Category Archives: Personal Leadership

April 25, 2017 · 9:21 am

First person, singular.

When I was a fellow one of the senior physicians at the children’s hospital where I trained approached me with a question:

“Dr. Callahan,” (she was always pretty formal). “Does your colleague Dr. Christopher have his own lab?”

“No ma’am” I replied (formal, too). “He works in the same labs we all do. Why do you ask?”

“Well in speaking with him he often refers to ‘his lab’ and I was just wondering whether the fellows actually had their own labs.”

We didn’t. I started to listen more carefully and noticed that Dr. Christopher (not his real name) had a tendency that afflicts many in leadership: the over-use of the first person (“I, me, my”). I acknowledge it is nowhere near as grating as referring to oneself in the third person (“Bo Jackson has to do what’s best for Bo Jackson”). But it is something I have noticed through the years, possibly a function of my own fear that I might sometimes lean in the same direction. Certainly positions of leadership can foster that way of thinking. People pay a great deal of attention to leaders wherever and whatever they are doing. They even notice and may comment on what the leader’s wearing (“Sir, I notice you wear Tom’s”). Perhaps that is why General George Patton said that leadership was theater. The leader is always on stage.

But it is too easy to succumb to the cult of the first person and increasingly cast our shadow over all we’re associated with: my team, my assistant, my hospital, my staff, my directorate, my lab. Pay attention to your own patterns of speech and see how many times you refer to yourself.

It would only be a bad habit if it weren’t for one thing. We may have bought into the traditional “heroic” model of leadership. The model is common in ancient literature. Leaders were known for their physical size, strength, or looks; individual personality traits or charisma. For example in Homer’s epic poem Achilles was a leader because of his demigod warrior status, Ajax as a result of his size and strength, and Hector because of his courage and dedication to his people. Early leadership theory focused on the leader and the leader’s persona.

Scottish writer Thomas Carlyle wrote in his book (the title is telling): On Heroes, Hero-worship, and the Heroic in history (1840), “For as I take it, Universal History, the history of what man has accomplished in this world, is at the bottom the History of the Great Men who have worked here.” His emphasis on the individual leader gave rise to the “Great Man” theory of leadership.

The problem is that we have entered an era of horizontal leadership where the best leaders are the best listeners; they are willing to relinquish power to accomplish goals, have the greatest ability to form and facilitate teams, and have the greatest emotional intelligence. The sun is setting on the great person theory (the traditional messianic or apocalyptic view we hold towards the occupant of the White House seems to be a persistent exception).

We should check ourselves. Excessive use of first person pronouns may reveal a tendency toward seeing ourselves in the “great man” or “great woman” spot light, to the potential detriment of our relationships with peers and subordinates who comprise the teams who really do the work.

The leader without a crowd following him; traveling and working with him, is simply taking a walk. We can too easily end up thinking “first person, singular” when we need the entire team – “first person, plural” – to get the job done.

Chuck Callahan Henry V 4.3 – Lead from the Front      https://henryv43.wordpress.com/

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February 13, 2017 · 6:24 am

The sound of the guns

I probably shouldn’t look at social media during church. But honestly, I was just opening the Bible App on my phone (!) The local “Nextdoor” link on my email was a post from someone living nearby: “Neighborhood too dangerous.” The author wrote, “We were talking about how annoying it is that we cannot walk outside without fear of being held up at gunpoint and it might be time to move to a safer place…”

It has been something of a bad week for our neighborhood. Someone was held up and robbed on the street I walk to work and a young man was shot a few blocks from our home. But none of this is new to West Baltimore or to the city where more than three dozen people have been killed since New Years. Perhaps it was just a little too close to home.

The post made me think of our pastor.

He was born and raised in Baltimore and despite growing up in one of the city’s toughest neighborhoods in a single parent home he has a college degree and is among the best read men I know. He had every reason and every opportunity to move away from the conditions in a city that Hobbes would likely agree are “solitary, poor, nasty, brutish and short.”

