August 10th
2013
Address to
University of Newcastle
Master of Clinical Medicine (Leadership and Management) Workshop Dinner
Stephen
Leeder
I
congratulate everyone present at this workshop, whether as a fellow in the
program or one of the program organisers or managers who support it or as
contributors to this workshop.
What
you are all doing is critical to the future of the health service that we all
work in. Without high quality
management, without leadership to point to a goal and remind us of why we do
what we do, we will not give to the future the best of what we are capable. But with management and leadership we
can seize opportunities and overcome obstacles in ways that may surprise us and
that will assure a positive legacy from the commitment of our lives to our
profession.
I
have followed the progress of the program from conception through birth to
infancy and am impressed with it.
I
have committed part of my life to medical education, so what is happening in
this course is of special interest to me.
You
are all great people.
I
know from my experience both in Newcastle and Sydney, with new educational programs,
the agony and ecstasy of the first cohort of participants – they get the best
and worst, they get the enthusiasm and the mistakes, rather like firstborn
children.
In
1986 I attended a one-day workshop in Sydney CBD on how to become a great
leader, run by an American evangelist-type who talked with boundless enthusiasm
and sold books and tapes. At the
start he asked us all: “Hand up if you are a first born child!” Almost four-fifths of us indicated they
we were firstborn. Apparently as
firstborn you are born to lead! So
as the firstborn of this new program, you folk are already at an advantage when
it comes to leadership!
Your
theme at this workshop is leadership and management. A definition of good leadership that I heard years ago has
stuck with me and it is that leadership is helping others achieve more than
they thought possible, more than they thought they were capable of
achieving. Leadership provides
direction. It provides hope. It is
optimistic. Leaders take people
with them. Leaders stretch the people
they are leading. They say “Come on!”
to the flagging spirits. They say “This way!” to those who are dithering. They
say “Take my hand” to those who are stumbling or out of breath. That’s what good leaders do and that is
what good leadership is.
Managers
in my experience are enablers. Managers make things happen. They understand the process of making
decisions, they know how to allocate tasks and resources to match those tasks, they
understand spread sheets, they enable, they discipline when needed.
I
have seen leaders who are good managers and vice versa. I have also seen good leaders who were essentially
devoid of management skills, and managers who could not lead.
A
couple of personal observations.
First,
doctors are not exceptionally good managers. Of course, you can name half a dozen doctors you know, as
can I, who are excellent managers.
But our training as doctors leads us to be individualistic, to make
decisions in diagnosis and therapy that affect the lives of our patients and for
which we and we alone, are accountable. Many doctors lead teams, but often you
will find someone else manages those teams. McKinsey Consulting hires a few – not many – doctors as
management consultants. So the
skills of management do not come easily or naturally to many doctors.
With
regard to leadership you will find many doctors who have pioneered new ways of
treatment, especially in surgery, that depend on effective leadership for
success. But the big picture, the
vision, the attributes of leadership that I described before, are not common
among doctors, at least in my experience, even in public health. Halfdan Mahler, a physician from
Denmark, served three terms as director-general of
the World Health Organization 1973-1988 and is widely known for his effort to
combat tuberculosis and his role in shaping the landmark Alma Ata Declaration that
defined the Health for All by the Year 2000 strategy. He
was a leader, a visionary man.
But
the eight Millennium Development Goals, established by the UN, were not
developed, nor led, by doctors, but by Kofi Annan, the Secretary
General of the UN and Jeffrey Sachs from the Earth Institute at Columbia
University. They pushed for a
halving of poverty by 2015 through goals that addressed infant and maternal
mortality, basic education and aid.
The goal of halving the number of people living on less than $1.50 a day
was achieved three years early, in 2012.
That’s what leadership can do, through inspiration, tenacity, clarity of
vision and passion.
So by now you’ll be wondering why your course organisers asked me to speak to you this evening as I bring dismal news. Well, it is not all that dismal! This is partly because we have many excellent managers, non-medical, in our health service and if you can find and engage with them, you will be very fortunate.
That’s
leadership, but what about management?
In the past two years I have chaired the board of the WSLHD. We were in serious financial bother and
morale was low. Enter Danny
O’Connor our CE who is a wonderful manager. He has brought order and respect and conversation to that
troubled district. He came saying
“I’m a team man” and he has been true to his word. He has won the respect of clinicians. He networks well. And as chair of the board I see my
job as being his body guard. I
don’t mess with his management. I
just take a whopping great stick to marauders.
I
have been involved in helping establish a new medical school in Newcastle in
the late 1970s and 80s and then the reform of the Sydney medical program in the
90s. Both required managerial and
leadership skills and in many ways I acquired those as I went along. I have been lucky – really lucky – that
in those endeavours I have had wonderful colleagues who worked closely with me
and educated me sometimes quite forcefully.
You
will acquire management and leadership skills through this course and you too
will be lucky. A lot of my
mistakes are ones you will learn how to avoid. The future of the health
service, in my opinion, depends on it being well managed. One example: the introduction of ICT
without change management is an easy way to waste billions of dollars. Yet we need that ICT to achieve the
connectivity that caring for people with chronic problems demands. We need to manage efficiently or we
will continue to do what we are doing now – asking people to pay more from
their pockets (a great inequity) to cover the difference between public funding
and the inefficient cost.
That this can be done is apparent from our Veterans Affairs health
service. It is also apparent in
the US – Kaiser, Intermountain, Harvard, and Mayo for example.
Are
there dangers in leadership and management for us as doctors? Let me identify one risk with
management and two with leadership.
We
will get ourselves into an impossible tangle if as clinicians we follow our
duty of care for patients at the same time as we try to be really smart
managers and also do our best by our patients. On some management matters we
need to stand aside for managers without clinical obligations. Decisions about
resource allocation need to be made at a higher level than in the ward.
As
leaders, we can get ourselves into bother if we construct for ourselves a
reality that is too far out of common experience.
When
I was dean of medicine in Sydney 1997-2002 I used to do a clinic a week at Blacktown
to keep in touch with clinical reality.
Fortunately, medical leaders have the chance often of continuing to do
some clinical work and that helps keep their reality clear and clean.
The
other danger with leadership is that it is charged with power and this can be
used to good or bad purposes.
Hitler was an amazing leader.
Ironically, the Kennedy brothers, all of whom used rhetoric and vision
to inspire their audiences, were fond of using a quote from George Bernard
Shaw. It was “You see things; and you say, ‘Why?’ But I
dream things that never were; and I say, ‘Why not?’” But while the quote does come from GBS, in fact it is drawn
from a play that he wrote called Back to Methuselah.
The
words were words spoken by the serpent in the garden in the biblical story of
Adam and Eve, where the serpent is the embodiment of evil, and it is tempting
Eve to disobey God and eat from the tree of the knowledge of good and
evil. Strong words, inspiring
words, but an abuse of power!
Leaders beware!
We
are very lucky. All of us –
clinicians, managers and others – here this evening know why we do what we do in
health care, what our goals are.
We know that our job is to express solidarity with suffering people, to
prevent, cure, relieve and comfort.
This vision enables us to lead and be led, to manage and be managed, in
pursuit of that vision.
So
leadership and management are critical skills for effective future health
care. We need doctors who can lead
and others who can contribute to massive management challenges of the
future. That’s YOU!
I
am delighted you are here, delighted you are doing this course, and delighted
that our health service will be in such good hands. I wish you all good fortune in your further careers.
Thank
you.
