Ian Morrison

Health care is complex. It is full of professions, guilds, unions, and community stakeholders, all of which make leadership more difficult. How do you lead in such an environment? I offer, with some humility, my five pillars of leadership:

1. Distinguish between managing and leading.

This is by no means an original thought, but it is at the heart of the health care leadership problem. Health care at all levels, from presidential policy to bedside decisions, is over-managed and under-led. What’s the difference? You can do no better, in my view, than John Gardner’s definition in his 1990 classic On Leadership (Free Press, 1990). To paraphrase Gardner, leaders distinguish themselves from the general run of managers in at least six respects:

• They think longer term.
• They understand the relationship between their organization and the wider environment.
• They reach and influence stakeholders beyond their own organization’s boundaries.
• They put heavy emphasis on the intangibles of vision, values, and motivation, and they understand intuitively the non-rational and unconscious elements in both leading and following.
• They have the political skill to cope with the conflicting requirements of multiple constituencies.
• They think in terms of renewal and adaptation to an ever changing reality, not just sticking to the system.

2. Respect leadership as a political process.

Leading an organization is more like running a small country than managing a large store. Leadership is inherently political, which frustrates many promising managers who have been promoted because of high marks, good work performance, and self-righteous excellence. In a world of coalition building, compromise, and horse trading, these managers get frustrated, and many fail as leaders.

3. Understand the American leadership preference.

Americans like reluctant leaders with a casual, easygoing style much more than pushy, formal ones. They like Tom Hanks in Saving Private Ryan or Jimmy Stewart going to Washington, not Gordon Gekko of “greed is good” fame. This is why George W. ran his campaign with a “gee shucks” style and Al Gore took “business casual” to new lows.

4. Honor moral leadership.

A lot has been made of values-based leadership in recent years, but even Attila the Hun had values. When people say value-based leadership, they tend to be implying they have the right values, therefore their position should be followed. I prefer to think about the moral base of leadership. Is your position on the side of the angels (consult your own God here)? Is it life affirming? How would it look on the front page of The New York Times? Does it feel right in your gut? And most important, what would your mother say?

5. Lead the revolution.

Strategy guru Gary Hamel’s new book Leading the Revolution (Harvard Business School Press, 2000) is a must-read about the importance of breakthrough innovation in business strategy. Hamel in a nutshell, and in his own words:

Health care desperately needs innovation, not just in process and tools, but in business and organizational design. We need leaders who can imagine better futures.

Ian Morrison is an author, consultant and futurist based in Menlo Park, Calif. A shorter version of this editorial was published in the March/April 2001 Issue of the Health Forum Journal.