1. Simone, Joseph V. MD

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In my last column (9/10/12 issue), I provided an overview of some key factors for successful management and leadership. The information was based on a selection from a few outstanding books on the subject collected and published by Alan Murray in The Wall Street Journal Essential Guide to Management, as well as my own experience.

JOSEPH V. SIMONE, MD... - Click to enlarge in new windowJOSEPH V. SIMONE, MD, has had leadership roles at St. Jude Children's Research Hospital, Huntsman Cancer Institute, Memorial Sloan-Kettering Cancer Center, the University of Florida Shands Cancer Center, the National Comprehensive Cancer Network, and the National Cancer Policy Board, and has served on the NCI's Board of Scientific Advisors.He welcomes comments and suggestions for future topics for his column. E-mail him

This is the second in a series on the topic, and coming next, in the October 10 issue, will be a column on the concept of a "leadership ladder."


I am writing specifically about leadership as applicable in a health care environment (although most good principles apply in any work environment, a few do not).


6 Styles of Leadership

Daniel Coleman, who popularized the notion of "emotional intelligence," described the following six styles of leadership used to motivate others. A key conclusion of his was that the best leaders may use all these techniques, moving among them depending on the circumstances. It would be a mistake to stick with one style all the time while the work environment is evolving.


* Visionary: This style is most effective when an organization needs new direction. A new dean or cancer center director takes over a limping med school or cancer center and moves people to a new set of shared dreams and goals. S/he articulates the goals but then sets people free to innovate, experiment, and take calculated risks.


* Coaching: Coaching works best with employees who show initiative and want more professional development. A one-on-one style develops individuals, showing them how to improve performance and helping them align their goals with the goals of the organization. This approach requires a delicate balance that avoids micromanagement, which can undermine a person's self-confidence.


* Affiliative: This style emphasizes teamwork, seeking harmony by connecting individuals with one another. Developing translational research that includes lab bench scientists with clinicians is a good example. Like all of these styles, too much of it can be counterproductive. Pressing too hard for group work can allow an individual's poor performance to slide by unseen, leading some to believe mediocrity is tolerated. Or it can bury a first-rate individual performance that is unappreciated and unacknowledged.


* Democratic: This works best when the direction of the organization is still unclear and the leader needs the collective wisdom of the group. But this approach can be disastrous in a time of crisis when swift, decisive, unilateral action may be needed. (See previous column on leadership during a crisis.)


* Pacesetting: This is the classic "lead by example" approach, which in my experience is one of the more effective approaches when always turned on. The leader sets the style and standards of operation by his/her own actions; is obsessive about doing things better and faster and asks the same from everyone. S/he makes sacrifices of time and energy to get things done to demonstrate what is expected of everyone. However, as with all of these styles, it can become counterproductive. A type-A manic leader who works 16 hours a day cannot expect everyone to do that, and unless this is a temporary condition due to a crisis, it is a bad idea for the leader, as well. A balanced life with time for family is far healthier.




The next topic covered in Alan Murray's book is Motivation, and his first simple sentence is important: "To be a great leader, you must understand your followers."


I would add, "with an open mind." I believe this is a major factor in determining the success or failure of a leader. I learned this from my mentor, Dr. Donald Pinkel, the first director of St. Jude Children's Research Hospital (he hired me right out of fellowship). St Jude was very small in 1967, so we could get to know everyone, from cafeteria personnel to chairs of departments.


I gradually learned to lead by walking around. When I became director in 1983, several times a month I would go to the top floor and work my way down to the basement walking the corridors, checking the working conditions and cleanliness, stopping to speak to people, asking about their families and listening to any complaints (or gossip) they wished to pass on. This took only 15 minutes or so, but brought me useful information and demonstrated my interest in all aspects of the institution.


Also, every morning at 7:30 I went to the cafeteria, got a cup of coffee, and sat at a table with five or six others-electricians, facility engineers, lab techs, an occasional trainee or faculty member, and a variety of others. All were welcome, and any topic was allowed for discussion. Sometimes it was baseball, sometimes the poor lighting in a room, sometimes news of a sick employee, and always a lot of joking and joshing around. Those 20 minutes were probably the most valuable effort of my day to understand the inner workings of the institution and the temper of those in the trenches. Some of those guys are still friends some 20 years after my departure from St. Jude.


A hundred years ago Frederick Winslow Taylor was the founder of the study of management and leadership. He believed, however, that the only thing that motivates workers is money. This turned out to be true for many, but as times have changed and the conditions and roles of workers have changed, the motivation of workers has also changed. Working in mines and factories was brutal, dangerous work in his day that paid relatively well. But the nature of work has changed. Today, many, or even most, jobs must offer the worker more than just money.


Douglas McGregor of MIT was a pioneer in debunking Taylor's approach, mainly in his book The Human Side of Enterprise. McGregor's studies led to his tenets of motivation:


* The expenditure of physical and mental effort in work is as natural as play or rest.


* External control and the threat of punishment are not the only means for bringing about an effort toward organizational objectives. Man will exercise self-direction and self-control in the service of objectives to which he is committed.


* Commitment to objectives is a function of the rewards associated with their achievement.


* The average human being learns, under proper conditions, not only to accept but also to seek responsibility.


* The capacity to exercise a relatively high degree of imagination, ingenuity, and creativity in the solution of organizational problems is widely, not narrowly, distributed in the population.


* Under conditions of modern industrial life, the intellectual potentialities of the average human being are only partly utilized.



In other words, in modern management, the goal is no longer to simply direct and control employees, but to create conditions that make them want to offer maximum effort on their own. Employees who harness self-direction and self-control in pursuit of common objectives, it turns out, are far more productive and effective than those working under a system of controls designed to force them to meet objectives they don't understand or share. If you give people responsibility, they often rise to the challenge.


That largely fits with my own experience. Good management requires respect for individuals and their capacities, and an insistence on candor, accountability, and excellence. Even those who are self-directed still require guidance from time to time. A great leader knows when to turn them loose and when to guide their direction.


But what if a person consistently fails to meet expectations despite coaching, trying to provide work that suits his/her talents, allowing freedom to set a reasonable pace and personal attention? This result may be due to laziness, a lack of talent, bad time management, or just a bad fit for the organization (which may include one or more of the others). In a bad fit, the person really tried, but simply couldn't adapt to the organization's culture and meet its expectations.


In that case, what needs to be said is: "We both have tried to make this work and it isn't happening. You are simply a bad fit for the job we need done; it is my fault as much as yours. You're unhappy, we're unhappy, and the best thing for both of us is to help you find a better fit, either in another area in the organization or (more likely) in another institution."


I have been astonished at how often the employee gets a better job (better fit), makes more money, and is much happier. Of course, no one has thanked me for firing them, but the result was often a good one for both.


Leadership isn't for everyone; it can be stressful, with long stretches of unrewarding labor. A great leader manages day to day, but mostly plants seeds for the long-term health of the organization, even though others coming later often pick the fruit of those efforts. Gratification at the success of others in one's group is a sign of a mature leader.


Part 2 of a 3-Part series on leadership. Part 1 appeared in the Sept. 10, 2012 issue.