Nurses, along with other leaders in healthcare institutions and like leaders in every industry, face tremendous and exciting challenges. Nurse leaders are confronted with the daunting challenges of care, economics, and good stewardship, along with the challenge of fulfilling their institution's mission—all in a cost-effective manner. There is no dearth of models and paradigms for cultivating the fine art of leadership, and so much has been written, taught, and practiced it borders on overwhelming. Leadership theories, like science and technology, appear obsolete every so often and one sees new questions needing answers. The autocratic and functional models of leadership in healthcare, which seemingly worked well in the past, now yield to newer models that reflect a deep hunger in our society where people long to be treated with dignity, respect, care, and compassion. Many models have been proposed, developed, and taught in an effort to meet this growing and deeply felt need. Each includes common threads that are proven, tried, and tested to produce the best leadership skills.
Servant Leadership, a 30-year-old idea, is a specific leadership and management concept slowly gaining popularity, especially in faith-based healthcare institutions. However, although theory is present, actually putting the concepts into everyday practice lags far behind.
LEADER AS SERVANT
Servant Leadership is based on the premise that a leader can select from two fundamental but opposing orientations toward his or her work. One orientation prompts him or her to "take" from the organization as many perks and privileges as the position allows, because in his or her view, the organization exists to provide a job, a title, status, and authority. The second orientation is when the leader asks, "What can I bring or give to this organization?" He or she has learned to "take" what is needed, but has a greater passion to give, serve, and contribute far more than what is expected. Unfortunately, and more often than not, leadership skills are used in the service of personal gain and career advancement rather than in the service of others.
In a short essay first published in 1970, Robert Greenleaf, the man who coined the phrase servant leader, described Servant Leadership this way:
The servant leader is the servant first.... It begins with the natural feeling that one wants to serve, to serve first. Then conscious choice brings one to aspire to lead. He or she is sharply different from the person who is leader first, perhaps because of the need to assuage an unusual power drive or to acquire material possessions. For such, it will be a later choice to serve, after leadership is established. The leader-first and the servant-first are two extreme types. Between them there are shadings and blends that are part of the infinite variety of human nature. The difference manifests itself in the care taken by the servant, first to make sure that the other people's highest priority needs are being served. The best test and difficult to administer is: do those served grow as persons; do they, while being served become healthier, wiser, freer, more autonomous, more likely themselves to become servants? And, what is the effect on the least privileged in society; will they benefit, or, at least, will they not be further deprived?"
Robert Greenleaf (1904–1990) worked 38 years for AT&T, retiring as Vice President in 1964. He launched a second career as a writer, speaker, and consultant after founding the Center for Applied Ethics. In 1985, it was renamed the Robert K. Greenleaf Center. Greenleaf's idea of the leader as a servant came about partly through his vast experiences working in leadership and service issues. In 1970 at the age of 66, he published his first essay on Servant Leadership titled, The Servant as a Leader, and numerous publications and books followed. Larry Spears (1998), a former CEO of the Greenleaf Center, identified 10 characteristics ascribed to the servant leader (Table 1). Spears points out that servant leadership begins with a desire to change one's self. Once that process has begun, it becomes possible to practice servant leadership at an institutional level.
Many individuals and institutions are applying servant leadership as both a philosophy and as a working model. Companies, even for-profit ones, are abandoning hierarchical models (authoritarian, democratic, transactional, participative, etc.), replacing these with the servant–leader approach. Servant leadership advocates a group-oriented approach to analysis and decision making to strengthen the organization and improve society, something resisted by leaders wary of this paradigm shift. The model emphasizes the power of persuasion and seeking consensus, over "top-down" leadership. At the heart of this concept is the importance of leaders nurturing both the institution and those individuals affected by the institution. In a second essay entitled The Institution as Servant, Greenleaf (1972) writes, "Caring of persons, the more able and less able serving each other is the rock upon which a good society is built." Servant Leadership is used in many settings today: profit and not-for-profit organizations, community leadership programs, service learning centers, educational programs, formal leadership/management courses, and by consultants working directly with various organizations.
