Leaders Must Walk a Tightrope of Transparency

Among leadership qualities, transparency poses a special challenge because it requires more strategic balance in academic and private practice environments.

ABSTRACT: Physician leaders are expected to possess or acquire the “ideal” qualities of successful leaders. Such qualities include credibility, authenticity and transparency. Although these qualities are vital collectively to being a great physician leader, transparency poses a special challenge because it requires more strategic balance to find the optimal amount of information to share in both the academic and private practice environments. Although applicable to leaders at all levels, this is particularly relevant for senior leaders such as chief medical officers and others in the C-suite.

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In a survey of 1,562 workers, 1 in 4 workers said they did not trust their employer, and only half said their employer was open and upfront with them.1 A likely reason for this distrust of is lack of transparency in the workplace and in communication.2 Leadership expert Warren Bennis describes transparency as “the free flow of information within an organization and between the organization and its many stakeholders, including the public.”3 It entails a leader’s ability to clearly and accurately disclose vital information to followers, which is a particularly important quality to being an effective leader.

A commonly expressed sentiment is that sunlight is the best disinfectant, meaning transparency is valuable in leading to accountability of public servants. Transparency also tends to expose wasteful practices and invites input from outsiders, potentially leading to increased effectiveness. Authoritative leaders sometimes are prone to insecurity and have difficulty with being transparent. Other reasons for a lack of transparency might be a closed-door culture in the organization, resulting from concern for a leader’s image or future career moves.

In an era of distrust in authority, employees value truth, and truth requires transparency. Good leaders understand transparency encourages conversation and opportunities for employees to contribute to growth of the organization.

So how does the value of more transparency apply to the health care workplace? Furthermore, do physician leaders need to lean toward being more transparent?

While transparency is valued by employees and can engender trust, too much transparency distorts behavior and changes conduct in workplaces. Complete transparency can leave workers feeling watched or exposed, which can de-press creativity and problem-solving, and even can result in the hiding of activities to feel a sense of control.4 Although leadership should encourage transparency, some boundaries are suggested to wall groups off from other teams. This was confirmed by research in which the concept of group transparency and team boundaries improved teamwork and efficiency, and resulted in a 40 percent decrease in average patient wait time in the emergency department.5

There is a difference between a leader being transparent versus enforcing transparency throughout an organization to the point where it may be a deterrent and have negative repercussions. Research also shows that distrust was more common in organizations where colleagues were freely copied on emails, compared to others where people were copied occasionally.6 The suggested explanation is that routine copying of many people sends a signal of distrust, which reduces trust and commitment to the organization.

Somewhat disturbingly, other research suggests that in organizations where there is too much transparency, workers convince themselves that they are entitled to cheat because they assume the organization knows everything and is there-fore responsible for policing them.6

Walking the Tightrope

The ability to clearly and accurately disclose vital information to followers is a particularly important quality of being an effective physician leader. Lack of transparency can have several manifestations — any or all of which can subvert the ultimate interests of the organization while derailing the career trajectory of the leader and those in immediate proximity.

Consider the following case scenario: One of the largest comprehensive cancer centers in the United States witnessed the forced resignation of its chief executive officer, who was attempting to implement a new strategy without adequate transparency. Facing a strong institutional culture known for a core product of world-class patient care, the strategy involved a critical shift in the mission of the hospital, from an academic institution dedicated to clinical cancer care toward a business-like environment with an increased focus on drug development, financial returns and research.

Physicians involved in the day-to-day care of patients were kept in the dark about the reasoning behind the shift in strategy and instead were asked to see more patients to subsidize the cost of research and drug development. An increasing climate of fear and pervasive dissatisfaction developed at the institution, leading to low morale and a broken relationship between the hospital's leadership and faculty. The predictable faculty attrition and decline in revenue ultimately resulted in the CEO’s resignation.

Should a leader disclose sensitive data that could damage morale and productivity, or information for which full implications are not well-understood? When disclosing ambiguous or negative data, consideration should be given to both the short- and long-term ramifications of the disclosure and the manner of delivery.

