Most Health Systems Say They Want Bold Leaders. Their Pipelines May Tell a Different Story.

If you ask senior executives what they want in their next generation of physician and healthcare leaders, you’ll hear familiar themes: strategic, dynamic, influential, able to lead change rather than just endure it. But when you look under the hood at who is actually moving into those “next step” roles, the picture is often very different.

The Quiet Pull of “Fit”

In most organizations, no one sits in a room and decides, “Let’s promote only safe, low‑profile leaders.” Instead, a quieter process plays out over the years. We tend to be drawn to people who look and think like our current leaders. We select and promote those who “feel right” based on what has worked here before. Those who don’t quite fit that mold either opt out of leadership roles or get labeled as “not a fit” and drift to the margins.

In organizational psychology, this is known as the Attraction-Selection-Attrition (ASA) model. First proposed by Ben Schneider, the premise is pretty simple: “The people make the place.” Over time, as individuals seek out environments where they fit, as organizations hire people who mirror their existing culture, and as people who feel like they don’t fit leave to find better fit elsewhere, organizations drift toward homogeneity. In other words, they end up having a lot of people who are pretty similar to each other.

Nothing about that is unique to healthcare. But in healthcare, where cultures naturally prize collegiality, clinical excellence, and not making waves, the ASA cycle can have very specific, unintended consequences for the leadership pipeline.

A Real (Anonymized) Case

In a recent project with a large organization, we used a comprehensive assessment battery, including the Hogan personality assessment suite, to look at two distinct groups: the top senior executive team, and the next layer of leaders seen as the pipeline for future top roles.

At the senior level, we saw what you might expect: a mix of personalities and a wide range of underlying values and motives. Some leaders were strongly driven by science and innovation, while others were driven by service and altruism, with averages on all of those scales being in the top quartile. It wasn’t perfectly balanced, but there was real variety in what energized them as leaders.

The pipeline group told a different story. When we looked at their leadership profiles, we saw a consistent pattern of homogenization. As a group, the pipeline was notably higher in dimensions reflecting rules-following and caution, as well as a preference for a workplace characterized by security and predictability (in each case, about 20 percentile points higher than the executives). They were also noticeably lower on scales related to being socially proactive and outgoing, and in creativity and vision/idea-generation than the executives they were meant to eventually replace.

More tellingly, when looking at the core motives that drive leadership behavior, more than half of the pipeline leaders scored in the Low range for the motives most associated with strong and dynamic leaders. In everyday terms, the data painted a picture of a pipeline that was:

  • Steady, responsible, and highly unlikely to cause drama.
  • Reluctant to stand out or strongly differentiate themselves.
  • Less inclined to communicate a clear personal agenda or passion.
  • Harder to read in terms of what they truly stand for as leaders.

On an individual level, these are capable, well‑intentioned leaders doing important work. Taken together as “the bench,” however, you see something else: a fairly homogeneous group of people who may come across as “safe” or “vanilla” at exactly the level where the organization says it needs visible, energizing change leadership.

Why This Is Risky for Physician Leaders

Healthcare doesn’t need generic heroics. It needs leaders who can hold clinical credibility while making tough system-level tradeoffs. It needs leaders who can challenge the status quo without blowing up trust, who can articulate what they stand for, and who can help others see a different future… and who want to be part of it.

If your informal notion of “fit” rewards being low-drama, low-profile, and universally agreeable, the ASA cycle will do exactly what it is designed to do. Your systems will attract people who are more comfortable keeping their heads down than stepping to the front. You will promote those who rarely rock the boat, even when the boat needs rocking. Over time, you end up with a succession pool that is highly dependable and rarely polarizing, but also less likely to galvanize others, take visible stands, or push the organization where it says it wants to go.

For physician leaders, there is an added twist. Organizations often over-emphasize clinical excellence and collegiality as signals of “readiness,” while under-emphasizing clarity of values, visible influence, and the willingness to lead on the issues that matter most.

Questions Worth Asking About Your Own Pipeline

You don’t need a full assessment center to start seeing this in your own organization. A few simple questions can be revealing:

  • When you tell stories about your “ideal” leaders, are they mostly about keeping things stable, or are they about moving things forward?
  • In selection and promotion conversations, how often do you hear “team player,” “safe pair of hands,” and “not polarizing,” compared to “sets a clear direction,” “has a strong leadership presence,” or “can carry the tough message”?
  • If you aggregate whatever leadership data you already have, does your pipeline show the kind of variety in motives, values, and styles that your strategy requires, or does it cluster around one safe profile?

If the answer is closer to the latter, your systems may be quietly steering you toward leaders who fit your past more than your future, or who make current leaders comfortable by being non-threatening rather than by pushing toward the future.

How CPLE Helps Make the Invisible Visible

At the Center for Physician Leadership Excellence, we spend a lot of time in this gap between what organizations say they want and what their systems actually produce. In practice, that often means:

  • Using robust leadership assessments (including the Hogan) with physicians and healthcare executives to surface not only personality and derailers, but also the values that drive how they lead.
  • Looking at data not just one leader at a time, but in the aggregate, to see where a leadership cohort may be unintentionally homogeneous, or even misaligned with the organization’s stated strategy.
  • Designing development and coaching that help leaders clarify what they stand for, strengthen their presence and influence skills, and learn to lead change within the very real constraints of healthcare.
  • Partnering with organizations to update selection and succession practices so “fit” is defined intentionally around “where you need to go” rather than unconsciously around where you’ve already been.

The goal isn’t to abandon the idea of fit; it’s to make sure your definition of fit doesn’t quietly drain the energy out of your leadership bench. If you are looking at your own physician or executive pipeline and wondering whether your systems are really building the leaders you’ll need five years from now, that’s a conversation we would be glad to have.

 

Schneider, B. (1987). The people make the place. Personnel Psychology, 40(3), 437-453.

Dickson, M. W., Resick, C. J., & Goldstein, H. (2008). Seeking explanations in people not in the results of their behavior: Twenty-plus years of the Attraction-Selection-Attrition Model. In D. B. Smith (Ed.), The people make the place: Dynamic linkages between individuals and organizations, (pp. 5-36). New York: Lawrence Erlbaum.