Perspective: The Language of Leadership : Academic Medicine

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Perspective: The Language of Leadership

Souba, Chip MD, ScD, MBA

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Academic Medicine 85(10):p 1609-1618, October 2010. | DOI: 10.1097/ACM.0b013e3181ee0045
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Human meaning is not given before language in and by some detached, prelinguistic domain and then labeled with words. Rather, language itself, always already ardently at play in our lives, is constitutive of the realities of our experience, opening up to us a uniquely human world. Language is the bridge between the created present and the uncreated future, affording leaders of medical schools with an underused opportunity to transform academic medicine. In creating and exchanging meaning, good leaders translate ambiguity into clear messages that convey the rationale for change and enroll others in a compelling strategy that fosters alignment and commitment. Because language influences our thinking and emotions, it is most powerful and effective for tackling challenges that rely heavily on conceptual, innovative solutions as opposed to those problems whose solutions are simple and technical in nature. However, many leaders in academic medicine spend much of their time in the domain of content, where issues are understandable, strategies are familiar, and solutions are seemingly apparent. Complex problems cannot be tackled by solely addressing content; the issue in question must be situated within an appropriate conversational context to provide a basis for action. Leaders do this by creating linguistic distinctions that prompt cognitive shifts in others, jarring them loose from their entrenched worldviews. This property of language—its ability to bring forth, out of the unspoken realm, innovative ideas and possibilities—will determine the future of our health care system and our world.

Imagine practicing medicine without being versed in the language of medicine, including all its formal terminology and informal jargon. Without access to this specialized linguistic domain, physicians couldn't understand normal physiology or pathophysiology. They would be incapable of synthesizing findings from the history and physical, labwork, and imaging studies to make a diagnosis. Words like marasmus, fistula, and tinnitus would make no sense. Communication in any kind of meaningful way with peers or patients would be unworkable.

Similarly, picture being a basic molecular geneticist without an understanding of terms like knockout, transgenic, vector, phenotype, or RNA interference. Without conversational access to the specialized language of molecular genetics, the context in which molecular geneticists work to make discoveries would not exist. Research would have little meaning to them, and they would be unable to relate to other scientists.

Command of the language of medicine provides clinicians with a resource that allows them to make sense of and interact with the world of illness and patients differently from those individuals who lack that faculty. Similarly, the language of research affords researchers a special perspective that enables them to experience the world of science uniquely and to connect with colleagues distinctively. These conversational domains (linguistic spheres), when learned, become contextual frameworks that use their practitioners to create the being and action that is necessary to be experts in their fields. Bruffee1 writes, “In any discipline … entities we normally call reality, knowledge, thought, facts, texts, selves, and so on are constructs generated by communities of like-minded peers.”

The language of leadership is no different. It is a context that generates access to the world of teams, departments, and organizations in a distinctive way, creating an opportunity to lead more effectively. But unlike the language of medicine and science—which is adeptly used by physicians and researchers—the language of leadership is uncommonly practiced with equivalent competence. One reason for this disparity is that we don't have a consistent and agreed-on language of leadership.2,3 The words leader and manager are used interchangeably by some people. To others, they denote very different activities. Moreover, language is generally thought of as a tool that labels; its constitutive nature (defined below) is less frequently appreciated. It is difficult to talk consistently about leadership, let alone exercise it effectively, without a shared understanding.

When we talk of mastering the language of leadership, we mean much more than becoming familiar with the meaning and application of words like vision, strategy, and culture. Kockelmans4 points out that “language is not essentially and exclusively for communication, it has a more important function within the tissue of experience. It is because man speaks that he has a world.” Everything we have created today, from the CT scanner to the U.S. health care system to the salaries we pay our faculty to the microchip, has been brought into existence through language. Language is the vehicle we use for making decisions, resolving most disputes, enacting legislation, sharing research discoveries, and articulating new possibilities. Without command of the language of a particular domain, be it leadership, medicine, business, or science, one cannot practice effectively in that domain.

Language is the critical link between the created present and the uncreated future.5 This connection gives language enormous clout. But the language of leadership, unlike the language of medicine, is not a skill that students, residents, or faculty necessarily acquire during their training. While we prepare our young people well for the practice of medicine and research, we often fall short in preparing them for the practice of leadership.5,6 Like mastering any language or skill, the language of leadership has to be learned, honed, and practiced.

