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Harvard Business Review – Servant Leadership

July 21, 2018


Written by Clay Smith

You Are a Leader

I recently read a helpful article in Harvard Business Review via Doximity.  It was a feature on servant leadership.  I’ll briefly recap the highlights and make application to the ED.

All of us are in some kind of leadership position.  A 4th year med student can lead the 1st year student.  An intern can help the medical student.  A senior resident can teach the intern.  An attending physician can be a role model for students and residents (or at least tell good stories and buy them coffee).  A community ED doc leads the team of nurses, RTs, medics, and care partners.  Some of us are in formal leadership positions.  The point is, this article speaks to all of us.  The opening quote from the article hit me hardest.

“When you’re a leader — no matter how long you’ve been in your role or how hard the journey was to get there — you are merely overhead unless you’re bringing out the best in your employees.”

If a leader is paid to lead and doesn’t improve not only the productivity and quality of care delivered but also the wellbeing of the people they lead, that is money wasted.

On the other hand, if a leader inspires those whom they lead to honesty, integrity, strong work ethic, excellence, quality, and great service to patients, they’re worth every dollar you pay them.

What is Servant Leadership?

It is a leadership style characterized by humility.

  • This type of leader recognizes they have much to learn from those whom they lead.
  • This type of leader uses what they learn from others to make everyone in their charge better at what they do.
  • This type of leader sacrifices and gives of himself or herself to make others succeed.
  • This type of leader models the behavior they want to see in others.

Dan Cable, author of this article, wrote:

“…servant-leaders have the humility, courage, and insight to admit that they can benefit from the expertise of others who have less power than them. They actively seek the ideas and unique contributions of the employees that they serve. This is how servant leaders create a culture of learning, and an atmosphere that encourages followers to become the very best they can.”

Putting It Into Practice

The author listed three ways to implement this kind of leadership:

  1. Ask how you can help employees do their own jobs better — then listen
  2. Create low-risk spaces for employees to think of new ideas
  3. Be humble.

I want to use these as a springboard for some ideas on how this might look in the ED.

Listen – Are you a medical director or chair?  Ask those who work the most shifts what problems they’re experiencing.  What makes them most frustrated or discouraged on shift?  Are you a residency program director?  Ask the residents where they are having the most trouble on shift.  Are you working in the community?  Ask the nurses, medics, and those with whom you work how they think the experience could be made better for patients.  Ask how you could improve efficiency.  Ask how you could make their jobs more efficient.  Ask the team how you could do better during a resuscitation.  Most importantly, we can ask our patients about their experience.  What can we do to make their stressful time in the ED a little easier?

Make space for failure – This is tough in medicine but not impossible.  Let the medical student tell you in detail how they would manage the patient.  Then put in the orders with them and make course corrections as needed.  Allow residents space to learn.  Are they checking a few more labs than you would?  That’s not a problem.  Are they ordering an unnecessary CT on a 2-year old?  Well, then you have to intervene.  But that can be done in a helpful and non-judgmental way. Also, sim lab and cadaver lab offers an excellent space to fail, and no one gets hurt.  Most importantly for encouraging innovation, allow those you lead to try out new ideas to improve flow, streamline imaging, etc.  And give them the resources to do it. 

Cultivate humility with a purpose – This concept breaks down if we feel superior to the people we lead.  We’re not superior.  Some may have more skill, more training, more experience, more knowledge, etc.  Some of our colleagues are smarter or more naturally gifted.  But everyone has equal value.  In the end, we are all just people.  And as we lead other people, we have an even greater responsibility to care for those we lead.  Thankfully, the ED has a nice way of taking us down a notch.  I still get butterflies right before a shift.  We truly don’t know what might come through the door.  I had a humbling experience Thursday night.  I was on the phone with an “outside ER doc” wanting to transfer a patient.  He had a few questions about the management that I was able to answer to direct the care during transport (because, you know, I’m the big-shot doc at the tertiary care center…).  He asked how fast I wanted to run the fluid in this sick DKA patient.  I said, “Let’s run it at 1.5 times maintenance in this 30kg kid.”  I was struggling to mentally calculate this while stammering on the phone, and he immediately replied with, “Great, I’ll run it at 105cc/hr,” faster than IBM’s Watson.  I may know a little more about pediatric DKA, but this guy’s brain was like a scientific calculator.  Everyone you lead has incredible gifts.  Part of being a servant leader is to ask questions, listen carefully, discover these hidden talents, and put them to good use.  Cultivating humility allows us learn from others, and this serves a purpose; it makes the care better for patients.

It’s the Patient…

Part of the strategy to keep the 1992 Clinton campaign on message was: “It’s the economy, stupid!”  Ultimately, leadership is not about us.  It’s about our patients.  The better we lead, the better care our patients receive.  And the more we can implement servant-style leadership, the more effective we will be.  What an incredible job we have.  If a banker leads well, the bank makes money.  If a business owner leads well, the company is profitable.  If healthcare leaders lead well, people’s health improves and lives are literally saved.  Don’t lose sight of the power and awesome responsibility we have as healthcare leaders.


And we are all healthcare leaders.

What are your thoughts?