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Simone's OncOpinion: Changing Views of Leaders and Leadership

Simone, Joseph V. MD

doi: 10.1097/


Seven years ago I wrote a series of three columns on leadership, prompted by leadership changes at the NCI and FDA (4/25/06 5/10/06, and5/25/06issues). I cited some well-known writers on this topic, such as Peter Drucker, and offered some guidelines for recognizing good leadership. The topic is endlessly fascinating to me because a leader has such an enormous impact on productivity and job satisfaction.

I read those columns again recently and thought they were OK, but I realized that my viewpoint had expanded because of responses to lectures I have given in the past few years on “Simone's Maxims,” which deal with leadership, institutions, and other issues.

That revelation was that ordinary people in ordinary jobs could assume leadership in those jobs without being given a fancy leadership title. The “lightbulb over my head” came from a simple note from two women who attended a program funded by the NCI to teach people how to build supportive care programs for cancer patients in their institutions. I gave two lectures, and a recent column describes that program (5/25/13 issue).

The women work in Colorado. They have given me permission to reveal their names and to quote their note. Here it is in its entirety:

Dear Dr. Simone:

Our new mantra: Institutions Don't Love You Back. We have a renewed sense of leadership—

Thank you,



The “mantra” is the first of Simone's Maxims. At that same meeting several attendees had approached me and said nice things about the talk, mainly that they gained a better appreciation of their roles and the importance of understanding and adapting to the culture that they worked in. When I got the note I finally stitched all the comments together in my mind, which turned on that lightbulb.

What I believe happened was that my talk planted seeds of empowerment through understanding the “rules of the game” and demystifying institutional culture to some extent. But the more powerful influence on the attendees was being together with more than 70 other people from across the country who were facing the same issues and who had heard and discussed the same lectures. The collegial and informal atmosphere over several days let the seeds sprout.

What each person does with that experience will certainly vary. But now I have the unexpected feeling that I have a continuing obligation to help them, if I can. Therefore, I will offer a few recommendations for assuming an unofficial, and possibly temporary, leadership role when action is needed but no direction is forthcoming from above.

One caution: these recommendations are not meant for new employees who have not yet earned a significant level of trust from colleagues. Rookies often would be viewed as “pushy” and “overreaching” if they tried to assume leadership roles, thus defeating their ability to lead.

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Know the Players

A person who wants to lead must know as much as possible about the cast of characters and their strengths and weaknesses. Decide who might be allies and who might aggressively oppose your moves. Ask yourself whether there is an existing method of addressing those problems and, if so, who in the organization would be responsible and who might act. If there is not, or if that person is one who never acts, please read on.

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Understand the Politics and Culture

Every organization has unwritten rules of behavior that are deeply engrained. Some of these “rules” may be established as part of a powerful leader's management style (and may change under that person's successor). These are landmines that must be identified and avoided.

If the first two recommendations sound military, that is not a coincidence. Sun-tzu was a military theorist who lived around 500 B.C. and who is the (reputed) author of The Art of War. His first rule was that you shouldn't fight a war if there is any other means of achieving your goal—in other words, war or confrontation is a last resort for solving only very, very important issues. This also applies to non-military efforts, such as those we are discussing.

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Be Prepared

The Boy Scouts got some things right, such as their motto. The one who walks into a meeting the best informed about an issue and the best prepared to address potential solutions is likely to be recognized as interested, intelligent, and sensitive enough to lead the task of fixing the problem. She may become the leader of the effort by acclamation.

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Whining is Counterproductive

If you don't like the way things are, don't constantly whine about it; that tends to erode morale. And even those who agree with your assessment may not be willing to support you because of your negativity and bad-mouthing. The appropriate old saying is “move ahead or get out of the way [i.e., leave],” and I would add, “and don't discourage those who are trying to improve things.” So whining like a child while offering no solutions is a losing proposition for you and your organization.

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Anyone who has a good idea for improving a bad situation should also be willing to volunteer to lead or be a part of the (usually) hard work needed for fixing it. Most staff members in medical facilities work hard and are reluctant to take on more responsibility. That is understandable, but if you can't or won't contribute in some way to fixing the problem, then you are saying that you have good ideas and valid complaints but someone else needs to do the work.

This is not a good way to get things done expeditiously or to convince colleagues that you are capable of leading any effort of the group.

Seasoned veterans in medicine, nursing, and other specialties often know the organization and its members very well. They are often very loyal to the institution and dedicated to the well being of their patients. The accumulated talent and wisdom that they have is too often wasted, because they are given no opportunity to grow. Leading small but important projects is one way to foster professional growth and job satisfaction.

Not all are suited to leadership roles, but those who are should be given that opportunity in any organization.

© 2013 by Lippincott Williams & Wilkins, Inc.
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