1. Simone, Joseph V. MD

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I have wrestled with the concept of what makes a great leader many times over the years and have written about it before, but I never grasped the essence satisfactorily. Changes in leadership are common in academic medical centers, hospital systems, and government agencies. Having observed such changes many times in my career, a recent experience once again has made me ask myself what makes a good leader of these organizations and, better yet, what makes a great leader.

Joseph V. Simone, MD... - Click to enlarge in new windowJoseph V. Simone, MD. JOSEPH V. SIMONE, MD, has had leadership roles at many institutions and organizations, and has served on the NCI's Board of Scientific Advisors. His

Leadership matters and it matters a lot. This statement would seem to be a no-brainer; however, it is common to see leaders chosen irrationally. This is true of business, a medical practice, a hospital, an academic institution, or a government agency. Books on business success, including leadership, seem to be everywhere. While books on leadership of non-profit organizations, particularly those in health sciences and health care, are almost non-existent, leadership qualities are shared in all industries. There are many faulty reasons for choosing a leader. Here are three.


1. Longevity

A dean may choose a faculty member to chair a department mainly because he has been with the organization for a long time. He is a nice guy, easy to get along with, and works hard. However, he freezes when having to make an important decision. That slows progress and healthy development of the program. This is especially damaging when he is extremely reluctant to fire or transfer anyone, so he puts the brakes on progress, which can endanger the morale of the team.


2. Scientific Excellence & Fame

It is a common, in my experience, to see a very good scientist with a huge bibliography appointed to a departmental chair when she has no leadership skills. She has no vision for developing and improving the department, she is not a good recruiter, and she has an imperial attitude toward those in lower rank. This situation often causes long-term problems among the faculty.


3. Lack of Leadership Experience

A candidate is hired despite his lack of experience in successfully leading a group of colleagues. Leadership is a talent that is partly or mostly in the person from childhood. That talent can be improved with experience. It is my own bias that most leaders have a history of leadership in families, school, church, Boy Scouts, or other such community or social organizations; absent that beginning, becoming a great leader is possible, but very difficult.


Models of Good Leadership

There are several gurus of management that have addressed this subject. One of my favorite sources of business management wisdom is Peter Drucker. This legendary sage understood and clearly described the features of running successful businesses. He is famous for believing integrity and high ethical standards are central to good business practice because it is the right thing to do, but also because it is good for the long-term health of an organization. Here is an excerpt from his work.


"What would I look for in picking a leader of an institution? First, I would look at what the candidates have done, what their strengths are-you can only perform with strength-and what have they done with it? Second, I would look at the institution doing the hiring and ask: 'What is the one immediate key challenge?' I would try to match the strength with the needs. Then I would look for integrity. A leader sets an example, especially a strong leader."


Drucker then quotes a famous and successful business leader and asked what he looked for in a leader. The man responded, "I always ask myself, would I want one of my sons to work under that person? If [the leader] is successful...would I want my son to look like that?" Drucker then concludes, "This, I think, is the ultimate question." And my favorite comment by Drucker, "Effective leaders delegate, but they do not delegate the one thing that will set the standard. They do it." Another well-known management expert, W. Edwards Deming, also held this last principle.


Deming is best known for being the American consultant who revitalized Japanese industry after World War II. "It is the responsibility of management to discover the barriers that prevent workers from taking pride in what they do. Rather than helping workers do their job correctly, most supervisors don't know the work they supervise. They have never done the job." Deming goes on to say that such supervisors often use numbers or quotas as the only basis for judgment, without understanding the nature of the work.


The greatest leader in American history was, in my view, Abraham Lincoln. A book that focused on his leadership and political skills cemented this view and, of course, on aspects of his personal character that shaped him (Lincoln: A Life of Purpose and Power). Lincoln's integrity, vision and bedrock principles were combined with uncommon political skills, which enabled him to navigate skillfully the most difficult and treacherous times of our country. He devoured information from all sources and sent aides into the field to obtain first-hand information that helped him make astute, strategic decisions. He was an uncommon leader who brought political enemies into his administration because he believed they were the best people for the jobs. This book is the best I have ever read on the subject of leadership.


Leaders With Vision

In my experience, it has been clear the ill effects of poor leadership, at any level from CEO to department head to housekeeping, insidiously permeate an entire institution. This invariably leads to inefficiency at best, and at worst leads to falling dominoes of lost opportunity or catastrophe. Effective leadership is often subtle but direct, nuanced but clearly understood.


What makes great leaders is not a secret. They have grace under pressure, which means both courage and character, while they remain focused on the important aspects of an issue in the midst of chaos. Great leaders repeatedly articulate a consistent, simple public vision by example, conviction, and actions. If the troops don't know what is expected of them, what direction is set or what the leader values most, that is the leader's fault.


However, this vision must be backed by public acts, not just words. There are many opportunities to demonstrate one's vision, both subtle and overt. Whom the leader hires, fires, and promotes sends the most effective signal, but smaller acts can indirectly express his or her values. Great leaders take satisfaction in the success of team members and try to hire people who are better than they are.


I end with two qualities that help distinguish a great leader from a good leader, especially in the not-for-profit world. First, though the great leader remains confident in her final decisions, she must have humility in sufficient measure to mitigate arrogance and promote active listening to those holding other views. Second, she knows that at some time she will be asked to compromise her basic principles. If her values cannot be sustained because of the environment or trustees, the great leader may choose to lose favor, be fired, or quit over a key principle. If the position or stature or pay means so much that the leader will not put her job on the line for a core value, she is no longer free and has taken a step onto a slippery slope. Great leaders start with the mindset of holding core values and principles dear, no matter what the cost.