Carrying the torch for physicians and patients: What are the key ingredients of leadership?

AMA Leader Commentary. By Ronald M. Davis, MD, Feb. 18, 2008.

AMA LEADER COMMENTARY

A few words about current events in medical practice

SEE ARCHIVES

A message to all physicians from AMA President Ronald M. Davis, MD.

The challenges facing medicine are well known to the readers of this publication -- physician payment cuts, high medical liability insurance premiums, managed care abuses, administrative burdens, unfunded mandates and so on. To protect our profession and our patients, strong physician leadership is needed -- now more than ever before -- within our medical associations, hospitals and communities.

Landing a man on the moon

During my AMA presidency, I've been asked on several occasions to speak on the topic of leadership. When I first put that talk together, I thought about consulting the many books and Web sites devoted to this subject. But then I figured I should demonstrate leadership by developing a presentation on leadership based solely on personal reflection.

So let me share with you 10 ingredients of leadership that rose to the surface as I thought about the leadership I've observed during the three decades of my career in medicine.

1. Filling the vacuum. Leaders must step up to the plate and fill vacuums of leadership. Donald Berwick, MD, for example, was a pioneer in health care quality improvement when, in 1991, he co-founded the Institute for Healthcare Improvement, for which he continues to serve as president and CEO. He was a major catalyst behind the formation of the patient safety movement and the Institute of Medicine's landmark report To Err is Human: Building a Safer Health System (published in 1999).

2. Pursuing noble causes. A medical student colleague of mine used to say that ambition without ideology is dangerous. I worry about people who climb the political ladder in an organization or jurisdiction when their positions on issues are unknown. Are they seeking higher office only because they enjoy the trappings of leadership? We should choose leaders because we believe they will use their authority to carry the banner for noble causes.

3. Recruiting a good team. Teddy Roosevelt said, "The best executive is the one who has sense enough to pick good men to do what he wants done, and self-restraint enough to keep from meddling with them while they do it." Very few of the big problems in the world today can be solved by one person. As Lee Iacocca once noted, "I've always found that the speed of the boss is the speed of the team."

4. Inspiring the team and the masses. Leaders need to inspire their teams and celebrate the work of their teammates. Some lead and inspire by quiet example, such as Steve Yzerman, who retired from the Detroit Red Wings in 2006 after being the team's captain for 20 years. Others have a megaphone manner of motivating the masses. Inspiration comes in different flavors.

5. Being bold. An extraordinary example of bold leadership was when President John F. Kennedy, in a speech to a joint session of Congress on May 25, 1961, announced a national goal, before the end of the decade, to land a man on the moon and return him safely to Earth. As everyone knows, that goal was realized on July 20, 1969, when Neil Armstrong touched down on the moon and said, "That's one small step for man, one giant leap for mankind." But few people today appreciate the courage required to commit the nation to that goal and to carry out that mission successfully (see box).

6. Taking risks. In a dynamic and unpredictable environment, one must take risks to achieve success. Dr. Richard Smith was editor of the British Medical Journal in the late 1990s when electronic publication of journals was in its infancy. He and his team began to offer many tools and services to readers on the journal's Web site, knowing that many of the initiatives would fail but hoping that some would succeed. Leaders should not fear failure, but should be willing to learn from it.

Leaders may need to bend rules, especially in slow-moving bureaucracies. In 2001, the chair of the Florida Board of Education suggested that the Florida State University trustees work for educational reform with the attitude that they would "ask for forgiveness, not permission." That's the motto for those working on rebuilding New Orleans, wrote a Tulane physician in the Dec. 20, 2005, Annals of Internal Medicine.

7. Aiming high and pushing the envelope. "The greater danger for most of us," said Michelangelo, "is not that our aim is too high and we miss it, but that it is too low and we reach it." Leaders use whatever authority they have -- power, money, the bully pulpit -- to extend their reach.