Consider the microvascular surgeon who, on discovering the “distinguishing” power of his or her optical magnifying loupes, remarked “I had no idea how much better I could see through these lenses. I notice things in a whole new context, one that I was unaware of before. I can see the tissue relationships from a different perspective, in a new light.” Much as surgical loupes can provide the surgeon with an advantage, leaders have access to a linguistic equivalent that allows them to distinguish the world more perceptively, thereby enhancing their effectiveness. In exploring the linkage between language and leadership in this article, the word language is taken to include not only spoken and written communication but also body language, facial expressions, tone of voice, and any other actions that have symbolic intent.7

Language and Human Evolution

Our ability to use language in a sophisticated manner is the single distinguishing characteristic that sets us apart from other animals.8 Language has enabled humans to bring to fruition inventions (urbanization, manufacturing, telecommunications) that have made social progress possible. Unlike Darwinian evolution, where the environment is the genetic sculptor, traits in cultural evolution are passed on through language from one generation to the next.9 This process, however, is not random—it is faster, more purposeful, and more strategic. For language to enter the repertoire of human activities, it had to convey an adaptive advantage from its earliest stages, or it would never have been conserved.10

Today, language is the critical sculptor of our future. Tom Wolfe, author of The Right Stuff, notes,

Once you have speech, you don't have to wait for natural selection! If you want more strength, you build a stealth bomber; if you don't like bacteria, you invent penicillin; if you want to communicate faster, you invent the Internet. Once speech evolved, all of human life changed.11

Whereas biologic evolution was the principal if not sole determinant of change for hundreds of millions of years, the recent introduction of language as an adaptive tool changed the possibilities. A noted authority12 explains, “What is happening is cultural change; within the envelope of the language faculty, languages are recycling the limited alternatives that this biological envelope makes available.”

Talk is the most ubiquitous social activity that human beings engage in. Not surprisingly, it is language that builds the social and cultural worlds we live in. It is a critical exploitable resource for exercising more effective leadership in academic medicine.

The Constitutive–Symbolic Duality of Language

It is increasingly accepted that human meanings are not given beforehand in an objective, prelinguistic realm, and then represented in words; rather, language itself, at work in the interactions of daily human existence, adds the meanings, and in so doing shapes the world.13 The writings of Dewey,14 Heidegger,15 Gadamer,16 Hyde,13 Deetz,17 Stewart,18 and Anton19 maintain that language (communication) is not merely symbolic but first and foremost constitutive. Speech is firstly consequential and secondarily referential.19 To say that language is constitutive means that language itself grants the specific nature of what it refers to, as something known that possesses characteristics that are distinguished and described using words (e.g., “The table is brown and three feet tall). Everything that is known is known by someone. There isn't something known that isn't known by someone. There is, of course, much that is unknown—unlanguaged and not known by anyone. How we “know” something—how we make sense of it and experience it—lives in language. Relativity was not known until Einstein discovered (“languaged”) it.

A desk, for example, is not a desk before language, even though it may exist as a physical object. Moreover, when we consider an object such as a desk, we are less interested in the desk itself and more in “the how of its intendedness.”19 We are interested in how the desk discloses itself through and by the different ways we can meaningfully engage and interact with it: by writing on it, decorating it, situating it in an office, etc. As succinctly stated by Gerkin,

Language constructs world. To have a world, to live in a world, means, for humans, to inhabit a time and place in which a certain language is connected with experience to give meaning to that experience…. Whenever any event occurs in our lives, be that so small an event as stubbing one's toe on a crack in the sidewalk, or so large and significant an event as entering into a marriage or contracting a dread disease, it does not become an experience to us until language is attached to the event and it is given meaning.20

This performative function of language conveys its ability not just to communicate information or label things but also to bring about or effect actions in accordance with social conventions.21 Heidegger15 reminds us that we do not just speak language; language also speaks us.

Deetz17 elaborated on this generative (constitutive) nature of language:

That which is revealed, understood, and held is in language…. Things without words are static entities; language makes things into possibilities of experience…. The object is constituted—given its specific nature—only in the human encounter.

John Searle22 characterized this uniquely human capability when he wrote, “My dog can see a person carry a ball across a line; but what he cannot see is the person scoring a touchdown.”

The constitutive (presentational) and symbolic (representational) properties of language are thus two sides of the same coin. They are complementary—“what we talk about, refer to, or symbolize, is never independent of us; we always already have had something to do with anything we make meaningful assertions about.”19 We are born into language such that we inevitably continuously stand and live in language. Things (objects, people, conversations, situations, relationships) are events in the world whose meaning reflects how they are perceived, interpreted, experienced, and represented. As Wachterhauser explains,

Far from separating the intelligibility of the world from us, or substituting its own intelligibility, the thesis that “Being that can be understood is language” roots language in the world and points instead to its integral connection with the things themselves.23

Reality does not exist outside the process of representation. Hence, to speak is to be in collusion with reality as eloquently articulated by John Dewey14 in his magnum opus Experience and Nature:

When communication occurs…. Events turn into objects, things with a meaning…. Where communication exists, things in acquiring meaning thereby acquire representatives, surrogates, signs and implicates, which are infinitely more amenable to management, more permanent and more accommodating, than events in their estate.

