The 'Being of Leadership' or 'Leadership as a State of Being'
Christian T. K.-H. Stadtlander, Microbiologist & Epidemiologist
1 May 2012
The recent article by Souba [1] discusses various aspects of leadership in the medical profession. The author points out that commercialisms of the health care delivery system is undermining the ethical foundation of the medical profession which is supposed to value service to patients above personal gains and rewards. He believes that the conventional model of medical leadership, which includes leading a successful clinical practice, having a distinguished research program, or seeking a promotion, is insufficient for preserving medicines venerable ethical heritage. Because the attributes of the existing model are primarily action- and results-oriented, he proposes a new ontological model that includes the following elements of `being: awareness, commitment, integrity, and authenticity. These four pillars of medical leadership are all shaped by and are accessible through language, thus play a role in conversations and influence decision-making and professional conduct. Souba [1] emphasizes that his model should not be seen as a replacement for the existing one (he recognizes that results are essential for performance) but rather as an important compliment in that it creates the ontological backbone upon which the ethical foundation of medicine is (supposed to be) grounded.
The model Souba [1] proposes is interesting and important. It allows physicians to reconnect with the original purpose of medicine, which is, to provide the best possible services to patients. More specifically, it refocuses physicians on the four prima facie principles of medical ethics (beneficience, non-maleficience, respect for patient autonomy, and social justice) [2] and it also aligns them with the more recently introduced ideas presented in the Charter of Medical Professionalism [3], which received much interest from the medical community [4]. Soubas ideas also complement the ethical principles developed by The Tavistock Group [5,6], a multidisciplinary group of health care professionals, which are intended to provide guidance for all those involved in health care, including patients and owners of health systems. Their principles cover rights, balance, comprehensiveness, cooperation, improvement, safety, and openness.
Leadership has a profound impact on outcome. In general, good leadership tends to lead to positive outcomes; the definition of what positive means can, however, greatly differ among people. In medicine, leadership is linked to service. For that reason, I believe Greenleafs Servant Leadership theory [7], which has been interpreted and expanded by many researchers in recent years [e.g., 8-13], fits well to the professional duties of physicians and the associated principles of medical ethics. In brief, a servant leader focuses on the needs of the people and asked how he can help them solve problems and promote personal development. When this leadership philosophy is adapted to the practice of medicine, it means that serving begins with the natural feeling that one wants to serve, to serve first; then a conscious choice brings a physician to aspire to lead others patients, practice staff, etc.. Those that have been served (should) become healthier, wiser, freer, and more autonomous, and are more likely themselves to become servants to others in need. In (medical) servant leadership, no one will knowingly be hurt by the action, directly or indirectly. The effectiveness of the servant-leader can be evaluated by looking at the lives of those who have been served [12]. Supporters of Greenleafs leadership theory recognize, like Souba [1], the deficiency of a leadership style which is self-serving rather than others-serving.
I agree with Souba [1] that awareness, commitment, integrity, and authenticity are all important characteristics for medical leadership. However, I suggest a fifth pillar humility which is also an element of `being and a part of the ontological dimension of servant leadership [11]. By definition, humility means the quality or condition of being humble [14]. In other words, it is a virtue of being modest and respectful. LaBouff et al. [15] recently showed that humble people are more helpful than less humble people, which not only demonstrate that humility is an important personality quality but also that it is directly related to service. Humility is not a weakness; it actually is a powerful strength [10]. In fact, it is so powerful that Collins [16] placed personal humility (and professional will) in the highest level (Level 5) in a hierarchy of executive leadership capabilities important for elevating organizations from mediocrity to sustained excellence.
My final discussion point relates to the phrase being of leadership, which Souba [1] uses in his article. The term `being has been defined in many different ways [17]. For me, `being of leadership implies the absolute existence in a complete or perfect state [17]; I would argue that this means an ideal state of leadership has been already reached and, thus, there is no room for further discussion because all elements of the `being of leadership have been defined. Cashman [18] uses a different phrase: leading through being. He explains: Being is our true nature, our core, our source, our inner Self. Being is the essence at the deepest level of our character supporting all action and achievement. He points to the personal journey it takes to discover the Self, a journey into being. Following Cashmans thoughts, I believe the phrase `leadership as a state of being would be more accurate than `being of leadership. `Leadership as a state of being indicates that a person is in a certain developmental phase; more precisely, the person has reached a state of being based on what he has learned so far about his unique personality traits and beliefs. In other words, it is one state of existing, a point of view gradually coming into being [17]. It promotes the idea that there is still plenty of room for further development. It is the expression of a personal identity during the discovery phase of self-introspection and self-exploration and includes, for physicians, the reflection on the ethical principles that guide the medical profession. My discussion about `being may be semantics, but I think we can all agree with the following statement: leadership is a complex learning process; it puts a person on a life-long journey that involves growing all aspects of leadership, not only those of the ontological dimension, but also aspects of the attitudinal and behavioral dimensions.
References
1. Souba WW: The being of leadership. Philos Ethics Humanit Med 2011, 6:5.
2. Gillon R: Medical ethics: four principles plus attention to scope. Brit Med J 1994, 309:184-188.
3. Project of the ABIM Foundation, ACP-ASIM Foundation, and European Foundation of Internal Medicine: Medical professionalism in the new millennium: a physician charter. Ann Intern Med 2002, 136:243-246.
4. Blank L, Kimball H, McDonald W, Merino J, for the ABIM Foundation, ACP Foundation, and European Foundation of Internal Medicine (EFIM): Medical professionalism in the new millennium: a physician charter 15 months later. Ann Intern Med 2003, 138:839-841.
5. Smith R, Hiatt H, Berwick D: Shared ethical principles for everybody in health care: a working draft from the Tavistock Group. Brit Med J 1999, 318:248-251.
6. Berwick D, Davidoff F, Hiatt H, Smith R: Refining and implementing the Tavistock principles for everybody in health care. Brit Med J 2001, 323:616-620.
7. Greenleaf RK: Servant Leadership: A Journey into the Nature of Legitimate Power and Greatness. New York: Paulist Press; 1977.
8. Keith KM: The Case for Servant Leadership. Westfield: Greenleaf Center for Servant Leadership; 2008.
11. Matteson JA, Irving JA: Servant versus self-sacrificial leadership: a behavioral comparison of two follow-oriented leadership theories. Int J Leadership Stud 2006, 2:36-51.
12. Anderson J: The writings of Robert K. Greenleaf: an interpretative analysis and the future of servant leadership. [http://www.regent.edu/acad/global/publications/sl_proceedings/2008/anderson.pdf]. Accessed 4/12/12.
13. Sipe JW, Frick DM: Seven Pillars of Servant Leadership: Practicing the Wisdom of Leading by Serving. Mahwah: Paulist Press; 2009.
14. The American Heritage Dictionary of the English Language. 4th edition. Boston: Houghton Mifflin Company; 2000.
15. LaBouff JP, Rowatt WC, Johnson MK, Tsang J-A, Willerton GM: Humble persons are more helpful than less humble persons: evidence from three studies. J Posit Psychol 2012, 7:16-29.
16. Collins J: Level 5 leadership: the triumph of humility and fierce resolve. Harv Bus Rev 2001, January:66-76.
17. Definitions of Being. [http://www.definitions.net/definition/being]. Accessed 4/11/12.
18. Cashman K: Leadership from the Inside Out: Becoming a Leader for Life. Provo: Executive Excellence Publishing; 1998.
The 'Being of Leadership' or 'Leadership as a State of Being'
1 May 2012
The recent article by Souba [1] discusses various aspects of leadership in the medical profession. The author points out that commercialisms of the health care delivery system is undermining the ethical foundation of the medical profession which is supposed to value service to patients above personal gains and rewards. He believes that the conventional model of medical leadership, which includes leading a successful clinical practice, having a distinguished research program, or seeking a promotion, is insufficient for preserving medicines venerable ethical heritage. Because the attributes of the existing model are primarily action- and results-oriented, he proposes a new ontological model that includes the following elements of `being: awareness, commitment, integrity, and authenticity. These four pillars of medical leadership are all shaped by and are accessible through language, thus play a role in conversations and influence decision-making and professional conduct. Souba [1] emphasizes that his model should not be seen as a replacement for the existing one (he recognizes that results are essential for performance) but rather as an important compliment in that it creates the ontological backbone upon which the ethical foundation of medicine is (supposed to be) grounded.
The model Souba [1] proposes is interesting and important. It allows physicians to reconnect with the original purpose of medicine, which is, to provide the best possible services to patients. More specifically, it refocuses physicians on the four prima facie principles of medical ethics (beneficience, non-maleficience, respect for patient autonomy, and social justice) [2] and it also aligns them with the more recently introduced ideas presented in the Charter of Medical Professionalism [3], which received much interest from the medical community [4]. Soubas ideas also complement the ethical principles developed by The Tavistock Group [5,6], a multidisciplinary group of health care professionals, which are intended to provide guidance for all those involved in health care, including patients and owners of health systems. Their principles cover rights, balance, comprehensiveness, cooperation, improvement, safety, and openness.
Leadership has a profound impact on outcome. In general, good leadership tends to lead to positive outcomes; the definition of what positive means can, however, greatly differ among people. In medicine, leadership is linked to service. For that reason, I believe Greenleafs Servant Leadership theory [7], which has been interpreted and expanded by many researchers in recent years [e.g., 8-13], fits well to the professional duties of physicians and the associated principles of medical ethics. In brief, a servant leader focuses on the needs of the people and asked how he can help them solve problems and promote personal development. When this leadership philosophy is adapted to the practice of medicine, it means that serving begins with the natural feeling that one wants to serve, to serve first; then a conscious choice brings a physician to aspire to lead others patients, practice staff, etc.. Those that have been served (should) become healthier, wiser, freer, and more autonomous, and are more likely themselves to become servants to others in need. In (medical) servant leadership, no one will knowingly be hurt by the action, directly or indirectly. The effectiveness of the servant-leader can be evaluated by looking at the lives of those who have been served [12]. Supporters of Greenleafs leadership theory recognize, like Souba [1], the deficiency of a leadership style which is self-serving rather than others-serving.
I agree with Souba [1] that awareness, commitment, integrity, and authenticity are all important characteristics for medical leadership. However, I suggest a fifth pillar humility which is also an element of `being and a part of the ontological dimension of servant leadership [11]. By definition, humility means the quality or condition of being humble [14]. In other words, it is a virtue of being modest and respectful. LaBouff et al. [15] recently showed that humble people are more helpful than less humble people, which not only demonstrate that humility is an important personality quality but also that it is directly related to service. Humility is not a weakness; it actually is a powerful strength [10]. In fact, it is so powerful that Collins [16] placed personal humility (and professional will) in the highest level (Level 5) in a hierarchy of executive leadership capabilities important for elevating organizations from mediocrity to sustained excellence.
My final discussion point relates to the phrase being of leadership, which Souba [1] uses in his article. The term `being has been defined in many different ways [17]. For me, `being of leadership implies the absolute existence in a complete or perfect state [17]; I would argue that this means an ideal state of leadership has been already reached and, thus, there is no room for further discussion because all elements of the `being of leadership have been defined. Cashman [18] uses a different phrase: leading through being. He explains: Being is our true nature, our core, our source, our inner Self. Being is the essence at the deepest level of our character supporting all action and achievement. He points to the personal journey it takes to discover the Self, a journey into being. Following Cashmans thoughts, I believe the phrase `leadership as a state of being would be more accurate than `being of leadership. `Leadership as a state of being indicates that a person is in a certain developmental phase; more precisely, the person has reached a state of being based on what he has learned so far about his unique personality traits and beliefs. In other words, it is one state of existing, a point of view gradually coming into being [17]. It promotes the idea that there is still plenty of room for further development. It is the expression of a personal identity during the discovery phase of self-introspection and self-exploration and includes, for physicians, the reflection on the ethical principles that guide the medical profession. My discussion about `being may be semantics, but I think we can all agree with the following statement: leadership is a complex learning process; it puts a person on a life-long journey that involves growing all aspects of leadership, not only those of the ontological dimension, but also aspects of the attitudinal and behavioral dimensions.
References
1. Souba WW: The being of leadership. Philos Ethics Humanit Med 2011, 6:5.
2. Gillon R: Medical ethics: four principles plus attention to scope. Brit Med J 1994, 309:184-188.
3. Project of the ABIM Foundation, ACP-ASIM Foundation, and European Foundation of Internal Medicine: Medical professionalism in the new millennium: a physician charter. Ann Intern Med 2002, 136:243-246.
4. Blank L, Kimball H, McDonald W, Merino J, for the ABIM Foundation, ACP Foundation, and European Foundation of Internal Medicine (EFIM): Medical professionalism in the new millennium: a physician charter 15 months later. Ann Intern Med 2003, 138:839-841.
5. Smith R, Hiatt H, Berwick D: Shared ethical principles for everybody in health care: a working draft from the Tavistock Group. Brit Med J 1999, 318:248-251.
6. Berwick D, Davidoff F, Hiatt H, Smith R: Refining and implementing the Tavistock principles for everybody in health care. Brit Med J 2001, 323:616-620.
7. Greenleaf RK: Servant Leadership: A Journey into the Nature of Legitimate Power and Greatness. New York: Paulist Press; 1977.
8. Keith KM: The Case for Servant Leadership. Westfield: Greenleaf Center for Servant Leadership; 2008.
9. Waddell JT: Servant leadership. [http://www.regent.edu/acad/sls/publications/conference_proceedings/servant_leadership_rountable/2006/pdf/waddell.pdf]. Accessed 4/14/12.
10. Patterson K: Servant leadership: a timeless leadership style. [https://www.christianleadershipalliance.org/?page=servantasleader]. Accessed 4/15/12.
11. Matteson JA, Irving JA: Servant versus self-sacrificial leadership: a behavioral comparison of two follow-oriented leadership theories. Int J Leadership Stud 2006, 2:36-51.
12. Anderson J: The writings of Robert K. Greenleaf: an interpretative analysis and the future of servant leadership. [http://www.regent.edu/acad/global/publications/sl_proceedings/2008/anderson.pdf]. Accessed 4/12/12.
13. Sipe JW, Frick DM: Seven Pillars of Servant Leadership: Practicing the Wisdom of Leading by Serving. Mahwah: Paulist Press; 2009.
14. The American Heritage Dictionary of the English Language. 4th edition. Boston: Houghton Mifflin Company; 2000.
15. LaBouff JP, Rowatt WC, Johnson MK, Tsang J-A, Willerton GM: Humble persons are more helpful than less humble persons: evidence from three studies. J Posit Psychol 2012, 7:16-29.
16. Collins J: Level 5 leadership: the triumph of humility and fierce resolve. Harv Bus Rev 2001, January:66-76.
17. Definitions of Being. [http://www.definitions.net/definition/being]. Accessed 4/11/12.
18. Cashman K: Leadership from the Inside Out: Becoming a Leader for Life. Provo: Executive Excellence Publishing; 1998.
Competing interests
The author declares no competing interests.