How Effective Leaders Harness the Future : Academic Medicine

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How Effective Leaders Harness the Future

Souba, Wiley MD, ScD, MBA; Souba, Matthew MSc, MLitt

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Academic Medicine 93(2):p 166-171, February 2018. | DOI: 10.1097/ACM.0000000000001955
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Human beings are fundamentally future oriented. Most of our decisions and undertakings are for the sake of a future to which we are committed or obligated. This future orientation is essential to effective leadership in health care, especially during this time of significant reform, when people are at risk of becoming cynical and disengaged. Conventional thinking holds that our effectiveness as leaders is primarily a function of what we have learned in the past—our knowledge, expertise, and experience. In contrast, the emerging model contends that our effectiveness is also a function of how the future (outcome) of our leadership challenges “shows up” for us. If, despite daunting circumstances, we can “see” an aspired future ahead, we are more likely to commit and engage. Our story of the future becomes the “narrative frame” through which we see and tackle leadership challenges today. Because organizations are fundamentally networks of conversations, an organization’s ability to create new language practices is tantamount to its ability to evolve. What makes the future compelling is the embodiment of our deepest convictions and ideals in our image of the future. Because health care reform has challenged the medical profession along the entire spectrum of its traditional values and roles, working toward a unifying vision of the future has been difficult. To enroll others in creating a better future, effective leaders must underscore the purpose and importance of their work and motivate them with inspiring stories.

To live as a human being is to be oriented toward a future. “While we live in the present, and draw upon the past,” writes Queen’s University professor of philosophy Paul Fairfield, “human life is inherently future-oriented in the sense that our choices and actions are undertaken with an anticipation of what they will bring about.”1 Whether our task is submitting a grant, caring for patients, or mentoring students, our endeavors are for the sake of a future to which we are committed or obligated. Our intentional actions, whether we are aware of it or not, include some view of the future—as we presume it will be, as we wish it to be, or as we dread it might be.

Nearly a century ago, the German philosopher Martin Heidegger identified the future as the primary temporal dimension of human existence, a dimension embodied by our projection forward into unfolding possibilities.2,3 Our existence is always “ahead-of-itself”2 as we incessantly take on our everyday activities for the sake of fulfilling our roles and responsibilities. As we press ahead, we have various choices or possibilities available to us, but they are limited by environmental constraints, the culture in which we have been raised, the traditions and laws by which we are governed, and the fact that we have limited opportunities in a limited amount of time within which to get anything done.4

In pressing ahead toward the future, each of us is also taking a stand on our life and the way in which we will live it. When we promise to provide our patients with the best care possible, we are making a commitment not only to them, but also to ourselves, to be a certain type of clinician. Given our inherent temporal nature, the way in which life “shows up” for us—via our thoughts, feelings, attitudes, and actions—is powerfully shaped by the future into which we are living.5,6 Understanding this future orientation is especially critical in health care now, at a time when anxiety and cynicism are common. By motivating others with stories about the future that are inspiring and engaging, today’s health care leaders must enroll their colleagues in creating an aspired future.

Because leadership is, most fundamentally, a process of communication that fosters the realization of a future that wasn’t going to happen otherwise,5,6 the purpose of this article is to (1) review the temporal nature of leadership, (2) underscore the caginess of the past, (3) highlight the enrollment of others in creating a new future, and (4) examine the role of language in creating that new future.

The Temporal Nature of Leadership: The Future Is Decisive!

Each of us has an implicit leadership theory, a mental model of what a good leader is and what exercising good leadership entails. Conventional thinking holds that our effectiveness as leaders is primarily a function of what we have learned and achieved—our skills, knowledge, expertise, and experience.7 The focus is on how past accomplishments shape the present. Although these factors of performance are undeniably important, the emerging model contends that our effectiveness as leaders is also a function of the way in which the future (outcome) of our leadership challenges “show up” for us (Figure 1)—that is, how we “see” the outcomes of the challenges we are now experiencing. For example, if the anticipated outcome of my recently submitted grant shows up for me as promising (“I believe I will receive a fundable score”), I will be optimistic and excited. On the other hand, if I see being funded as doomed, my ways of being and acting in the present will match that view—I will be dejected and deflated. All the skills and knowledge in the world will not do us much good if we see the future as hopeless.

