© Springer International Publishing Switzerland 2015Melina R. Kibbe and Herbert Chen (eds.)Leadership in SurgerySuccess in Academic Surgery10.1007/978-3-319-11107-0_7
7. Common Mistakes in Leadership
Department of Surgery, University of Connecticut, UConn Health, 263 Farmington Avenue, Farmington, CT 06030, USA
David W. McFadden
I was quite flattered when asked to contribute to a textbook on surgical leadership until I was told I was invited to write the chapter about leadership mistakes. After an initial hesitation and false sense of insult, I decided “yes!” because over my past two decades of leadership in academic surgery, I have unquestionably made a great deal of mistakes. Mistakes are valuable because you can only learn from them, and if shared, others may learn from them too. I decided, with the use of a few important references, to provide what I believe are the top ten mistakes that a surgical leader, or perhaps any leader, may make. I assure you that I have made them all, and unfortunately I will unquestionably commit at least a few more during the remainder of my career. I ask the readers to review my list of Suggested Readings of classic articles and textbooks that are worthy of their study if they aspire to successful surgical leadership careers.
First, leadership matters! In Joseph Simone’s words: “What makes great leaders is not a secret – they not only have grace under pressure, which means both courage and character, they remain focused on the important aspects of an issue in the midst of chaos, and they repeatedly articulate a consistent, simple public vision.” It is also important to differentiate between leadership and management. It is often said that management means doing things right whereas leadership is doing the right thing, and much more difficult. As a surgical leader, you will need to be both a manager and a leader. Management issues tend to be urgent, the daily putting out of fires. They can be briefly satisfying in solving, but can and will get in the way of leadership issues, which are more important and often less immediately gratifying. Peter F. Drucker was probably the most famous, prolific, and profound management thinker that ever lived. I recommend you many of his works and will include them in my reference list. Many of his axioms can be applied to leadership.
The first and most important step in building leadership skills is to be self-aware of your own weaknesses and strengths, and to work on minimizing and improving them, respectively. Do not be afraid to seek counsel or coaching. Seek feedback rather than waiting for it to happen. Ask yourself, when interviewing for a job, if your direct supervisor (Dean, Chair, CEO) is a mentoring individual. Often Chairs are hired without any support or promise for their own professional development. Perhaps there are a few natural leaders out there who do not need it, but not me. I have hundreds of leadership and business school textbooks on my shelf, all of them read and highlighted. There are several more in my Amazon queue. None, however, has taught me as much as the one-on-one sessions I have had with the great mentors of my career. Leadership, like surgery, is a lifelong learning experience. Embrace it. My fiftieth birthday present to myself was entering an MBA program.
In Halverson’s article, it is wisely stated that leadership is two sides of the same coin: self-management and team management. Self-management is based on emotional intelligence, which as per Daniel Goleman is the ability to manage oneself and one’s relationships. I encourage you to read or review Goleman’s salient work about emotional intelligence. Briefly, emotional intelligence comprises four essential domains: Self-awareness, self-management, social awareness, and social skills. Goleman further divides leadership styles into authoritative, coaching, affiliative, democratic, pacesetting, and commanding. Bing Rikkers, in his wonderful Presidential Address to the Central Surgical Association, comments that surgical leaders must be able to use multiple leadership styles depending on the situation. He likens these to the golf clubs in one’s bag that one may appropriately remove and deploy depending on the shot required. For example in the operating room, when there is a sudden injury to the right hepatic vein, a surgical leader would use a commanding leadership style, as using the democratic style or coaching style could be lethal. I continue to see many surgical leaders use the commanding, or “surgical mentality” style by default, in situations where affiliative or democratic leadership is far more appropriate.
Another important reference that I recommend to all serious readers and students of leadership is the recent Rules by Donald Rumsfeld. Irrespective of whether you like his political beliefs and career, there are many pithy and profound rules that apply to business, government, military, and surgery. Many of them will be used in this chapter, as I rarely have anything original to say. In the essence of brevity, I would like to give you this particular David’s Top 10 list. I apologize in advance for the curmudgeonly and frequent use of quotations. The 10 are not ranked in order of ignominy or priority. They also all interrelate at some level.
