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The Art of Leadership

October 28, 2008
by Pete Rivera
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While IT and business skills are critical, leaving leadership development off the table is a perilous long-term strategy

I entered the civilian workforce after serving 21 years as a Navy Medical Service Corps Officer. People often ask me what I miss the most and they are especially curious about how a military environment compares with a corporate organization - are they dramatically different, or somewhat similar?

In fact, there are only two strong differences that stood out for me. First, I didn't worry about what I was wearing to work; we all wore the same uniform every day. More importantly, in contrast to much of corporate America, I missed the strong leadership structure. By strong, I don't mean the stereotype drill sergeant that barks orders or salutes anything that moves. I'm talking about military personnel who stand out because they have earned the respect of their peers and the people who work for them. The presence of so many skilled leaders is no accident; it's the result of the military's methodical approach to leadership development.

Pete Rivera

Pete Rivera


The military is well renowned as a place to learn new skills and develop discipline. Technical training programs are major recruiting tools for young people looking for a career path. However, the military's professional development extends far beyond hands-on work skills to include the more complicated but incredibly important job of developing men and women as leaders. The military has implemented a formal program of teaching and mentoring that is it weaves throughout the “corporate” structure of its organizations.

Many healthcare organizations, on the other hand, inadvertently discourage the development of leaders due to insecurities within their organizational structure or fear of losing employees to other positions or hospitals.

This type of philosophy is exemplified in popular training programs such as Total Quality Management and Six Sigma, which focus on product and outcome management. Technical skills are strongly emphasized; leadership skills are minimized.

Large healthcare organizations often fill manager and director level positions externally rather than developing internal candidates.

Meetings are primarily used for project updates, issues monitoring, and budget tracking with little attention to team building and leadership development.

Employee appraisals are often tailored to reward productivity and completion of projects. The ability to lead teams, maintain cohesive working environments, minimize turnovers through high morale, and inspire motivation through example is not recognized.

For many CIOs, leadership is a soft skill, something that is not tangible and therefore does not deliver a return on investment (ROI). Of course the ROI in question is hard dollars, and what is overlooked is the cost of hiring and maintaining qualified employees.

According to the Society of Human Resource Management (Alexandria, Va.) the cost for hiring a new employee is about 38 percent of the departing employee's annual salary. The U.S. Bureau of Labor Statistics (Washington) predicts that by 2010 we will encounter the most severe shortage of skilled workers in the history of this country. These two factors combined should wake up many CIOs to realize that retention does indeed have a hard ROI.

So why do we have such a high turnover rate in many large healthcare organizations?

Too many hospitals operate in a culture of fear. As a consultant, I often talk with employees who approach their jobs with anxiety over fear of failure, fear of job loss, and fear of being in the spotlight fordoing something wrong. This fear contributes to a climate that can best be described as abusive. These abusive environments undermine employees emotionally and physically, and contribute to absenteeism, which ultimately leads to employee turnover.

Managers at all levels can contribute to this debilitating environment by their own cynicism or misguided attempts to side with employees against “higher ups.” Managers wanting to be a friend rather than a leader affects how communication is delivered, and is an essential part of leadership and professional development.

Unthinking quips such as - “If my neck is on the line for this, then everyone's neck is on the line,” or “I hate the idea also, but if that's what the higher-ups want us to do, then we have to do it,” or “It's time for another reorganization, you better get your resume up to date” - can send shock waves across your department and become sure-fire morale busters.

I was logged in to my LinkedIn account (http://www.linkedin.com) which is a professional business network, and the following question appeared on its blog: Is leadership just the art of management with charisma and assertiveness?

Leadership can be an elusive term. Often, we're able to point out a leader, but we have a hard time defining the traits that make someone a good leader. That's because leadership is as much an art as it is a science. The best definition of a leader is a person who can influence and direct other people to achieve goals.

