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Volume 37 , Issue 4
July/August 2017
Page 467

Editorial: Leadership in Clinical Practice

Robert E. Chavez, DDS

DOI: 10.11607/prd.2017.4.e

Within each clinical team, a leader emerges who takes on responsibility for a performance set. Most often, this leader is the clinician. Of the many hats the leader wears, creating and evaluating the success of the practice is perhaps the most critical. The practice’s core values, mission, and purpose constitute the tripod of direction and behavior on which the team is balanced. These glorified headings, however, must be translated into practical daily behaviors.

The Erhard-Jensen Initiative on Leadership¹ provides a framework for such a behavioral nexus. This course, taught in many Fortune 100 companies and in United States military schools, puts integrity foremost among foundational characteristics in developing the opportunity set for performance.

In our offices, the consideration of integrity in terms of good versus bad, right versus wrong, or what should or should not be is rejected in favor of the value (where you are in its expression) placed on the concept. As a practical concept, integrity is defined as honoring your word.

This foundation and the other core values developed as a team or instituted from top down are metaphorical mountains the team must continually climb. There is a duty to identify misses, failures, or inconsistencies perceived within the group in singular or group interactions and bring them to the parties responsible. The key to this lies in the explanation and elucidation of the definition by Michael C. Jensen²:

1. What you said you would do or not do (in the case of do, doing it on time)

2. What you know to do or not do (in the case of do, done as it was meant to be done and on time, unless explicitly stated to the contrary)

3. What you are expected to do or not do, even when not explicitly expressed (in the case of do, on time, unless explicitly stated to the contrary)

4. What you say, giving your word to the existence of some thing or state of the world (your word includes the ability to give evidence to the utterance)

5. What you stand for, in the form of a declaration made to one or more people, or even to yourself, as well as what you hold yourself out to others as standing for (eg, as a clinician, assistant, or hygienist)

6. The social moral standards, the group ethical standards, and the governmental legal standards of right and wrong or good and bad behavior in the society, groups, and state in which one enjoys the benefits of membership

An organization honors its word internally, between members of the organization, and externally, between the organization and external parties with which it deals. This includes what is said by or on behalf of the organization to its members as well as to outsiders.

Immediate criticism of this definition and its adoption by the practice occurs when circumstances prevent keeping one’s word. For those instances, acknowledging the failure and immediately taking action to clean up the mess caused will enhance the perception, augment the attitude, and amplify the hope of a superior performance set. Thus, out-of-integrity behaviors (inability to keep one’s word) are stepping stones to a more cohesive, integrated, directed team. A sense of satisfaction then develops in the equality and equanimity of all members of the clinical team; one’s word is honored—the performance set is enhanced.

In our offices, we have included integrity in our constellation of core values, using the acronym SPIRE— support, professionalism, integrity, respect, and excellence. Our staff have enjoyed months of team meetings on the court regarding how these values are applied. Our daily routine at close of day is to acknowledge behaviors and instances that exemplify SPIRE. At monthly meetings, examples are read and are drawn for special consideration.

Integrity is a single element that, for us, has been effective in melding a large group of dedicated people into a cohesive, involved, caring clinical team. Along with authenticity, being committed to something bigger than one’s self and being a cause in the matter,³ we see power in leadership without coercion.

Robert E. Chavez, DDS

ARCH Orthodontics

References

1. Erhard W, Jensen MC, Zaffron S. Integrity: A Positive Model that Incorporates the Normative Phenomena of Morality, Ethics, and Legality—Abridged (English Language Version). https://papers.ssrn.com/sol3/papers.cfm?abstract_id=1542759. Accessed 22 May 2017.

2. Jensen MC. Integrity: Without It Nothing Works. https://papers.ssrn.com/sol3/papers.cfm?abstract_id=1511274. Accessed 22 May 2017.

3. Erhard W, Jensen MC, Zaffron S, Echeverria J. Introductory Reading for the ‘Being a Leader and the Effective Exercise of Leadership: An Ontological/Phenomenological Model’ Course. https://papers.ssrn.com/sol3/papers.cfm?abstract_id=1585976. Accessed 22 May 2017.

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