I have been wanting to write about leadership skills for sometime. Leadership development is a personal growth process that never ends. The leadership learning curve did not begin until many years into my professional life. I followed a long and nontraditional path through the elected governance of my practice to become  “a leader.” When I was finally a part of the senior leadership team representing the voice of the physicians and participating in decisions that would make a real difference in the evolution of our practice, I quickly learned that I did not know  much. There is a lot to learn beyond knowing how to read a balance sheet or negotiate a contract. Over time I have learned that the learning never ends.

I am far from an authority on the subject of leadership. I do know that examining our errors and failures is the most effective path to progress. My objective over the next few months is to post a few notes on various leadership topics that you may find helpful and interesting. I will draw on my personal experience and my reflections now that I am retired and my leadership years are over. One thing that I know for sure is that self examining leadership in a time of change is important.

I started out writing one post about leadership. That’s like trying to boil the ocean; so, this post is  a memoir laced introduction, and then some specifics about the broader based skill set that leadership requires in times that call for transformation. In the future I hope to talk about several other connected leadership topics like leadership and integrity, leadership teams, distributed leadership, leadership with and without authority, VUCA leadership, Lean leadership skills, and how to develop leadership. It’s ambitious but I am looking forward to the journey.

I love books and despite the convenience of Amazon there is nothing that I enjoy more than wandering around in a bookstore. When I get to the shelves in the business section I get the impression that there are more books on leadership and change management than any other subjects. My own library contains all the classics in leadership and some that were once the flavor of the month but now don’t get much attention. Talking about leadership and criticizing leaders for their failures has been a big part of the conversation since our ancestors began hunting in bands. We aren’t even the only species that depends on leaders or that has competition for leadership!

I can imagine that after a long day of hunting on the Serengeti with nothing to show for their efforts, and if there was nothing to roast, there would be much grunting and grousing around the campfire. Perhaps there were debates about whether or not it was time for a leadership change. Things have not changed much. The bands of hunters are now corporations, teams, departments in government, and the like, all organized around some idea, mission, product, administrative responsibility, or other such effort. Our teams and games are analogously organized as reflections of our more serious group endeavors and wars. We like to see organized groups move toward a goal, and every team has a coach or manager on the sidelines, and in many sports there is a leader on the field of play.

It was a little bit of a surprise when both the Yankees and the Red Sox fired their managers this year.  Both teams exceeded preseason expectations, and had successful seasons; but in the end, they both were eliminated from the playoffs by the Astros. The owners of both teams must not have had confidence that they had the right leader to produce a better result next year. I can imagine that even leaders like Belichick and Brady would not survive long if the Patriots suddenly started playing like the Cleveland Browns. The life expectancy of leaders is often all about what followers have recently experienced, and what they are expecting to experience in the very near future.

Yuval Noah Harari writes in Sapiens: A Short History of Humankind that our species rules the planet because 70,000 years ago we moved from just hunting in a pack to organizing ourselves around fictions that represented shared objectives that were abstract and often false. One example he offers of a false concept that was an effective organizing principle for a few millennia is the concept of the divine rights of monarchs. That fiction was rejected in France when they cut off the King’s head. Another fiction or myth that still lives is that paper money actually has value, and now by extension, that plastic credit cards have value. Money works because we all accept it as having value. The concept of credit is an even more abstract idea that is dependent on wide acceptance and trust.

When we lose confidence in these shared myths and accepted concepts things change, and we have events like revolutions, the collapse of markets, and the closure of banks. We all struggle until we restore trust in the myth or move on to a new one. We demand that our leaders be aligned with our myths. Our national myth has a set of Judeo-Christian and Western European values as its foundation. Atheists, Buddhists, and Muslims need not apply for high elected office.

Leadership is aligned with the myth and is the keeper/custodian of the current organizational fiction when things are going well. When things falter and there are questions about the underlying organizing principles and the power of the operative myths or constructs to harmonize our activities in a way that makes things better, we often think about changing leaders before we give up the myth and change the operating principles. Moving on to a new organizing principle or myth seems harder than just changing leaders. It’s easier to say, “What did he know anyway?” or “She lost her way; power went to her head.”

