A Healthcare Leader’s View on the Top 5 Leadership Skills

The most important elements for women leaders in large healthcare systems.

Posted Jan 06, 2019

Antonette Zeiss/APA
Dr. Antonette Zeiss
Source: Antonette Zeiss/APA

As part of this blog series focused on new perspectives on women’s leadership, I share not just research but also real women’s stories on their experiences. Each interview is structured around a similar set of questions to allow for the emergence of some comparisons and commonalities. However, each woman’s perspective will be different. They each share their experiences, perspectives, struggles, and lessons learned, either from the perspective of being an emerging or underserved/underrepresented female leader, of being a mid-to-senior level female leader, or of being a thought leader or researcher in this field. 

Dr. Antonette Zeiss retired several years ago from the highest position in Mental Health in the Department of Veterans Affairs (VA). This was the first time that a psychologist held this position and the first time a woman has held this position in VA. She now applies her experiences and knowledge to support other leaders as a consultant. I sat down with her to learn what elements she found to be most important for her own leadership trajectory and what advice she would give to support women’s leadership development now. 

The themes that struck me most as woven throughout her story included taking calculated risks, overcoming misperceptions (including internal fears or assumptions), having the right skills to manage conflict, and having the right leadership skills for the job

What does leadership mean to you?

I think it’s important to recognize the multiplicity of leadership. You especially need multiple leadership roles in a more team-based environment. For example, in healthcare a more distributive leadership style makes sense—you have people with different strengths providing important leadership components. You may need one leader who is a good organizer of tasks, another who provides the emotional capacity to draw people out and manage conflict, another who has specific content knowledge, and/or yet another who has strong charisma for an outward facing public relations capacity.  

However, I think there are 5 qualities that are especially important for all leaders to possess:

  1. Be nice. I know some women might not like this word, but in this context I mean: Be respectful, supportive, and willing to challenge, but not in an attacking way. 
  2. Be responsible. Meaning, take care of things yourself by figuring out what the problem is and taking care of it. Don’t just depend on others to do it for you. Analyze how best to handle a situation, take tough actions, repeat. Make sure people can count on you.
  3. Never turn your back on a wave. This is a metaphor meaning be willing to stay involved even when there are big waves coming in. You can ride some of them, can ride over some of them—there are many ways to manage them, but make sure not to avoid them. See them as opportunities, not something to avoid. 
  4. Have a vision. Have a vision for the outcomes you hope to achieve, for example, how you think things could best function, and have a system to get to that place.
  5. Grow things. Since my retirement, I’ve been thinking a lot about this now that I garden more. This is related to vision. Once you have a vision, think about how best to accomplish it—develop and grow it. This also involves being able to mentor and grow others. 

What factors (internal and external) do you think helped you obtain higher leadership roles? Are there factors that got in your way (or could have)?

I initially set out to have an academic career and started as faculty at Arizona State University (ASU) in Tempe, Arizona. Against my wishes, I got thrust into being in charge of an onsite clinic. I initially wasn’t happy about it. I thought that teaching, doing research, and writing grants were most important—not also managing a clinic. But I ended up doing really well in this role and improved the organization of the clinic and brought in funding and resources. 

I then got an opportunity to be a visiting faculty member at Stanford University for a year. After that year, I switched careers to work for the Department of Veterans Affairs (VA) in a hospital setting. I initially supported a research project and soon became Director of Interdisciplinary Team Training in Geriatrics, which later evolved into supporting a broad mandate to promote interprofessional care in VA. This position involved training at the regional and national levels, as well as locally.  It also involved close contact with staff in the Office of Academic Affairs at VA Central Office in Washington DC, so I had broad leadership responsibilities as soon as I took this position.  

Based on my success in the role and other training I was doing for Psychology Service at VA Palo Alto, I was promoted to be the Director of Psychology Training at the local level, which also meant staying connected at the national level. Each of these steps included important leadership opportunities and experiences to help with the next. 

It was important to me that I was doing a great job, not that I was being a leader. After some time, I went to work for the VA’s Central Office in Washington DC, as the Deputy Chief Consultant for Mental Health.  Although it meant leaving a place I loved, I was excited about working with an interprofessional national group of VA mental health leaders to develop and implement the new VA strategic plan to help grow mental health in innovative and crucial directions. 

Through all these career steps, I have had some difficult situations and I had to learn to speak up and depend on colleagues I cared about and trusted, and who I knew cared about me.  It’s important to understand that leaders need to get input about how to approach difficult situations, not just try to handle everything alone.  Collaboration in all aspects of leadership is vital. 

What was the most challenging transition period for you in your career? Were there any pivots you had to do to rise through the ranks? 

The biggest transition for me was very early in my career when I moved from my faculty position at ASU to teach for a year at Stanford and then to work in VA. That transition was difficult for many reasons. My husband had to give up a position he loved in VA at Phoenix in order for us to make the move, and then we had to figure out together the best path for the future. 

I didn’t know what to expect. When I went to VA, I knew it would be different from my faculty job. One thing that helped was that I discovered it was not as different as expected: I was still able to be involved with research projects, teach and supervise, thus allowing me to continue the roles of clinician, researcher, and teacher while also building in a planned administrative role. 

Ultimately, I was called to the idea of improving systems, and my experience at developing interprofessional health care systems informed this hugely. My position at VA was a huge opportunity since it had from the start included constant interaction with VA Central Office. 