Too many organizations mistakenly believe that a leader is the person who has been placed in charge. In doing so, they fail to understand that a person given positional authority does not automatically posses the influence necessary to lead a team. The position may give a person the right to direct activities, but without the leadership skills to inspire confidence, earn respect, and foster loyal cooperation, organizational goals can be difficult to achieve.

So how does the military accomplish what so many hospitals fail to achieve? A key element of military leadership training is the recognition that in carrying out an order, you make it your own. “Owning the order” means automatic buy-in throughout the organization. How would the military model look in a corporate organization? Consider a senior management decision to implement a new hospital information system. Organizational directors pass the word to next level managers that a new system will be implemented, and managers are assured they will get full director support during the implementation. Directors talk about the new system as if they came up with the idea on their own, and are therefore one hundred percent all behind it. Managers bring their teams together to discuss the new plans. At no point are the terms “they” or “senior management” or “we have to do this” used. Question and answer periods are used to flush out potential issues and identify risks without digressing into “complaint” sessions.

By simply changing the way information is communicated, managers can enable staff to believe in the process, trust the direction, provide constructive input, collect concerns and empower all employees to support the goal. Team building occurs naturally as each member feels the empowerment and the value of their contribution.

The military tends to weave in leadership training at all phases of professional development, and they provide that training during each job change or for all new employees entering an organization. While healthcare IT organizations routinely recognize the need for continuing technical training, they seem less convinced about the need for leadership training. This gap may be a result of the lack of formal leadership training at the graduate level where there are far fewer leadership courses because the focus is on business (financial) management. People resources are normally mentioned as a commodity on the bottom of the list after inventory control.

CIOs should take a page from the military playbook and embrace leadership training as an indispensable element of managerial professional development. In response to the LinkedIn question, charisma and assertiveness will only get you so far. You need to provide actual tools for junior leaders and managers so that they can be successful in guiding staff which leads to the successful completion of organizational goals.

Regular senior staff meetings should include periodic leadership topics, and organizations should have its staff rotate the task of presenting these topics. This gives them the opportunity to study, learn leadership concepts, and sharpen presentation skills. Hosting a leadership retreat at the end of the year with guest speakers and leadership development workshops is often the best way to start a healthy dialogue on how to bring out those traits. If you're too close to the problem you may miss the root cause. Bring in some help from people that can look at the big picture and not be influenced by the history of the organization. At the end of these retreats you will discover some remarkable attributes from sources that you least expected.

Since leadership is as much an art as it is a science, you will find some employees that just don't get it. This is often the case with employees that have not been exposed to examples of good leadership, and that are born and bred with an “institutional mentality.” For these folks, it's the way it's always been, and most are reluctant to change. This is a challenge for any CIO wanting to change the culture of a department. Remember that leadership is developed, and so one has to be open to evolve. If you have individuals that are not willing to change, then they will be left behind.

We have a new generation entering the workforce. The “Generation Y” crowd is more independent and less loyal to large organizations. What we provide to this new breed of employees early on in their careers can make the difference in their desire to jump ship at the first opportunity. Providing individuals with skill sets that will enable them to forge a clear career path within an organization is one way to keep employees engaged. Give your managers the tools to help manage these new employees. Keep an open door and take the time to meet with them — they want to feel that their voice is heard. They have many ideas and are not afraid to tell you, if you are willing to listen.

My favorite military mentors held “Captain's Call” which was an opportunity for the senior commanders to meet with the troops without their managers and directors present. This is done at all levels, even from General to Private. One such exchange resulted in a complete revolution in Marine Corps personnel equipment. All from a single comment from one Private to one General. Of course, this General happened to be the Commandant of the Marine Corps.

Most importantly, what do you want to be remembered by when you leave for new opportunities or retire? It's not always about the systems you put in place, but the employees that will quote your “words of wisdom” when they themselves are trying to achieve a common goal.

Pete Rivera, a retired Navy Medical Service Corps officer, is senior healthcare consultant with Hayes Management Consulting, Newton Center, Mass.
Healthcare Informatics 2008 November;25(11):57-59

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