How leading from behind can transform healthcare

(Originally published by Hospital Impact)


“My preference is to lead from behind.”

“You do what?”

I recently had the opportunity to meet with an amazing group of healthcare leaders, each representing a different sector and all coming together to improve the healthcare system locally, regionally and beyond. It was a mosaic of ideas, philosophies and approaches, each intertwined with opportunity, challenge, hope, ideal and complexity.

We discussed the importance of patient and family partnerships in ensuring care plans are aligned with patient preferences and thus lead to improved patient safety, compliance, engagement (of both clinician and patient) and improved health and healthcare outcomes. Further, we focused on the need to engage patients not only at time of care (which again is critical) but also much further upstream to ensure we design care systems which best position patients, families and clinicians to develop relationship and trust, tell and hear whole stories, gain a 360-degree picture of flames to be fanned as well as those barriers to health to be eliminated, and together create care pathways honoring the patient and leveraging this relationship.

We focused on the importance of quality improvement and the need for a collaborative approach to system redesign to better position members of care teams, i.e., physicians, nurses, therapists, administrative staff and others to improve care provision and better position each team member to do what they do best for the betterment of their patients, their teams, their communities and themselves. We paid close attention to the adverse effect the broken system is having on caring, dedicated, compassionate physicians and nurses and how collaborative leadership is needed to fix the brokenness, honor these healers, and better position them to be successful and rediscover joy in healing.

With a variety of opinions offered, health leaders highlighted the need for innovation in healthcare financing aligned with new care model designs. We discussed with great interest and engagement the need for a new vision that would be shared with confidence and implemented effectively.

And then it happened …

The subject of leadership approaches and styles came up, and I said: “My preference is to lead from behind.”

And aside from the visceral reaction of “You do what?” … the room became silent.

You know the old saying, “the silence was deafening.” I have now truly experienced this phenomenon.

Note: I have tried to live my professional life according to an S3 Leadership Style:

  • Servant (S1): it’s not about me (it’s about the mission)
  • Steward (S2): it’s not mine (and thus the careful and responsible management of all entrusted to my care)
  • Shepherd (S3): people are precious

And especially over the past 9-plus years, I have focused on improving my shepherding leadership skills:

A leader, he is like a shepherd. He stays behind the flock, letting the most nimble go out ahead, whereupon the others follow, not realizing that all along they are being directed from behind.”
— Nelson Mandela (as per Linda A. Hill, HBR)

I have focused on developing and leading agile, strong, confident, S3 team members (leaders) who are energized by and dedicated to the mission, compassionate and caring about their team and their community, about themselves and about all those they (we) serve. And I ensure they are well-positioned to truly make a difference.

And yet …

And yet these amazing leaders sitting around the table with me and engaged so deeply in improving care for our patients, families and communities were not familiar with this form of leadership. And in fact the term “leading from behind” was perceived as a negative–as a way to not lead but rather to follow (in its weakest connotation).

So, what happened next?

We had an amazing discussion of leadership philosophy and impact. We discussed great leaders and their visions, principles and influence. We honored one another’s perspective, we listened to one another and we made note of our observations without judgment. We learned from one another, we each grew, and we each noted how this learning and sharing has better positioned each one of us to achieve our missions.

So today let’s continue to lead, to learn and to share, together.

Questions for your consideration:

  • What is your leadership philosophy?
  • How do you manifest this philosophy?
  • What difference are you making?
  • How do you measure the impact of your philosophy?
  • How are you serving those you are blessed to lead?

Let’s learn and lead together as together we improve the healthcare system for all.


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