Figure 1:
Factors that shape and affect leadership effectiveness. The two models are complementary.

No matter how daunting the circumstances we are confronting, if we can “see” an aspired future that is achievable, we are much more likely to be engaged and committed. Said somewhat differently, the future that we are living into or projecting ourselves into is the “narrative frame” through which we see our leadership challenges in the present. Consider narratives such as “This new curriculum is going to really help our students” or “These new quality programs will be great for our patients.” Contrast those inspiring narratives with other disheartening ones, such as “This place will never change,” which still permeate some of our health care organizations today. At the source of our effectiveness (and joy) is the narrative inside of which we are doing what we are doing.

University of Virginia researchers Hernandez and Guarana8 recently demonstrated that job satisfaction and engagement are not only strongly influenced by a worker’s current circumstances but also by his or her expectations for the future. Organizations that are able to project an employee’s career trajectory over time are more likely to have higher engagement and satisfaction. Even employees who work under the most difficult of circumstances will usually remain engaged if the future looks bright.

As a leader, one’s commitment to the future must go beyond one’s individual agenda. Propitiously, a desire to commit to and connect with something bigger than oneself is innate. Research by Andrew Newberg and colleagues9 has shown that there is a “persistent and peculiarly human longing to connect with something larger than ourselves …, [which] is biologically, observably, and scientifically real.” As leaders, the future for which we are taking a stand must be anchored inside a commitment that is bigger than we are, the realization of which fulfills what we truly care about. In the words of Kofi Annan,10 former secretary-general of the United Nations: “To live is to choose. But to choose well, [we] must know who [we] are and what [we] stand for, where [we] want to go and why [we] want to get there.” The future we commit to does not have to be big and bold, but it must be something that is important to us, so that it “fuels” our actions.

The Double-Edged Sword of the Past

While our focus thus far has been on the future, this is not to imply that the past is irrelevant to leadership. Drawing judiciously from past experiences is a primary source of wisdom for leaders and an important determinant of their effectiveness. We can get into trouble, however, when we let certain events from our (often distant) past constrain our choices. Emotional, traumatic events, especially those that occurred in childhood when we were highly impressionable and vulnerable, yet lacked the cognitive and emotional maturity to reason logically,11,12 are retrieved readily, and powerfully influence what we decide is possible (Figure 2). Most of these decisions are the result of the brain’s misinterpretation of something someone said or did decades ago that we misconstrued as meaning we were unacceptable, inadequate, or did not fit in.13 Bestselling author John Green14 reminds us that “you do not remember what happened. What you remember becomes what happened.” The brain’s account of an event (I got a “D” on the exam, so I am dumb) is an inaccurate version of what really happened (I got a “D”), but the brain’s interpretation becomes our truth, our reality. This neural misconstruction leads to false negative beliefs about the self, which can live on for an entire lifetime.

Figure 2:
How coping strategies are created. When we situate a decision from the past (“I’m not good enough”) in the future, the future becomes limited in terms of possibilities for action. Such a restricted future hampers our leadership effectiveness.

For most of us, the past is what shapes our behavior in the present. This is because the past is inappropriately stored in the future such that we unknowingly let what has happened restrict what is achievable. Some lessons from the past are relevant for the future; they can even be lifesaving. Thus, we always, to some extent, live out from our past into the future. But many people are stuck in the past, hamstrung by beliefs that imprison them such that their future is merely a continuation of their past. For example, when I say, “I am not good enough to be a department chair,” or “The study section will reject my grant,” or “We don’t do things that way around here,” I have already created a frame (narrative) that limits what is possible in the future. Those lingering narratives that were generated decades ago (e.g., “I am not good enough”) are warehoused in the future because they remain unresolved. They are still “pending cases,” so to speak.

