What’s Your Why?

By Robert L. Moore, MD, MPH, MBA, Chief Medical Officer

“Leadership requires two things: a vision of the world that does not yet exist and the ability to communicate it.”

– Author Simon Sinek

After being in leadership roles for 25 years, I have conflicted feelings about Simon Sinek’s central message in his famous 2009 TED Talk and book Start with Why: How Great Leaders Inspire Everyone to Take Action.
Sinek argues that communicating the underlying Why behind a company, a product, a service, or a proposal is key to engaged, charismatic leadership.

Not What your staff do.  Not How a service works.

But Why does our team come to work every day? Why is the basis of our inner motivation to work where we do, and to do the work we do.  It is a powerful idea and one missing from communications of uninspiring leaders.  It is undeniable that all of us as leaders need to effectively communicate the Why when are interacting with our staff, and when presenting new ideas to our executive leaders or governing board.

However, since this idea was popularized, I have seen troubling side to this:  leaders who passionately articulate the Why to justify an operational plan or regulatory framework (i.e. the How and What) which are not based on past experience or wisdom, not logically thought out, and really doomed to failure.  These leaders feel that their passion for a worthy Why renders mundane or unneeded activities such as starting with the wisdom of principles, weighing options, and seeking skeptical feedback.

For example, we all agree that eliminating health inequities is a very important goal and may be the Why that some of us are working in health care.  However, if my passion for this Why is so strong that I begin to believe that whatever ideas to reduce inequities that pop into my head are worthy of everyone’s support, without wisdom, analysis, or discussion, I’m likely to create programs or policies that will have significant unintended negative consequences.

Having passion and understanding and articulating the Why are important leadership abilities, but no less important than:

  1. Having the wisdom to search out knowledge on what has worked and what has failed in the past to address this problem.  Learn from the past to prevent making the same mistakes.
  2. Testing ideas on a smaller scale before spreading a new program widely.
  3. Use the scientific method and an understanding of statistics (and not wishful thinking) to judge the success or failure of these pilots.
  4. When the situation calls for widespread adoption of something new, use sound management principles, project management, and implementation science methodology.

Explaining the Why is motivating.  Having a well thought-out and logical What and How will still end up being a key to enduring success and excellence.

Acknowledge the importance of the underlying Why, but leverage your wisdom and experience to move to a sounder What and How.

Leadership Lessons from Covenant of Water

Robert Moore, MD, MPH, MBA, Chief Medical Officer

“We can’t let our empathy get so overwhelming that we stop making good decisions.”

– Abraham Verghese, MD

Abraham Verghese is a professor of Internal Medicine at Stanford University, and author of four books. His most recent novel—Covenant of Water—was released in May of this year. It is a 70-plus year multi-generational story that follows a medical mystery, a family with an inherited trait that predisposes them to death from drowning in a part of India where water is everywhere, and most everyone is an excellent swimmer. It is a beautifully crafted tale; his descriptions of diseases, diagnosis, treatment, and medical education are understandable to a non-medical audience but are strikingly realistic given Dr. Verghese’s unique combination of being an excellent physician and an excellent writer. It is long (775 pages), but well worth the time. The audio version takes longer to get through, but the author narratives it nicely.

While there is much to take away from this story, I was stuck by three leadership lessons which I can share without spoilers.

The first is a theme in many writings and dramas about physicians and nurses: the tension between empathy and distance from our patients, and how both are needed to best care for those we serve. Our patients need to sense that we care about them as individuals, that we respect who they are and where they came from. At the same time, they expect us to be able to ensure that our empathy does not inhibit considering unpleasant alternative diagnoses, using reason and effort to determine the diagnostic possibilities, balancing the wisdom of our experience with the humility of uncertainty. Since this tension is always present in our profession, reading a book or seeing a drama about how this plays out indifferent settings is good for us, from time to time, to maintain our humanity and our commitment to excellence.

The second and third lessons come from a memorable side character who seems to live forever, given his role throughout the book: the local marriage matchmaker. Toward the end, a few months before his planned retirement, he shares a few of his ten rules of thumb for success.

One of these lessons is that every family has small problems, and since they are small problems, they are really not problems at all for achieving his goal (a successful match). This is a generalizable leadership lesson: there are always small problems. If we are looking for a time when there are no problems or a staff member who is perfect, we will paralyze ourselves. Changing our mindset to think of small problems as really no problem allows us to move forward with less worry.

The other lesson was, “Set a date!” Setting a date creates a sense of purpose, of urgency, and increases substantially the probability that all will come together by the date set. Another way to think of this: don’t wait for everyone to agree on a date or what would need to happen before a date is set. Plan the party and send out the invitations!

There are some potential traps to setting dates that are unrealistically soon or unchangeable, depending on the degree of bureaucracy of those you are counting on to achieve that date (remember the Healthcare.gov rollout!). However, even in the setting of a bureaucratic impossibility of meeting an initial deadline, setting a date gets the process moving along, so that the first postponement is more likely to be an achievable deadline.

All three leadership lessons involve an element of intentional self-deception, suppressing our empathy in the first lesson, choosing to ignore small problems in the second, and selecting a deadline with doubts that all barriers can be overcome in the third. Self-deception is not unique to leaders; it is part of being human. A group of leadership philosophers called the Arbinger Institute published a book in 2000, Leadership and Self-Deception, which dissects this idea with an extended parable.

Two summer recommendations for long drives or plane flights in the months to come–enjoy!