When then-Surgeon General C. Everett Koop, MD, was preparing to release his landmark report on nicotine addiction in 1988, he feared the White House would delete any strong policy recommendations he might put into his preface. To bypass the censors, he phrased his recommendations in the form of questions (with equal impact): "With the evidence that tobacco is addicting, is it appropriate for tobacco products to be sold through vending machines, which are easily accessible to children? ... Should the sale of tobacco be treated less seriously than the sale of alcoholic beverages, for which a specific license is required (and revoked for repeated sales to minors)?"

8. Challenging the odds. Henry Ford said, "I am looking for a lot of men who have an infinite capacity to not know what can't be done." Donald J. Palmisano, MD, JD, led the AMA's campaign for medical liability reform as our president in 2003-04. Despite the long odds against Senate approval of tort reform, he told the AMA House of Delegates that "we're one day away from getting these reforms ... the day when a school bus overturns, and children are seriously injured -- and there are no neurosurgeons or trauma surgeons available nearby -- because there was no reform ... because some senator ignored the facts."

9. Rolling up their sleeves. Leaders show their teammates and troops that they're willing (or even happy) to get their hands dirty in carrying out the tasks of the day. They get out of their bunkers and lead their soldiers into battle. When the Henry Ford Health System became a major sponsor of the Heart Walk (the American Heart Assn.'s lead fundraising event), Nancy Schlichting and Tony Armada, the CEOs of HFHS and Henry Ford Hospital, sat on a dunk tank in a "Dunk the CEO" kickoff fundraiser.

10. Leading the way in times of crisis. Crises create opportunities and urgencies for leadership. Natural and man-made disasters, for example, are invariably accompanied by spellbinding stories of heroism by rescue workers, health care personnel and others. Many leaders have been defined by their responses to emergencies. The AMA Council on Ethical and Judicial Affairs has stated that physicians have an ethical obligation to provide urgent medical care during disasters, although they should balance the immediate benefits to patients against the risks to their own safety and health and thus their ability to care for patients in the future.

This list of ingredients of leadership is incomplete. And I'm sure I could add dozens more by consulting those books and Web sites on leadership that I've studiously ignored. Readers -- are there any key ingredients you'd like to add to this list?

The bottom line is that every physician can show leadership in helping to solve the major problems we face in health care and public health. "Never doubt that a small group of thoughtful citizens can change the world," said Margaret Mead. "Indeed, it's the only thing that ever has."

Dr. Davis, a preventive medicine physician living in East Lansing, Mich., served as AMA president during 2007-08. Dr. Davis died on Nov. 6, 2008.

Back to top

ADDITIONAL INFORMATION:

Landing a man on the moon

On Sept. 12, 1962, in a speech at Rice Stadium (near NASA's space center in Houston), President John F. Kennedy described the challenge of landing a man on the moon and returning him safely to Earth:

"[I]f I were to say, my fellow citizens, that we shall send to the moon, 240,000 miles away from the control station in Houston, a giant rocket more than 300 feet tall, the length of this football field, made of new metal alloys, some of which have not yet been invented, capable of standing heat and stresses several times more than have ever been experienced, fitted together with a precision better than the finest watch, carrying all the equipment needed for propulsion, guidance, control, communications, food and survival, on an untried mission, to an unknown celestial body, and then return it safely to Earth, re-entering the atmosphere at speeds of over 25,000 miles per hour, causing heat about half that of the temperature of the sun -- almost as hot as it is here today -- and do all this, and do it right, and do it first before this decade is out, then we must be bold."

Note: A transcript and videotape of this speech are available online (webcast.rice.edu/speeches/19620912kennedy.html).

Back to top

Copyright 2008 American Medical Association. All rights reserved.

The doctors are in the house
The AMA's House of Delegates is holding its Interim Meeting Nov. 7-10 in Houston, addressing issues such as health system reform and physician payment.
AMA House - Slideshow - Updates