When incidents from our past—especially those stressful, emotional experiences—are unresolved, we tend to relive them over and over. Resolution, sometimes referred to as “completing the past,”15 involves, figuratively, putting the past back in the past where it belongs. The expression “completing the past,” as we use it here, does not refer to ending the past. Rather, it is used to signify getting closure. Although the past cannot be eradicated, it can be reinterpreted (relanguaged, renarrated) so that its chokehold is loosened. As a result, space (room) is created in the future for previously unavailable ways of being a leader and enacting effective leadership. This process of resolving the past is the ontological equivalent of cleaning out your attic.

Not only is our recollection of the past generally inaccurate (we remember and distort selectively), it is almost always exaggerated or overstated. Nearly five centuries ago, Michel de Montaigne, the French Renaissance philosopher, said, “My life has been filled with terrible misfortunes, most of which never happened.”16 Indeed, most of our imagined catastrophes never materialize. Moreover, the past is frequently taken to be permanent and unalterable, but, as Boston University Professor Peter Berger17 argues, this assumption is incorrect:

Common sense is quite wrong in thinking that the past is fixed, immutable, invariable, as against the ever changing flux of the present. On the contrary, at least within our own consciousness, the past is malleable and flexible, constantly changing as our recollection reinterprets and re-explains what has happened.

How does one go about getting closure with the past? The process begins by recognizing that no matter what our past, it does not have to determine our future. Most of us have more say over our future (and the past) than we think we do. Although the facts of our histories are what they are, we can reinterpret or reframe them and, in so doing, put our disempowering narratives back in the past where they belong. Completing our past involves altering the framing (narrative) lens, through which we interpreted the situation we were dealing with decades ago, that led to the decision that we are not good enough the way we are. This allows us to reinterpret our past so that what happened (the facts) shows up differently (context). In creating a new frame of reference, we begin to act in response to the facts rather than the drama of our narrative. Rather than seeing the “D” that we got on the test through the framing lens of “I am dumb,” we see what happened through a lens of compassionate objectivity. This allows us not only to empathetically understand that at the time we diagnosed ourselves as “dumb,” we were too young and egocentric to separate ourselves from our experience, but also, now, as adults, to separate the facts of what happened long ago from the story we have told ourselves. The fact is that I got a “D.” “I am dumb” is a just a story I manufactured. Completing our past is liberating—it moves the past back into the past and liberates the future, a future no longer confined by “I am not good enough.”

Exemplary leaders do not let failures from the past dictate the future. They reinterpret those failures as experiences that were critical for their learning and for building resilience. Sadly, some leaders keep encumbering incidents from their past alive for decades, and they live into a default, fated future, one that is largely an extrapolation of the past.

Creating a New Future

To recapitulate, although all of our encounters have a temporal structure, the way in which the future shows up for us—that is, hopeless versus hopeful—shapes our ways of being and acting today.5,6 In turn, our moment-to-moment, situation-to-situation ways of being and acting determine our effectiveness as a leaders, which shapes the future that unfolds. The good news is that we can change (reframe) the way in which the future we are living into shows up, thereby altering our effectiveness in life. “To a startling extent,” says forecaster Dan Burrus,18 “our vision of the future is a self-fulfilling prophecy. Change your view of the future, and you direct your future.”

Harvard Professor Amy Edmondson19 outlines three stages for creating a new future: (1) Envision a compelling future, (2) enroll people in realizing that future, and (3) engage them in figuring out what work must be done to fulfill the new future. Implicit in this process is that the future envisioned is important to us, one we care about deeply. “The individual must care if he is to act on his anticipation,” stresses former Princeton Professor of Psychology Sylvan Tompkins20: “If I am not excited by or delighted at the prospect of a possible future state of affairs, I cannot otherwise be governed by positive possibility.”

