Build on Solid Leadership Principles

ES 175Jazz musicians have chops, hockey players have moves, and leaders have favourite ideas they use over and over.

This post summarizes principles that became themes in our ED transformation (No More Lethal Waits: 10 Steps to Transform Canada’s Emergency Departments). Leadership books bulge with other great ideas, too.

[I worry that this post feels a bit breathless, like drinking from a large hose. I promised it for those who do not have time to read the book. Cheers!]

Leadership Principles

Find out what motivates people.

People are moved by different things. For example:

  1. Promise of reward.
  2. Fear of punishment.
  3. Resonance with concepts.
  4. Appeal to morality.
  5. Social pressure.

If you only speak to one aspect of motivation, you leave out 80% of your audience.

Learn the language of influence.

Doctors, new to leadership, often act like doctors. They investigate, diagnose, and treat.

This does not work well in administration. Influence starts with relationships, shared project objectives, respect, and commitment to work together. Read more here: influence.

Don’t hide the pain of bad news.

Let people work through it with you in the room.


It takes 5 communications to get one message across.

Think Complexity

By now, you have probably heard about complexity theory. Check out How to Lead Using Complexity Theory.

  • Baking a cake is simple.
  • Sending a rocket to the moon is complicated.
  • Raising a child is complex. Success with one child is no guarantee of success with the next.

Too often, military and machine metaphors dominate healthcare thinking. Metaphors shape our solutions. Mis-applied metaphors feel awkward and hold teams back.

Learn to Love Conflict

Do not blame conflicts on personality. Look for the ideological debate that underlies the conflict. Very few conflicts are only about Jungian clashes: Personality Conflict – An Excuse Great Leaders Never Use.

Read Governance

Focus on outcome, describe success. People engage when things matter to them, make a difference to them, and are enjoyable for them.

Form follows function, and function follows purpose. We need to understand our purpose in medicine.

Stakeholder needs, wants, and preferences shape what we decide to accomplish but should not block positive change.

Spend time learning about governance. Here’s two earlier posts:

Governance Expert Pearls

Great Decisions Great Governance

Manage Attitudes

These days, no one gets fired for saying, We’re going to lose!

Clinical competence is necessary but not sufficient for outstanding performance.

Attitude must be a key measure of Performance Management.

Process vs Leadership

People change the names but never tire of chicken versus egg debates:

  • Which comes first?
  • Can leaders lead transformation without a process destination?
  • Can departments change, without leadership, if the destination is clear?

I think leadership comes first. Process based on rigid designs that offer grand solutions never work as promised, outside of car factories.

Even assembly line technicians use skill and judgement.

Complex, messy systems, like healthcare, require leadership before process.  Terrible processes can perform reasonably well with outstanding leadership. But we need both for excellence.



That gives you a taste of Step 9 in No More Lethal Waits: 10 Steps to Transform Canada’s Emergency Departments. One more to go!

Photo credit of my dream guitar Gibson ES 175

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2 Replies to “Build on Solid Leadership Principles”

  1. Shawn,

    Some interesting thoughts as always. A couple of things I’d argue. Unfortunately in health care, we conflate roles of administration/management and leadership all too often. Skills at one do not translate to skills at the other (and clinical skills don’t lead to either), and often work at cross-purposes. Both skill sets can be developed, but people tend to be better at one or the other (if they’re capable at all).

    Moreover, leadership is something aspired to. Administrative responsibilities are generally taken on grudgingly. You have to WANT to be where you’re at before introducing change to a department. The usual administrator’s approach–change because the Ministry/Board/CEO says so–is an invitation to resistance.

    Complexity theory is fun, but IMO I have yet to see its practical use in health care. It’s great for modelling hypothetical scenarios, and perhaps keeping our “Spidey-senses” alert for unknown unknowns lurking around the corner. Sadly, health care is still a field dominated by bureaucratic, top-down management. The abstract thinking needed to grasp (and I suppose) make use of complex systems theory is probably rare among hospital administrators and Ministry minions.

    And as someone who’s terrible at it, baking a cake is far from simple. The directions are simple, yes. But the outcome is by no means a certainty even when directions are followed to the letter.

    Keep up the good work. Glad someone still has a positive outlook on this.

    1. Great note, Frank!

      I agree, leadership skills need to be developed, just like clinical skills. I also agree that many people WANT to be in leadership, especially our non-physician colleagues. Leadership offers them a huge bump in salary, better benefits, and the chance to make a bigger difference.

      I know very few MDs to WANT to be in leadership per se. In fact, most physicians I know in leadership got into it because they saw something that needed to be changed. They did not want the position; they wanted solutions. They wanted to get in, make a change, and then move on. Docs take a HUGE income cut to serve in leadership. But leadership grows on you. You realize that you can make an impact on 100,000 patients with one decision, instead of one patient per decision.

      I agree that our current, top-down system does not like complexity. I also agree that cakes are not always simple! 🙂

      Thanks so much for taking time to read and comment. I sure appreciate it!!

      Best regards,


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