Leadership Without Authority:Influencers of Culture in Your Practice 

Influencers in popular culture demonstrate how individuals without formal authority can shape trends, ideas, and behavior. In a medical practice, the same principle—leadership without authority—can play a pivotal role in shaping team culture, supporting collaboration, and enhancing patient care. 

Leadership without authority refers to individuals who, despite lacking direct supervisory roles, exert meaningful influence over peers, superiors, and patients. Their impact can be either constructive or detrimental, depending on how their influence is applied. Recognizing and nurturing positive leadership behaviors in these individuals can help build a stronger, more cohesive practice environment. These informal leaders often serve as connectors, communicators, and catalysts for cultural change. They influence through actions rather than titles—often becoming trusted resources and role models within the team. 

The following styles of leadership without authority support professional growth, team cohesion, and operational excellence across various roles in a practice: 

Peer Leadership - Peer leadership fosters collaboration by encouraging colleagues to work together outside of traditional hierarchies. Strong peer leaders build trust through clear communication, empathy, and mutual respect. When team members feel heard and appreciated, they are more likely to invest in their work and contribute meaningfully. These leaders inspire by modeling shared values and empowering others to take initiative, creating a productive, engaged team environment. 

Leading Up - Leading up involves influencing those in higher positions through effective communication and alignment with organizational goals. Individuals who lead up present ideas with confidence and advocate for resources and support. They understand the broader strategic objectives of the organization and use that knowledge to align team goals with leadership priorities. Building trust and rapport with superiors opens the door for ongoing dialogue and shared decision-making. By positioning themselves as collaborators rather than critics, they become valued partners in strategic discussions and problem-solving. 

Leading Patients - Leading patients means guiding them with empathy, education, and advocacy. Building rapport with patients cultivates trust and improves engagement in care. Educating patients about their conditions and treatment options empowers them to take an active role in decision-making. This shared decision-making process often enhances adherence, satisfaction, and clinical outcomes. Effective leaders ensure that patients feel heard and supported, helping to create a care environment that centers the individual’s values and concerns. 

ACTIONS THAT BUILD TRUST 

A strong team culture thrives on deliberate actions that promote trust, accountability, and collaboration: 

Fostering Positive Culture Creating an environment where team members feel valued encourages idea-sharing and collaboration. 

Transparency, open dialogue, and inclusive practices promote a stronger team culture. Peer recognition programs and shared success celebrations reinforce behaviors that strengthen morale and build emotional investment in the team’s success. 

Consistency and Feedback Minimizing errors and maintaining consistency builds reliability and efficiency. Structured onboarding, time management training, and ongoing feedback loops support professional growth and reduce avoidable setbacks. 

Process Review and Input Routinely assessing workflows and gathering feedback from staff fosters a sense of ownership and continuous improvement. Teams that adapt to feedback and iterate on their processes demonstrate resilience and an ability to meet evolving demands with agility and mutual support. 

ACTIONS THAT ERODE TRUST 

Trust is a cornerstone of effective leadership. When it is compromised, even the most well-intentioned teams can falter: 

Gossip and Poor Communication Negative communication and gossip undermine relationships and create toxic dynamics. Misinformation and hearsay breed confusion and misalignment, which can fracture team cohesion and disrupt day-to-day operations. 

Lack of Accountability When individuals avoid responsibility or deflect blame, trust erodes. Inconsistent standards or failure to follow through on commitments leave teams unsure of expectations and weaken mutual respect. 

Unequal Burdens and Exclusion When some team members consistently shoulder heavier workloads without recognition—or are excluded from decisions affecting their work—resentment and disengagement often follow. Equitable participation is essential to creating a culture of fairness and shared investment. 

CONCLUSION 

Creating and sustaining a healthy practice culture requires collective effort and conscious leadership at all levels. Leadership doesn’t require a title—individuals who naturally build rapport, model desired behaviors, and support their peers play a vital role in driving engagement and shaping culture. Identifying those who lead peers, superiors, and patients, and encouraging their positive influence can enhance both practice success and team satisfaction. Investing in these informal leaders while addressing behaviors that undermine trust can unlock the full potential of every individual on the team. 

Taking the time to identify leadership without authority, nurturing the positive actions that strengthen culture, and coaching out the negative actions that are holding the team back may be valuable to your success and influence as a leader in your practice. 

MARIE CZENKO 

• Senior Management Consultant 
• Allergan Practice Consulting Group of Allergan Aesthetics, an AbbVie Company 

JEANIE MANLEY 

• Management Consultant 
• Allergan Practice Consulting Group of Allergan Aesthetics, an AbbVie Company