To enroll others in creating a new future, effective leaders must remind them regularly of the purpose and importance of their work. Leadership works best when people are valued as individuals more than as vehicles of abilities or achievements. Moreover, explaining to others why change is necessary and urgent is a frequently overlooked task. Changing people’s entrenched beliefs and behaviors, which have helped them be successful for decades, almost always requires a story about the future that engages and captivates them. That future, which is only a possibility today, must be appealing enough to draw people out of their comfort zones and accord them the necessary courage to take on the status quo. It must be realistic enough to occur for people as feasibly achievable. Simultaneously, the future must allow them to show up for themselves as capable of effecting it. And, the new future must be inspirational enough to unite and align them so that their decisions and actions can be coordinated efficiently and effectively.

Although there are several ways to convey the manner in which some “thing” (object, person, leadership challenge, etc.) shows up for us, the best (most accurate) way is almost always through language. There may be something uncertain or inexpressible about what we are attempting to express, which limits our ability to convey it, but, indeterminate or not, we can communicate what it means to us only by way of language (see below). Wharton Professor Andrew Carton21 stresses the importance of articulating a future using image-based words to trigger sensory information that captures a graphic picture of the future, one that employees can easily imagine. When leaders include vivid images in their communications, they are transporting employees to the future by telling snippets of a compelling story—a story that captures events that have yet to unfold. In a recent study of 151 hospitals, a specific combination of leadership messages—a large number of sensory images combined with a small number of core values—was shown to boost performance by triggering a shared sense of the organization’s ultimate goal and teamwork.22

Futures anchored by a commitment that is larger than leaders’ personal agendas are powerfully effective—invariably, they embody a concern that employees care about deeply and for which they can unconditionally take a stand; they bring about a revision in the employees’ narrative lenses and the way the circumstances they are currently dealing with occur for them; and they give team members the courage to break free of long-standing constraints. Committing to such a future will give leaders the power, freedom, and intrinsic self-expression to lead effectively in dealing with the circumstances they confront. New ways of being and acting will emerge. When others experience leaders who are committed to a future that is bigger than they (the leaders themselves) are, a halo effect occurs, and that experience motivates the others to follow.

A compelling future will alter how people think and act in the present. Check it out yourself. Think about a situation where achieving some goal motivated you to go the extra mile, a mile you would have passed on if the goal (the future) had not been as captivating. The future is a means or vehicle to alter behavior, right now, in the moment. Many of our present decisions and actions depend crucially on our beliefs about the future.

At its essence, reform or institutional change is about people; it is imagined by people, led by people, wrought by people, and can be thwarted by people. Because most of us are risk averse, we tend to resist adopting new ways of being, thinking, and acting. A change in the way in which the future shows up for us is the most practical way of altering our behavior in the moment. Reenvisioning a hopeful future and taking steps to realize that future has taken years in health care, but the “old” model (which many of us still remember well) is finally being ousted. “You never change something by fighting the existing reality,” Buckminster Fuller has written, “To change something, build a new model that makes the existing model obsolete.”23 We can alter behavior with mandates and decrees, but the best way to get people on board is to articulate a future that is alluring enough, worth going after enough, that they will think and act differently.

The Future Lives in Language

If time is the horizon through which we encounter and experience leadership, language is the medium through which we understand and interpret it. Comprehending any concept (e.g., “leader,” “leadership”) is inseparable from language. Although not all being can be reduced to language (William James24 characterized certain experiences as ineffable), sensemaking—“being that can be understood”—is always linguistic, and it is this linguisticality that renders it interpretable.25

Every organization is, most fundamentally, a web of thousands of conversations that occur, almost unknowingly, day in and day out. An organization’s ability to create new, relevant language practices is tantamount to its ability to evolve.26 Donald Sull, senior lecturer at the Massachusetts Institute of Technology Sloan School of Management, and consultant Charles Spinosa stress that leaders can overcome some of their thorniest problems by introducing what they call “promise-based management.”27 By more effectively using a simple speech act—the promise—leaders can model how to use language to create an aspired future. Promises are the fundamental fibers that weave together orchestrated actions in organizations. Sull and Spinosa27 write:

Promises are the fundamental units of interaction in businesses. They coordinate organizational activity and stoke the passions of employees, customers, suppliers, and other stakeholders. While they hold an organization together, they are as fragile as they are crucial. Individuals’ divergent worldviews and objectives tug constantly at the filaments of promises, and unexpected contingencies can tear precarious agreements. Leaders must therefore weave and manage their webs of promises with great care—encouraging iterative conversation to make sure commitments are fulfilled reliably.