But he didn’t leave. Instead he studied, trained and prayed and with his wife planted a church in West Baltimore within a mile of the highest density of gun violence in the city. He was with the line of pastors at the uprising after the events surrounding the death of Freddie Gray two years ago this spring. He leads by example in the city of his birth that he could easily and justifiable have left behind.

This morning I was stuck by what drew me to his leadership and to this church.

We spent thirty years in the Army where among the highest virtues was the willingness to run toward the sound of the guns.

Now we are serving with this leader and these brothers and sisters who have chosen to do the exact same thing – literally and figuratively – on some of our nation’s most dangerous streets.

A couple commented at a dinner recently that it is not uncommon in our neighborhood to hear gunshots at night. These men and women whose church meets in a local public school; who are led by a courageous pastor and his wife are far more familiar with the sound than we are.

Perhaps I am drawn to this leader by the same qualities I have long recognized in those with whom I served in uniform:

True leaders run toward the sound of the guns.

We have found a community and leaders who live this.

And it feels a lot like home.

Chuck Callahan Henry V 4.3 – Lead from the Front      https://henryv43.wordpress.com/

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January 28, 2017 · 2:29 pm

The problem with rice bowls

Rice Bowl

  1. A task performed by a specific individual or group in exchange for compensation.
  2. A protected job, project, program etc.

Reaching back a decade or so I remembered an episode that taught me about our tendency to defend our turf and our “rice bowls.”

When I was Chief Medical Officer earlier in my career, I received a late evening email from my CEO while I was away on a business trip. The message informed me that the discharge nurses who were busily working under “my” section of “Health, Plans and Operations” were going to be moved to a new discharge management cell that would be run under the Chief Nursing Officer. The cryptic part of the message was that they were to be combined with the Department of Hospital Social Work, to be run under the office of the Chief Nursing Officer. I replied by email that I was a bit confused.

“Did you mean to imply that you were moving social work as well?” Social work was a department that had been aligned under the Chief Medical Officer – “my job” – for decades. It seemed odd that my Boss would realign a whole department without even mentioning it to me.

I learned by email the next morning that was exactly what she meant.

My first response was visceral. This was a personal affront! To have one of my subordinate departments removed from me span of control without even letting me know ahead of time. Disrespect! The CEO and my peer to whom my subordinates were transferred must have had no regard for me and for my position.

Someone had reached into my rice bowl and extracted rice without the decency of even letting me know!

Moments later I realized I was being ridiculous.

First, I knew my Boss and my colleague. They were no more interested in affronting or insulting me than I would be them. Even if they hadn’t thought of it, how justified would my outrage be without even considering and understanding the circumstances? In terms of “extracted rice” it was not as though I had any shortage. The traditional organization of our hospital placed all clinical activities except nursing under the leadership of the Chief Medical Officer.

No, the problem with this rice bowl was not the rice.

It was much more the idea of someone else reaching into my bowl.

I had reacted to the thought that someone else would reach over and violate the boundaries of my rice bowl, especially without even the decency of asking me first.

What was the cure for this flood of inane emotions? First, I had to choose to give people I trusted the benefit of the doubt they had earned through our relationship together. I also had to remember that my Boss and colleague were in fact acting consistently with the way I knew that they always acted.  They were working on organizational improvement, efficiency and improved patient care.

Perhaps “forgiveness” is too strong a word for the response I needed. They did not mean to insult me. However, if I felt insulted I could certainly forgive them the unintentional affront. It might justify a conversation in the future to avoid this misunderstanding. But she was my boss, after all.

Finally I had to accept a willingness to share the rice as well as the access to my rice bowl. I know that I didn’t have the opportunity to talk about this ahead of time but for the life of me I could not think of any particular reason why it was a bad idea. The difference between “dialogue” and “discussion” is that with dialogue I am willing to consider the possibility that my preconceived notions are wrong. In discussion my intent is to convince you of the error of your ways. I had to approach this decision with the willingness for dialogue and not necessarily the effort to persuade.

There is plenty of rice and work to share. Feel free.

You might just let me know when you would like to reach over toward my rice bowl – if only so that I don’t bump your hand with my own.

