James D. Hess, Ed.D., Bavette Miller, Ph.D.
Context: Physicians leading clinical organizations function as the managers of knowledge-based entities, creating and implementing solutions to complex problems in ever-changing circumstances. The physician leader is faced with the sometimes overwhelming responsibility of delivering the best possible decision to achieve or further the mission of the clinical entity. The ability of clinical organizations to contemplate, evaluate and implement quality decisions is dependent upon a multitude of intrinsic and extrinsic factors. While the management of extrinsic variables may be more difficult to control, the identification and management of human variables such as emotion is pivotal in the effort to increase the quality of decisions and decision-making processes within the clinical enterprise. The purpose of this paper is to provide practical guidance to physicians in the application of emotional intelligence skills within the clinical leadership setting to improve decisions and decision-making processes.
Methods: Goleman’s and Boyatzis’ et al. four essential elements of emotional intelligence as well as their associated 20 behavioral competencies were utilized to develop a methodology for the practical application of emotional intelligence skills to physician leadership and decision-making within the clinical organization. 1,2
Results: The authors developed a series of assessment questions and observations for applying each of the behavioral competencies associated with emotional intelligence to decision-making within the clinical department.
The clinical organization is unique from other business settings in that it must provide services to customers (patients), adhere to regulatory oversight and produce new knowledge while simultaneously altering customer (patient) behavior. Physicians leading clinical organizations create and implement solutions to complex problems in ever-changing circumstances. Milkman, Chugh and Bazerman noted in the knowledge-based economy, a knowledge worker’s primary deliverable is a good decision. 3 Thus the physician leader, which in some instances might include supervising physicians, residents or even medical students, is faced with the sometimes overwhelming responsibility of delivering the best possible decision to achieve or further the mission of the clinical entity. The ability of clinical organizations to contemplate, evaluate and implement quality decisions is dependent upon a multitude of intrinsic and extrinsic factors. While the management of extrinsic variables may be more difficult to control, the identification and management of human variables such as emotion is pivotal in the effort to increase the quality of decisions and decision-making processes within the clinical enterprise.
Goleman described the importance of recognizing and managing emotional variables in the leadership environment, noting that possessing emotional intelligence is equally or more important than IQ.4 According to Goleman 4 :
“Emotional intelligence is a different way of being smart. It includes knowing what your feelings are and using your feelings to make good decisions in life. It's being able to manage distressing moods well and control impulses. It's being motivated and remaining hopeful and optimistic when you have setbacks in working toward goals. It's empathy; knowing what the people around you are feeling. And it's social skill—getting along well with other people, managing emotions in relationships, being able to persuade or lead others." 4
Emotional intelligence has a natural connection with the philosophy of the physician profession. The empathy skills utilized by physicians to connect with their patients are the same skills inherent to the practice of emotional intelligence in relationship management. Because clinical settings possess aspects of both the cognitive and affective domains, physician leaders as decision makers must operate simultaneously in the realms of logic and emotion, and emotional intelligence can serve as the bridge between the two. Moreover, the behaviors associated with emotional intelligence may be learned and applied to improve the overall quality of decisions and decision-making processes within the clinical enterprise.
Emotional intelligence has been the subject of a significant amount of literature over the past three decades, ranging from debate over whether emotional intelligence is innate or learned, to the categorization of specific behaviors that define emotional intelligence. However, little has been contributed to how the behaviors associated with emotional intelligence may be utilized by physician leaders to enhance decision-making in the management of a clinical department. For the purposes of this study physician leaders may be defined as those who are responsible for managing other clinicians and practitioners within a clinical department, whether it be in an academic or private setting. The purpose of this paper is to provide practical guidance to physician leaders in the application of emotional intelligence skills within the clinical leadership setting to improve decisions and decision-making processes.
Goleman’s and Boyatzis’ et al. four essential elements of emotional intelligence, as well as their associated 20 behavioral competencies, were utilized to develop a methodology for the practical application of emotional intelligence skills to physician leadership and decision-making within the clinical organization.
