ContentsIntroduction 2 2 8IntroductionLeadership is the skill to enable and enthuse a team to achieve an ethically defined goal by creating an empowered culture. Leadership fulfills the purpose of guiding teams towards a greater common good in a manner that transforms both, the leader as well as the followers, leaving behind enriching effects that can last longer than the teams themselves. This means that by providing a shared vision, I catalyze the process of formation of closely-knit teams which bond on the basis of mutual trust, integrity, honesty and humor. Such teams often deliver results which are over and beyond the expected because they are energized their shared passion and belief. Creating such teams necessitates that I as a leader shed my ego and set the tone by fostering open lines of communication with my team and facilitate permeation of the same process throughout the team. Another essential prerequisite for leadership is authenticity. I set the tone by being competent, erudite, upright and trying to practice active listening. Empathizing with my team keeps me aware of their innovative ideas, enhances my capacity to respond to their needs based on the demands of the situation and gives me their buy-in as and when our organization mandates change. To do so effectively, I make use of the Ringelmann effect and consequent research at Wharton1. Teams would consist of about 5 members and when larger ones are needed, an informal representative would be selected, ideally on a rotating basis. Possible candidates for the coordinator would be, in ascending order of preference, achievers, individualists or best, strategists. I would ensure that we maintain fluid and flexible teams that are nimble and agile enough to react with the speed required in today’s complex and constantly changing health scenario. I believe multiple styles of leadership need to be implemented seamlessly, based on the demands of the situation and within the resource constraints. Theories & Journal EntriesI find that the more evolved theories which consider leader-follower mutual interactions are a better fit for the health sector, and while all the leadership theories examine the context through varied perspectives, they have many common underlying principles. The first of these is the strength of the connect that I, as a leader, have with my followers. A transient connect was all that it took for Kennedy, a transformational leader, to inspire a janitor to exceptional commitment, pride and job satisfaction at the space station. This connect normally needs to be deep and takes time to build. It establishes the tone of the relationship and determines whether it will remain functional and task related (transactional) or go right through the spectrum to evolving into a long-term rapport (transformational). Other common tenets across the theories are trust, empathy, understanding, flexibility and dignity, which are essential to maintain work environments that incorporate integrity and openness. When health care providers find a conducive work environment, they subconsciously transmit it in their interactions with patients and families, leading to greater satisfaction levels and better outcomes. As healthcare services are accessed mostly during tough times, establishing such an atmosphere of warmth and caring is especially important. Another common thread across leadership is the adherence to ethics, which is of high priority today in the healthcare sector, not just because of its traditional role of maintaining human life and dignity, but because our rapidly changing world is increasingly becoming fraught with challenges like gene manipulation, multiple gender orientations and physician assisted euthanasia, and the transparent social media rapidly enacts its role as a vocal and powerful watchdog. I have to lead by example, hire with caution, and ensure subsequent appropriate training so that set standards and protocols are adhered to. I have mellowed down and am more open now in many respects while establishing this important connect but being ethical continues to be the non-negotiable central tenet of my leadership philosophy.This mandates that as a leader, I understand the personality, motivations and aspirations of my followers so that I can create a good fit between the tasks and my team members. I need to anticipate the extent and manner in which they would need a helping hand, because as per the Path Goal Theory, the extent to which I am able to create an enabling environment by removing obstacles proportionately affects the extent and pace of achievement of the allocated tasks.This process is affected by the social and cultural context. As more women join the workforce, and this is especially important in my sector, where up to 70 percent of the employees can be female, that I recognize and acknowledge the unique challenges women face. I implement innovative ideas to ensure that they can feel safe, cared for and fulfilled. This is a win-win situation because not only is my team more productive as a result, I also see lower employee turnover – and both contribute to increased performance on all fronts. I have a soft corner for women, having faced traditionally ingrained cultural constraints against gender and I do all I can to make life easier for them. Experience has also made be on guard because come what may, professional performance must be the sole criteria for assessment at the workplace. I find it disgusting to see women at all levels of the hierarchy take unfair advantage by playing the gender card – whether it is to take up a lesser workload or go unfairly up the ladder.
What I do handle with greater ease is diversity in race, ethnicity and cultures as I have travelled extensively and comfortably lived across five continents. The increasing diversity of populations, rapid incorporation of technology for training and communication and the greater availability of choices for patients means that health care consultations are increasing in types, frequency and scale. Teleconsultations and medical tourism are the way of the future and I would lead my team to mirror the increasing pluralism in society. With the increased quantum and frequency of travel, global health, my favored realm of action, needs strong, dynamic, competent leaders, trained to navigate political and cross-institutional contexts, more so amid crises. Diplomacy, strategy development and professional collaborative behaviors are my focus areas in global health. I have naturally evolved to this niche area of specialization, having handled multicultural teams for extended periods of time during my tenure at the federal level in India, where the bureaucracy is so Theory X based that the very few Theory Y bureaucrats there are, are welcomed like a breath of fresh air. Where ever in the world we are, the context is the deciding factor for achieving success. The more skilled and educated the employee and the more cerebral and creative the task at hand, theory Y managers would be able to handle that very well but if I had to deliver results within tight time frames, theory X would have to blend in to a large extent. Theory X can backfire badly during times of crisis. My experience has shown that being open, honest and truthful and appealing to the innate humane side of human beings is more successful than application of type X personality characteristics, even more so in a culture where the leader is expected to act as a type X personality. Junior, less educated, male subordinates generally give in more easily and to a greater extent that what they do when bossed around. This is also corroborated by University of Michigan Leadership studies where employee-oriented supervisors were found to be more productive. This is a situation where both benefit – when supervisors (the leaders in today’s context) would care for the employees who, in return, would have greater productivity and hence the organization would benefit. I believe that Argyris’ Theories -in-Use and Theories-in-action are interesting because it is the theory X type of leaders who more likely have a discrepancy between their theories stated Theory-in-use and their actual theory which they would implement. But in times of crisis as in Emergency Rooms, times in the Labor Room when a would-be mom faces complications (Post-Partum Hemorrhage can be fatal in minutes), asphyxiated patients, major surgeries, as in cardiac surgeries -– these are times when the boss centered leadership of the Tannenbaum Schmidt model is perfect for application. In public health, management of disasters and public health crisis such as the Ebola crisis, leaders such as Dr Skinner McGregor, have to act in that mode during acute times if they have to achieve the intended effect. But to be able to act effectively in times of need, they need to exercise a subordinate type leadership during times of training, ie less crisis mode times so that they can establish mutual credibility, faith and trust with their followers. Constantly being in the boss centered or Theory X mode results in failure as neither would the leader be able to or even try to gauge his followers’ capabilities, nor would there be any opportunity for mutual interaction.