One big benefit of being a part of “community” is to be the recipient of the concern of others when something does not go as expected. I know that many faithful readers were scratching their heads wondering what might have happened when by 3:30 last Friday they had not received an email in their inbox to announce that the latest edition of Healthcare Musings was ready for them to read. When nothing had arrived by 5 PM, one of my family members surprised me with a phone call to ask if I was ill or in the hospital. She knew that I never missed a posting.
The answer that I gave her was that I was fine and that the posting had gone up on the Internet at exactly 3 PM, as it always is. What did not go as planned was that the notice of its posting did not go out because of an issue with “Get Response,” the service that sends out a notice of a new post to all subscribers. I was more and more distraught as the hours passed and the origin of the issue remained unclear. “These things happen” is never enough explanation at the patient’s bedside, and that placeholder answer was not enough to calm me. Cyberspace is new territory for most of us and we all expect that mysterious things happen there. I guess the event suggested the sad fact that a lot of my identity and sense of reputation is tied up in readers being able to count on seeing the notice whether or not they read what follows. I will need to think about what that means for a while. I am not sure it is a good sign.
The notice finally did go out in the wee hours of Saturday morning after my technical guru, Russ Morgan, the man who really makes these notes possible, discovered that the issue was not a technical issue, but rather it was a business systems issue. A recent change in a telephone number on our account had interrupted the automatic billing process, and our account had been discontinued without notice. We do live in a very complex world where what happens often does not make sense. I think that I could write a post about the unintended consequences of highly automated systems that are driven by algorithms, but I will save that note for another day and just give a big heartfelt thanks to Russ who had two big jobs Friday evening and on into the wee hours of Saturday morning. Job one was to discover the underlying problem. Job two was to hold my hand and calm my anxieties. He succeeded in both tasks, proving once again what a remarkable and generous person he is.
As I reflect on the discomfort I felt knowing that there were some people out there who were wondering why what they expected had not happened, I realized that in many activities in our communities, and in the practice of medicine, we have always been dependent on people like Russ. He represents those people who are both critical thinkers and can solve big problems, but that alone is not enough. They also have the ability to manage big problems while simultaneously managing the fears and concerns of the “afflicted.” Almost always they table their own agenda to deal with the concerns of others. They never suggest that the demands on their time are an imposition. Their response is always, “What can I do to help?” I think it is a manifestation of a type of personality that we associate with a traditional sense of professionalism that we take for granted, but is essential to the stability of our communities. There are people like Russ who are quietly doing what it takes to keep things moving in any successful enterprise. They are concerned 24/7 about what is happening and are always ready to step forward because they are committed. Without these individuals there would be even more chaos and dysfunction in these “fast times.” These people are quiet leaders, and I think they model behaviors that we sometimes take for granted. We are often attracted to leaders who look like they come from central casting, but if we think back on when we were best served, we find it was when we had leaders who set aside their personal agenda for the greater good and facilitated our search for the solutions we needed as they simultaneously dealt with our fears and hopes while reminding us to stay true to our core principles and values.
That was the kind of leadership demonstrated by Lincoln, the two Roosevelts, and even Lyndon Johnson that Doris Kearns Goodwin described in her recent book, Leadership In Turbulent Times. That is the kind of leadership and character we sense we have lost with our current president. I hope that whoever the two candidates are in 2020, the election will be won by the person who comes closest to the ideal of being able to lead in the resolution of big problems while reassuring us that we are making progress toward the ideals of our foundational values. I am not convinced that Donald Trump will be a candidate because he doesn’t move us closer to the true resolution of the problems that challenge us, and his disrespect for norms of civility move us further from, not closer to, the realization of our foundational values. There is much written about his successes in producing a stronger economy and how his “America first” trade policies seem to be making a difference, but these successes are built on policies that promote inequality at home and abroad and are unlikely to endure. His policies and operating principles are inconsistent with our journey toward our espoused ideals.
There has been a lot written about “servant leadership” and “leading from behind.” There has been less written about distributed leadership, but all three ideas are meaningless without a defined relationship to “community.” To those three forms of community oriented leadership, I would add Lean Leadership which focuses on organizational success by requiring that leaders coach, mentor, and empower those that they lead. I have written several posts that have focused on Lean Leadership as a powerful tool for medical leaders who seek to pursue the Triple Aim.
I am convinced that there is a high degree of alignment between these four conceptual descriptions of how leaders function when their goals are defined by the needs of the community rather than by raw personal ambition. There is also a high degree of similarity between those four concepts of leadership to the characteristics Jim Collins found existed in many successful companies. He described the best of what he found as “Level Five Leadership” in his book, Good to Great: Why Some Companies Make the Leap…And Others Don’t. The principles of Servant leadership were first described in 1970 by Robert Greenleaf, a very atypical executive and leader at AT&T, in an essay entitled “The Leader As Servant.” There is now a Robert K. Greenleaf Center for Servant Leadership. Their website describes the concept of servant leadership. I added the bolding to emphasize what speaks to me:
While servant leadership is a timeless concept, the phrase “servant leadership” was coined by Robert K. Greenleaf in The Servant as Leader, an essay that he first published in 1970. In that essay, Greenleaf said:
“The servant-leader is servant first… It begins with the natural feeling that one wants to serve, to serve first. Then conscious choice brings one to aspire to lead. That person is sharply different from one who is leader first, perhaps because of the need to assuage an unusual power drive or to acquire material possessions…The leader-first and the servant-first are two extreme types. Between them there are shadings and blends that are part of the infinite variety of human nature.