Dewey is affirming that language enables us to convert events and occurrings into “talkable” objects that are meaningful in the sense that we can name them, categorize them, debate them, and engage them. Consider the phenomenon we call a sunset. You might describe the experience as a mix of orange and red colors. A photochemist would say that the intense hues are due to light traveling at a shallower angle and traversing more atmosphere such that longer wavelengths (reds and oranges) are detected by the eye. A theoretical physicist might explain that all those photons and particles at play in creating the visual image we call a sunset are really not matter; rather, they are complex subatomic events or occurrings that we turn into things by using words like wavicles and strings. Without this ability to convert an event or an occurring into an object, we could not make meaning of or participate meaningfully in the world. Our “reality” is a constructed interpretation constituted inside a shared language that functions as a kind of lens that makes reality more intelligible, opening up to us a distinctively human world. Thus, while reality is not created solely by language, as humans we have the world we have because we have language. Our truth reflects the way the world has linguistically disclosed itself to each of us in our experience.

Language and Sensemaking

Sensemaking, that is, making something “sensible,” is a uniquely human capability.24 “What gave our species its ascendency,” writes Bickerton,10 “was not so much the power to communicate as the power to think, to imagine, and to plan, using our language-constructed model of reality as an arena in which to rehearse possible future actions.” Virtually all sensemaking is socially constructed inside of the conversations that we have had, are having, and will have. “Sensemaking,” note Weick and colleagues,25 “is central because it is the primary site where meanings materialize that inform and constrain identity and action.” Conversations are thus powerful, underleveraged instruments leaders can use to invent a high-performance future.5 In the leader's role as a sensemaker and sensegiver, language can provide a competitive advantage in leading organizational change.26

Organizational members ascribe and credit leadership to people who structure experience in a meaningful way. Smircich and Morgan27 write, “They emerge as leaders because of their role in framing experience in a way that provides a viable basis for action, e.g., by mobilizing meaning, [and] articulating and defining what has been previously remained implicit or unsaid.” Notice how President Barack Obama acts as “sensemaker” and “sensegiver” by clarifying an uncertain reality for the members of the National Academy of Sciences in his speech to them at their 2009 annual meeting:

[T]here are those who say we cannot afford to invest in science, that support for research is somehow a luxury at moments defined by necessities. I fundamentally disagree. Science is more essential for our prosperity, our security, our health, our environment, and our quality of life than it has ever been before [Applause]…. [S]o I'm here today to set this goal: We will devote more than 3% of our GDP to research and development. We will not just meet, but we will exceed the level achieved at the height of the space race, through policies that invest in basic and applied research, create new incentives for private innovation, promote breakthroughs in energy and medicine, and improve education in math and science [Applause].28

In creating and exchanging meaning, good leaders translate inchoate psychological experiences into an explicit and communicable form to explain their reasons for a decision, to convey their feelings, and to make comprehensible their complex experiences in narrative form.29 This process of meaning-making in a community of practice30 helps people tackle their problems and, in so doing, achieve their collective goals; it is relatively routine for problems that are simple (technical) because, by and large, the issues and their solutions are straightforward.

Adaptive challenges, in contrast to technical problems, are complex learning problems31–34 for which the organization has little or no preexisting experience or solutions. They are complex because they are difficult to get our arms around. They can be solved only by people learning new ways of working them out. Not only are adaptive challenges difficult to grasp and tackle, they are easy to avoid, deflect, or deny. We often unsuccessfully attempt to solve them using technical solutions. For example, we throw money at them—but this tactic is at best a temporary one that may be useful but is never sufficient. Failure to differentiate technical problems from adaptive challenges may be the single most important reason for leadership failure today.34

A consistent characteristic of an adaptive challenge is that there is no common agreed-on understanding of the problem.2,32–35 In other words, different people make sense of the problem differently. They have trouble describing the challenge succinctly. They have conflicting opinions about its causes. They propose different solutions. They have varied opinions about whose responsibility it is to solve the problem. The current debate over health care reform is an adaptive challenge. Physicians “see” the problem through their filters, the payers have a different perspective, the government has its point of view, and the public has its biases. Technical solutions will not adequately reform our health care system; adaptive work will be essential. Adaptive work is always required when our deeply held beliefs are challenged, when the values that made us successful are less relevant or obsolete, and when legitimate yet competing perspectives emerge.33 No wonder the health care reform debate has been contentious.

The professionalism challenge in medicine is another example of a complex challenge. Lucey and Souba36 maintain that the current approaches to enhancing professionalism—reinforcing rules, rewarding right behavior, and removing those who falter—are important but inadequate tactics. They write,

Tackling the professionalism problem as a complex adaptive challenge begins with developing a shared vision (the aspired future state) and a shared understanding of the problem (the current reality). The problem begins here because, typical of all adaptive challenges, there is considerable disagreement about what a culture of professionalism should look like and how much of a professionalism problem exists today.36

Tackling complex challenges is no easy task. The work begins by engaging the various stakeholders in a dialogue in order to develop a shared understanding of the challenge: What are the issues as you see them? What are the hidden assumptions and “elephants” in the room? What are you willing to give up in order to solve this challenge? Accordingly, language is especially critical when it comes to solving adaptive challenges. Why? Because reality is socially constructed24,37 and the language we live inside of and in which we have our conversations prominently affects how we experience circumstances, problems, and people; in other words, how they “show up” for us.

