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Leadership Lessons from Shakespeare

Jim Fisher
Jim Fisher

An enthusiastic group of 26 surgeons and surgical nurses gathered to hear stimulating lessons on Leadership Day for surgeons, held at the Vaughan Estate on April 24, 2009. Jim Fisher, Vice Dean, Programs at the Rotman School of Management developed the theme that "leadership is thoughtful; it is not about charisma". Using the example of King Henry V as portrayed by Shakespeare, Jim developed his nine-block conceptual framework for successful leadership in action, illustrated in a nearby figure. Henry's management included careful planning. He chose the site of battle to be a tapered field where the overwhelming numerical superiority of the French could be confounded. They stumbled over each other in the mud as they approached the small end of the funnel where the English troops stood their ground. He organized the structure - sharpened wooden spears were positioned diagonally in the ground to impale the French horses as they charged. He assembled the required team of long-bow archers, a novel weapon, far superior in accuracy and range to the cross - bows used in the past. These were positioned safely between the spears. The arrows that he brought from England, made of Spanish yew, would not shatter when they struck their targets.

The leading component of his action plan included a vision of the future in which generations would look back at the heroism of his troops and see them as noblemen. He aligned a heroic group of committed fighters by telling those who did not share the motivation of the heroic "happy few" that they should take their pay and leave. This eliminated those who might be seditious or troublesome. He appealed to the soldiers' self-esteem and sense of belonging by placing himself in the front line - neutralizing any doubts about his commitment. In engaging his troops, Henry articulated and lived the values consistent with his vision of a band of heroes.

Jim recommended the book Leadership and the Quest for Integrity by Badaracco and Ellsworth as the best book available on leadership. (1) It emphasizes involvement. Followers need to control their space. The Political theory of leadership requires that we give followers their choice within the boundaries of the leader's plan. Good followers are volunteers who have chosen to do their work. "If you pay them and walk around to check on them, you'll get the minimum - while you are watching. They have to choose to volunteer for the rest."

The Directive theory of motivation states that we want decisions from the boss, even if we don't agree. Leaders should make decisions on issues people want decided - "We'll do X by Y." Values are important; we feel better about ourselves if we are doing X. Good leaders manage, lead and engage. Too idealized a vision is discouraging. "World class care for everyone immediately" sends everyone home feeling like losers. Make the vision achievable, not unrealistically ideal. He commented that we in healthcare treat each other badly compared to the business community. We are doing heroic work, and it should be far easier to inspire each other. When he was working for Neilson, he felt that the company dealt with its customers and co-workers better, even though the motivating values and vision were far less heroic. "Stuffing Mr. Big bars down the throats of boys, and Caramilk down the throats of girls - stuffing fat and sugar into people isn't highly motivating, so we pushed the idea that it's Canadian and that we deal with our customers and co-workers better than other companies."

"In the political world Obama did all three leadership tasks well (managing, leading, engaging). He was always clear, always on plan. Stephane Dion couldn't do the manage part, though he was fine on the others. John McCain and Hillary Clinton couldn't manage the plan." The vision sometimes changes so the thoughtful leader adjusts to the situation, the resources and the purpose. Leaders use objective left-brain corporate considerations as they measure output, and subjective personal right-brain approaches when they look to the authenticity of their leadership.(2) They use the left and the right brain to determine who they have to get on-side. Objective information is easy to obtain. Emotional intelligence is more critical to success. In Henry V, the king walks around disguised in a cloak the night before the battle, listening to learn what the soldiers won't tell him. They believed that the king will be ransomed if captured, a common practice at that time; that the plan was bad, and that God did not favour their enterprise. His speech counters all these misconceptions.

Download text of this speech

Link to the video clip of Kenneth Branagh's delivery.

Analyzing the resources of the leader, there were objective resources like long bows, shatter-proof arrows and physical geography. There were also emotional, right brain resources. In the long line of the many French kings who had ruled England since 1066 Henry V was the first who could speak the Anglo-Saxon language. He was credible to his men, based on his emotional intelligence (3) and knowledge of their culture from his days of carousing in bars.

(Click for full size image)

The Matrix Revisited

Brendan Calder
Brendan Calder

Brendan Calder led us through a spirited exercise utilizing his famous Responsibility Matrix. (4) This management tool identifies for each management decision: 1. who is Responsible for getting it done; 2. whose Consensus is required; 3. whose Input is required; 4. who does the Work; 5. who must be Advised Before; and 6. who must be Advised Later. Bryce Taylor replaced the surgical exercise planned for Brendan's analysis with the group by introducing the news - fresh that day - of the H1N1 influenza epidemic. Participants had fun struggling with this exercise; it clearly demonstrated how failure to assign and articulate individual responsibility when a decision is made can delay and/or prevent its implementation. Here are some key recommendations that are not typical of our decisional policymaking processes: "assign only one R"; "minimize the number of Cs"; "define consensus clearly - consensus means parties may still like their own differing opinions but are willing to commit to and support the proposed decision".

