However, in hospital systems, academic medical centers, and even private practices, leadership is often addressed in a more sporadic and passive manner. Formally coaching staff when they take on minor leadership roles is not common. Periodic assessment of leadership skills is also uncommon when compared with assessment of the productivity of that unit's activity. The attitude often is, “I will know strong leadership when I see it”—once again a passive approach.
And even in that situation, whether a leader is personally popular or on good terms with the boss often carries more weight than leadership skills. We often forget that a unit may succeed despite the leader and that its success could/should have been even greater. Sometimes a leader is the smartest person in the room or has an aggressive approach that cows the people under him; that may secure his position, but it doesn't mean he is a good leader.
I believe that most successful leaders are born with some leadership ability; perhaps 25 to 50 percent of leadership skills come from their DNA and early environment. There is often some sign from private life that suggests a person has some leadership ability. But that still leaves a lot of room for development.
In trying to study leadership and what skills are most critical, the major source is business books. The problems with these sources are that many are poorly written, maddeningly repetitious, idiosyncratic and/or not generalizable to medical institutions; many also have a lot of fluff and blank spaces with very little meat.
A few business books, however, are quite good, with insight based on experience and data, rather than the weaker and more common source of anecdotes and individual case studies.
A book that attempts to sift through the books and find those useful few is The Wall Street Journal Essential Guide to Management: Lasting Lessons from the Best Leadership Minds of Our Time, by Alan Murray, the Deputy Managing Editor of the WSJ. Murray has collected wisdom from a handful of the best thinkers on leadership and management.
I strongly recommend this book (2010; ISBN 9780061840333, HarperCollins; also available in a Kindle edition), but for those who prefer a shorter version, read on.
I have extracted from the book some high points using the following guidelines. The book goes much deeper on related subjects in chapters on Teams, Financial Literacy, and Going Global, but I am focusing mainly on the core values of the Leadership and Management chapters.
Also I selected those points that are relevant to systems of medical care and academic medicine, and that resonate with me from personal experience, thus “verifying” the applicability to medicine of the pearls of wisdom. Finally, Murray cites his sources carefully and I will also do so, both to credit the authors and in case you wish to go deeper into particular ideas.
Differences between Management & Leadership
What is the difference between management and leadership? (Warren Bennis, On Becoming a Leader. 1998)
* “The manager administers; the leader innovates.
* The manager is a copy; the leader is an original.
* The manager maintains; the leader innovates.
* The manager focuses on systems and structure; the leader focuses on people.
* The manager relies on control; the leader inspires trust.
* The manager has a short-range view; the leader has a long-range perspective.
* The manager asks how and when; the leader asks why and what.
* The manager always has his eye on the bottom line; the leader's eye is on the horizon.
* The manager does things right; the leader does the right thing.”
Two caveats on this list: First, managers may appear far less valuable than leaders, but both are needed for the success of complex organizations. Second, in recent decades where value comes increasingly from the knowledge of people, and where workers may no longer be undifferentiated cogs in an industrial machine, management and leadership may be difficult to distinguish because the traditional skills listed for each are often necessary for both. This often applies to medicine in all its forms.
People not only look to managers to assign work but also to define for them a purpose, organize them, and nurture their skills. Peter Drucker, a guru on the subject, was one of the first to recognize the “knowledge worker” and the changes that meant for organizing work. He said the knowledge worker needs leadership more than management; the goal is to help make the specific strengths and knowledge of every individual more productive. This seems particularly applicable to the rapid changing field of medicine and its skilled employees.
Common Mistakes of New Managers (Linda Hill, Harvard Business Review, 2007)
“Myth 1: Managers wield significant authority. Most new managers are shocked to learn how constrained they feel. One new manager said, “Becoming a manager is not about becoming a boss. It's about becoming a hostage.” They are enmeshed on a web of relationships with bosses, subordinates, peers, and others in and outside the organization. They must recognize that authority is a myth and that they must negotiate their way through that web of interdependencies or face frustration and failure.
* Myth 2: Managers must control their direct reports. New managers are often insecure in their roles and think their titles confer authority. Over time, good managers learn that they must earn the respect and trust of subordinates by demonstrating their own character and competence and the ability to get things done.
* Myth 3: Managers must focus on forging good individual relationships. Managers need to focus on building a team above personal relationships. Making friends is fine as long as it doesn't get in the way of the key elements of the manager's job. Linda Hill, who studies new managers in depth, believes they must focus on “-harnessing the collective power of the group to improve individual performance and commitment.”
Leadership in a Crisis – How to Be a Leader (Bill George, Wall Street Journal —3/25/09))
* “Leaders must face reality. Leaders need to look at themselves in the mirror and recognize their role in creating the problems. Then they should gather their teams together and gain agreement about root causes. This is a crucial step; attempting short-term fixes that address the symptoms of the crisis and not causes only assures they will lapse back into the same problem.
* No matter how bad things are, they will get worse. Many leaders cannot believe that things could really be so grim. This causes leaders to undershoot the mark in taking corrective actions. They frequently take a series of steps, none powerful enough to correct the downward spiral. It is far better for the leader to anticipate the worst and get out in front of it. All I can say to this is “Amen!”
* Before asking others to sacrifice, first volunteer yourself. Everyone is watching to see what the leader will do. Will they stay true to their values? Will they be seduced by short-term rewards, or will they make near-term sacrifices in order to fix the long-term situation?”
There is much more in Murray's book and I will deal with other issues in a future column, but if you want to go deeper yourself, get the book.© 2012 Lippincott Williams & Wilkins, Inc.
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