WORLDVIEW AND LEADERSHIP
Every person has a unique, complex way of thinking of and viewing the world. Our worldview is a composite of our cognition, genetics, life experiences, mental models, assumptions, belief systems, and memories (Baker, 2001). Worldview plays a major role in determining the outcomes of our lives. How we view our world determines what we do, and what we do determines outcomes. Our collective worldview determines outcomes of the society in which we live and the organizations for which we work. Hopefully, both personal and collective worldviews grow and change as we move from lower to higher levels of thinking. Maturity level also determines worldviews, and it is generally recognized that people who are immature exhibit self-serving worldviews. Higher levels of maturity demonstrate consideration for others and a level of self-sacrifice along with proactive behaviors (Covey, 1995). Because people are at different stages of maturity and thinking, an incredible diversity of worldviews exists.
Leadership is largely influenced by worldviews, and since this determines how we lead, one finds a great deal of diversity in leadership styles. Many leadership models have been developed and can be viewed along a continuum. At one end of the continuum are the power models (authoritarian leadership), and at the other end is servant or similar models. The power end of the continuum finds leaders with worldviews based around the demonstration of power whether personal, organizational, or political. At the other end, people and the world are viewed as interdependent realities, and respect for all is at the heart of this leadership model. It does not necessarily mean that one is wrong and the other is right, because the mission of the organization should determine which model of leadership is employed.
The power model is useful for organizations like the military where destroying or stopping the enemy is paramount. One needs to be hard nosed and aggressive in such situations. Unfortunately, this model is used inappropriately in many organizations, government agencies, and religious institutions where rank, intimidation, and hierarchical privileges are used to "lead" people. If the mission of an organization is to serve others—customers, patients, employees, and others, the power model becomes highly ineffective. A model based on empowerment, valuing the growth of others, encouraging creativity, and so on should be considered instead. A common mistake is to subscribe to one particular worldview and hold to it regardless of circumstances. As Abraham Maslow supposedly said, "He that is good with a hammer tends to think that everything is a nail" (ThinkExist.com, 2009).
MODEL VERSUS METHOD
People might subscribe to the servant leadership model, but attempt implementation using patriarchal or authoritarian methods. Greenleaf posited that servant leadership is about making the people around the leader grow, to be healthier, wiser and more autonomous, and likely to become servants themselves. A servant leader facilitates the growth of others to a greater level of maturity and service. Their worldview chooses service over self-interest; the 10 characteristics in Table 1 are systematically developed in such leaders. Other aspects of servant leadership relate to one's character evidenced by courage, discipline, and the love with which one chooses to lead. It also relates to closely following the greatest of all servant leaders: Jesus Christ.
There are many biblical titles for Jesus Christ, but if he preferred one, it may have been Servant of the Lord. Jesus said of himself, "For even the Son of Man did not come to be served, but to serve, and to give his life as a ransom for many" (Mark 10:45). The Apostle Paul wrote of Jesus, "He made himself nothing, taking the very nature of a servant, being made in human likeness. And being found in appearance as a man, he humbled himself and become obedient to death—even death on a cross" (Philippians 2:7–8). The picture of Jesus as Servant is clearly laid out in scripture (Table 2).
In view of the example left to us by Jesus, my worldview of leadership encompasses the following essentials:
Character: Often confused with reputation, character is described and highlighted by its absence rather than by its presence. Character is "What we do when no one is looking." But more than what we do, character defines who we are. Leaders who care understand first and foremost who they are when no one is looking and what matters the most. Leaders give evidence of strong character by:
Being courageous: Making tough decisions thoughtfully, carefully, and prayerfully.
Practicing discipline: Demonstrating self-discipline in everyday behavior, controlling one's thoughts, behaviors, words, temper, and moods.
Showing love: Going beyond the usual emotional definitions of love, to a choice that is made to do the hard work of loving people by being tender when needed, tough when necessary, and sacrificial when called for.
Courage: Spiritual courage is at the core of all courage. The hardest form of courage is tested when one's faith, integrity, fears, and doubts are being stretched. It takes courage to grow in relationships where one needs to be vulnerable and take risks. It takes courage to make moral decisions viewed as unpopular. It takes courage to stand alone when everyone else goes the other way. A courageous leader is one who acknowledges his or her fears and faces them, instead of running away or blaming others. It takes courage to operate ethically and morally when one is viewed as idealistic or hopelessly out of date. Leaders who demonstrate spiritual courage understand that this is not an optional character quality, but a transformational way of thinking.
Discipline: One hallmark of 21st century America is instant gratification. The idea that achievement must happen quickly and expediently is a common expectation, even in the workplace. However, the aspect of achieving success through delayed gratification calls for a certain level of personal discipline. When leaders are not self-disciplined, the results are usually disastrous, as evidenced by recent events in the financial world (Lenzer, 2008). Leaders who value self-discipline display composure, presence of mind, cool-headedness, patience, and restraint, even in the most difficult situations. The simplest definition of discipline is the quality that allows a person to do what needs to be done even when he or she does not feel like doing it.
Love: This is a difficult concept to sell to leaders who are motivated by goals to achieve, quotas to meet, and deals to be cut. These become so important that people are either a means to an end or unnecessary obstacles to their progress. Tenderhearted people develop a tendency to empathize with others and to feel what they are feeling. Leaders who do not feel this kind of love for others can look at those struggling, hurt, or upset and realize there is a problem, but lack compassion toward them. Tenderheartedness goes beyond feeling. It regards each individual as a person of unique worth and value, and a tenderhearted leader demonstrates worth and value to all. The downside is the possibility of being too tender and allowing oneself to be manipulated and ineffective. The flip side of tenderhearted love is tough love.
Leaders who realize tough love is necessary have firm convictions about two important things: (1) it is more important to tell the truth than to keep the peace, and (2), the well-being of the other person is more important than maintaining their current comfort level. People who express tough love are able to make tough decisions for the sake of others while maintaining sensitivity and compassion. Love can also be sacrificial; being both tough and tender requires time, energy, effort, and all the emotional resources that the leader can summon. Leaders who are truly fulfilled in their role understand the sacrifices demanded by this role. Loving people and loving what one does can be very hard work, but the payoff is tremendous.
Developing this kind of character does not come with education, training, seminars, good resolutions, or checklists. It requires a total commitment to a source outside of oneself (to Jesus Christ, in my worldview), a lot of hard work, years of being faithful when no one notices, and experiences of pain before character becomes consistently noticeable to others. Leaders of this caliber recognize that strength of character is an urgent need not only for them but also for society.
The process of becoming a serving leader demands that one understands one's own strengths and weaknesses and acknowledges them. Daniel Goleman (1998) discusses the need to have emotionally intelligent people in the workplace. He describes an emotionally intelligent person as one who displays the following characteristics:
Self-Awareness: The ability to recognize and understand your moods, emotions, and drives as well as the effect they have on other people.
Self-Regulation: The ability to control or redirect disruptive impulses and moods and the propensity to suspend judgment and think before acting.
Motivation: A passion to work for reasons that go beyond money or status, and a propensity to pursue goals with energy and persistence.
Empathy: The ability to understand the emotional make-up of other people and skill in treating people according to their emotional reactions.
Social Skills: Proficiency in managing relationships and building networks, and ability to find common ground and build rapport.
Do you desire to be a servant leader? Rate yourself using the questionnaire in Table 3, which incorporates components of a) Greenleaf's servant leadership, b) worldview, c) character, and d) emotional intelligence. The questionnaire is designed to elicit qualities of servant leadership. Discover areas where you fall short and determine to set a course of personal growth.
The metaphor of servant leadership is a powerful model for today's leaders. Customers (patients, families) and our colleagues need nurses who are servant leaders; employees need leaders who listen to and empower them, rather than dominate or tell them what to do. If leaders pay attention to the qualities mentioned, an important framework is built to ensure long-term effects of related management and leadership approaches. Meaningful change is created when servant leadership is used as a foundation for all leadership activities. Leaders of the 21st century must employ ideas, values, and emotional energy to develop future leaders throughout all levels of the organization. If leaders have a teachable point of view combined with a special focus in developing others, it ends as a win-win situation.
Leaders with a new dimension of leadership skills can begin doing things differently from old patterns or habits, such as helping people to integrate their personal values with the values of the workplace and be able to explain the paradoxes when the values collide. Instead of focusing only on technical skills, strategy, organizational issues, fiscal viability, etc. (all of which are important), servant leaders are also able to deal with hard and soft issues of relationships and valuing of people. If leaders in an organization cannot create a culture that values both personal integrity and empowerment of their people, then all one has is formal leaders and not true leadership. The new culture of leadership develops out of a deep sense of stewardship about oneself and others. But leaders must constantly revisit their mission to ensure that their current structures and systems are in alignment with the mission. Otherwise people in the organization lose a sense of what they are about and why there are there. People with different personalities, different approaches, and different values can and do succeed, not because they are made to, but because they have a genuine desire to serve each other. When serving, loving, and caring for one another is at the heart of any organization, results and success follow naturally.