Doctors and leadership:
oil and water?
Richard Smith
Editor, BMJ
What I want to talk about
• Examine leadership
• Look at why leadership is
problematic for doctors
• Describe two examples of
outstanding doctor leaders
What is leadership?
• There is no simple definition
• My working definition is that leaders
have two main tasks:
• To set a path, goal, or vision for the
people who are being led.
• To motivate people to pursue and
eventually achieve the goal.
What sort of goal do I mean?
•
•
•
•
To put a man on the moon
To defeat Germany in the Second World War
To create a national health service in Britain
To improve the management of patients with
hypertension in a general practice
• To reduce waiting times in emergency
departments
• All of these tasks have to be done with others
- and that is true of most important tasks
Studies of leadership
• Until the late 40s the belief was that
leaders were born not made and had
particular traits: intelligence,
extraversion, etc.
• From the late 40s until the late 60s
the central belief was that it was how
leaders behave that mattered. It was
a question of style. As such it could
be learnt.
Studies of leadership
• From the late 60s until the early 80s
the idea was that leadership depended
on the situation in which leaders found
themselves. Some would be good for
some circumstances but not for others.
• Since the early 80s the central idea is
that leaders need vision and charisma
and that leading and managing are
different.
Characteristics of
charismatic leaders
• Charismatic leaders through role modelling
"represent the values and beliefs to which
they want followers to subscribe"
• They build positive images and express ideas
that appeal to followers ideologically
• They set high expectations and are confident
that followers can reach them
• They arouse emotional responses in followers
relative to achieving the goals
Managers and leaders
are different
• Managers and leaders are different.
• Power is potentially dangerous, and
so large organisations have
developed a collective managerial
ethic that stifles imagination and
creativity.
• Abraham Zaleznik, Harvard Business Review
Managers and leaders
Managers
Leaders
Employ persistence, tough
May be engaged in a
mindedness, hard work,
psychodrama of power and
intelligence, analytical ability,
politics.
tolerance, and good will to solve
problems
Goals arise out of necessities
rather than desires.
Adopt a personal and active
attitude towards goals.
Managers and leaders
Managers
Leaders
Limit choices
Create new approaches and open
up issues
Coordinate and balance
Alter moods, evoke images and
expectations, and establish
specific desires.
Like to work in teams but prefer Inspire and work with strong
low emotional involvement
emotions
Concentrate on survival
Take risks
Max DePree
• A dollar invested in Herman Miller in 1975
worth $4854.60 in 1986
• "Great leaders have the strength to
abandon themselves to the wild ideas
of others."
• "The art of leadership is liberating
people to do what is required of
them in the most effective and
humane way possible."
Max DePree
• "Leadership is an art, something to
be learned over time, not simply by
reading books. Leadership is more
tribal than scientific, more a weaving
of relationships than an amassing of
information."
Warren Bennis:
• "Leaders do the right things,
managers do things right."
• "The traditional view of leadership
is to get people to do what needs to
be done. I say it's getting people to
want to do what needs to be done."
Warren Bennis
• "Failing organisations are
overmanaged and underled."
• "Organisations decline because
people forget what is important."
Nelson Mandela
• “I am not a leader I’m a servant.”
Empirical studies on leadership
• Vision
• Communicating the vision.
• Empowerment - giving and sharing
power not restricting it
• Trust
• Working with others
Doctors' problems with leadership
• Doctors are used to working
primarily as individuals. Guard their
independence jealously.
They value autonomy highly - but
leadership is about working with
others.
Doctors' problems with
leadership
• Doctors and power: when I use
the word power who do you of?
Gandhi
• “We must be the change we wish
to see.”
Gandhi
Doctors' problems with leadership
• Doctors feel uneasy about power.
Think of it negatively.
• At the same time they are often
unwilling to cede power - something
that is important in empowering and
leading. They are wary of
abandoning control to others - yet
that is what leadership is often about
Doctors' problems with leadership
• Would think it presumptuous to set a
vision for an organisation
• Are not used to systems or organisations
anyway
• Have little experience of setting strategy.
Have difficulty seeing the broader picture
• Are awkward with teams. Too inclined to
try and dominate them rather than lead
them.
Doctors' problems with leadership
• To used to telling people (patients)
what to do rather than inspiring or
empowering them
• Are driven by science and suffering to
behave tactically and reactively rather
than strategically
• Are too fond of hierarchies
• They are wary of expressing emotion
in themselves
Doctors' problems with leadership
• Are inclined to be analytic rather than
creative, imaginative, and sympathetic
• Poor at manipulating symbols and
creating organisational excitement
• Are often poor communicators
• They are happier with puzzles rather
than problems
Doctors' problems with leadership
• Doctors for these reasons have
problems being leaders and being led
• "Leading doctors is like herding cats."
