A group practice of surgeons has elected Tom as board president but he is struggling to find common agreement among members with varying agendas

The Issue

Tom is one of a number of surgeons in a group practice. These surgeons are partners in the practice with a subgroup elected as a board that brings management and strategic proposals to the partnership for a vote.

As a partnership, the surgeons make decisions based on consensus. Though the practice has been generally successful, they have not been seeing significant growth or profitability. Tom, along with some of the other surgeons, knows the practice needs to step up its game and be more efficient.

However, with many of the partners in different stages of their careers with varying risk profiles, it’s rare for them all to agree and for any innovative strategic initiatives to be passed.

When Tom was asked to be the board president, he saw this as an opportunity to bring change and move the practice into a more current operating model to serve themselves, their hospitals and their patients better.

As a surgeon, when Tom enters the operating theatre he’s in charge and knows exactly what to do. But as the leader of the group practice, he’s struggling to come up with the right answers, particularly among the more stagnant and belligerent members of the partnership.

He’s starting to be worried that he will let down those who put their confidence in him.

The Interventions

Elizabeth Barrakette

Managing partner, BRK Partnership

As a successful surgeon, Tom’s controlling leadership style in the operating theatre is critical. In that setting he knows exactly what to do and is rarely challenged. As a manager and practice leader, effective leadership can be very different, especially when leading a group of surgeons who, like him, all have made their career occupation one in which they each are the ultimate boss. It seems Tom is trying to succeed as board president as he does in the operating theatre based solely on his ideas of what is expected and what needs to be done.

Tom would benefit from re-envisioning his role as the partnership leader, independent of his role as a surgeon. The coaching opportunity would be for him to get comfortable letting go of needing to have all the answers, and learning to engage others in the process. With a coach he can take stock and define what it means to be a successful leader. Though initially he may consider success to be finding the perfect solution on which everyone can agree, reality might be otherwise.

As a starting point, he might consider asking the team what their expectations are of him now that they have asked him to lead. He can consult with them on what has gone well in the past, both for him and for previous board presidents, and what could be further improved.

Bringing the team together in thinking and the decision making process is generally a leadership success factor. Role playing in coaching sessions can be key here. Working with his coach, Tom can try different response scenarios to identify and test what approach feels most authentic for him to get participation and cohesion out of the group.

Role playing can also add an element of insight and empathy to the individual partners as he tries to sit in their seat at the table and respond accordingly to their needs and concerns. This process of engaging his colleagues over time will be invaluable as he develops his alternate leadership style versus that which is required of him in the operating theatre.

Magdalena Bak-Maier

Facilitator and coach, Make Time Count Ltd

This is an interesting case for leadership coaching and helping Tom learn to influence without his ego getting in the way.

I agree with the approach above and would suggest three interventions.

  1. There’s a lack of clarity about Tom’s role, expectations and also where true authority and responsibility sit. There’s also the need to influence the group. Tom may well be at the helm but it could be very enlightening for him to constellate his practice as a system.

Creating a system map with Tom would raise his awareness about what/who is at the centre? Where is everyone’s attention? Where is the true power? We could also explore what happens when growth, profitability and success are introduced.

Doing this either with Tom in a one-to-one session to develop such a meta view or facilitating such a session with the team and debriefing the result with Tom could also work.

  1. Working with Tom on his confidence will be key. Strong groups (and surgeons fall in that category) demand decisive and confident leaders. Tom is beginning to doubt his ability. This will erode the quality of his connection with others because part of his attention will be on his own performance. We need to address this!

Using embodied work, I would invite Tom to step into his fully confident self and observe his physiology and thinking from this place. I’d explore the specific resources he needs to act with embodied confidence. This intervention is incredibly effective for boardroom level roles and often pinpoints concrete actions that will improve confidence and strengthen relationships.

  1. Tom needs a clear compelling vision he can communicate to his peers and I’d work on that with him.

Having done this a lot with clients, I’ve come to appreciate the importance of being able to engage others with something concrete while understanding that the final picture may turn out very different.

Learning how to engage in this way is a key skill for leaders like Tom.

  • Join Dr Bak-Maier on 3 September for a master class on resilience coaching. Book here: