Donald Trump’s message and his personality struck a chord with at least half of the U.S. electorate. His supporters would argue that the challenges and threats we face require a strong, bold leader. It could be said that healthcare is facing unprecedented challenges too, and that we need similarly strong, bold leaders who are not afraid to break from tradition or to “break some eggs to make an omelet,” so to speak.
President-elect Trump is perceived by many as bold, unafraid, dynamic, charismatic, hard-nosed, and aggressive – characteristics often associated with “strong” leaders. He has promised that he will not be politically correct, will break from traditional approaches if necessary, and is not afraid to be offensive or make people uncomfortable in implementing the solutions HE knows are right for America. But, is the idea that strong leaders are effective leaders a myth?
The myth of the strong leader
In his recent book, The Myth of the Strong Leader, renowned Oxford politics professor Archie Brown examines how we should choose and evaluate leaders. Brown challenges the widespread belief that strong leaders – meaning those who dominate their colleagues and the policy-making process – are the most successful and admirable. Though we may dismiss more collegial styles of leadership as “weak,” it is often the most cooperative leaders who have the greatest impact.
Brown’s book examines leadership styles of a range of political leaders from dictators to democratically elected executives. He notes that even in democracies, people are often drawn to executives who are charismatic, opinionated, and sometimes aggressive. Brown further states that the electorate particularly likes leaders who promise to dominate other policy-makers to achieve their agendas.
Brown argues, though, that when a leader believes too strongly that only he knows best, he can take shortcuts in problem-solving that lead to disastrous results. In other words, leaders who are unconstrained by others in making their decisions tend to make significantly poorer decisions. (I’m reminded of President-Elect Trump’s assertions during the election that he “knows more than the generals” – a position I’d imagine he’s softened after actually meeting some of those generals.)
Many U.S. presidents’ ambitious agendas were ultimately thwarted by Congress or the Supreme Court, while many of the most effective leaders effected dramatic change because of their mastery of collegiality and collaboration.
How does this apply to healthcare?
As President-Elect Trump is likely discovering, the American government is somewhat more complex than even his far-reaching business entities. Similarly, healthcare organizations, even small community hospitals, are incredibly complex. The services provided, balancing the mission with the business, gaining buy-in from highly trained, intelligent, autonomous constituencies, and the complex payment and ever-changing regulatory structure – does this situation lend itself to the traditionally “strong” leader?
Perhaps. Perhaps it’s exactly what we need. Rather than consensus-building, which has been the focus for the past decade or so, do we need to target strong, dynamic, charismatic leaders ready and willing to act boldly and take risks, doing what they know is right, even if they must upset the apple cart? Certainly some leaders suffer from fear of upsetting anyone or the negative impact of ANY decision, so nothing gets done.
I worked on a project that recommended a change to how the operating room would function in order to make big strides for what had been identified as the hospital’s most valuable service line. It promised to improve patient care and profitability. The immediate concern expressed by the CEO, “But if we make that change for the orthopedic surgeons, the other departments won’t be happy!” Rather than making the change and evaluating how we could get other departments to move in the same direction, he was more concerned about dealing with the fallout of what was, at least on paper, the right thing to do.
At the other end of the spectrum, I saw a CEO solve his OR problems by simply setting the terms of what he needed from an anesthesiology group. He presented the terms to the two groups that were serving the hospital. One group balked at his demands, thinking they had leverage. The other said that they could meet the terms and were able to service the entire OR. The next morning, one group got a new contract and the other a termination letter. Some members of the medical staff were furious at what they perceived as a strong-arm tactic. Others loved the fact that their CEO made the tough decision that was in everyone’s best interest, in spite of the blow-back.
I’m not sure the medical staff, though, would respond well to Mr. Trump’s tendency toward hyperbole and willingness to be a bit loose with facts and figures. Physicians, as a group, are naturally skeptical and moved more by logic than emotion. Initially, they may react positively to his “100%” assurances that he will fix the OR regardless of who it upsets! His tendency toward inconsistent messages, depending who’s in the audience, might have him feeling the wrath of the nursing staff pretty quickly, though!
The traits of successful hospital leaders
In my experience, the most successful hospital leaders combine key traits – the ability and willingness to make a difficult decision and deal with the repercussions AND the ability to build consensus and gain trust. I’ve not seen anyone take the approach of a Donald Trump and have doubts that it would work.
Unlike U.S. politics where there are really only two groups to consider – Republicans and Democrats – a hospital leader has to consider nursing, the medical staff, front line staff (possibly a union), the community, and patients. An approach that is too abrasive or divisive is only likely to yield gains with one group while alienating all of the others.
In The Myth of the Strong Leader, Brown points particularly to Abraham Lincoln as an "outstanding example of how collaborative and collegial leadership could be combined with attachment to principle.” That means making difficult, strategic decisions that are sure to alienate some but are in the long term greater good.
I’m also reminded of a blog we wrote some time ago on U.S. military leaders. While George Patton’s bombastic, Trump-like, style was suited for one very specific function, it was Dwight D. Eisenhower who had the mix of skills necessary to successfully serve as the Supreme Commander of the Allies and, eventually, as one of our most respected Presidents.
One thing is clear. There is no “ideal” leadership profile for every situation. In our experience, an organization needs to effectively define the skills and styles best suited to its situation and goals, then deliberately evaluate candidates and make an informed decision. If the decision is to target “strong leaders” in the mold of President-Elect Trump, I’m sure our team can target those attributes for you!
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