1. Simone, Joseph V. MD

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Niccolo Machiavelli (1469-1547) lived in the midst of the culturally vibrant but dangerous medieval climate of shifting political alliances in the Florentine Republic and the Italian City States. By all accounts he was intellectually sharp and observant. He was an advisor to princes in Florence, especially the Medici clan. He was a politician, historian, diplomat, and philosopher admired for the high quality of his Italian language, a relatively recent version of modernized Latin. During that time he wrote both The Prince and The Art of War. In the former, he describes what a prince (or any political leader) should do in a variety of circumstances.

JOSEPH V. SIMONE, MD... - Click to enlarge in new windowJOSEPH V. SIMONE, MD. JOSEPH 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. He has served on the NCI's Board of Scientific Advisors, and his

"Machiavellian" is a widely used term to describe the ruthless pursuit of political ends without regard for morality. Machiavelli says that rulers should embody virtue and honor, but that success often must come from disregard of ethical concerns.


The Prince gained enormous notoriety and wide readership because most readers assumed the author was teaching and endorsing evil and immoral behavior. Because of this, the term "Machiavellian" is often associated with deceit, deviousness, ambition, and brutality, although Machiavelli likely used the approach only as a stylistic device to gain the readers' attention for his close analysis of the actual techniques used by rulers.


On close reading, however, it turns out that some of the advice he offers is not morally offensive and may be applied to leadership in general in any complex organization-academic or commercial, then and now. I have a particular interest in the qualities and challenges of leadership and am quite willing to learn from an Italian who knew a great deal about it, sometimes with his head on the line.


We must remember the age and times when these were written; I have left out quotes that I feel are amoral or deal with acts of war. What follows is my interpretation of some of Machiavelli's advice as adapted to the 21st century in academic and clinical environments:


He who wishes to be obeyed must know how to command:

In other words, a leader must know how to lead, direct, and correct without bloodshed but with an acute understanding of those under his command. A deep knowledge of the personality, character, and capabilities of the staff is an invaluable asset when asking or directing someone to act. A lack of clarity when giving directions or delivering orders with anger or disrespect is a formula for confusion and unhappiness-either of which will at best compromise efficiency and at worst be demoralizing.


There is nothing more difficult to take in hand, more perilous to conduct, or more uncertain in its success, than to take the lead in the introduction of a new order of things:

The temptation of a new leader to radically change the structure and function of an underperforming organization should be approached only after detailed preparation. The current culture, even if obviously faulty and inefficient, is what all the employees and officers are accustomed to. Radical, sudden changes without addressing and informing the team can destroy any trust in the leader.


Without clear language and transparency concerning the exact purpose and rationale, the result is often catastrophic. The potential negative consequences of the major change that may occur in the short or long run must be revealed along with the reason for taking that risk.


A return to first principles in an organization ["republic" in the original] is sometimes caused by the simple virtues of one man [or woman]. His [/her] good example has such an influence that the good men [/women] in the organization strive to imitate him, and the wicked are ashamed to lead a life so contrary to his example.


This is a long version of the adage to "lead by example." If leaders behave well concerning their own work habits and social interactions, they silently embed the expectation that all the employees should have impeccable work habits and social interactions.

Figure. Portrait of ... - Click to enlarge in new windowFigure. Portrait of Niccolo Machiavelli by Santi di Tito

It is not necessary to have exact duplication of another's behavior, but emulation of valuable courtesies and camaraderie, kindness, and consideration toward others, if copied over and over makes for a much more pleasant and productive environment.


Whosoever desires constant success must change his conduct with the times:

The leader who is successful and has a happy team may feel reluctant to make any changes. The leader has done well so far, so why change? But the surrounding world is always changing-sometimes slowly and sometimes rapidly.


The medical field, for example, has been changing rapidly over the past decade, and it is sad to watch those leaders who waited so long before acknowledging the importance of change. The leader may be forced to make quick and financially negative changes-e.g., mergers, buying private practices, agreeing to be obtained by a giant system in which he and his team will have little to say in the new management, if they stay at all.


Medicine is a very competitive and financially rewarding arena, and keeping up with what is happening and making serious plans for adapting is essential for survival.


The first method of measuring the intelligence of a leader is to look at the [people] around him:

This is an adage that most senior people learn quickly. In fact, one of "Simone's Maxims" says the same thing in a different way: "First-class people recruit first-class people; second-class people recruit third-class people." As my dear departed friend and colleague Allan Granoff told me early in my career at St. Jude: "Hire really good people; they will make you look good."


He was so right ... and the reverse is also true: "Hire poorly trained or poorly motivated people and they will make you look bad."


Machiavelli may have gotten an overly bad reputation in the 16th century. He was often quoting the ancients and living at a time of constant wars and regal shenanigans. In any case, he had many good ideas for surviving in that environment.