus on their abuse more than their practicality, and we often associate them with negative personality traits or behaviors, such as manipulating others to your own advantage.

Looking at the positive side, power can be defined as having an elevated position or responsibility, a heightened intellect or talent, or great integrity.4 Politics can mean simply “influencing people and decisions.”4

Power and politics can have a significant impact on our relationships, for better or for worse. To be effective in our organizations, we cannot be naive about these issues. We need to correctly assess the relative power of the individuals involved, their relationships with one another, and the politics at play. If we do not accurately understand these dynam ics, we may jump to conclusions, focus too much on personality issues, and fail to foster important relationships.

3. Choose being effective over being right

One common personality trait physicians possess is the need to be right. Unfortunately, this can limit our effectiveness and influence in our organizations. Many battles are waged just to prove that we are “correct” or “right.” Although the battle may seem satisfying to the winning party, it is often at the expense of an important relationship. This is particularly problematic when the battle involves someone at a higher power level in the organization. The self-awareness we develop when we work on EI will help us pause in these situations and ask ourselves, “Is it more important to be right or effective?” If our goal is to maximize our impact at all levels of the organization, attempting to be effective is the much better option.

Another version of the need to be right is the defense of absolute truth. Although there are some absolute truths, often what others believe is true does not match what we believe is true. As our social and political discourse has shown, different people looking at the same information will often interpret it very differently. Therefore, as we strive to be effective, it is often better to use a softer, nuanced approach to sharing ideas, observations, and perspectives than to charge in with our own version of the facts.

Next time disagreement surfaces, don't engage in arguing. Instead, lean in, become curious, and ask clarifying questions to better understand the other person's point of view and needs. In doing this, you will demonstrate that you prioritize the relationship over the issue, even if it seems the other person doesn't. This will help to de-escalate the situation and facilitate important conversation. It may also lead your supervisor and others to see you as a bridge builder and positive contributor, a perception that can help you influence decisions at higher levels in the organization.

4. Be intentional and prepared

As we work to achieve effectiveness across our organizations, another helpful leadership skill is being intentional in our words and actions. Everything we say or do should involve thought and have purpose with the ultimate goal in mind. For example, if we want a positive workplace where people take responsibility to make things better, yet we're constantly complaining with or about our staff, then we aren't going to be effective.

There may be a fine line between intentional and rigid. For example, if leaders are so focused on their talking points that they won't engage in real conversation, people can feel manipulated or perceive them as disingenuous. But if we convey a true belief in what we say, “walk the talk,” and communicate in a consistent and measured way, being intentional will ultimately be perceived as positive and helpful.

To be intentional, we must also be prepared. This is especially important for meetings and presentations. It can be hard to carve out time from a busy patient care schedule to prepare for opportunities like these, but winging it is not a good solution. Know your audience. Know your message. Show up on time. And craft your request in a deliberate and positive way that can be heard by the other parties. When you're prepared, you'll come across as calmer, more confident, and more professional, which will help you foster good relationships and build influence across your organization.

5. Help your supervisor

The first way to help your supervisor is to understand the limits of his or her authority and power. It is not uncommon to overestimate our supervisor's ability to make decisions and direct resources. There are often practical, institutional policies and financial limits to what our supervisor can do. Frustration often results when our interpretation of what can be done does not match the reality of our supervisor's ability to deliver on our request.

Next, understand your supervisor's needs and goals so you can look at your issues from his or her perspective. It will be much easier to accomplish your goals, and get the necessary resources, if they align with the goals of your supervisor and institution.

When you don't get what you need, you may be tempted to go around your supervisor and appeal to a higher authority, but this is almost never a good idea. Your supervisor's supervisor will generally prioritize supporting his or her direct report over granting your request. Even if you succeed in getting a decision reversed, it can create significant difficulties in the relationship with your supervisor that may never be repaired. When you need to communicate with someone higher up in the organization, it is best to inform your supervisor ahead of time so he or she is not caught off guard.

6. Disagree without being disagreeable

While this may sound trite, an important element in being effective is finding win-win solutions. Expecting others to completely give up what they want for what we want is counterproductive and unrealistic. People often create win-lose scenarios and are dismayed when they are rejected. You can spare yourself great misery by creating solutions that help everyone.

If you can't find common ground with the other party, avoid drawing lines in the sand. Rather than becoming overly frustrated, making ultimatums, or initiating personal attacks, it is best to respectfully agree to disagree. This allows you to maintain your integrity and preserve the relationship so you can reengage in the future without bad feelings.

As you work through disagreements, keep the discussion about the issues at hand, not the other person. In other words, make the problem the problem. It can be tempting to blame the disagreement on the other person. Even if this strategy works from time to time, it damages the relationship and will fail in the long-term. Focusing on the issues in a calm, professional manner is the best way to achieve success.

7. Don't expect credit

If you expect to get credit for all (or even most) of your good ideas, you will quickly become frustrated and bitter. The “seeds” we plant as we share our ideas often only become reality when our supervisor or other leaders in the organization internalize the ideas. This process often results in our ideas being presented as the leader's ideas or the team's ideas. When this happens, try to be happy about your success in getting the idea off the ground, and don't get hung up on needing the credit. You may feel overlooked in the moment, but others have likely noticed your contribution and will respect you for not needing applause.

Practice makes better

Being influential and effective in our organizations depends more on internal factors and our own leadership skills than on the capabilities of those to whom we report. If we focus on developing our own leadership skills, we will increase our likelihood of having a positive influence at all levels of our organization, garnering resources for our teams, and being successful and satisfied in our work. It won't be easy, of course. Being self-aware, hitting the “pause button,” prioritizing relationships, etc., is daunting. We shouldn't expect perfection even as we strive for it. However, we can all be works in progress.

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