What Are You Looking For in a Leader?
Are leaders made or born? A recent article summarizes the literature and points out that people who are more adjusted, sociable, ambitious and curious are more likely to become leaders, and these personality traits account for 53% of the variability in leadership behaviors. IQ, while important, accounts for only 5%. Taken as a whole, up to 60% of what makes for leadership has a strong heritable component. Well-crafted leadership coaching can boost competency by 20-30%. So the real answer is leaders are first born with the tendency, but then have to be reinforced by environment, circumstances, and learning.
When considering physicians as leaders, it is fair to say most are reasonably sociable, ambitious, and curious. Unfortunately, the prolonged adolescence of medical education is something that not every physician outgrows, so it is probably not true they are all “well-adjusted.” Some are and some are not. At the same time, medical education does seem to select for and magnify narcissistic personality traits, a phenomenon often described by our state impaired physician program experts. Professor Chamorro-Premuzic also reports “curious, sociable, and sensitive leaders tend to be more charismatic, though charisma often reflects dark side traits such as narcissism and psychopathy.”
Research has also shown several personality traits are associated with becoming an effective leader. The best leaders show high levels of personal integrity, which enables them to create a fair and just culture in their teams and organizations. They also tend to have high emotional intelligence, which allows them to stay calm under pressure. Those with a high degree of narcissism, on the other hand, are more prone to behaving unethically and create unethical environments.
Suppose you are considering physicians for leadership in your organization. Where should you focus your investigation? I suggest the two things that need to be the two key points are “well-adjusted” and demonstration of integrity. So how do you know?
To determine how well-adjusted the physician is, look at what he or she does away from the practice of medicine. The “hospital rat” is rarely well-adjusted and will not do well in a leadership role. Integrity is best judged by the way the physician practices medicine. Despite the current emphasis on “quality,” this can be difficult to determine. The physicians practicing at the highest level of integrity clearly make decisions based on what is in the patient’s best interests after consulting the patient and family. This might seem obvious, but can be difficult to determine, as what physicians “do” does not capture this reality very well.
Suppose you are fortunate enough to have several well-qualified candidates. Do you want to select those who seem to be great leaders, or is it enough to be merely a good leader? James Bailey has recently written that we often mistake what we mean by this distinction. He notes we commonly think of leadership as a spectrum from awful on one end, progressing to good and then great. He disagrees, though, and suggests good and great leadership are qualitatively different.
“Great leadership is powerful, dominating, often overwhelming. It can sweep people along through sheer animation. Great leadership excites, energizes, and stimulates.”
Good leadership, on the other hand, is more muted.
“To speak of good leadership is to speak of protecting and advancing widely accepted principles through means to ends. It denotes doing the “right” thing. There may be legitimate differences in interpretation…(but) good heeds the best interests and welfare of others…The tug between great and good leadership is one of perpetual and dynamic coexistence.”
He goes on to postulate a 2x2 square. Leadership types are classed as not great/great on one side and good/not good on the other side. Great leadership provides force, while good leadership provides direction. This results in four possible combinations. A leader who provides direction (good) but lacks force will be an amiable leader. One who is not great and not good is vacant (absent). One who is both great and good will be a vital leader, but one who is great, but not good, will be maleficent.
Perhaps this is another way of looking at the characteristics we looked at earlier—the good leader has a high degree of integrity, where the great leader has a high degree of charisma. To get the best combination, you need both. Although Professor Bailey did not state an opinion, I suspect the “vital leader” is a rare commodity. Sadly, the maleficent leader may be less rare. Absent leadership is also common, but good leadership can be found if one is looking for it.
So should medical organizations settle for good leadership? Can they afford great leadership? I think the answer has to be context specific. If your organization is thriving and the future looks good, then the answer to the first question is yes. If the organization is not thriving and the future is bleak, then survival is going to require the disruption a great leader brings.
16 October 2016
 Chamorro-Premuzic T. What Science Tells Us About Leadership Potential. 21 Sep 2016. https://hbr.org/2016/09/what-science-tells-us-about-leadership-potential. Accessed 27 Sep 2009.
 Bailey, James R. The Difference Between Good Leaders and Great Ones. 22 Sep 2016. https://hbr.org.2016/09/the-difference-between-good-leaders-and great-ones/ Accessed 27 Sep 16.
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