Category Archives: General Leadership

     For though ye have ten thousand tutors (paidagōgos) … ye have not many fathers…”
          Letter from Paul to the Church at Corinth (1 Corinthians 4:15)

The business of becoming a grandfather over the past few months has given me pause.  First I have to get over the sense that am far too young.  I think of grandfathers as old.  I couldn’t possibly be at that point…

Assuming that it is possible (and that seems to be the case) and acknowledging that age is at least in part a way of thinking, one characteristic of being more senior is that you are also more circumspect.  While I blundered into parenthood three decades ago without a whole lot of thought or worry that I might not get it right (“How hard can it be?”) this major life change comes with a bit more thought; perhaps even angst.

My wife made an observation recently that I have found myself contemplating: maybe this business of being a grandfather is more about being a mentor than a coach.  And maybe that means that it will take more of my right brain. Continue reading →

For the past several years I have been using a model for leadership based on the Latin word “Ducimus,” meaning “We lead, “  borrowed from the motto of the Royal Canadian Infantry.  Perhaps my own roots drew me to this phrase.  On the wall of the U.S. Army Infantry school at Ft. Benning in 1980 was slogan I have found myself returning to since I left there at the age of twenty: “Lead, follow, or get the hell out of the way.” (Pardon the language, but that’s what it said.) The idea captures the essence of leadership in any domain: to lead from the front and to step forward when your natural inclination is to run away.

We approach leadership opportunities with three areas of focus.  Regardless of the task, we must lead self, lead others and lead work in the unique context of the place or the mission we are responsible for. Continue reading →

Fourth of July weekend 2012 is the 149^th anniversary of the Battle of Gettysburg.  There will be a lot written about the battle in the next year by true Civil War and Gettysburg experts.  I have enjoyed walking the battlefield a number of times and am always struck by a new leadership lesson when I visit.  These are some of the lessons learned from a couple of visits to Gettysburg in the last year.  Consider making the trip yourself if you are in the area.  Read Michael Shaara’s The Killer Angels or watch Turner’s “Gettysburg” movie (the script is almost exactly the same as Sharra’s book) before you visit.  Pay attention to the individual stories as well as the overall strategies.  You will see the leadership lessons as well.

1. Tactical immediacy will trump strategic primacy every time.

General Robert E Lee intended for the decisive battle not to be fought at Gettysburg but rather closer to Philadelphia, Harrisburg or Baltimore.  Brigadier General John Buford’s Union cavalry forced Confederate General Heth’s division into battle on July 1st 1863 outside of Gettysburg against the specific orders of Lee, forcing the battle earlier than Lee wanted and yielding the initiative and ultimately the high ground to the Union army.  Heth’s men were heading toward Gettysburg to look for shoes, a very tactical exercise.

2. Initiative is almost always a good idea.

Union General John Reynolds took the initiative and deployed his Corps to the high ground southwest of Gettysburg on July 1st, which turned out to be one of the key strategic decisions of the battle. Brigadier General Gouveneur Warren, an engineer staff officer probably saved the high ground from being turned when he ordered without any authority to do so, Colonel Strong Vincent’s Brigade to defend Little Round Top on the afternoon of July 2nd.  Colonel Joshua Chamberlain, part of Vincent’s brigade, repulsed the last threat to the high ground when he ordered and executed a bayonet charge against the Confederate’s flank attack late on the afternoon of July 2nd. Continue reading →

Medicine is intrinsically tactical.  At its core are the single patient and provider in an exam room, at the hospital bed or in the operating room.  The expert clinician is recognized to be expert primarily by his or her tactical prowess.  It is true that the successful provider eventually learns that operational coordination with the health care team across the boundaries is essential for optimal care outcomes. But it begins with the tactical exercise of one-on-one clinical care.

It is also true that at some level, strategic leadership is everyone’s business.  Determining personal “strategic” goals and objectives both personally and professionally should be every leader’s priority. But in a health care system, overarching strategic planning is the purview of the CEO, the board of directors and for the military, the colonels and generals.  Operational leadership fosters coordination between services and departments.  This role belongs to vice presidents, deputies, chairs and chiefs, and to our majors and lieutenant colonels.  Their work is coordinating between services and corps to get work done across different disciplines.

But all of these more senior leaders enable the work of the clinician, the nurse, technician and provider, our enlisted or our junior officers.  These are our specialists, lieutenants, captains and the younger majors– at the bedside, in the OR and the clinic.  If American medicine in general and military medicine in specific are leaning forward at the very precipice of rapid evolutionary or even cataclysmic change, it is these tactical officers who will lead us forward.  So to these staff members belong the future of medicine.  They are the backbone of our clinical systems.  As a lifelong student of leadership, how can I advise them?  To you graduates, how can I encourage you to focus your energy?  How can you become the very best leaders in your “spheres of influence?”  I think that the key will be for you to focus on these three things:

Competence.  First, you must excel at what you do.  Our patients and your peers assume that you are competent. You have to be more than that honestly, because to say a provider is “competent” is tantamount to an insult. You have to be the very best that there is in your specialty.  You must go beyond being just board certified and be the very best. This level of competence goes beyond just being good at doing what you learned how to do.  You should always be looking for better ways to do things. Don’t become married to the ways things have been done, no matter how persuasive your mentor.  Just because it works doesn’t mean it works the best.  Every shred of evidence-based medicine has taught us that we must constantly seek the best, most efficient, highest quality – and least expensive and least variable – way of executing your clinical processes. Find it. Continue reading →

Leadership experts aren’t. Leadership should be a matter of lifelong study.  Leaders (those who end up in positions of responsibility and authority) should be students of leadership (the ability to motivate a group of people toward a common goal.)  To be a lifelong student means that one has never quite arrived at the level of leadership “expert.”  There are always more lessons to learn.  Be wary, therefore about those who tout to be leadership experts.  It is much more of a journey than a destination. Continue reading →