Because language influences our thinking, reasoning, emotions, and actions,38–45 it is most powerful for tackling challenges that rely heavily on conceptual, innovative solutions as opposed to those problems that are intelligible and more technical in nature. Holtgraves and Kashima29 maintain that “the effects of language on cognition will tend to be greater for more abstract and ambiguous domains (e.g., person perception) relative to more unambiguous and concrete domains (e.g., object perception).” This “criticality” of language becomes all the more important, given that the challenges we face in medicine are becoming more complex, more inexact, and more discombobulating.

It is not easy to master and practice language that fosters a shared understanding of challenges that are abstract, associated with palpable emotions, and have less of a physical counterpart. But it can be done, and the outcome can be transformational. When Martin Luther King, Jr., said, “I have a dream that my four little children will one day live in a nation where they will not be judged by the color of their skin but by the content of their character,” his words made sense to and resonated with virtually everyone, regardless of their education, age, gender, social status, or race. His language helped people let go of outdated ways of thinking and working so they could “get on the same page” and create the necessary adaptive leadership to tackle racial disharmony.

Thus, leaders play a critical role in shaping our meaning-making. Consider a team of medical residents trying to figure out (make meaning of) a patient's sudden onset of tachycardia. A differential diagnosis is developed and discussed in an attempt to make “common sense” of the findings. The various assessments, hunches, and insights are integrated using language; without language, the residents could not care for the patient. Language, notes Neuman,46 is what “ensures that an indeterminate signal will find its appropriate conformation, rather than fall prey to an infinite regression of … interpretations.” As so aptly stated by Wittgenstein,47 “The limits of my language mean the limits of my world.”

Language, Context, and Distinctions

The word context refers to the space (domain) in which something—a problem, a situation, a person—shows up or occurs for us. The notion of context involves the fundamental juxtaposition of two entities: a situation (event) and what surrounds the event that is being examined; the latter provides the resources (cues) for the appropriate interpretation of the event.48 Because no two people draw on these contextualization cues in the same way, we each create different contextual frames; that is, we each “see” the world differently. The relationship between event and context is not unlike that between “cultured cell” and “cell culture.” In our own lives, we are the context for “what happens” in our lives. Stuff happens in the context of me. I am the space in which the events of my life occur.49

In every conversation, language acts as a “behind the scenes” conversationalist that mediates between speakers. It is seamlessly woven into the contextual fabric of every organization, regulating the spoken and the unspoken, cloaking the unsaid but conveyed, and defending our lenses and filters. Leaders use language to dynamically refashion the context that provides organization for action within the conversation itself.48 Each additional linguistic move modifies the existing context and, in so doing, creates a new arena for subsequent interaction. In other words, talk itself constitutes the main resource for the organization of context. Malinowski50 argues that language becomes intelligible only when it is embedded within its context of situation; moreover, language is “an indispensible element of concerted human action,” a meaning-making vehicle that directs people to take steps to get things done.

Because our mental maps and frames of reference are linguistically sculpted, they strongly influence our contextual interpretation. For example, Mike's assertion that John can't be trusted puts limits on the range of possibilities for how Mike (and possibly others) deals with John. On the other hand, language can be an undeniably potent resource that leaders use to create an insight that changes people's thinking. Listen to the words that Robert F. Kennedy51 spoke minutes after Martin Luther King, Jr., was shot and killed on April 4, 1968:

In this difficult day, in this difficult time for the United States, it is perhaps well to ask what kind of a nation we are and what direction we want to move in. For those of you who are black … you can be filled with bitterness, with hatred, and a desire for revenge. We can move in that direction as a country, in great polarization—black people amongst black, white people amongst white, filled with hatred toward one another…. Or we can make an effort, as Martin Luther King did, to understand and to comprehend, and to replace that violence, that stain of bloodshed that has spread across our land, with an effort to understand with compassion and love…. What we need in the United States is not division; what we need in the United States is not hatred; what we need in the United States is not violence and lawlessness, but is love and wisdom and compassion toward one another, and a feeling of justice toward those who still suffer within our country, whether they be white or whether they be black.

In the context of what America was founded to stand for most fundamentally, Kennedy's speech helped angry people distinguish that retaliative acts to King's assassination made no sense. His speech inspired them to let go of old concepts (we'll get even!) and long-standing content (years of racial disharmony) that were damaging. This distinction helped people see new possibilities for action. Kennedy created a new context from which new thinking, new behaviors, and new actions could arise. His speech disclosed to people that, in spite of the tragic circumstances of that night, they could intentionally choose not to live a content-dictated life. They could create a new context which could serve as a foundation for taking a stand for a future that was not an extrapolation of the past. On a night where looting, arson, and rioting were widespread in dozens of others cities across the South, there was not a single act of vandalism in Indianapolis. The story illustrates that who we are and who we become are shaped by the linguistic contexts that we create and live inside of.

Many of our problems are revealed in conversations that communicate some sort of perpetual complaint (e.g., “Things will never change around here” or “He will always be a nonteam player” or “If we had their resources we could be great, too”). For example, if my constant complaint is that my boss is a micromanager and an ineffective leader, my thoughts and behaviors in dealing with him will be influenced by that particular way he occurs to me. I could become irritated and judgmental and I may disengage, but I might benefit by getting to be “right” by keeping a mental log of all the times he micromanages. The downside of this racket7 is that my effectiveness at work may diminish and negatively affect others.

My reality, however, could be different. Whether my boss is or isn't a micromanager, a shift in context creates the possibility for different results. I could, for instance, change my context to something like, “He is very detail-oriented and likes to be involved in decision making. His leadership style doesn't make sense to me because the situation occurs to me differently. What can I do to support him so he can focus on our most pressing priorities?” This way of observing offers the opportunity for a very different working relationship. It opens the door for a conversation to explore roles and responsibilities. It creates space for coaching. It generates possibilities that were not available before. If I do not change my context, one thing is sure: My present way of dealing with my boss becomes my “default” future,7 which limits my ways of dealing with my boss. Each of us has the power to create our own context—at work, at home, in every encounter and relationship. Context is critical; it is powerful; it is decisive.

Our interpretations—of people, situations, and conversations—are colored by our experiences, memories, and beliefs. Where we get into trouble is when we treat our interpretations as facts, as objective reality. When that happens, situations and people “are what they are,” and we can't change them. The best we can do in this is/fixed reality is contrive and maneuver a bit here and there as we deal with the all the problems at work that we assume won't change.5 Once we've locked in on the way we believe the future will be, we will fully align ourselves with it in our thinking, speaking, and actions.

Thus, in confronting most any problem,

there's a future that has already been written about it. This future includes people's assumptions, hopes, fears, resignation, cynicism and “lessons learned” through past experiences. Although this future is almost never talked about, it's the context in which people try to create change. These filters and assumptions are called blind spots because we can't see that we have them.7

This creates a dilemma: Since I am in the clutch of my mental models (which prevents me from observing impartially what is actually there), I must free myself from their grasp or at least relax their hold on me. How do I illuminate my blind spots and shift my contextual self's indistinct way of observing so that what occurs to me is as close as possible to what actually is? By making the indistinct more distinct with distinctions.

Distinction is the basis of language and all logic. “Everything is made of distinction…. Every idea contains an implicit distinction between that which it indicates and that which it does not indicate.”52 Because contexts are usually background phenomena, distinctions help reveal them. A language distinction creates a new way of understanding—a new lens, new frame of reference for “seeing” the world we live in. Distinctions are critical because they are the portal to “what we don't know we don't know.” In the act of distinguishing, we reveal obstacles (e.g., invalid assumptions, outmoded beliefs) we can remove and, in so doing, make space for more effective leadership. For example, when I can distinguish that I don't need to act “professorial” to prove myself and be liked by others, I am at liberty to give up that behavior. In the absence of such distinctions, we live automatically into our So-So (same ‘ol, same ‘ol) future, and nothing much changes.5

Language has always been with us, so we take it for granted. Like the air we breathe, it's just there. But it is the most important faculty we have for getting traction in our lives. Language is the primary vehicle we have for creating leverage, for getting a purchase on and a “return” on life. To harness the power of language, leaders must develop an alertness to the unspoken but communicated, and they must create the safety for people to say what they've been thinking but have been unwilling to say. With time, people begin to see the connection between their contextual thinking, their behaviors, and the results they get. They begin to use language not just as a descriptive, comparative tool but as one that invents. Zaffron and Logan7 write,

Future-based language … has the power to create new futures, to craft vision and to eliminate the blinders that are preventing people from seeing possibilities. It doesn't describe how a situation occurs; it transforms how it occurs. It does this by rewriting the future.

Note how HHS Secretary Kathleen Sebelius53 uses language to “rewrite the future” of global women's health in her speech at the Secretary General's Luncheon on April 14, 2010:

Women and girls are particularly vulnerable to ill health and are comparatively underserved by health services…. We know that improving the health of women and girls frees up untapped potential…. When women and girls have access to health care, including family planning and other reproductive health services, we see rapid and lasting progress. When women are valued, educated, and enjoy legal and property rights and protection, and when their reproductive rights are supported, they have smaller families, healthier children, and live longer lives…. Women the world over are primarily responsible for managing water, nutrition, household resources, and accessing health services for their families. When women receive the care they need, their families, communities, and all of society benefit. When women are healthy and can make their own decisions about their reproductive lives, the gains ripple through their entire community.

While context refers to the background circumstances relevant to a particular situation, content refers to the specific conditions of the situation or problem that is being addressed within the background of the larger context. Leaders in most organizations spend much of their time in the domain of content, where the issues are familiar, strategies appear to be straightforward, and solutions are seemingly apparent. This approach is generally successful during times of stability and predictability. But in times of rapid change, when uncertainty and disequilibrium are routine, content-based information, while necessary, is insufficient for decision making. During such tumultuous times, context is as important as content in tackling complex problems. All strategic planning invariably depends on some capacity to situate the issue in question within an appropriate context. As interlocutors interact, language enables them to make meaning.

As a leader, if I can eliminate (or illuminate) my blind spots and biases so that the way that any situation or person “shows up” for me is as close as possible to the way it or that person actually is, the possibility now exists for me, as a leader, to exercise leadership as effectively as possible, in the most natural way for me and with the greatest degree of integrity, authenticity, and humanness. Leaders use the power of language to create insights that nudge us to revise our frameworks and mental maps for viewing the world around us. Writer Kenneth Burke54 emphasizes that language doesn't simply “reflect reality”; it also helps “select reality” as well as “deflect reality.”

The story of the two cancer researchers illustrates the power of context. A few years ago, I was visiting a comprehensive cancer center and had the opportunity to meet with several junior faculty. It was grant deadline time, so many investigators were busy at work putting the final touches on their proposals. I happened to be about 10 minutes early for one of my appointments, so I strolled down one of the adjacent halls. I walked by one open door where a researcher appeared to be busy at work. Not wanting to disturb him but somewhat curious, I stopped and asked, “How are you doing?” The investigator paused and looked up, annoyed by my intrusion and said, “Can't you see I'm writing a grant? I don't enjoy this work. And I know I'm going to get the shaft from the study section. But my chairman insists that I get funded.” I promptly apologized for my interruption and made my way back to my scheduled appointment.

A short time later I met with another researcher who similarly was hard at work. Her desk was covered with reprints, gels, figures, and other important materials. “That looks like hard work,” I said, “and I bet it can be discouraging knowing that the pay line is so unfavorable.” The relatively young woman stood up from her computer and replied while sipping her coffee,

It is hard work and it requires lots of dedication. I know it's going to be many hours before I finish this grant and I know the chances of getting funded aren't in my favor. But, it's a labor of love because I'm discovering a cure for cancer.

The difference between these two cancer researchers was not intrinsic or circumstantial. As the story illustrates, the context we create can powerfully influence the way we live and experience our lives. Our effectiveness (and fulfillment) in life is not so much a function of what we're doing as it is a function of the context inside of what we're doing. The first scientist saw his circumstances—a seemingly hopeless situation manifested as an outwardly defeatist attitude—as determining his experience. His focus, so it seemed, was on content, and, perhaps he lived a content-driven life. In contrast, the second researcher seemed to have more of a context-orientation in living her life. Rather than see herself as a victim of her circumstances—in this case, a lousy pay line—she appeared to be more interested in being the author of her own future. Her stand—for curing cancer—was inspiring, to say the least.

Language, Change, and Performance

Leading organizational change can be understood as a process that is managed and made sense of through language. “The language of change can be a liberating force or an analytical prison,” observe Pettigrew and colleagues.55 Language both enables and limits what and how we think and the actions we take. The word stroke, for example, means one thing in the context of treating cerebrovascular disease but something quite different in the context of playing tennis. Contextual language shapes the way we “make sense” of health care. Parse56 stresses that words like delivery system, consumer, provider, and cost-effectiveness reflect a business-model context rather than a patient-centered one. She writes,

To call health care pathways a delivery system is language that conjures an image of a model with an assembly line of efficiently moving products to consumers…. These words with their images, sounds, and suggestions are so embedded in the health care language that they not only reflect but continue to foster the idea that humans are objects who must fit into a standard system where uniqueness is ignored and personal meaning is not honored.

Attention is the currency of the language of leadership,32 and change requires getting people's attention. Davenport and Beck57 report,

Overall, the factors most highly associated with getting attention in rank order, were: the message was personalized, it evoked an emotional response, it came from a trustworthy source or respected sender and it was concise.

Connecting with the audience in a meaningful way that captures their hearts and minds is a skill that leaders can and must learn. Observe how President Obama personalizes his health care speech to Congress on September 10, 2009:

More and more Americans pay their premiums, only to discover that their insurance company has dropped their coverage when they get sick, or won't pay the full cost of care. It happens every day. One man from Illinois lost his coverage in the middle of chemotherapy because his insurer found that he hadn't reported gallstones that he didn't even know about. They delayed his treatment, and he died because of it. Another woman from Texas was about to get a double mastectomy when her insurance company canceled her policy because she forgot to declare a case of acne. By the time she had her insurance reinstated, her breast cancer more than doubled in size. That is heart-breaking, it is wrong, and no one should be treated that way in the United States of America.58

While the language of leadership must be energizing and engaging, it must also prompt cognitive shifts59 that jar people loose from their entrenched worldviews. While language is not the sole determinant of what can be thought, it clearly influences what habitually does get thought. Kegan and Lahey60 write,

All leaders are leading language communities. Though every person, in any setting, has some opportunity to influence the nature of language, leaders have exponentially greater access and opportunity to shape, alter or ratify existing language rules…. The only question is what kind of language leaders we will be.

Three language commitments—promises, complaints, and stories—each of which involves a shift in speaking practices, can positively influence organizational performance and morale in a short period of time. The first—the promise—is a simple but powerful mechanism that can go a long way in getting things done. Sull61 points out that execution hinges on the quality of promises made and on the consistency with which those commitments are honored. In this context, the objective of conversations for action is to weave a web of commitments that ensures coordinated action. The most effective promises are public (to avoid special deals), actively negotiated, voluntary, explicit, and linked to institutional priorities. Leaders are, above all, their word.

The second, the complaint, is one of the most common negative behaviors observed in many organizations. As energy-depleting as complaints and complainers can be, they do have a silver lining. People do not complain about what they don't care about. Inside the complaint, there is a value that is not being honored, which accounts for the displacement of energy and passion. In other words,

the language of complaint essentially tells us, and others, what it is we can't stand. The language of commitment tells us (and possibly others) what it is we stand for. Without having our complaints taken away and without giving them up, transforming language enables us to make a shift from experiencing ourselves as primarily disappointed, complaining, wishing, critical people to experiencing ourselves as committed people who hold particular convictions about what is most valuable, most precious and most deserving of being promoted or defended.60

When we make this distinction our thinking becomes open to change, creating the opportunity to amend our speaking from the language of complaint to the language of personal accountability.

Finally, because organizations are networks of conversations, the nature of those storied interactions determines the future. Herein dwells the third language commitment, stories. Ford62 stresses that organizations are

constituted in and by conversations…. Producing and managing change involves shifting that network of conversations by intentionally bringing into existence and sustaining “new” conversations while completing (and removing) current conversations.

A major cause of organizational inertia lives in the background stories and conversations that reinforce the mental models, organizational routines and relationships, and underlying values that determine future behavior.62,63 Said otherwise, problematic behaviors are embedded, retained, and maintained in collective stories64 such that an organization's future can become an extrapolation of its past. Creating a new future begins with disclosing the unspoken so people can let go of their counterproductive conversations and stories so there's room for new, more constructive narratives to be woven into the cultural fabric. In essence, the “clearing out” of antiquated and obsolete worldviews, an exercise aided by distinctions, creates the space for new ways of thinking and doing. This process, and the self-discipline involved, is the linguistic analogue and ontological equivalent of cleaning out your attic.

Language and Transformative Learning

We each come to the table with a set of fixed and unchallenged assumptions that unconsciously lead us to listen to what we hear in predetermined ways. When someone starts to say something, much of the time we already have an opinion of what it will mean. This automatic, reflexive listening acts as a filter that screens out what does not fit with our mental maps. It limits possibilities for new learning and for organizational transformation. Our background listening says, “You are this way and you won't change,” or “We don't do things that way around here.” Language is merely a medium for labeling things that are already there. Today is just another version of yesterday, and much of what will happen tomorrow is already given.

Accordingly, effective leaders listen in such a way that they recreate for themselves what is being said, such that the speaker is left with the experience that “what is” for the listener is a replication of “what is” for the speaker. Boje and colleagues65 stress that

we do not just report and describe with language; we also create with it. And what we create in language “uses us” in that it provides a point of view (a context) within which we “know” reality and orient our actions.

At a meeting of the promotions and tenure committee, for example, members create their own unique context that influences the way they engage with one another. That context affects the way they make sense out of dossiers, how they vote, and what they say and don't say. How the promotions and tenure committee chair's linguistic cues are interpreted affects her effectiveness and the degree to which her language “sticks” or gives texts “staying power.”66

Transformative learning involves revising our ingrained, often rigid frames of reference through critically self-reflecting on the assumptions on which our interpretations, beliefs, and habits of mind are based.67 Studies by Deborah Tannen,68 professor of linguistics at Georgetown University, suggest that men and women approach conversations and transformative learning differently. While men are more competitive, seeking status and jockeying for position, women value consensus, experiencing the world as a supportive network of relationships. Women tend to look for win–wins and encourage broad input. Transparency coupled with openness to new ideas is key to building trust, especially at a time when unpredictability is the rule rather than the exception. As writer and humorist Gelett Burgess69 said, “If in the last few years you haven't discarded a major opinion or acquired a new one, check your pulse. You may be dead.”