7.2 Number One: Failure to Appreciate That Institutions Do Not Love You Back
This is the first rule from Joseph V. Simone’s classic and “a must read” manuscript entitled “Understanding Academic Medical Centers: Simone’s Maxims”. Although this at first blush may sound cynical, one simply cannot assume the same respect or appreciation from an enterprise that one would from a friend or family member. Frequently, you will be astonished that even the most wizened senior faculty believes that they somehow merit special dispensation because of their longevity or past productivity or sworn allegiance to an organization. Repeat after me: “What have you done for me, lately?” Simone refers to a colleague who opines that the only true job security is the ability to move to another position, because of professional independence. In these days of rotating Chief Executive Officers and Deans, I am sad to say that institutional loyalty to an individual, especially a chair, cannot be counted upon. Institutional lifespans are long, yours is ephemeral in comparison.
Although I will discuss this later in example number six, the concept of “tickets or chits” should be mentioned here. Jerry Shuck, in his presidential address to the Central Surgical Association, presented the hypothesis that an individual is given a certain and fixed number of tickets when granted a leadership position. The number of tickets granted is a carefully guarded secret that this individual never knows until the last one is spent. The purpose of this digression is that when there is a change in leadership at the Dean or CEO level, the chair’s reserve of tickets may precipitously decrease or disappear.
7.3 Number Two: Failure to Respect That Leadership Cycles Have a Natural Ebb and Flow
As Joseph Simone famously said “for academic leaders, the last ten percent of job accomplishment may take as much time as the first ninety percent, and may be not worth the effort.” He goes on to state that the average leadership duration should be 10 ± 3 years. Thomas Starzl reportedly said that surgical chair positions should have durations of 7 ± 2 years. I personally believe that the era of the chairmanship lasting until retirement is a dinosaur, like many of those who did such. New leadership at the Dean, Executive VP, or CEO levels are likely to bring in their own teams irrespective of the successes of the incumbents. Be prepared and try not to take it personally. In addition, it is important to have the insight that you no longer have the passion or institutional support to take your Division or Department to the next level. It is no service to anyone if you are just going through the motions, or as Rumsfeld says, “if you are coasting, you are going downhill.”
In saying this, I must comment that it is not a good thing to be constantly on the search for a better opportunity. There are no well-kept secrets in academic surgery, and if a sitting chair is looking at another position, he or she must be willing to accept the brinksmanship that may result at home. Also, you probably will only receive one retention package. Your second trip to this particular well may result in a firm handshake and best wishes. Simone states that you should consider an academic move only if there is an improvement in anticipated environment and opportunity of 50 % or more. The grass may look greener, but when you get there it most assuredly will not be as green as you thought.
You will also be faced, as a leader, with faculty members who are constantly interviewing for another position. Often, they will tell you this on an initial conversation after you have arrived. Listen carefully, but make no promises or retention offers until you have done your due diligence as to the faculty member’s value and track record of such claims. If the individual was an internal candidate for your position, listen even more carefully and gauge whether he or she will be an ally, or a passive or aggressive impediment to your vision. It is often best to cut the cord and allow them a graceful exit. Beware of faculty who announce that they have another offer, and a better one, as your first introduction to their job hunting. Michael Zinner wisely told me that anyone can have a first interview, or “first date”, but once a second date is scheduled, it is appropriate and respectful to notify the chair.
7.4 Number Three: Failure to Remember That First-Class People Recruit First-Class People; Second-Class People Recruit Third-Class People, or as Rumsfeld Says A’s Hire A’s, B’s Hire C’s
The late William Longmire once told me that his secret to success as the first chairman at UCLA was to hire great division chiefs and then get out of their way. Of course, he modestly simplified his success. I later learned that this advice originally came from Theodore Roosevelt. Dr. Longmire provided his leaders with resources, support, and promoted them vigorously internally and nationally. He was neither afraid nor intimidated by their excellence. Michael Zinner, inarguably one of the greatest surgical leaders of our time, stated it this way to me, “learn to bask in the reflected glow.” After all, it really does not matter who gets the credit as long as the job gets done well. Rikkers says it this way, “leadership need not be lonely, wise chieftains grant authority and responsibility to those they had delegated assignments”. Do not be afraid of hiring people who are smarter, more accomplished, or even better surgeons than you. Genghis Khan was an icon of political and military genius, but his greatest strength was in the ability to recognize and recruit excellent generals. Rikkers also state that the two most important roles of a leader are mentorship and recruitment. Mentorship leads to retention of those whom you have recruited. Rikkers also states truthfully that a lack of autonomy has been a driver for divisions of surgery to seek departmental status.