For leaders in particular, language brings forth, out of the unspoken realm, innovative ideas and possibilities. Leaders develop possibilities by creating linguistic distinctions that prompt cognitive shifts in others, jarring them loose from their entrenched worldviews. We are drawn to future-oriented leaders who articulate a compelling vision in a way that speaks to us and includes us. In so doing, leaders yank us out of the status quo, lift us out of our usual selves into our best selves, and mobilize us to take action. Without something like a transformation—inspired by an expressed vision or outcome—your future is likely to be a continuation of your past.

Professor Jens Beckert,28 managing director of the Max Planck Institute for the Study of Societies, points out that it is through narrative that images of future states become explicit. In shaping what we do, how we do it, and why we do it, these narratives are compelling. Expressed images of the future can inspire action in the present so as to close the gap between the two. It is the future that shapes the present—or, to be more specific—it is the images and articulations of the future that shape present decisions.29

Drawing from Georgetown Professor William Blattner,30 understanding yourself as a leader is not about bringing about some possible, future state of yourself. The possibility of being a leader is not an end state or goal; it is not something that you “someday will be.” You are always becoming. Regrettably, for most of us, the future, or our future self, is an extrapolation of the past that lives in descriptive and comparative language—for example, “I’ll never get that job because I don’t have an impressive CV” or “If I speak up (against the status quo), I’ll be labeled a non-team player.” In contrast, future-based language does not describe anything in the present reality. Instead, it linguistically creates a possible future to which the speaker is giving his or her word in the moment of speaking; thus, rewriting the future begins with shifting how the leader occurs for him- or herself.31 As a leader, creating a new future for one’s organization usually means reinventing oneself. A different self must show up each day. Said otherwise, every system—the human operating system is no exception—is built exactly to get the results it gets. Because every system also has a design limit, a jump in performance invariably means new ways of being and acting. Because our lives are constituted in and through our written and spoken conversations—which establish the frames within which we become aware of ourselves and others and within which we set goals—one of a leader’s most important tasks is to jettison the disempowering stories that limit his or her freedom to lead. We need a language that can jar ourselves and others loose from the engrained beliefs and assumptions so that we can create a new future for health care.

Because the future we are living into shapes our way of being and acting in the present, we can each jumpstart our own transformations by asking the following question: What can I say about the future that is compelling (important) enough that I am willing to go to the mat for it? What can I articulate about a future that is greater than my own personal agenda? What can I express about the future that is not run by my limiting stories from the past? and What future will grant me ways of being and acting that align with my intrinsic self-expression as I tackle my current challenges? A stand on behalf of a powerful, compelling future alters the possibilities in the present. What was previously unavailable is now a possibility (Figure 3). When we create a new future, our circumstances do not change, but they now exist in a new frame, in a new light.

Figure 3:
The future we are living into shapes our ways of being and acting in the present.

Our ability to create and sustain our vision of the future is only partly derived from reason and intellect. Four-time presidential advisor David Gergen32 emphasizes that the inner soul of a leader flows into his or her decisions and actions far more than is generally recognized, and the leader’s values often shape his or her agenda during his or her time at the helm. It is the embodiment of our deepest convictions, values, and ideals in the image of the future that suffuses that future with energy and staying power.

Because health care reform has challenged the medical profession along the entire spectrum of its core values and its traditional roles, it has been increasingly difficult to create a bold unifying future (vision) behind which people can line up. Furthermore—and this is a distinction worth emphasizing, or reemphasizing if it is already apparent—although most of our endeavors are for the sake of a future to which we are committed or obligated, life is actually lived in the present. The future, ironically, never actually comes; it only appears to be coming. What actually comes is the present; the future is merely anticipated. Thus, to enroll others in creating a better future, an effective leader must remind them regularly of the purpose and importance of their work (their goal, the outcome) and motivate them with inspiring stories (images, promises) of what is to be.


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