1. Simone, Joseph V. MD

Article Content

Changes in leadership are common at government agencies and the academic medical centers influenced by them. Having observed such changes recently, I have begun to ask myself what makes a good leader of these organizations and, better yet, what makes a great leader.

leadership. leadersh... - Click to enlarge in new windowleadership. leadership
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; it matters a lot. This is so whether the organization is a business, a practice, a hospital, an academic institution, or a government agency. Books on business success, including leadership, seem to be everywhere. Typical is the book, Winning, by Jack Welch, the former CEO of General Electric, which became a bestseller. While books on leadership of non-profit organizations, particularly those in health sciences and healthcare, are almost non-existent, leadership qualities are shared in both venues. So let's review what some gurus of management have had to say on the 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 that 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 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 whom he asked what he looked for in a leader. And 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."


He continues, "In human affairs, the distance between the leaders and the average is a constant. If leadership performance is high, the average will go up." And finally, "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. This view was cemented in my opinion by a book that focused on his leadership and political skills and, of course, on aspects of his personal character that shaped the former (Lincoln: A Life of Purpose and Power). Lincoln's integrity, vision, and bedrock principles were combined with uncommon political skills acquired in his Illinois years and with a keen sense of public opinion. These 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 engaged some political enemies in his administration because he believed they were the best people for the jobs.


In my experience, it has been clear that 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 not only have grace under pressure, which means both courage and character, but 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 he remains confident in his final decisions, he must have humility in sufficient measure to mitigate arrogance and promote active listening to those holding other views. Second, he knows that at some time he will be asked to compromise basic principles. If his values cannot be sustained because of the environment, 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 his job on the line for a core value, he is no longer free and has taken a step onto a slippery slope. Great leaders have the mindset upon taking a position of holding core values and principles dear, no matter what the cost.