Chuck Callahan Henry V 4.3 – Lead from the Front      https://henryv43.wordpress.com/

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January 5, 2016 · 5:47 am

Getting started someplace else…

It seems that we all become a little more philosophic and retrospective as one year slowly wanes and another begins. One year ago I was working in rural West Africa generally unaware that the conditions there were closer than I knew to what many experience in the United States. I never imagined that I would be learning more about those very conditions and their impact on health a year later.

Yet here I am in a new position, two thirds of the way through my Michael Watkins First Ninety Days, wondering whether I have almost reached the point where I am more of a contributor to my new organization than a drain on it. As a brief reflection, several things have struck me this month about this transition to a civilian job after 31 years working in and with the military. (I think my last civilian job interview was with Ponderosa Steak House when I was in high school!) I am working in a new organizational and geographic culture, carrying a new position and title that I sometimes wear with the same awkward discomfort as I do one of my still new suits. (“Should I button or unbutton my suit-coat button?”) Here are some of the things I remind myself of these days:

  • You have earned the right to speak by nature of your background and experience. You have not earned the right to be listened to, at least not yet. Choose your words carefully.
  • No one really cares where you came from or what you did there. Certainly no one cares as much as you do. Think about that the next time you are tempted to say, “When I was at…” It gets old faster than you think.
  • To modify a quote from Larry King, “Nothing that you say today will teach you anything.” If you want to learn a new culture you need to be quiet, open your eyes, watch and listen.
  • You are not who you were. As Michael Watkins says you have to “promote yourself.” It’s not a matter blowing your horn by dropping into every conversation just how extraordinary you are but by believing that what it says on your ID badge or office door is who you are supposed to be. We always do best what we did best last. But you weren’t hired to do what you did no matter how good you were at it. You were hired for what they believed you can do now. So do it.
  • Stop looking backwards. Some of the most embarrassing falls I have taken through the years happened when I wasn’t paying attention to where I was walking and instead glanced over my shoulder or focused too far ahead. (One on the steps outside the Rutgers Commons as a college student comes to mind; a spectacular aerial display of flying notebooks and papers.) Relax. No one’s gaining on you and it wouldn’t really matter if they were. Pay attention to putting one foot in front of the other.

One of my very good friends, also retired from the Army, provided the most crucial encouragement of my “retirement transition.” It came at a time when the road ahead was unclear and I was still hearing the echoes of the things I didn’t get to do in uniform.

“You have to believe that the best years of life are still ahead of you,” he told me. It is a matter of faith, but also a matter of sanity. I suspect that with the potential influence of attitude, it can also be a self-fulfilling prophecy. But as is often the case with faith and vision in leadership – personal and corporate – it is a matter of choice.

The leader chooses to believe. And so believing inspires faith in others.

Chuck Callahan Henry V 4.3 – Lead from the Front https://henryv43.wordpress.com/

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November 4, 2015 · 5:01 pm

When “BLUF” is a bad habit

Some bad leadership habits follow us home.

I was talking with my wife early one morning a week or two ago. She was discussing her social work call schedule. She mentioned that there was primary and secondary call, and that she was generally on “second call.” From my frame of reference as a doc covering intensive care units I wondered how often the person on second call was actually called in. It became my “bottom line” question and I almost interrupted her several times as she spoke about her concerns regarding training for call to get my question answered. I came close to the exercise of a bad leadership habit: the drive toward “BLUF” – bottom line up front. Only it was my bottom line I was interested in, not hers.

But I caught myself.  And I allowed her keep talking. She needed to process her experiences. And I needed to hear what she had to say. The experience reminded me of a leadership lesson I have had to repeatedly learn; one that I know I have mentioned here before and I think is related at least in part to having a temperament of extroversion.