Miles Shore
Miles Shore

Miles Shore, Professor of Psychiatry at Harvard Medical School and an affiliate of the Centre for Public Leadership, Kennedy School of Government at Harvard, developed the theme of senior leadership teams to augment, intensify, or supplement the impact of the thoughtful individual leader. He cited the work of the Hay group, with Richard Hackman of Harvard (5), which reports a study of senior teams in a variety of industries. Senior leadership teams can be informational, like the Alcoa team that met every Monday morning on a worldwide conference call to inform the CEO, consultative- advising the CEO on strategy and management, coordinating- integrating and aligning different divisions within the organization, or decision-making. Decision-making teams can do all four of the functions and may be extremely effective if they are properly organized and supported by top leadership. The Senior Advisory Committee of the Department of Surgery, comprised of all of the University Division Chairs and Surgeonsin-Chief is an excellent example of a decision-making team. Miles emphasized that senior leadership teams are needed during periods of rapid growth, when new areas of activity are taken on by the organization, when major capital expenditures are contemplated or when entering a new stage of the organization's life cycle.

It is critical that the senior leadership group be a real team and not a pseudo team, that is, members must have the skills and knowledge required, and the participants must know that they are members of a team - it should not include ex officio members. A well-functioning team requires stability, and consistent support by the leader of the organization. All members should come to all meetings and the team should have significant tasks. Each member of the team should add value regarding the purpose of the organization, and the team should have a compelling direction to pursue, rather than simply a schedule of pro forma meetings.

Team enablers include a structure of the right size, eight to nine people, and a focus on the whole organization rather than its contending parts. Lincoln accomplished this at a national level by changing the language describing the United States. After the Gettysburg Address, the standard usage became "the United States is," rather than "the United States are." Additional enablers include a supportive context with sufficient resources and logistic support, and team coaching. This should come from the team and from the CEO, including debriefing summaries of each meeting which then serve as the agenda for the next meeting. This is classic Brendan Calder "get it done" technique. (4)

To illustrate the formation of a senior team, Miles tied together the Jim Collins theme from Jim Fisher's talk on Henry V. "You need to get the right people on the bus and the wrong people off the bus." (6) He told us that Henry V chose the right group of senior leaders to join him at Agincourt, bypassing his troublesome brother Thomas, Duke of Clarence. Thomas was their father's favourite, and had made a military alliance with elements of the French aristocracy, generating suspicion that he was trying to set up a political regime in France in opposition to Henry. When early in Henry's reign various perquisites were bestowed, Thomas was deprived of what he had expected, and was only bought off by large amounts of money, and some lesser titles. Henry went further outside the immediate royal family to build his senior leadership team, basing appointments on merit rather than nepotism or the conventions of the noble hierarchy. He chose a relative outsider, Henry Chichele, as Archbishop of Canterbury on the basis of his legal expertise and loyalty rather than the more flamboyant but headstrong and ambitious Henry Beaufort, the expected candidate. His "senior team" of leaders in the French campaign was made up of experienced warriors, men who had succeeded in suppressing the Welsh uprising. These seasoned leaders brought with them not only expert archers and armoured men-at-arms but, more important, their own experience in war to ensure the success of Henry's campaign.

Larry King interviews Bryce Taylor

Joe D'Cruz
Joe D'Cruz

Leadership Day closed with a spirited imitation of Larry King, including the red suspenders, by Rotman Professor of Strategy Joe D'Cruz interviewing Bryce Taylor about his ten-year term as Surgeon-in-Chief at the University Health Network. One of the first lessons that Bryce learned is that you must express your strong opinions in a committee meeting, but if the consensus opinion about a subject differs from your own, you must enthusiastically support that opinion and decision when the meeting is over.

Painfully, he had to make the cuts that go with a deficit budget during the last recession, though many felt the hospitals might have succeeded despite the submission of deficit budgets. Bryce finds cuts in budget deeply disturbing; a 2% budget cut may mean an 8 or 9% reduction in care, because in 2009, reductions in service also lead to reductions in revenue in a volume-funded system.

He described a good example of Jim Collins' removal of "the wrong people on the bus." (An innovative and disruptive surgeon once created a new device to use in the operating room. He proceeded to use it over the nurses' objections, and this ultimately led to a suspension of privileges. The disrupter eventually "found a new bus").