When there is an effective change of the organizing story or fiction, it is often true that the new principle is first seen as a message from a new and charismatic leader that is at variance with the old operating principles. Marx, Lenin and company, Jesus, or the Prophet Mohammed may be examples of this phenomena. Occasionally, someone notes that there is a new idea that is evolving that is in search of new leaders. I would offer Clay Christensen’s concept of “market disrupters” as an example. Christensen was not a leader per se, but his thesis sent current leaders or new wannabe leaders scrambling to see if his new ideas worked for them. I can remember the awe and sudden affiliation that I experienced with Barack Obama when he suddenly burst onto the scene with a new message of hope in 2004 at the Democratic Convention that nominated John Kerry.

Looking back at how organizing stories have evolved over the last 500 years, it’s obvious that the growth of information produced by the scientific method of solving problems has destroyed many myths and the organizations that depended on them. Facts and the laws of science have transformed much of our society, but the process is not over and there is continuing resistance as we can see in the political debates about climate change. Culture and a desire to maintain the status quo coupled with self interest can still trump “enlightenment” and perpetuate operating systems long past the time when they are a positive organizing principle.

The most unstable part of our current mythology has to do with interpersonal relationships, and the relationships between races. For most of the last 70,000 years we have been quite comfortable with inequality, male dominance, and the abuse of minorities. We have manufactured supporting myths like “Manifest Destiny” and the “White Man’s Burden” to justify and support the global extraction of wealth for our own purposes through Imperialism and Colonialism. Many of our current leaders are caught in the transition between myths. This is true in politics and it is also true in healthcare.

In stable times good leadership in business often settles into “hard” management skills. One error is to equate management with leadership. In a stable environment it is often more than enough for leaders to be proficient in a basic a set of traditional business management skills like marketing, finance, supply chain management, and product research. In times of global transition like we are experiencing in healthcare and manufacturing, not to mention almost every other aspect of human endeavor, from driving taxis to education, those “hard” or left brain skills may be necessary, but they are no longer sufficient for successful leadership.

Now we hear about the “soft skills” and the related right brain attributes that are required for leadership in times of great transition. Those soft and right brained skills were part of what Daniel Pink was writing about when he published A Whole New Mind in 2005 and facetiously predicted a right brain take over of the world. Many of our market controlling healthcare organizations are still being lead by leaders chosen for their “hard skills.” The pressure to get through this difficult moment and get back to the way things were, sort of the healthcare equivalent of “Make America Great Again,” makes us think that if we could just use our “hard skills” better, and do what we have always done with more intensity that might make us more effective, we will “right the ship” and all will be well again. Staying with what we know, even though it is not working, is more attractive than the pain and uncertainty of a transformation to a new mindset and a new “myth” that right brained/soft skilled leaders might facilitate.  

About 25 years ago as I was evolving as a “leader” through my activities in governance, I become fascinated by a whole new set of subjects. My specialty of cardiology seemed to be best understood from the position of systems theory which enabled my understanding of how things related to one another and facilitated clinical decision making. Blood flow as a function of force and resistance always made sense. I began to see analogous situations in our business. I began to notice that when things did not turn out as I had expected when I made a therapeutic decision, the reason could be better understood with insights from complexity theory. Armed with some knowledge of systems and complexity, there were many things that still could not be explained, especially when the process was managed by people. Problems made more sense when I learned a little bit about biases and other factors in the irrational choices of people. The observation of biases as explained by behavioral economics coupled with science, systems engineering, and complexity theory all seemed to be linked and hold promise, so I read more.

All of this theory was compatible with something I had known all along. I always believed that the servant leader model of leadership, or what Jim Collins called level 5 leadership was the best leadership framework for a healthcare organization. The icing on the cake for me was how all of these tools came together in the concepts of Lean philosophy and leadership. Foundational to the successful deployment of all of these skills is leadership empathy and the ability to sustain relational contracts.

It would be remarkable for one individual to suddenly appear on the scene with all of these tools polished and perfected, ready to rescue your practice or health system. I do believe that we have the ability to shape and mold the leaders we need. I believe it is possible to impart the components of the toolkit I describe to a new generation of leaders who could foster the transformation from what is failing to what might enable us to inhabit the new world of the Triple Aim. How to develop tomorrow’s leaders will be the subject of another letter sometime soon.