Invited Perspective

Leadership: It’s All About YouRobert J. Weber, MD

INTRODUCTION

My initial thoughts on being asked to contribute to this series: It’s a great opportunity forintrospection and reflection; it’s nice to be invited with a good group of people, really, butthere’s a whole “leadership skills industry” out there; and, as my part comes near the end ofthe series and the others are friends, I might be able to “borrow” a bit.well then, yes, I’d bedelighted! So, as I begin to write, let’s see. I have enjoyed the series.what are itsprincipal themes?

THEMES FROM LESSONS LEARNED THROUGH LEADERSHIP

Despite having long friendships with the earlier authors in the series, I’m amazed by thediversity of their approaches to the topic and also gratified by what I see as common,overarching themes. The first is their obvious enthusiasm and pride in physiatry, their lifework. The second is that all the authors express a deep sense of satisfaction and pride inwhat they have accomplished through work with their patients, programs, and colleaguesand believe that they are part of something important, meaningful, and worthwhile. Were Inot committed to 1500 words, I would stop here, because my core believe is that lead-ership is about outcome rather than process. At best, what a leader can accomplish is tomake something of importance better and to derive from that achievement a sense ofvalidation. For that, physiatry is rich with opportunity.

R.J.W. State University of New York, UpstateMedical University, Syracuse, NY. Addresscorrespondence to: R.J.W.; e-mail: weberr@upstate.eduDisclosure: nothing to disclose

SOME LEADERSHIP TOOLS

To guard against possible sloth, I did write my thoughts on the journey through leadershipbefore reading the prior contributions to this series. I see leadership as a very personal,unique, and one might say idiosyncratic amalgam of an individual’s personality and valuesinteracting with his or her environment. There are, however, some mechanics of leadershipthat can be learned to ease the path and that may even be sufficiently valuable to justify a“leadership skills industry.” What follows is a rough guide and personal thoughts onleadership and success.

It is important to learn to effectively and sincerely apologize and become comfortabledoing it early and often. The fact is, few people care about understanding why theyshouldn’t be angry or disappointed or why they should be more patient. A straightforward,unequivocal apology is a good start on a process that may restore calm. As a leader, youhave the opportunity to apologize for the acts of many. Doing it well is one of the true waysto demonstrate leadership.

How you say things matters. For example, moving the team forward requires successalong the way, so learn to give good news well; don’t squander those increasingly rareopportunities to celebrate the really good events. Promotions, new partners, grants,papers, and patient compliments—celebrating these successes makes leadershipworthwhile. They should be savored. Giving bad news well, if such a thing can be done,is an even more important skill. This task frequently falls to the leader, and how well youdo it may ultimately come to define your leadership period. No one can/should make badnews good, but providing context and possibly acceptable options can help reduce thedamage. This task can be really hard. Be ready; it is worth seeking help to master thisskill.

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972 Weber LESSONS LEARNED THROUGH LEADERSHIP

I describe PM&R as a “young specialty,” a descriptionequally applicable to our leaders. Opportunity in PM&Rcomes early; new clinical practices often fill with patientswithin months, academic advancement and chairmanshipscan appear before age 40, and major leadership roles appearbefore age 50. Leaders in our field tend to be vigorous,enthusiastic, and have the optimism of youth, althoughsometimes they are not yet fully tempered by experience.Although experience can be a great teacher, it can also bedamaging. How can you temper a lack of experience? Despitesome skepticism regarding the “leadership skills industry” asa whole, I have found value in participating in well-struc-tured, immersive leadership programs. No, they are nottransformative, but you can select from that experience a fewtools to rely on in situations where you most often stumble.Even if it is not the ideal tool for the immediate task, yourfacility and comfort with the technique will enable you to getthe job done. The calm and confidence that you can thusproject is a key part of creating the perception of leadership.

Enthusiasm at any age can mistake leading by example asproving that you can work harder and longer than yourcolleagues. The hours some organizations expect from theirleaders are stunning. Fatigue produces poor decisions anddiminished ability to provide essential support for yourteam. Does your example exhaust the team and cause peopleto withdraw or self-protect? Effective leaders must support asustainable work culture, which is ever more important asthe expectations of workers change with the generations. It’sabout working smarter, not always working harder orlonger.

For me, a take-home tool I still use is the Nominal GroupTechnique [1]. It’s a simple way to enable a group (oftenindividuals in various levels or roles in an organization, suchas a rehabilitation team, academic department, or practicegroup) to establish priorities or explore options. It also en-courages individuals to participate by decreasing the influ-ence of supervisors or strong opinion makers on the process.In my experience, the technique provides a comfortable pathto a group consensus, or at least about the best next steps,and I always keep on hand the only hardware required, apackage of 3 � 5 cards.

Leadership courses often provide a litany of sinscommitted by challenged leaders; select a few, but only afew, of these behaviors to extinguish from your own in-teractions. Some are easy—for example, don’t always seek tobe the one wielding the white-board marker. Others, such astruly distributing responsibility, are harder but worth theeffort. Changing behaviors is easier if you are fortunateenough to have a trusted mentor or confidant to providereinforcement.

Is there a best leadership style? After all, who hasn’theard another person’s style criticized? Consider the stylesof Steve Jobs, Bill Gates, Henry Ford, Larry Ellison, andJack Welch. Could it be any clearer? Everyone has aleadership style, but there isn’t a particular leadership stylethat is required for success. Most of us need to round offsome sharp edges and tone down (or up) a bit but notrebuild ourselves. It’s all about reaching a comfort levelwith your colleagues, team, and most importantly, your-self. Mentors can help, but validation must come fromwithin.

One of your most critical responsibilities as leader is tonegotiate on behalf of the patient, the team, the practice, orthe department. Books and courses help by providingtechniques—you must know your “BATNA” (best alternativeto a negotiated agreement) or at least whether to divert fullpower to the forward shields or to the weapons system. Butyou shouldn’t negotiate with yourself. Successful negotiationrequires a willing partner. Thus it is critical that from theoutset you work to create the preconditions in the localenvironment that will support “principled,” not adversarial,negotiations [2]. Being right isn’t always enough. Creatingwithin your system of care an appreciation of what youcontribute of tangible value gives you leverage that willenable you to effect win-win solutions.

SUMMARY

The ancient Greek aphorism “know thyself” offers usefulguidance on becoming an effective leader. It suggests thattamping down the part that is about you, working with andthrough others, and continually working to improve offersthe “social animal” a way forward. However, its logicalextension (usually attributed to Groucho Marx), “I don’twant to belong to any club that would accept me as amember,” suggests that expectations for personal changeshould be modest. I believe that having trusted mentors/confidants, having the ability to trust and support your team,learning from success as well as mistakes, and having theability to change with circumstances strengthens leadership.In the end, the leader is and must be self-validating andcomfortable making decisions and then moving on. Thatpart is “all about you.”

REFERENCES1. Delbecq AL, Van de Ven AH. A group process model for problem

identification and program planning. J Appl Behav Sci 1971;7:466-491.2. Fisher R, Ury W, Patton B. Getting to Yes: Negotiating Agreement

Without Giving In. 2nd ed. New York, NY: Penguin Books; 1991.