I have often found myself as a hospital leader being briefed by subordinates, paging through the briefing slides to see where the briefing was going and then cutting to what I thought was the main point without allowing the argument to be built. It was a bad but perhaps learned behavior. Once while I was briefing a very senior Army general about our hospital construction as we drove to the site in his vehicle, he cut me off at the third slide and asked, “Bottom line doc: is it on-time and under budget?” Well not exactly, Sir…

I know we are busy and that this is a technique to keep things moving and our schedules manageable. But perhaps we are missing opportunities to develop leaders at work. We are certainly selling ourselves short in missing opportunities to expand our own perspective. And at home when listening to family and friends, we need to take care that we don’t allow efficiency to replace empathy.

On the savanna among our ancient ancestors, the leader was often the first one to move. We need to remember that the leader’s courage to move has to be balanced by the willingness to “be moved” by those whom we lead.

It happens through careful attention and intention to their need to know they’ve be heard and listened to.

Chuck Callahan Henry V 4.3 – Lead from the Front https://henryv43.wordpress.com/

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September 30, 2015 · 5:10 pm

Transition: For or From?

I have learned to be wary of “from.”

A decade or so ago when I was serving as chief medical officer, one of my tasks was to meet with all of the providers leaving military service to get a sense of why they were leaving, and to determine whether there was something we could do to retain them in the military. (I often discovered that it was a conversation that should have taken place with a direct supervisor well before my meeting. But that is a separate observation about first-line healthcare leadership. It is too easy in medicine to lose the business of the person in the busyness of practice.)

Over a number of encounters I noticed that the reasons for leaving fell into two large categories: those who were leaving “for” something and those who were leaving “from.”

The “for’s” included a range of different items: better job opportunities, additional training, geographic pressures. Often the “for’s” were based on the needs of the spouse or family. Over time I occasionally saw these providers again and asked them how they were doing with the decision they had made. The question was a bit like what Sandy McGrath asked his friend Eric Liddell regarding his decision not to run in a heat in the 1924 Olympics because it was on a Sunday (Chariots of Fire, 1981). “Any regrets?” his friend asked him, and I asked the providers about leaving military service. I often got the same answer Liddell gave in the movie: “Yeah. No doubts, though.” Having a strong “for” softened the regrets of leaving the camaraderie, adventure, job satisfaction and career opportunities for these providers.

The response to “from’s” was generally different. Continue reading →

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August 17, 2015 · 5:19 pm

A source of medical leader ineffectiveness?

Some of the same skills that make physicians, nurses, medical administrators and allied health professionals excel in our clinical roles can potentially hinder our effectiveness as leaders. If the process of recognizing these risks were automatic we wouldn’t need to think about it. And there would be an even greater number of effective healthcare leaders.

Unfortunately, every group I speak with can quickly relate stories of a bad leader or two. While bad leadership may be common, I contend that intentionally bad leadership is rare. People don’t get up in the morning, and while shaving or brushing their hair, look in the mirror and say, “Today I will be a bad leader.  I will mismanage and mess with someone’s career…” That should be sobering for us, however well-intentioned we may be. In the spirit of continual reflection and renewal, it’s worth examining three strengths we develop in the study and practice of healthcare that can sometimes be leadership liabilities.

Talented tacticians.
Healthcare is inherently tactical.  We learn the craft of medicine one patient at a time: one exam room, one hospital bed, one operating room.  It is a pattern reinforced through decades of training during the crucial years of adult development. After training, daily practice is a series of independent encounters in the ambulatory or inpatient arenas.  The rules of patient privacy necessitate our forgetting the last patient as we move onto the next.  Sometimes we may not think about them again until the lab or consult comes back, or we see them in follow-up.  There is little time or expectation for the awareness necessary to string together patterns of patient problems or behaviors, or for us to think about the larger, strategic implications of our medical practice.  The way of thinking may spill over into our personal lives where our best intentions to be the people/partners/parents we know we should be become lost in the tyranny of day-to-day “tactical” execution (drive the kids, take out the trash, finish the lawn etc). Continue reading →

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June 22, 2015 · 8:37 am

Inquiry: an academia and leadership “main thing?”

“The main thing is to keep the main thing the main thing.”