Warren Bennis
• The University of Hell
• “There is no kingdom too small for a
doctor to be king of.” John Green
Do doctors’ problems with
leadership matter?
• Doctors have created organisations that are
hard to lead and have a tendency to elect
compromise candidates and deliberately
avoid those who might display leadership.
• This is important because--worldwide--they
are too often reacting, usually negatively, to
the ideas of others rather than taking the
lead, helping to move things forward
Successful doctor leaders
Max Rosenheim
• Born in 1908, educated at Cambridge and
UCH. Served in the RAMC during the war.
• Joined the department of medicine in 1946
and became professor of medicine in 1950.
Developed an outstanding department.
• Became president of the RCP in 1966 and
was president until 1972. He mobilised the
college so that it could speak for the country
as a whole.
Max Rosenheim
• He made it more responsive to the young
and to the regions. The number of fellows
increased by 1000 during his time.
• He particularly developed postgraduate
education in the college.
• He brought the three colleges together and
created the MRCP (UK).
• He created the Faculty of Community
Medicine.
• Died in 1972
Max Rosenheim: vision
• He had a vision of a much expanded and more
responsive and influential RCP and of
improved PG education.
• He had an "indomitable sense of purpose once
his mind was made up."
• "He usually had a very clear idea of what
conclusions a committee was going to reach
even while he was making his short neutral
introductory remarks."
• BMJ obit says he "introduced a wind of change
into the RCP and transformed it with
tremendous results."
Max Rosenheim:
communication and trust
• Communication - travelled all over the
country, never refused an invitation.
• Tremendous energy
• Trust - ”He was able to engender
complete trust."
• "Such was his personality that it
generated intense loyalty."
Max Rosenheim: empowerment
• Demonstrated empowerment by giving
away power to Faculty of Comunity
Medicine, Scottish colleges, new
fellows, regions, and the young.
• The essence of empowerment is that by
giving away power you increase the
total sum of power - and, as the leader,
your own power.
Max Rosenheim: working with others
• ”In his unit he was like a father with
his children, proud when they did well
and not jealous."
• "Max's great strength lay in his warm
friendliness and his capacity to get
others not only to work well together
but to believe that they were helping to
shape decisons."
Iain Chalmers
Iain Chalmers
• Founder of the Cochrane Collaboration, now a
worldwide movement that is transforming
healthcare
• As a young doctor, worked for a spell in Palestine
• Once an obstetrician in Wales; became worried
that much of what he was doing might be harmful
• Learnt epidemiology
• Founded National Perinatal Epidemiology Unit,
the forerunner of Cochrane
• Now moving into criminal justice, education, and
medical history
Iain Chalmers: vision
• A vision of medical interventions
being based firmly on evidence,
particularly to avoid the harmful
• A vision of how this might be
achieved, through a worldwide
collaboration
Iain Chalmers: communication
and trust
• A relentless communicator--both
through journals and the like and
with individuals
• Trusted absolutely: will tell you what
you don’t want to hear, in the nicest
but most persistent way
Iain Chalmers: empowerment and
working with others
• The original “Tom Sawyer”--get others
painting the fence and then sleep
• “If you don’t mind who gets the credit
there is no limit to what you can achieve.”
Mark Twain
• Has created a worldwide network
• An unequalled ability to expect and get the
best from people and to make sure they get
the credit for what they have done
Conclusions
• Leadership is important to effect change
• Leadership is primarily about setting a
vision and motivating people to want to
achieve the vision
• Communicating the vision, building trust,
empowering people, and working in teams
are also important
• Leadership and management are different
Conclusions
• Doctors have problems with leadership,
both leading and being led
• But there have been and are outstanding
examples of doctors leading
• Leadership is not entirely inborn but nor
can everybody learn to lead.
• As a profession we need to think more
about leadership and encourage the
development of doctor who can lead - or at
least not stand in their way.
The Boss
The Boss drives his men,
The Leader inspires them.
The Boss depends on authority.
The Leader depends on goodwill.
The Boss evokes fear
The Leader radiates love.
The Boss says “I”.
The Leader says “We”.
The Boss shows who is wrong.
The Leader shows what is wrong.
The Boss knows how it is done.
The Leader knows how to do it.
The Boss demands respect.
The Leader commands respect.
So be a leader,
Not a Boss.