To facilitate transformative learning, leaders must help others become aware of and critical of their own and others' tacit assumptions and unarticulated presuppositions. Learning is a social process, and effective discourse depends on how well the leader can create a situation in which

those participating have full information; are free from coercion; have equal opportunity to assume the various roles of discourse … are empathic and open to other perspectives; are willing to listen and to search for common ground or a synthesis of different points of view; and can make a tentative best judgment to guide action.67

It is not about imposing some particular point of view but rather about becoming more amenable to new ways of perceiving, interpreting, and acting in the world.

Language and Our Future

Our intelligence has created for us a curious conundrum. In using our remarkable language-endowed brain to discover new biotechnologies, design new drugs, and develop greater comforts in life, some of our fellow human beings have ended up with the short straw. Yesterday's solutions have created today's problems. For all our intellectual horsepower, we seem to solve fewer problems and create more complex ones. Jonas Salk once said, “If all the insects on earth disappeared, within 50 years all life on earth would disappear. If all humans disappeared, within 50 years all species would flourish as never before.”70

Tolle71 describes the dangers of relying solely on intellectualism to solve our problems:

I was convinced that all the answers to the dilemmas of human existence could be found through the intellect…. I didn't realize that thinking without awareness is the main dilemma of human existence.

Can we use the intelligence that got us where we are today more intelligently going forward? Indeed, the clock is ticking, and we're well into the fourth quarter. A fascinating 2003 book by J.F. Richard72 suggests we have 20 to 30 years to “turn things around” on earth. That was seven years ago.

The single biggest leadership challenge for the world today is getting people with contrasting values, competing priorities, diverse backgrounds, and different worldviews to embrace diversity and work together.5 It is a dilemma that is only accentuated in a world that's flat. Tackling this seemingly intractable challenge will require world-class leadership exercised by world-class leaders who lead world-class conversations. Inside of this dialogue, leadership must begin on the inside, where each of us forges the foundation for living our lives. Language constitutes that foundation, infusing it with integrity and our word. In granting us access to ourselves and to the world, language is the gateway to transformation.

“You can always count on Americans to do the right thing after they've exhausted every other alternative,” Winston Churchill once said. That we've exhausted every other option appears to be our current situation in health care—at least that's the way it occurs to many people. But can we “talk” our way out of our current dilemma? Seriously, we must. Bickerton9 argues that each of the properties that distinguish human intelligence and consciousness from that of other animals can be shown to derive directly from properties of language. He notes,

It is this power to transform imagination into fact that distinguishes human behavior from that of our ancestral species, and indeed from that of all other species. It is exactly what enables us to change our behavior, or invent vast ranges of new behavior, practically overnight, with no concomitant genetic changes.

Indeed, this very property of language—its ability to bring forth, out of the unspoken realm, innovative ideas and possibilities—will determine the kind of health care system we will create and will shape the future of our world. Language is the most underused resource leaders have at their fingertips.5 We must take advantage of that opportunity, and we must do it as a community. “Nothing happens without personal transformation,” wrote quality guru W. Edwards Deming.73 The only safe space to allow for this transformation is a learning community.74

In a 2002 interview,75 developmental psychologist and Harvard professor Robert Kegan raises the evocative question: What order of consciousness will allow human beings to respond transformationally to the demands of a pluralistic postmodern culture? “Transformation,” notes Kegan, “is a process by which each living piece, or part, is, in a certain way, better recognizing its true nature. It is what we are called to do, what the universe needs of us.” Sadly, our attachment to the key measures of looking good and measuring up in our culture hinders the personal journey of transformation and contributes to the sense of meaninglessness that many people experience today.5,76,77 Fundamental questions such as, “What role do I play in transforming our health care system?” and “What does it mean to live more consciously as a human being?” tend to be ignored. Consciousness, asserts Morwood,78 expresses and experiences itself through selflessness, by serving others.

How do we get there in a world that's not just flat but also confused and irritable? Can language be the driver of constructive change? Kegan asks,

What does it actually mean to live it or to experience it, as opposed to just talking about it? Do we have the language to speak about [transformation]?… Language has all these constraints built into it … [that] may make it impossible to talk about these notions of union and oneness.75

Going forward, do we let language use us or do we use language? What kinds of conversations might help us get the ship righted? British mathematician and philosopher Alfred North Whitehead79 writes, “The mentality of mankind and the language of mankind created each other.” Will we let our mentality be shaped by the language of complaints, excuses, entitlement, and what-have-you-done-for-me-lately? Or, will we choose the language of commitment, teamwork, caring, and personal responsibility? The language we choose will be the architect of our future.



Other disclosures:


Ethical approval:

Not applicable.


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