The Leadership Equation

March 9, 2019 | by Jeffrey D. Shapiro, MD
The Leadership Equation

Having traveled extensively promoting the incorporation of high reliability principles in the anesthesia care team workplace, I can confirm what many in the patient safety movement have learned: Organizational change is hard. Beyond credibility straining sloganeering and cute acronyms, how we create change and make change “stick” is just as important as what or how to improve patient safety. Embracing a reliability culture that creates patient safety requires change, and leadership creates change.

The importance of strong leadership cannot be overemphasized. Some leaders are born ready to lead. Affable and charismatic, they inspire us to achieve while imparting a sense of connection and empowerment. However, most leaders are nurtured, mentored and developed. Developing future leaders is probably one of the more important responsibilities of those in leadership positions, but how do we assist this mentoring? My equation for leadership is simplistic, but a great starting point for defining and developing strong, motivated leaders. The requirements of leaders:


The “3 Cs” of leadership

leadership-infographicClarity of vision. If you want to lead change, do you understand what needs to change and why? Creating the vision is often a byproduct of the collaborative efforts of many, not just the individual.

Courage of conviction. Do you believe in the change needed regardless of its popularity? Focus polls and shifting decisions do not inspire confidence in others to adopt change. Sometimes leadership is lonely. Leaders face challenges through constructive conflict, and many times through unconstructive conflict.

Communication. The ability and willingness to communicate the “why” change is required is an essential prerequisite of successful change implementation. Avoiding communication vacuums to minimize uncertainty and promote transparency is key.

The “2 Ps” of leadership

Passion. Transparency, authenticity is recognized by our colleagues. Your willingness to “walk the walk,” not just “talk the talk,” is often what distinguishes us from management, and make no mistake, leadership and management are different. The ability to inspire others comes from our passion to lead.

Pragmatism. The central dogma of leadership is that there should be no dogma. Successful organizational change often comes piecemeal and slowly. Organizational sensitivity, like operational sensitivity, requires a grasp of the bigger picture and all the steps necessary to achieve the required change. How we get there many times requires give and take, small victories and minor setbacks, but always with an open mind to making change successful.

“EI” of leadership

Emotional Intelligence: One definition of emotional intelligence is the ability to recognize and understand emotions in yourself and others — and leverage this awareness to manage your behavior and relationships. How we perceive the motivations and actions of others can often be the difference between successful engagement and positive organizational change or failure. Developing the skills to listen, understand opposing viewpoints and the art of compromise will many times help mature relationships necessary to create change. 

One of our biggest challenges as leaders is successful change implementation. The technical aspects of change are often prioritized over organizational aspects, which many times result in hampering an initiative’s odds of success. Implementing a patient safety initiative is no different...unfortunately. 

Thomas Kuhn, noted physicist, author and philosopher, said, “People are unwilling to relinquish a paradigm despite all its faults—if there is no plausible, viable alternative to take its place.” Simon Sinek has shared with us the value of investing in “Why.” When the individual can make the emotional connection to change, not just the factual or technical association, understanding and compliance is improved.

We as clinicians need to embrace change required to keep our patients safe. However, it is strong effective leadership that needs to create and implement the change necessary for improving patient safety. 


Jeffrey D. Shapiro, MD, is Director of the MEDNAX Anesthesia HRO Patient Safety and a practicing anesthesiologist with American Anesthesiology of Georgia.