Everyone is interested in the topic of leadership. If you wanna write a book that people will read, choose leadership as your topic. And at Amazon, lists over 111,000 books on leadership. Leadership sells. When it comes to healthcare delivery we do need to talk about leadership. Just as in all organizations, leadership in healthcare matters. As you may recall, leadership was a problem in the early phases of Mary's illness. The senior attending physician failed to set priorities. He lost sight of what was most important, Mary's life. He was distracted by administrative duties and his research. He failed to lead his team, and most upsetting to me, he delegated the supervision of Mary's care to a relatively inexperienced senior resident. Also, Mary's nurses failed to lead. They were fearful of speaking up and only admitted that they were aware of the mistakes made by the intern after I inquired. No one took charged and no one integrated the recommendations of the many consultants. It was only after I transferred Mary's care to a trusted cardiologist that good leadership became Evan. He organized and lead an impressive life-saving team effort. Usually when we think about leadership, we immediately envision presidents, prime ministers, generals, or CEOs. So the first question I would like to ask you, is how much of a difference do you think the CEO makes in the success or failure of an organization. Based on the current salary structure for CEOs in the Fortune 500, I suspect you'd feel the CEO is the primary factor responsible for a company's or an organization's performance. Let me share my answer by having you imagine the driver of a car skidding on ice. As the car careens across the road, the guardrails, the curbs, Lady Luck, and God, rather than the driver, determines the fate of the car and its passengers. And just like the driver of the car, studies of leadership strongly suggest that external factors powerfully influence an organization's success or failure regardless of who is leading. When we think of leaders, we often think of heroic figures. And based on many of their biographies and autobiographies, these famous leaders often appear to have changed their countries and their companies all by themselves. But in reality, the person at the top of the pyramid depends on the leadership of everyone else in the organization. Modern research on leadership suggests that the heroic leader is rarely effective. And one person alone is unlikely to significantly influence a healthcare system. External factors, culture, and the effectiveness of the many other leaders within the system play major roles. Effective leaders form leadership teams, utilizing the same approaches we described during our classes on teamwork. In my view, healthcare leaders in particular should avoid the wheel and spoke model of leadership. Because this approach leads to burn out. No one person can have their finger on every aspect of such a complex system. And also this results in the loss of job significance and satisfaction for those who report to the leader at the top of the organization chart. Beware of the arrogant leader whose approach is my way or the highway. A distributive model of leadership is far more effective. This model encourages the lowering of the hierarchy and reduces the power grade, a critical condition for improving the quality and safety of patient care. A distributive model also increased thesis, job satisfaction. And renders an organization more agile, and capable of making adaptive changes quickly, in response to the external, as well as internal challenges. Most modern leadership experts recommend this, not this. So, if the role of CEO is not the answer, who else within our healthcare delivery system should lead? The answer is everyone. Not only administrators, but caregivers, support personnel, and patients can and should lead. Having experienced first hand the consequences of deficient leadership in the first stages of Mary's hospitalization, as well as outstanding leadership during your stay in the ICU. I propose a very simple definition for leadership. A healthcare leader is anyone who influences others to objectively improve human health. Notice this definition emphasizes results, not talk. I encourage all healthcare institutions to embrace this definition. Leadership depends on context. And when the prevailing culture in an institution encourages top-down leadership, patients, nurses, caregivers, and support staff are disempowered from influencing others to improve health. They are not allowed to lead. Research on leadership reveals two important, exciting realizations about leadership. First, you do not have to be a born leader. Leadership can be taught. And I strongly recommend that all healthcare institutions provide leadership training for all their staff. Not just their administrators. Second, there is no specific personality type required to be a successful leader. Each person who inspires to become a leader, or whom is recruited to be a leader to a leadership position, should avoid the temptation to emulate an admired leader. Each of us should recognize and use our unique strengths to inspire and lead others. Every leader must remember Shakespeare's adage in Hamlet, this above all to thine own self be true. Some highly successful leaders are quiet, calm, and deliberate in their actions while others are vocal, excitable, and act quickly. As discussed earlier, the culture of the organization and external conditions often play a far greater role than personality in determining a leader success. Remember, we can all lead, and particularly those on the front lines of healthcare, both patients and caregivers should lead. There's so much to do. Look at all the fixes that are represented by the small blue dots on the bottom. Notice I keep showing you this figure, because it emphasizes the large number of improvement projects that require the attention of front-line leaders. And you can be one of those leaders. What are the characteristics that I admire in a leader? Openness, I like to know where I stand and what the leader is really thinking. I, personally, am very bad at guessing what someone else is thinking. Humility, I have always admired the humble leader. And this wonderful characteristic is underemphasized in healthcare leadership. Genuine interest in others combined with the desire to help everyone to reach their maximum potential. The ability to empower others. This requires trust and a willingness to delegate. Self awareness, being able to hold a mirror up and see your behavior through the eyes of others. Particularly for men this is one of the most difficult skills to develop, but very necessary. There are good listeners. The foremost important words for an effective leader are what is your opinion? A great leader knows and follows his or her North star, that is a moral leader. As an example of how to follow your North star, I wanted to share the story of Dr. Thomas Zeltner the longest serving secretary of health for Switzerland, 19 years. When Thomas was a young teenager, his father developed severe hypertension with blood pressures of 300 over 230. Physicians were unable to control his father's blood pressure. As a consequence he developed congestive heart failure and had to quit work. His father became very depressed and Thomas was required to care for him after school. With tears in his eyes, Thomas recalls how his father suddenly lost consciousness and fell into his arms as they sat together in the living room. His father had suffered a fatal stroke. Thomas never forgot his father's chronic debilitating disease. This first hand understanding of chronic illness explains his passion for improving public health. As the Secretary of Health he strongly opposed lobbying by the cigarette companies to stop the world health organization from publicizing the health risk of cigarette smoking. These activities placed him as the number 2 on the cigarette companies' enemies list. Later in his career, he proposed to lower the reimbursement rates for laboratory tests. Fees for blood tests had not changed in over a decade, despite dramatic improvements in automation that had reduced expenses. Physicians were outraged and convinced their patients to oppose his new policy. He met with the medical societies to explain his rationale. At one meeting the audience pummeled him with tomatoes. At times he felt as if the whole country was against him. However, in his heart, Thomas knew his actions were just and fair and he stuck by his principles. As leaders, we all need to stand by our principles, even if we end up getting pummeled by tomatoes. Thank you.
