Training + Mentoring + Personality = Leadership

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Are healthcare leaders born with the capacity to lead or a can anyone be trained to lead?
It’s the old nature versus nurture debate, and the scientific underpinnings suggest that both sides of this equation play roles in effective leadership. Though some individuals may have personalities more suitable for leadership, which might be genetically influenced, all who aspire to leadership can and should receive specific training and formal mentoring, i.e. be nurtured as part of professional development.
The characteristics of higher-impact leadership in healthcare have been discussed comprehensively by Swensen et al.* These elements, including person-centeredness, front-line engagement, relentless focus, boundarilessness and transparency can be taught as components of a formal curriculum alongside other elements, such as providing clarity of purpose, being willing to learn from failure, giving genuine support to staff, and demonstrating resilience in the face of adversity.
In my view, one of the most important characteristics of effective leaders is the ability to genuinely appreciate the advice and counsel of subordinates. Then to let them know, even though not all of their input will be acted upon, that it was appreciated. Listening to staff and valuing their contributions instills a sense of partnership and collegiality, which in turn helps foster joy and meaning in the workplace.
What is missing from all of this is the importance of either actively or passively mentoring subordinates. In other words, leaders passing down habits, behavioral characteristics and perspectives to those rising toward leadership. It is not just mentoring by effective leaders that has value there also is much to learn from examples of weak leaders, including behaviors to avoid and the consequences of such behaviors. This also contributes to the portfolio of experiences appropriate for leadership development.
What is missing from all of this is the importance of either actively or passively mentoring subordinates. In other words, leaders passing down habits, behavioral characteristics and perspectives to those rising toward leadership. It is not just mentoring by effective leaders that has value there also is much to learn from examples of weak leaders, including behaviors to avoid and the consequences of such behaviors. This also contributes to the portfolio of experiences appropriate for leadership development.
Case Studies: What I Learned from Weak Leaders
Twice during my career, I have worked for executives who were particularly weak leaders. I learned a lot about what not to do and how not to behave by observing these individuals and by being on the receiving end of their weak leadership.
One leader, the chief executive of a hospital, saw himself as always being above the fray and removed from the pragmatics of management. He spent most of his time interacting socially with executives of other organizations and their spouses, much to the detriment of his own institution. He seemed always to have his eyes on the next steps in his career, neglecting his current responsibilities. Subordinates, motivated to do their best, time and again were disappointed by his lack of interest. In some meetings he would actually drift off to sleep. He could be complimentary but only in a superficial sense, failing to grasp the deeper significance of what was being proposed. He wanted simple solutions to complex issues so he could quickly move onto something else. As long as the hospital looked good, he was happy even though many programs were weak and could have benefited from his leadership and attention. The other mid-level executives and I struggled on, but there were times when his behavior was terribly disappointing. This leader was an “empty suit”.
The second weak leader was an individual who was insecure about his own personal power. He had come to his position of responsibility after having been removed from a chief executive position due to ineffectiveness. Why he had been selected for this new leadership position was not clear, though he was now being given a second chance as a division head, not as a chief executive.
Unfortunately, he lacked many attributes of effective leaders. He was disorganized and his personal office was always a mess. He ruled by directive without seeking advice from his staff, often criticized individuals in public, and generally displayed his insecurity and immaturity for the world to see. He came in late and left early, failing to set an example of a strong work ethic.
I was responsible for managing a separate large clinic several miles away, one with identical highly complex community-based programs to that headed-up by this second weak leader. When external regulators inspected our respective clinics, my clinic received outstanding marks and his failed miserably. We chatted about this one evening over coffee and he became defensive, even combative in his demeanor. He blamed his staff for his insufficiencies and failed to recognize that he was substantially responsible for their performance by not being nurturing and supportive. Our relationship became contentious because he knew I was more effective than he was. He actually made professional threats against me. Fortunately, he was removed from his position and returned to clinical medicine full time. In that setting he was eminently successful and admired by colleagues. For leadership he was the wrong person in the wrong job at the wrong time.
It is evident that selecting the right people, providing them with the right training and mentoring them in a nurturing and supportive fashion are essential for leadership development.
  • 1. Swensen S, Pugh M, McMullan C, Kabcenell A. High-Impact Leadership: Improve Care, Improve the Health of Populations, and Reduce Costs. Cambridge, MA: Institute for Healthcare Improvement; 2013. Available on


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