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Excerpts from Bryce Taylor’s book “Effective Medical Leadership”

This is the last in a series of excerpts from Bryce Taylor’s outstanding book “Effective Medical Leadership”, reprinted with the kind permission of the University of Toronto Press.


Leadership Styles
Plenty has been written about why certain people are effective leaders – mostly based on the characteristics of present-day leaders. Psychological analysis may also help in defining the character traits that precede effective leadership. One such psychological evaluation tool is the abbreviated Myers-Briggs test.10 By answering seventy-two questions you will obtain your type formula according to Carl Jung and Isabel Myers- Briggs, along with your strengths and preferences.

Many leaders are ENTJ (extroverted, intuitive, thinking, judging), which may represent a combination of characteristics aligned to the classic larger-than-life so-called field marshal boss, seen more frequently in the movies than in real life. However, Jim Collins, a business authority and writer, has observed that frequently the effective leader in business is a quiet, self-effacing person whose main set of characteristics is not the outward persona of the typical field marshal but simply one that gets results and that others follow. As reported in his book Good to Great,11 Collins found that often the most effective leaders were quiet, modest, data-driven individuals who were always thinking about the success of others in the organization. The notion of the unassuming organization man behind the scenes is much more common and compelling than the typical in-your-face, Lee Iacocca version.

Bryce Taylor
Bryce Taylor

Effective leaders come in all shapes, sizes, colours, and stripes, and their common trait is that they get results. The problem in medicine is, what results are we talking about. Which of the following outcomes are you concerned about as a medical leader: patient outcomes, patient mortality, medical error, financial solvency, innovation, successful research and educational programs, doctors toeing the line, and/or recruitment and retention of the best minds and hands?

The answers are yes, yes, and yes – perhaps all of the above – but the response is clouded by our inability (to date, anyway) to reliably and accurately measure many of these variables on an ongoing, consistent basis.

Leaders have personalities that may play well in the positions they hold, but in many cases there may be traits that actually hamper effectiveness. Personality traits are ingrained and might be analogous to the genotype. However, the public behaviour, or phenotype, of a person can be learned and modified, and this phenotype can create styles of leadership that are useful in getting results.

Many aspects of effective medical leadership can be learned.

Daniel Goleman, Richard Boyatzis, and Annie McKee, in Primal Leadership (2004),12 describe six styles of leading, and these have varying effects on the target followers. The six leadership styles that they examined in a large number of business leaders are coercive (also known as commanding or directive), authoritative (visionary), affiliative, democratic, pace-setting, and coaching.

It’s fun to categorize known leaders into an appropriate slot, but when you go through the exercise, you quickly realize that styles are assigned to individuals according to how their images seem to fit; how they actually operate on a daily basis may be quite different and certainly more complex than a single style would allow.

It’s important to realize that what you see may well not be what you get when you assess behaviour from afar. One of the most effective leaders I have ever worked with had the outward appearance of employing a typical coercive style.


Don’t Judge a Book by Its Cover
Doctor D was (and is) decisive, powerful, futuristic, action-oriented, fasttalking (and, with his Australian accent, almost unintelligible when excited). As chief executive of a major teaching hospital he demands much of his team members and deals quickly and decisively with important prospective issues as well as unexpected ones.

In a public town hall meeting, when faced with some difficult confrontational questions, he once declared, ‘Well, if you don’t like what we’re doing, you don’t have to work here; you have other choices!’ What could be a more coercive approach than that?

However, Doctor D is the most democratic person with whom I’ve ever had the privilege of working. He has always sought out the opinions of others, achieved buy-in from his managers, and been very respectful of all sides of a problem presented to him – and not infrequently he has changed his mind without concern for how conciliation would appear to others. Clearly, his outward appearance to many spoke to one image (coercive), but his real modus operandi indicated quite another (democratic).

One of my favourite illustrations of a leadership style was that of Cito Gaston, who was manager of the Toronto Blue Jays baseball team in the early and mid 1990s. This was memorable for me, a baseball enthusiast who has followed the Blue Jays since their inception in the American League in 1977 (the interest had been spawned many years prior to that, when I was a member of the ‘knothole gang’ watching the Toronto Maple Leafs of the International League in the 1950s).


Let Your Players Play
Cito Gaston was regarded as the quintessential ‘players’ manager’ because he was a patient, hands-off macromanager, seldom intervening in his coaches’ teaching, although he had previously been a hitting coach. He was supportive of his players, especially the more experienced leaders in the clubhouse. Gaston let players play and concentrated on positive relationships among members of the team. He was never negative in public with the media.

Cito Gaston and the Toronto Blue Jays were rewarded with world championships for three years (1992, 1993, and 1994, the latter being a default position during the famous strike year), and, of course, like most managers, Gaston was fired several years later.

Ironically in 2008, Cito was surprisingly rehired to inject a struggling underperforming team with at least change or at most a significant improvement in results.

The above description is typical of the affiliative leader who creates harmony, builds emotional bonds, and puts people, their values, and their emotions first.

Without going into details of the other leadership styles, I subscribe fully to the notion that each style has its value, and all situations may require varying styles. One writer likens this to club selection during a golf game – choosing the right attitude and methodology for the right moment, that is, a kind of situational flexibility. This might be seen by some as inconsistent or indicative of multiple personalities. I summarize this flexibility in the leadership talks I give by suggesting that all styles may be required in the same day: you’re coercive or commanding in the operating room when the going gets tough; you’re visionary when you’re in the planning mode; you should be coaching much of the time with residents and students; you’re affiliative with your divisional staff and your support staff; you’re definitely democratic at home if you’re smart; and you may be pace-setting when you’re feeling your oats, but you should watch that!

As a medical leader you can be somewhat unpredictable in your handling of various situations, but you must be entirely predictable as far as principles and values are concerned.

University of Toronto Press, 2010
ISBN 978-1-4426-4200-3

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