1. Simone, Joseph V. MD

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This column is one in a series on the importance of leadership in cancer research and clinical programs. Trying to understand leadership, good and bad, has been an endlessly fascinating journey for me. And I am not alone. The shelves in the business section at Barnes and Noble are filled with books on the subject and airport concessions, even in smaller airports, always have such books. The Harvard Business Review reliably prints many articles, universities offer continuing education courses, and celebrities give well-paid lectures on leadership. Why is the subject so popular? The answer is easy: because leadership is difficult and because leadership is so important to any enterprise.

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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

A parenthetical note of caution here about business books: I have read my share and found the majority to be useless. They are filled with simplistic nostrums, are endlessly repetitive, and have an almost total dependence on anecdotes (case studies), which by their nature are totally retrospective and uncontrolled. Only a small percentage of books provide an enlightening synthesis or novel viewpoints, so caveat emptor.


In my own case, an interest in the qualities of effective leaders has been greatly intensified beyond sporadic reading. It helps for me to review my own experience of watching great leaders in action, assessing my own role as a leader of academic programs and hospitals, and through my consulting work, which provides opportunities to examine in detail the work and effectiveness of many leaders in health care.


In an earlier column, I described what some experts believe makes a great leader, or rather, what kind of performance and outcome is apparent in very successful leaders. This is an important distinction. It is much easier to identify an effective leader after the fact than before or during his or her tenure. This raises interesting questions, such as: Are leaders made or born? Can someone be taught to be an effective leader? Can one identify an effective leader beforehand? Are all effective leaders "successful?" I hope to shed a bit of light on these issues from the literature and personal experience.


Are leaders born?

Yes, partly. I agree with Bill George, a former corporate CEO. In his book, True North: Discover Your Authentic Leadership, he expresses in several ways that the core characteristics of leadership, the soul of leadership, cannot be taught. I have come to believe that what is true for most skillful activities is also true for leadership. Not only is one's DNA a major influence, but George points out that personal crises and other life experiences early in life and later also prepare one to be an effective leader.


Although I loved the game, no matter how hard I tried, I could never have been a competitive college football player. I was the wrong size and shape, terribly slow, and had other interests that were more important to me. A friend once told me of a conversation he had with a CEO of a large corporation. He asked the CEO how he could tell if a candidate was likely to be an effective leader. He replied, "Simple, I just asked them what they did in high school." He was making a point that the signs of an aptitude for leadership show up early.


Can one teach effective leadership?

Only partly and only if the basic soul of leadership is already there, I believe. One can be taught certain techniques and skills through mentoring and graduated experience. But that is a refinement of the basic foundation of good instincts about human nature, character, ambition, and self-confidence. I also believe one can teach, or try to teach, a potential leader that unless he/she gets pleasure out of seeing those being led succeed and get the glory because of his/her efforts, a leadership position may not be a good choice, no matter what other talents are in place.


Can one identify an effective leader beforehand?

This is very difficult and typical search processes often fail to identify the right leader for the specific job. In my view, the best predictor of an effective leader is evidence of effective leadership in the past. This seems to be a catch-22: "I don't know if you will be an effective leader unless you have already been an effective leader. How can one become an effective leader if one never gets the chance?" But this is not as dumb as it sounds. If someone has had experience as a leader, even in a voluntary or relatively minor position, it usually means the person wanted to be a leader and went after the job, or was recognized by others as someone they would like as their leader. If he/she were successful in that role, that provides a degree of greater security in the evaluation.


In my personal experience, there are two top reasons for the failure of leaders. First, a candidate is hired for the wrong reasons, e.g., an outstanding scientist is hired to be chairman of a department or a dean primarily because of a long bibliography and an expansive CV. These are poor indicators of an aptitude for leadership, yet are often the most powerful influence on the decision to hire. Second, the candidate likes the position for its stature and power, but doesn't really like (or understand) the job of leadership. This type often is just a boss or even a bully, but not an effective leader that leads the team to perform at its best.


Are all effective leaders successful?

No. This is one of the great faults of business books on leadership. Too often, the only measure of an effective corporate leader is an increase in market share or stock price. In academia, it is grants obtained or papers published. Books don't sell if they describe the leader who, despite seemingly insurmountable obstacles, managed to bring his so-so team to a much higher level of performance than expected. Or the leader who inherited a staff ill-fitted for the job, but was able to rearrange the workforce and workflow to help them perform at their very best. The athletic directors of college sports know this well. They often hire a coach who has turned a chronically losing team at a second- or third-tier sports college into one that wins half its games. They recognize the coaching talent despite the mediocre player talent.


In summary, effective leaders are born with an innate aptitude shaped and grown by life experiences and refined by mentorship and experience; all three are necessary. Although not fail-safe, one makes a better bet on a prospective leader who has a record of successful leadership in the past, no matter at what level. Finally, excellent and effective leaders may not be judged successful by the world's standards, but they may have done an excellent job with the resources and conditions provided-and they usually know that in their hearts.