Clinical servants: a novel view of leadership

REAR Admiral Grace Hopper of the United States Navy once said: “You cannot manage men into battle. You manage things; you lead people”.

This is a leadership principle that is applicable to health as well as to the military.

Clinical leaders know from experience that managing health professionals is like “herding cats”, and there is more value in leading cats rather than herding them. So how does a health manager lead clinicians?

Peter Drucker, the Austrian-born, American founder of modern management, consultant, educator and author, defined the leader as “someone who has followers”. This makes sense, as a leader without a follower is just a person having a walk by himself in the park.

However, this is a tautological argument, as the question then becomes, how does a health manager gain clinician followers?

I believe the answer is through servanthood.

Robert Greenleaf, a contemporary of Drucker, said that “good leaders must first become good servants”. Greenleaf founded the modern servant leadership movement, but this concept is not new.

The classical example of a servant leader has to be that of Jesus. Putting aside personal theological and religious beliefs, there are some profound lessons to be learned from his actions in the Book of John, 13:1-17 of the Bible. In that passage, Jesus, despite being the leader of the disciples, washed the disciples’ feet and was a servant to them. He did this as an example, so that they can learn to serve others. But because Jesus served the disciples, they willingly followed him.

This is an example of servant leadership. In fact, in the Book of Matthew, 20:26-28, Jesus says overtly: “Whoever wants to become great among you must be your servant”. So the concept of servant leadership goes back at least 2000 years.

But the point of this article is not to preach from the Bible. As a researcher and educator interested in clinical leadership, I believe servant leadership is as relevant today as it was in biblical times, especially in the context of health.

If you Google servant leadership, you will find a myriad of books on the topic. The concept of servant leadership resonates with people. People are no longer satisfied with charismatic, powerful leaders who are out to only serve themselves or their bosses.

They are seeking authenticity. They want to follow a leader who leads through service, rather than the leader who expects to be served.

So what exactly is servant leadership?

Greenleaf himself defined servant leadership as “the servant-leader is servant first… It begins with the natural feeling that one wants to serve, to serve first. The conscious choice brings one to aspire to lead … The difference manifests itself in the care taken by the servant-first to make sure that other people’s highest priority needs are being served”.

This definition perfectly describes clinicians who transition into leadership roles. The clinician starts off as the practitioner who serves patients through caring, which leads to a conscious choice to lead so that a greater population of patients can be served. The literature in this area supports this finding – clinicians move into leadership roles in order to serve a larger population.

James Hunter, in his book The servant, describes it in a similar way – the servant leader starts with the will to serve the community. This service leads to authority given by the community, which then leads to leadership of, and in, the community.

In this way, servant leadership turns the traditional power balance and authority gradient model completely around. In the servant leadership framework, the leader is at the bottom of the organisational chart, supporting everyone else above him or her.

The leader is no longer reliant on power to command and control, treating employees as tools, but is the servant leader who inspires and equips employees as resources, and views customers, or patients, as allies.

This concept of servant leadership is aligned with other modern leadership frameworks, such as Bernard Bass’ Transformational leadership model from the book of the same name, where the leader seeks to influence, inspire and provide individualised consideration of followers.

It is also consistent with Jim Collins’ level 5 leadership idea from his book, Good to great, where the level 5 executive “builds enduring greatness through a paradoxical combination of personal humility plus professional will”.

In addition, servant leaders are built on a network of relationships with friends, supporters and associates, as opposed to traditional feudal leaders, who tend to create a charmed circle of closed confidants with exclusive members, and followers outside. As such, servant leadership is in line with current leadership models that are based on loose hierarchies but strong networks. The servant leader, in order to lead, is therefore required to listen to a network of contributors, and builds consensus through transparency, diversity and openness.

Also, servant leadership fits with current models around followership.

In the traditional, unilateral leadership model, the leader has multiple followers, which suit the predictable, linear operating context, where the leader is the expert, and the followers are novices, leading to a hierarchical structure, where followers adopt a predetermined, passive role.

However, in a VUCA (volatility, uncertainty, complexity, ambiguity) environment such as the health system a dynamic, two-way leadership model is required, where you have both expert leaders and expert followers in a strong network, where the roles of the leader and follower interchange, regulated by talent and context.

This happens daily in the health environment, where the health leader defers to clinical expertise as required, and the clinician consults the professional manager in turn.

In conclusion, I am proposing a revival of the concept of servant leadership in the clinical context – clinical servant leadership. Clinicians, and for that matter, people in general, will follow the leader who has their best interest at heart, and who genuinely wishes to serve them. As Albert Einstein once said: “The high destiny of the individual is to serve rather than to rule”.

As clinical leaders, let us aspire to serve, so that we can lead.

Professor Erwin Loh is Chief Medical Officer of Monash Health in Melbourne.