The Leader Index

In January 2019, the ABIM Foundation launched its Trust Practice Challenge, an initiative to address the “trust gap” in health care by identifying practices that foster trust and trustworthiness in various aspects of the health care system. The Foundation would later launch Building Trust to build on this open call.

Physician leader performance is formally assessed each year at the Mayo Clinic through its Leader Index, an evaluation of five key leader behaviors based on a 12-question staff-wide survey.

A team at Mayo has identified truthfulness, transparency, character, capability, partnership and respect as trust-generating leader behaviors that positively impact physician professional fulfillment, satisfaction and burnout. The team has determined that it is possible to measure the behaviors, and develop and select leaders for them.

Under this trust practice, an organization computes a Leader Index for every work unit leader based on the annual staff survey.  The Leader Index is shared with every physician leader, and physician leaders receive feedback on the impact of their behaviors. Each leader is offered support to improve his or her performance, and consequently physician trust, satisfaction and burnout measurements progress as behaviors improve.

The Leader Index process is transparently shared with all physician leaders. Leaders understand the behaviors and the survey questions. As part of each leader’s annual review, the Leader Index findings are presented to each department chair to discuss opportunities for improvement. Each Chair then creates a personal improvement plan, including executive coaching, leadership development programs, and emotional intelligence assessment workshops.1, 2


  •  Include: Nurture a culture where all are welcome and psychologically safe
  •  Inform: Transparently share what you know with the team
  •  Inquire: Consistently solicit input and ideas of associates
  •  Develop: Support professional development and career aspirations of staff
  •  Recognize: Express appreciation and gratitude in a meaningful way to colleagues

Proof of Concept:

In published findings, Mayo has demonstrated the importance of front line leadership on the well-being and professional satisfaction of physicians. It observed that leadership ratings had a strong association with burnout and satisfaction at the level of individual physicians (after adjusting for age, sex, duration of employment at Mayo Clinic, and specialty area). For every point upward on a 60-point scale, there was 9% greater staff satisfaction and 3.3% less burnout. At the department and division level, 11% of the variation in burnout and 47% of the variation in satisfaction with the organization was explained by the Leader Index of the chairperson. 3

The leadership qualities, behaviors and actions that Mayo evaluated are specific and teachable. For example, it found it possible to improve leader performance in these ways: keeping colleagues informed, encouraging staff to suggest ideas for improvement, having career development conversations, providing feedback and coaching, and recognizing a job well done.

Research has shown that the leadership qualities of physician supervisors have a direct positive effect on the personal well-being of the physicians they lead. These findings have important implications for the selection and training of physician leaders. The results also provide new insights into organizational factors that impact physician trust in leadership and their well-being.


Based on its success with physician leaders, Mayo decided to expand the Leader Index practice to all ~3,300 point-of-care leaders (e.g. – nurse managers, pharmacist chairs, accountant supervisors, etc.).  The Leader Index practice was successfully diffused within Mayo Clinic, a large multi-state system with 22 hospitals, varied practice settings, including academic and community-based models, and physicians from all specialties who are distributed in five different states. Mayo has first-hand experience with scalability and reproducibility in different work settings (community and academic) and with different professionals and disciplines.4

Deployment of a Leader Index is feasible in all organizations with employed physicians. And it is relevant and useful for all organizations, regardless of relationship with physicians. Even if annual staff surveys are not utilized and individual Leader Indices not calculated, organizations can help leaders understand the value of these five behaviors for interactions with all colleagues.


1. Swensen, S., et al., Leadership by design: intentional organization development of physician leaders. Journal of Management Development, 2016. 35(4): p. 549-570.

2. Swensen, Shanafelt. Organizational Framework to Bring Back Joy in Practice. The Joint Commission Journal on Quality and Patient Safety 2017

3. Shanafelt, T., et al., Impact of Organizational Leadership on Physician Burnout and Satisfaction. Mayo Clinic Proceedings. 4/2015 90(4): p. 432-440 4. Swensen, S., et al.