TIP: For women who are interested in new challenges and professional development opportunities, Dr. Zeiss’s trajectory demonstrates the importance of being open to new opportunities, taking risks, and finding ways to connect with leaders above you in an organization. 

From your perspective, what leadership issues do people face today? Are there differences you see between men and women? What do you think is contributing to this problem and are there ways that women themselves might be contributing to this problem or sabotaging potential future opportunities?

Going back to the issue of “being nice”: Specific to women, unfortunately, the perception of “niceness” becoming a bad term needs to be overcome, as much as the perception of being “aggressive” if they are too challenging of others. 

Some of this is socially constructed within male-dominated fields—women fear they have to either be “nice” by accepting whatever men decide or be “fierce” in finding a way to challenge. Seeing a woman’s role in this black-and-white way can be a path to failure.

Sometimes women address a problem in a way that is too vague to provide enough guidance for what they want to see. Other times, they may go in the other direction and end up overstating, possibly even attacking. 

Neither approach is optimally effective in resolving problems. Women need to know how to pursue problems and address conflicts comfortably without expressing anger, attacking, or understating the issue (running away from the wave). They need to learn how to deal with a problem or conflict in a way that allows them to disagree in a respectful and useful way. There is actually a great book series, starting with Getting to Yes (see references), that I recommend to everyone who hasn’t read it. It especially helps with dealing with conflict in larger systems.   

A recent online article interviewing women CEO’s supported this sentiment with one CEO saying “You can be ambitious and aggressive, but still generous and kind… it doesn’t have to be all or nothing.” Note that Dr. Zeiss is not saying this shouldn’t also apply to men. In the news there has been a lot of discussion around how men can get away with expressing anger and attacking (e.g., Brett Kavanaugh’s behavior) and still be successful but women are villainized for the same thing (e.g., Serena Williams). Despite the fact that some men might have more leeway to get away with that behavior, and women  are allowed a more restricted set of behaviors deemed to be “appropriate” (see Ruderman & Ohlott, 2002 and Morrison, White & Van Velsor, 1992, in references, for more on this), all leaders get more respect when they learn how to better manage conflict.  

Another problem I see is women not believing they are good enough and turning down or not pursuing opportunities at higher rates than men. They might worry that they won’t be able to balance their personal and professional life as much as they want. You don’t see that concern as much with men. 

(TIP: See my previous post on how to pursue more of the right opportunities.) 

Women might need help with a bit more cognitive reframing. They can work on telling themselves “I will be able to maintain balance, I can do it,” instead of sending the message that they are not interested. 

Women also worry more about whether they have totally adequate skills for a leadership position, whereas men are more likely to believe they have adequate skills and can readily develop whatever else is needed—a not unreasonable approach, and women certainly should have confidence in their current abilities and their ability to learn and grow. (See Parsons, 2017 and Lipman, 2018, in references, about how women underestimate their abilities and allow worrying to interfere with success.) 

Note that the reality is that in many households, women still do have the majority of household-related responsibilities (see reference list for several readings on this topic). Dr. Zeiss’s advice doesn’t ignore that reality but rather reminds us that we should not shut the door to opportunity before trying to see if you can make it work and having the confidence to try to make it work.

If there one piece of advice or book you would offer to women aspiring to become leaders, what would it be? 

I have several:

  1. I mentioned the Getting to Yesbooks, which I highly recommend. 
  2. An interesting experience as you rise to leadership is that some people get afraid of you in your leadership position. In general, I have been seen as a nurturing, supportive person, but in relation to my roles and titles, some people who did not know me well indicated that they felt I was scary. This is very uncomfortable for me.  You have to get used to that. 
  3. In addition to being scared of leaders, people may over-admire you, put you on a pedestal, and have many other emotions as a reaction to you in the leadership role that is different from you as a person.
  4. I will also add that leadership in different fields may look quite different. The research of good leadership in healthcare versus corporate organizations is different in some ways. It’s helpful to know which qualities are required for these different fields. 
  5. Finally, I highly recommend creating opportunities to connect, for example through special interest groups, and to receive and provide mentoring

Creating opportunities for mentoring and training not only helps individual women who are interested in leadership, but also helps teach men to be better mentors for women and trains the system to be more proactive and effective

Mentorship and training can involve things like how to handle conflict in productive ways, dealing with harassment, finding leadership opportunities, etc. I’m not sure how to do it at the interprofessional level but we are now focusing on this more for psychologists within the Association of VA Psychology Leaders (AVAPL). The American Psychological Association (APA) also has an excellent training program for women psychologists seeking leadership opportunities. I don’t think these activities require codifying new policies but rather making a cultural shift or change

References

Fisher, R., Patton, B., & Ury, W. (2011). Getting to yes: Negotiating agreement without giving in (Rev. ed.). New York: Penguin Books.

Ruderman, M. N., & Ohlott, P. J. (2002). Standing at the crossroads: Next steps for high-achieving women. Jossey-Bass Inc., Publishers.

Morrison, A. M., White, R. P., & Van Velsor, E. and the Center for Creative Leadership (1992). Breaking The Glass Ceiling: Can Women Reach The Top Of America's Largest Corporations?[Updated Edition]. Perseus Publishing.

Parsons, N. E. (2017). Fresh Insights to End the Glass Ceiling: New Research and Solutions to Make the Glass Ceiling a Thing of the Past. Leader Voice Publishers.

Lipman, J (2018). That's What She Said: What Men Need to Know (and Women Need to Tell Them) About Working Together. Harpercollins Publishers.