Essential Qualities of Healthcare Leaders: The Four T’s

Dr. Catherine DeAngelis was practicing clinical quality improvement much before it became a buzzword in healthcare. It was my pleasure to host a reception on behalf of the UC Davis Women in Medicine and Health Sciences Program for Dr. De (as she is usually called) during her recent visit to UC Davis.

Dr. De is a remarkable role model on many levels for healthcare improvers, especially those who fall into my specific demographic of women in academic pediatrics and public health. She has been a nurse and a pediatrician, whose first faculty position was at the Columbia College of Physicians in New York in the early 1970's. There, she worked on improving healthcare systems in Harlem and Manhattan utilizing physician-nurse practitioner teams. She felt that nurses were often underused, and that they had the ability and training to work with physicians as a team and contribute more substantially to healthcare.

When asked about the essential qualities of leaders, she spoke about four traits that served her well
... the 4 T’s: Tenacious, Tough-minded, Thick-skinned, and Tenderhearted.

Tenacious: Dr. De described her childhood in a coal-mining town in Pennsylvania, where she noticed that the two most respected people in her small town were the doctor and the priest. Her childhood dream was to become a surgeon, and her idea of playing with dolls involved cutting and stitching them up. Medical school was financially not feasible for her family at the time, and she trained to become a nurse. She worked at Columbia Presbyterian Medical Center as a nurse for a year before going back to school - this time to the University of Pittsburgh school of medicine.

Tough-minded: She was JAMA’s first woman editor-in-chief in the journal’s 116-year history. Before she took on this position, she negotiated a governance plan with JAMA that allowed her complete editorial freedom and the ability to report to a journal oversight committee, as opposed to American Medical Association management. She also increased JAMA’s publication of research articles on women and children’s issues.

Thick-skinned: Dr. De spoke about the responsibility of journal editors to rigorously evaluate scientific manuscripts, and to stick to their guns under pressure from organizations or authors with conflicts of interest.  To quote The New York Times, “If Tony Soprano were seeing a pediatrician instead of a psychiatrist, it would be Dr. Catherine D. DeAngelis. And he would have been scared straight long ago”. She is widely-known for her role in advocating that results of clinical trials on humans be reported in a public registry, to enhance transparency in research and to prevent misrepresentation of research findings.

Tenderhearted: Dr. De spoke about her experience as a third year medical student, when a patient kept asking for his nurse and the ward staff was unable to figure out who he was referring to. It turns out that the “nurse” he was looking for was the then medical student Dr. De. The patient was puzzled that she was not his nurse, since she took the time to talk to him and to comfort him “like a nurse”. She mentioned how her experience as nurse influenced her to be more compassionate and to appreciate the team-based nature of healthcare. As she told me - “From the person who mops the floor to the one who brings the food tray - thank them for their work, because life would be terrible without them.”

Do you have a 4T story - either from your own experience as a leader, or from a healthcare leader you know?

- Ulfat Shaikh

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