In their 1997 book The Power of Alignment George Labovitz and Victor Rosansky attribute this quote to Jim Barksdale, former CEO of Netscape, (although it may come originally from Stephen Covey’s Seven Habits of Highly Effective People, 1989).  For my three decades of medicine in the uniformed services, the main thing was pretty straight forward: caring for Service Members and their families.  I remember considering a transition to civilian-life at about twenty years into my career.  While paging through the directory of a local hospital I found myself looking at the physicians’ pictures and musing, “I wonder what their ‘main thing’ is?”  I stayed in the military until they told me it was time to go home.  I think that the clear sense of the main thing was a big part of the reason.

Now I have worked in academia for nearly a year.  Part of the adjustment has been trying to answer the same question: “What is academia’s main thing?”  To a newcomer, the university seemed at times to be a random collection of instructors, researchers and research assistants, statisticians, administrators, teachers, clinicians (in medical academia) all circling in parallel orbits.  I could argue that the medical or graduate students were the central focus, but some staff members rarely interacted with the students.  The search for a unifying “main thing” proved elusive.

A possible answer to the question occurred to me recently while I was listening to a post-doc researcher present her work.  She described how each experiment had led to the need for further experiments.  One question answered led to fresh questions unanswered.  It struck me while she was speaking that when academia functions as it should, its “main thing” is inquiry. Continue reading →

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May 6, 2015 · 10:15 am

Baltimore: Another Red Pill?

The 2014 Ebola outbreak was a “red-pill moment” for the world.  Ebola is a terrible disease that broke out in the worst possible place and has only been controlled through the herculean, heroic efforts of the local national and international communities. The young nations of Sub-Saharan Africa have some of the most fragile healthcare systems in the world. Save the Children’s report “A Wake-up Call” brings the disparity into focus.  The report suggests that it would take $86/year to provide minimum essential services. In 2012 the governments of Guinea, Liberia and Sierra Leone spent $9, $20, and $16 per person/year respectively on healthcare, while the US spent $4,126 and Norway $7,704. Martin Luther King said, “Injustice anywhere is a threat to justice everywhere.” Perhaps this year with the rise of globalization we recognized that failing or overwhelmed healthcare systems anywhere are a threat to health everywhere.

In The Matrix (1999) Morpheus warned Neo of the risks of seeing the world as you wish it to be instead of seeing it as it really is. “Taking the red pill” has become a popular cultural reference for swallowing the sometimes painful truth of reality.

As many mavens have observed on both sides of the argument, the lessons we must draw from Baltimore cannot stop at the need for police reform. The stark statistics are also arresting: an African-American baby born in Baltimore between 2006 and 2008 had a significantly shortened life expectancy compared to a white baby born during the same period (70.2 vs. 76.2 years). The African-American baby was twice as likely to be born at low birth weight (15.1% vs. 7.4%) and was nine times more likely to die before the age of one. Nine times. Baltimore is emblematic of all our American cities including our Nation’s capital, where the death rate for poor children is similar to that of children in El Salvador or Cambodia.

We have a choice. We can continue the rancor and continue writing things to be read by those who agree with us; blaming each other while we do nothing.

Or we can move toward recognition and admit: Something is terribly wrong. Someone must be wrong. Perhaps, just perhaps… we are all wrong about something. Continue reading →

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January 17, 2015 · 7:19 pm

Leadership Lessons from an ETU

I did not arrive to work in Sierra Leone in any kind of leadership capacity.

Prompted by the news and the conviction of Faith, in October I signed up with USAID and then with Partners In Health to serve as a clinician caring for patients with Ebola.  I was initially scheduled to go to Liberia but with the growing need in Sierra Leone I was rerouted a week or so before my travel date.  We arrived in Sierra Leone on Wednesday December 3rd, trained aggressively and began working in the Ebola Treatment Unit (ETU) in the Maforki Chiefdom of Port Loko by that weekend.   Providing care to these wonderful people in partnership with the courageous Sierra Leonean nationals and a cohort of exceptional international professionals was one of the true honors of my life.