“The difference manifests itself in the care taken by the servant-first to make sure that other people’s highest priority needs are being served. The best test, and difficult to administer, is: Do those served grow as persons? Do they, while being served, become healthier, wiser, freer, more autonomous, more likely themselves to become servants? And, what is the effect on the least privileged in society? Will they benefit or at least not be further deprived?“
A servant-leader focuses primarily on the growth and well-being of people and the communities to which they belong. While traditional leadership generally involves the accumulation and exercise of power by one at the “top of the pyramid,” servant leadership is different. The servant-leader shares power, puts the needs of others first and helps people develop and perform as highly as possible.
If you clicked on “The Servant As Leader” link back a few paragraphs you found a PDF of Greenleaf’s 1970 essay. Greenleaf begins his essay with the recounting of Hermann Hesse’s story “A Journey To The East.” David Brooks references the same story in his discussion of community leadership on page 285 in his recent book, The Second Mountain: The Quest For a Moral Life. Greenleaf writes:
Hermann Hesse’s story, The Journey to the East, tells of a band of men, each having his own goal, on a mytical journey to the East. With them is the servant Leo, who does their menial chores, sustains them with his spirit and his song, and, by the quality of his presence, lifts them above what they otherwise would be. All goes well until Leo disappears. Then the group falls into disarray and the journey is finally abandoned. They can not make it without the servant Leo. The narrator, one of the party, after some years of wandering finds Leo and is taken into the order that had sponsored the journey to the East. He discovers that Leo is the titular leader of the order, its guiding spirit, a great and noble leader.
Leo portrays at once two roles that are often seen as antithetical in our culture: the servant who by acting with integrity and spirit, builds trust and lifts people and helps them grow, and the leader who is trusted and shapes others’ destinies by going out ahead to show the way.
Can these two roles merge in one real person—for all manner of men and women, in all levels of status and calling? For some time I have said yes to the first question. My sense of the present leads me now to say yes to both questions. This paper is an attempt to explain why and to suggest how.
Wikipedia continues its description of the philosophy of servant leadership by saying that it has been distilled into ten characteristics by Larry Spears:
…listening, empathy, healing, awareness, persuasion, conceptualization, foresight, stewardship, commitment to the growth of people, and building community… servant-leadership is an ethical perspective on leadership that identifies key moral behaviors that leaders must continuously demonstrate in order to make progress on Greenleaf’s …”best test.”
Perhaps is is too much of a digression, but I hope it is worthwhile to take a high level look at Greenleaf’s “best test” which is a framework for assessing an organization to judge whether it fosters an environment that promotes servant leadership.
The assessment follows Greenleaf’s Best Test™ from principle to practice by investigating four categories of inquiry.
- The bulk of the questions follow Greenleaf’s model by investigating the outcomes for those who are being served. Included are items that correlate support for physical and emotional health, opportunities to gain and integrate knowledge, avenues to express heightened autonomy, and opportunities to continue the cycle of service.
- Another group of questions ask how well servant leadership principles are being followed in the organization.
- The goal of servant leadership is to create a leader-full organization where everyone can serve an appropriate leadership position, but the assessment still contains a group of questions that probe the behaviors of designated leader.
- Finally, the questions that make this an unusual assessment are those that ask about matters of heart, spirit, joy, and community. These human experiences give juice and meaning to work, yet are not often discussed, much less measured.
All four characteristics of the Servant Leader model and its “best test’ seem reminiscent to me of the ideals and principles of Lean Leadership and to a lesser degree, Jim Collins’ concept of Level Five Leadership. I was saddened as I thought about most of the medical organizations that I have seen in the context of the four characteristics, especially # 4, matters of heart, spirit, joy, and community. Could it be that trying to practice medicine in an environment that is blind to issues and matters of heart, spirit, joy, and community is a risk factor for professional dissatisfaction and burnout?
Think about that question in the context of the pursuit of individual goals versus working in a community of purpose. Brooks talks about our cultural disease of “hyper individualism” and the dissatisfaction and disillusionment that paradoxically increases for many the higher they climb in their chosen careers. He contrasts hyper individualism with relationalism. I would like to explore that contrast in depth. My objective is to get you thinking about the value of practicing as part of a community for community. Over the years I have developed the bias that “community” is an uncomfortable word for many when it is applied to a profession or used in the larger sense of those who live and work where we live and work. There is more to come.