The authors developed a series of assessment questions and observations for applying each of the behavioral competencies associated with emotional intelligence to decision-making within the clinical department. A template of assessment questions and observations was developed to assist physician leaders in the practical application of emotional intelligence skills to decision-making with the clinical leadership setting.
The definition of emotional intelligence and the context in which the term should be used has been debated for decades.5 Thorndike first coined the term “social intelligence” to describe the skills utilized in understanding and managing people. 6 Later in 1940, Wechsler noted the influence of other factors on intelligent behavior and posited that models of intelligence could not be complete until those factors were more fully understood.7 The term “emotional intelligence” was first used in the United States in a doctoral dissertation studying the acknowledgement and effects of emotion.8 This work was followed by an emotional intelligence model described by Salovey and Mayer articulating emotions could enhance rationality and that individuals would be better served to work with, rather than against, their emotions.9 Bradberry and Greaves noted emotional intelligence skills, when considered cumulatively, were vital in representing mental and behavioral functions of individuals beyond their native intelligence.10
The bulk of the literature in emotional intelligence may be encapsulated in the description of three models: 1) ability model; 2) trait model and 3) mixed model. The ability model as described by Salovey and Grewal posited that individuals have varied abilities to process and react to emotional circumstances and as a result develop adaptive behaviors to deal with social situations. 11 The trait model proposed by Petrides, Pita and Kokkinaki was based upon the premise emotional intelligence represents a cluster of self perceptions operating at the lower levels of personality.12 This focus on behavioral dispositions relied heavily on self measurement and as such was more resistant to scientific calibration. 12 The mixed model was best characterized by Goleman’s description of emotional intelligence as a wide array of competencies and skills driving leadership performance.4 Goleman’s model was based on the premise emotional competencies are not innate traits, but rather learned skills that may be developed and improved.4
In a follow-up study Goleman noted the very best corporate leaders, while diverse in their leadership styles, share in common the characteristics of self-awareness, self-regulation, motivation, empathy, and social skill.13 These skills according to Goleman allow superb leaders to understand their own as well as others’ emotional makeup well enough to move people to accomplish institutional objectives.13 Goleman’s original work on emotional intelligence described the following essential elements or abilities: 1) knowing one’s emotions; 2) managing one’s emotions; 3) motivating oneself; 4) recognizing emotions in others and 5) handling relationships.4 Goleman’s theory of emotional intelligence and its characteristic behaviors has been further refined to include both individual and organizational behaviors and outcomes.13 The more fully developed emotional intelligence model as described by Goleman and Boyatzis, Goleman and Rhee refined the original five elements into four dimensions and further subdivided these characteristics into 20 behavioral competencies as outlined in the following table.1,2
Addressing the role of emotional intelligence in decision-making processes, Sevdalis, Petrides and Harvey noted that although empirical research has emphasized the relevance of emotions in decision-making processes, individual differences in the perception and experience of emotion have been largely overlooked.14 The authors concluded when people make decisions, they often think about the emotions that outcomes are likely to trigger.14 Further, Sevdalis, Petrides and Harvey outlined decision-makers: 1) anticipate their emotions before a decision materializes; 2) experience them when they receive the outcomes of their decision and 3) recall them from memory when they contemplate past decisions (good or poor).14 Mellers, Schwartz and Ritov concluded emotions people expect to experience or have experienced as a result of their decisions are important determinants of their current and future behavior.15 Winter and Kuiper noted individuals differ systematically in how they experience emotions, how they differentiate among emotions and how much emotional information they can process. 16
Every physician leader shares the goal of enhancing the quality of decision-making within the clinical department, and the application of emotional intelligence skills can assist in the attainment of that goal. Physician leaders who are self aware and can accurately and honestly assess their strengths in comparison to others in the organization have the advantage of leveraging the attributes of others in the decision-making process. The ability to assess the potential emotional outcomes and reactions of decisions can empower physician leaders to predict the sentiment of those affected by decisions, thereby increasing the probability of a more positive decision outcome. The process of building and maintaining relationships necessitates an emotional perspective and while time consuming, will generate better decision outcomes. Additionally, decisions worth making often generate conflict. The ability to manage that conflict requires an emotional intelligence skill that can determine the ultimate success of the decision-making process.
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