Leadership - so what is it anyway?

As a former National Medical Director’s clinical fellow and demitting chair of the FMLM Trainee Steering Group (TSG), I am sure I am meant to know the answer to the question in the title.  In defining leadership, it is inevitable that more questions ensue.  Are leadership and management the same thing? Can you teach it or is it an intrinsic quality? Does it apply only to those in official leadership roles or is it everyone’s responsibility?  Before I attempt to answer these common interview questions, I will describe three attributes that, to me, define great leadership.

The first is moral courage. I genuinely believe it takes courage to be a good leader and certainly those I admire most possess this quality in abundance. It means committing yourself to pursuing the best interests of those you serve and persevering when obstacles occur. Moral courage does not equate to always getting it right, in fact having the strength of character to admit mistakes and missteps is a necessary component.  But it does involve having a clear sense of purpose and the determination to follow through on this despite what life throws in the way.

Secondly, the ability and desire to improve or innovate are fundamental to great leadership. The more I experience, the more I understand that change is the only constant in life. The best leaders embrace this wholeheartedly. Leading evidence based change in healthcare can take many forms.  It can be exhibited anywhere from a radical overhaul of existing systems through to a commitment to continuous improvement in the areas in which we work. The next decade may witness the most rapid evolution of healthcare in memory with the ongoing integration of machine learning, big data and genomic sequencing. We need clinicians to be at the leading edge of developments to ensure patient care remains front and centre in an increasingly complex world. As a profession, we want to be ‘doing’ not being the ‘done too’; taking an active role at an individual, team and systems level.

The third and final attribute in this list is embracing (calculated) risk. Putting yourself in a position others will not is a risk. Embarking on untried and untested paths is a risk. Setting a vision, communicating that idea to others and committing yourself without guarantee of success is a risk. On occasion, it can feel more comfortable to stay within the neat constructs of the familiar, but this is unlikely to bring long-term satisfaction or produce significant achievement. Not everything will work out exactly as planned and, no doubt, frequently not to time. Living with uncertainty can be an uncomfortable feeling to become familiar with but is a necessity for those who want to positively disrupt the status quo. 

Courage to step up, vision and desire to introduce positive change, and an ability to embrace risk and uncertainty define outstanding leaders. Not only do these attributes benefit others, but they also enhance the triumvirate of intrinsic workplace motivators described by the analyst and author Daniel Pink; autonomy, mastery and purpose.¹  Combining clinical practice with leadership responsibilities provides a medium in which each of these facets can prosper.

To return to the original interview questions (leadership).  Do I think leadership and management are the same things?  In truth, I don’t think it matters.  To create the change, you need to be able to see a future that doesn’t exist and subsequently use drive and organisation to shape that future.  The terminology for each stage of the process probably doesn’t matter.  Can you teach it or is it intrinsic? Well this question plays to my biases, I think the medical profession can achieve anything it chooses, but you have to want to do it so, in the end, it is the ‘choosing’ to lead that is key.  Is leadership only for those in official leadership roles (big L leadership) or is everyone a leader (little 'L' leadership)?  At the risk of being repetitive, it is for everyone who chooses to create a change or a different future and finds a way to make it happen; the title matters less. 

Finally, what is leadership anyway?  I don’t have an Oxford dictionary definition to answer this question. In the best examples, it is to commit wholeheartedly knowing that failure is a genuine possibility.  It is facing the wicked problems head on and not being defeated or cowed by external forces.  It is believing in your abilities and surrounding yourself with others who will support you when that belief is at a low ebb.  Most of all it is taking responsibility for your life and using the talent you have to make a difference. 

1. Daniel Pink (2009) Drive: The surprising truth about what motivates us, 1st edn., New York: Riverhead Hardcover