In our own assessment of emerging physician leaders at Cedars Sinai, we found strong self-management skills, with a wider variation in social awareness and relationship management. This is not surprising given the selection bias that those who go into medicine are trained to be self-reliant, and are taught to become objective in the face of pain and suffering. This baseline helped us focus training in the important aspects of social skills in influencing group behaviors.

Although there are four realms to emotional intelligence, for leaders, success many times rests on their ability to resolve conflict. Conflict is not necessarily negative; opposing viewpoints may bring clarity to a situation. The Thomas Kilmann Conflict Mode Instrument (TKI) was an outgrowth of work in the 1960s on managerial styles [23]. It recognizes that there are gradations of assertiveness and cooperativeness in any conflict negotiation. Assertiveness is the degree to which you try to satisfy your own needs, cooperativeness in the degree to which you try to satisfy others needs and be receptive to their ideas. These are not mutually exclusive. Depending on the situation, each style may be appropriate.

If one places assertiveness on the Y axis and cooperativeness on the X axis, five styles become apparent:

We were somewhat surprised to find that our leadership group primarily dealt with conflict by accommodation then avoidance and compromise. Only one physician scored strongly in collaboration; this was a member of the voluntary medical staff who has been successful in organizing community based practitioners. We were encouraged that when the group as a whole was retested, after a year of service in various roles, we saw a shift in avoidance behavior with increases in compromise and collaboration. Many organizations offer negotiation training for leaders. The key aspect is that conflict is not only unavoidable, but channeled properly can lead to innovation and increased performance.

Perhaps one of the greatest innovative disruptions in organization performance management is 360° feedback. Gone are the days when subordinates were evaluated only by their supervisors, who themselves were responsible to a level higher in the organizational chart. Personal success was narrowly defined and corporate cultures focused on shareholder value or for academic medical centers on grants, patient care dollars, and charitable giving. A true understanding of mission, vision and core values was lacking. Personal growth and the ability to manage and supervise the mission required a far greater understanding of one’s own style, strengths, and areas of opportunity. The 360 also requires high levels of trust and self-awareness to yield meaningful behavioral change. Selection of the feedback tool, the raters, the method of feedback and the integration into the culture are key decision points to be considered. In general, the more feedback from multiple sources, the better [24]. The ability to lead teams that are multigenerational and multidisciplinary is an increasingly important skill, different from the leadership learned in the operating room.

At Cedars Sinai, 360 evaluations are available on an individual basis, and chairs receive pooled feedback from their faculty, including trends and comparison to other departments. Other organizations incorporate 360° evaluations into the culture beginning with onboarding. There is an explicit expectation to receive and give feedback at all levels. Done well, 360° evaluations not only enhance personal performance, but also can guide an organization to develop programs in areas consistently identified as high impact. The risks of the 360 is to focus on deficiencies and then not have the resources in place to optimize individuals’ performance. It is also vital to tie the evaluations of the individual to clear understanding of the organization’s goals. If the mission is the service of the local urban community, cultural awareness should be included; if it is to compete in a highly specialized technology transfer environment, the ability to understand big data and communicate that clearly is paramount.

As with any form of evaluation, standardized testing is but one component of an overall program of personal and professional development. You can be coached, read self-help books, and do exercises to better read facial expressions. But the journey as a leader, and in finding joy in one’s life, comes from within. Souba describes the “Inward Journey of Leadership” as a continuous process of self-reflection, discovery and growth [25]. It focuses on accurate self-awareness, not defined by the size of one’s CV. It is expanded by seeking feedback and constantly comparing your interactions with others to your inner values. Genuine human connections, forged through both adversity and success, are the greatest tools in understanding our own emotions and how we are perceived.