Although I was not formally in a leadership role until I became ETU clinical lead the last week or so of my time there, I was aware of the challenges and I was very impressed with the leadership team assembled.  Applying the critical dyad of “attention and intention,” I discovered that in the ETU, as is usually the case, leadership lessons abound:  “If the spirit of the student is in you, the lessons will be there” (Sir William Osler).  Here are several of my observations.

Master Narratives and Names.  New expatriate staff arrived at Maforki regularly.  It would have been very easy for the “long-timers” (those who had already been there a week or two) to develop the kind of exclusivism that could disrupt team development and undermine the “changing class picture.”  One solution was to aggressively learn the new peoples’ names and stories and take the initiative to reinforce that knowledge by introducing them by name and “narrative” to the folks who were already there.  People won’t readily surrender personal identity to take on group or team identity until the former is at least acknowledged.  The same practice was an important part of getting to know the local national staff and to build the team with them.

We need to practice “intentional inclusivity.” This follows by purposefully including newcomers into existing rituals.  For us at Maforki this meant eating meals together and inviting new colleagues on the morning walk to the ETU through the town of Port Loko.  It was a tremendous opportunity to get to know one another and to reinforce our new, shared identity.   “Not good with names” is not a viable excuse in leadership.

Lead from the front.  Nicollo Machiavelli wrote “It is the duty of a good general to be the first man in the saddle and the last out of it.” One of the most difficult aspects of work in the ETU was learning to accomplish the clinical tasks while wearing the personal protective equipment (PPE). The outfit included a Tyvek suit, plastic apron, boots, mask, shield and multiple pairs of gloves (I always wore three).  The process of ritually removing these garments (“doffing”) took a good 20-30 minutes if done fastidiously.   You were always anxious to get on with the process so you could get out of the suit.  (On top of which there was no way to urinate while in PPE, which added an occasional sense of urgency!)   Still it was always a choice to allow the more junior people to leave first and to monitor them carefully for safety as they went through the process.  Who should get to get out of the saddle first?

Practice calm in chaos.  We all need to know our leadership style in comfort and in chaos.  I have long known that my style of comfort is characterized in Goleman’s model as “affiliative;” focusing on the importance of people and relationships.  I value the input of others and in chaos I have the tendency to oscillate from firing from the hip with too quick decisions that may lack the collective input to the relative paralysis of dialog that involves too much “thinking out loud.”  So what I try to do in chaotic moments is to be quiet (not natural for me) to listen, to decide, then to reinforce, move on and check back with the results of the decision.  It is a discipline that has taken practice and even after many years, still requires intentional reinforcement.

Ditch discouragement and disparagement.  “Bitching” (pardon the language) is a natural way of blowing off steam in stressful situations.  People and circumstances can be frustrating and the process of complaining and commiserating is therapeutic.  Unfortunately it can also be destructive if it degenerates into slander or gossip.  And it can be poison if it proceeds unchecked.  Discussions about an individual’s performance have no place in public unless you are talking about yourself and the anecdote ends with laughter(!) Similarly, habitual negativity can become a weight that drags everyone down.  There may be a time and a place for both, but the leader’s job is to redirect the discussion when necessary.

Resist retreat.  Everyone gets worn out.  I found that by about week three or so, my enthusiasm for going in to the red zone waned through the course of the day.  I noticed the same trend in some of my colleagues who seemed like me at times to look subconsciously for other tasks to be spared the arduous, intense physical and emotional work.  The first step is to acknowledge that the feeling is normal and may even be self-protective.  And then one has to consider again Machiavelli’s “rule of the saddle.”  Leaders should be the first in and the last out.  In some of these times it was helpful to have a trusted colleague with whom one could commiserate in private, and then together like Rocky Balboa, we would “get back in the ring.”

One of my good friends, Colonel Mark Thompson reminded me a decade ago,”You don’t really have to be good to be a leader… you just have to be present and positive.”  I would expand to this degree: the definition of a good leader may well be the one who is both present and positive, whether he or she is in a formal leader position or not.

And so effective leadership often boils down to this: showing up and looking up.

 

Chuck Callahan  Henry V 4.3 – Lead from the Front  https://henryv43.wordpress.com/

 

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