The long-term benefit to the organization might outweigh the initial impression, as more growth and development of the team or organization may occur in reaction to negative feedback than positive feedback. Moreover, maintaining a high level of transparency might intrinsically improve employee engagement as team members believe leaders consider them a key part of the decision-making process. Team members who feel a sense of inclusion are more likely to embrace ideas they had a part in developing, fostering support for the leader’s ideas while discouraging dissension (see Table 1).

Refinement and Clarity

Walking the fine line between information that should be transparent and that which should be kept private can be challenging. A “closed door” culture might exist in an organization either because of leadership insecurity or concern for damaging its public image. The rate of disclosure might matter as well. Sharing the tactical plans of the business leadership with clinical employees in a gradual and strategic manner might evoke greater support from frontline physicians.

Transparency about the goals of the organization and reasons for the objectives established should be shared. Unless people know and understand the overarching vision, the leader cannot sell or put it into operation. This is important because the frontline physicians are responsible for the execution of these plans. Focusing on transparency also subjects a leader’s vision to scrutiny, which can help refine and clarify the message so that it remains relevant for the years ahead while simultaneously celebrating accomplishments in the present.

Skillful communication is an essential tool of a physician leader. For instance, questions about proprietary financial information are usually met with a response such as “I cannot share that” and a suggestion to move on to the next ques-tion.7 A leader who endorses transparency in an organization, but implies that the questioner doesn’t “need to know that,” damages his or her credibility and the ability to collaborate in the future with others in the organization.

A more tactful response explaining the limitations on the disclosure of certain information while transitioning to a conversation about topics where transparency is in place would successfully respect the privacy required between teams and appreciate the transparency maintained among groups.7 When leaders want to be transparent and the news to be transmitted is “bad news,” there is no substitute for personal interaction. Face-to-face sharing and transparency is a display of honesty that generates loyalty to the organization among co-workers, as propagated by the leader’s demonstrated commitment to personally share information. However, with most mass communications disseminated digitally, such as through email, effort should be made to maintain a personal touch with those to whom the information is being delivered.

Transparency requires consistent, perhaps daily, communication to lead to better workforce engagement. Furthermore, because of improved cultural dynamics through the value of transparency, trust can be grown in an organization.

Only 40 percent of employees say they are well-informed about their organization’s goals, objectives and strategies.8 In another survey, 70 percent of employees reported more engagement when leadership communicated updates and organization strategy.9 Practical ways to demonstrate transparency include erring on the side of transparency, sharing information in a timely manner, encouraging questions and answering them as directly and satisfactorily as possible, with respect for requirements for privacy. These habits demonstrate the leader’s own perspective and vision, and unspoken authenticity.10

An authentic leader lays out the case for how an organization will benefit from the strategic, but consistent, use of transparency. By shedding the right amount of sunlight, employees will have the information needed to engage, trust and collaborate. By preserving boundaries, proprietary information can be respected, teams can be nurtured, and negative or uncertain information can be used for growth and development. It’s a tightrope, but clear vision, good lighting and excellent communication will help a physician leader talk the talk and walk the walk.

Bhagwan Satiani, MD, MBA, FACS, FACHE, is a professor of clinical surgery and director of the Faculty Leadership Institute at the Ohio State University Wexner Medical Center.

Michael K. Essandoh, MD, is an anesthesiologist and an associate professor in the College of Medicine at the Ohio State University.

Ritu Salani, MD, MBA, FACOG, is a gynecologic oncologist and an assistant professor in the College of Medicine at the Ohio State University.

Ehud Mendel, MD, MBA, FACS, is a neurosurgeon, clinical director of the Spinal Biodynamics and Ergonomics Laboratory and a professor in the College of Medicine at the Ohio State University.

Heather C. Brod, MA, is the executive director of faculty affairs in the College of Medicine at the Ohio State University.

Stephen C. Koesters, MD, FACP, FAAP, is an assistant clinical professor of internal medicine and pediatrics at the Ohio State University’s Wexner Medical Center.

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