Bryce Taylor
Bryce Taylor

"Being surgeon-in-chief is a tough job, but there are now eight or nine excellent candidates" - a testament to the respect, efficiency and followership Bryce has brought to the position of Surgeon-in-Chief. Bryce says, "I have the best surgical job in the country. The various clinical and academic outputs of our surgeons are phenomenal. I view my success as the success of others. I get a tremendous kick out of the success of other surgeons, like seeing Steve Gallinger's cadre of four young stars take hepatobiliary and pancreatic surgery up a level, or recruiting as our new head of plastic surgery Stephan Hofer, who actually was the star of a daily reality TV show in Holland, in addition to being an outstanding reconstructive surgeon and leader."

Larry King asked Bryce to explain how the transformation from "just a surgeon to leader" developed. "After my clinical general surgery training in Toronto, I went to England where I engaged in basic research, and then started my career at Toronto Western Hospital where I performed a wide variety of operations in general surgery. During my time at Toronto Western, I was the year 2-3 coordinator for the medical students, then became director of post-grad education for all U of T surgical residents. There were no specialty program directors at the time, so I interviewed each and every resident entering all specialties and also throughout his/her training, trying to provide the best experience possible for about 150 residents! From 1989-99 I was Chair of General Surgery for the 10 university hospitals - a position characterized by lots of responsibility but with little authority and no budget. For the past ten years I have been the Surgeon-in-Chief and Director of Surgical Services at UHN. The latter job involves a commitment to finances, quality of care, and workload of everyone who works in surgery. I never really sought any job I eventually took on - I did them to learn, for a challenge, because they were interesting, and because I could see certain areas where there was a job to be done. It sure was a challenge when I was Chair of General Surgery and Division Head at UHN, we introduced the liver transplant program, we were flying all over Canada and the US to harvest organs, we always had challenges of doing more with less, and at the same time I remembered that I had a large family whose members saw too little of their Dad!

Work with independent, individualistic physicians and surgeons is always a tightrope walk. As independent practitioners, none of us likes change. As an example, the surgical checklist project, which may reduce the incidence of complications by 4%, and has numerous welldocumented advantages as reported in the NEJM, (7, 8) has not been universally adopted. Despite being easy and cheap, the checklist has not yet been embraced in North America with the enthusiasm that was predicted; the challenge was laid that 4000 hospitals in the US would adopt the surgical checklist within three months of the publication of NEJM article, but to date only a small proportion of that number have implemented it. We have an opportunity at the University of Toronto to lead the continent!"

The evaluations of Leadership Day were enthusiastic. Jim Waddell wrote:

"In my previous leadership positions I was fortunate to know most of the individuals with whom I worked and was able to bring about change through personal connection. In my new position as the Lead for the Expert Panel for Orthopaedic Surgery in the Province of Ontario I am largely working with individuals throughout the province with whom I do not have a personal connection and often have little understanding of the local circumstances that influence or direct their behaviour.

I attended this leadership session because I wanted to know more about large, complex organizations, how they are run and the decision-making processes they use to set priorities. This is particularly relevant with many of the large hospital corporations responsible for delivering orthopaedic care throughout the province as well as the 14 LHINs that are expected to coordinate the actions of the respective hospitals within their borders.

This course offered valuable insights into corporate decision making and those points along the process of concept, planning and implementation where one might influence the ultimate result and augment the leadership of others."


(1) Badaracco, Joseph and Ellsworth, Richard. Leadership and the Quest for Integrity. Boston: Harvard Business Review Press, 1993.

(2) George, Bill. Authentic Leadership: Rediscovering the Secrets to Creating Lasting Value. Jossey-Bass, 2004.

(3) Goleman, Daniel. Emotional Intelligence. New York: Bantam. 1997

(4) See page 13 at http://www.surgicalspotlight.ca/Shared/ PDF/Summer07.pdf

(5) Wageman, R, Nunes, D, Burruss, J and Hackman JR. Senior Leadership Teams. What it takes to make them great. Harvard Business School Press.2008. 241 pp.

(6) Collins, Jim. Good to Great: Why Some Companies Make the Leap ... and Others Don't. New York: HarperCollins, 2001.

(7) http://www.surgicalspotlight.ca/Article. aspx?ver=Winter_2009&f=Main

(8) Hayes AB, et al. A Surgical Safety Checklist to Reduce Morbidity and Mortality in a Global Population. New England Journal of Medicine Jan. 29, 2009;360(5):491-499.

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