1. Doctors and leadership: oil and water?
Richard Smith
Editor, BMJ

2. What I want to talk about
Examine leadership
Look at why leadership is problematic for doctors
Describe two examples of outstanding doctor leaders

3. What is leadership?
There is no simple definition
My working definition is that leaders have two main tasks:
To set a path, goal, or vision for the people who are being led.
To motivate people to pursue and eventually achieve the goal.

4. What sort of goal do I mean?
To put a man on the moon
To defeat Germany in the Second World War
To create a national health service in Britain
To improve the management of patients with hypertension in a general practice
To reduce waiting times in emergency departments
All of these tasks have to be done with others - and that is true of most important tasks

5. Studies of leadership
Until the late 40s the belief was that leaders were born not made and had particular traits: intelligence, extraversion, etc.
From the late 40s until the late 60s the central belief was that it was how leaders behave that mattered. It was a question of style. As such it could be learnt.

6. Studies of leadership
From the late 60s until the early 80s the idea was that leadership depended on the situation in which leaders found themselves. Some would be good for some circumstances but not for others.
Since the early 80s the central idea is that leaders need vision and charisma and that leading and managing are different.

7. Characteristics of charismatic leaders
Charismatic leaders through role modelling "represent the values and beliefs to which they want followers to subscribe"
They build positive images and express ideas that appeal to followers ideologically
They set high expectations and are confident that followers can reach them
They arouse emotional responses in followers relative to achieving the goals

8. Managers and leaders are different
Power is potentially dangerous, and so large organisations have developed a collective managerial ethic that stifles imagination and creativity.
Abraham Zaleznik, Harvard Business Review

9. Managers and leaders

10. Managers and leaders

11. Max DePree
A dollar invested in Herman Miller in 1975 worth $ in 1986
"Great leaders have the strength to abandon themselves to the wild ideas of others."
"The art of leadership is liberating people to do what is required of them in the most effective and humane way possible."

12. Max DePree
"Leadership is an art, something to be learned over time, not simply by reading books. Leadership is more tribal than scientific, more a weaving of relationships than an amassing of information."

13. Warren Bennis:
"Leaders do the right things, managers do things right."
"The traditional view of leadership is to get people to do what needs to be done. I say it's getting people to want to do what needs to be done."

14. Warren Bennis "Failing organisations are overmanaged and underled."
"Organisations decline because people forget what is important."

15. Nelson Mandela
“I am not a leader I’m a servant.”

16. Empirical studies on leadership
Vision
Communicating the vision.
Empowerment - giving and sharing power not restricting it
Trust
Working with others

17. Doctors' problems with leadership
Doctors are used to working primarily as individuals. Guard their independence jealously They value autonomy highly - but leadership is about working with others.

18. Doctors' problems with leadership
Doctors and power: when I use the word power who do you of?

23. Gandhi
“We must be the change we wish to see.”
Gandhi

25. Doctors' problems with leadership
Doctors feel uneasy about power. Think of it negatively.
At the same time they are often unwilling to cede power - something that is important in empowering and leading. They are wary of abandoning control to others - yet that is what leadership is often about

26. Doctors' problems with leadership
Would think it presumptuous to set a vision for an organisation
Are not used to systems or organisations anyway
Have little experience of setting strategy. Have difficulty seeing the broader picture
Are awkward with teams. Too inclined to try and dominate them rather than lead them.

27. Doctors' problems with leadership
To used to telling people (patients) what to do rather than inspiring or empowering them
Are driven by science and suffering to behave tactically and reactively rather than strategically
Are too fond of hierarchies
They are wary of expressing emotion in themselves

28. Doctors' problems with leadership
Are inclined to be analytic rather than creative, imaginative, and sympathetic
Poor at manipulating symbols and creating organisational excitement
Are often poor communicators
They are happier with puzzles rather than problems

29. Doctors' problems with leadership
Doctors for these reasons have problems being leaders and being led
"Leading doctors is like herding cats." Warren Bennis
The University of Hell
“There is no kingdom too small for a doctor to be king of.” John Green

30. Do doctors’ problems with leadership matter?
Doctors have created organisations that are hard to lead and have a tendency to elect compromise candidates and deliberately avoid those who might display leadership.
This is important because--worldwide--they are too often reacting, usually negatively, to the ideas of others rather than taking the lead, helping to move things forward

31. Successful doctor leaders

33. Max Rosenheim
Born in 1908, educated at Cambridge and UCH. Served in the RAMC during the war.
Joined the department of medicine in 1946 and became professor of medicine in Developed an outstanding department.
Became president of the RCP in 1966 and was president until He mobilised the college so that it could speak for the country as a whole.

34. Max Rosenheim
He made it more responsive to the young and to the regions. The number of fellows increased by 1000 during his time.
He particularly developed postgraduate education in the college.
He brought the three colleges together and created the MRCP (UK).
He created the Faculty of Community Medicine.
Died in 1972

35. Max Rosenheim: vision
He had a vision of a much expanded and more responsive and influential RCP and of improved PG education.
He had an "indomitable sense of purpose once his mind was made up."
"He usually had a very clear idea of what conclusions a committee was going to reach even while he was making his short neutral introductory remarks."
BMJ obit says he "introduced a wind of change into the RCP and transformed it with tremendous results."

36. Max Rosenheim: communication and trust
Communication - travelled all over the country, never refused an invitation.
Tremendous energy
Trust - ”He was able to engender complete trust."
"Such was his personality that it generated intense loyalty."

37. Max Rosenheim: empowerment
Demonstrated empowerment by giving away power to Faculty of Comunity Medicine, Scottish colleges, new fellows, regions, and the young.
The essence of empowerment is that by giving away power you increase the total sum of power - and, as the leader, your own power.

38. Max Rosenheim: working with others
”In his unit he was like a father with his children, proud when they did well and not jealous."
"Max's great strength lay in his warm friendliness and his capacity to get others not only to work well together but to believe that they were helping to shape decisons."

39. Iain Chalmers

40. Iain Chalmers
Founder of the Cochrane Collaboration, now a worldwide movement that is transforming healthcare
As a young doctor, worked for a spell in Palestine
Once an obstetrician in Wales; became worried that much of what he was doing might be harmful
Learnt epidemiology
Founded National Perinatal Epidemiology Unit, the forerunner of Cochrane
Now moving into criminal justice, education, and medical history

41. Iain Chalmers: vision
A vision of medical interventions being based firmly on evidence, particularly to avoid the harmful
A vision of how this might be achieved, through a worldwide collaboration

42. Iain Chalmers: communication and trust
A relentless communicator--both through journals and the like and with individuals
Trusted absolutely: will tell you what you don’t want to hear, in the nicest but most persistent way

43. Iain Chalmers: empowerment and working with others
The original “Tom Sawyer”--get others painting the fence and then sleep
“If you don’t mind who gets the credit there is no limit to what you can achieve.” Mark Twain
Has created a worldwide network
An unequalled ability to expect and get the best from people and to make sure they get the credit for what they have done

44. Conclusions Leadership is important to effect change
Leadership is primarily about setting a vision and motivating people to want to achieve the vision
Communicating the vision, building trust, empowering people, and working in teams are also important
Leadership and management are different

45. Conclusions
Doctors have problems with leadership, both leading and being led
But there have been and are outstanding examples of doctors leading
Leadership is not entirely inborn but nor can everybody learn to lead.
As a profession we need to think more about leadership and encourage the development of doctor who can lead - or at least not stand in their way.

46. The Boss