In the final year of my previous degree, my graduating report for the subject of Information Systems and Organisational Development was titled "Gods and Monsters". Inspired by the body of work (1984-1991) of INSEAD's Clinical Professor Manfred Kets de Vries' in leadership development and organisational design, the essay looked at how the personality and the idiosyncrasies of those at the top (the organisations' leaders) shape the behaviour, culture, processes, and ultimately the outcomes, of the organisation and its people.

Today, much of the importance placed on leaders can be seen through the extensive requirements of their 'training'. Perusing the website on courses in Leadership at the Australian Graduate School of Management, it is noteworthy that almost all of their qualifications cover both the principles and practices of Leadership, often in combination with team management and decision-making skills.

Whilst the effectiveness of leadership continues to be very much measured by outcome, there appears to be a new wave of thinking regarding its qualities, commonly attributed to the changes occurring in the business environment. When the Australian Financial Review's BOSS Magazine amassed a panel of business, political, charitable and educational heads to determine a list of 'True Leaders' in August this year, they looked at both the leaders' abilities to address adversity as well as the corporation's outcomes. "Accordingly, the qualities of courage, strength, integrity and humility were the planks of successful leadership…" (AFR, 2008). The Harvard Business Review magazine conducted a similar exercise in the same half of the year, just as the waves of a crashing market began to thunder. The article pointed to a change in the business environment and a time for "high-commitment, high-performance" leadership, citing four strategies. These were: firstly, earning the trust of their organisations through the "unvarnished truth"; become deeply engaged with their people; mobilising their staff around a focused agenda and finally, reinforcing their organisations' "collective leadership capabilities" (HBR, 2008). Finally, management tomes such as "What the Best MBAs Know" (2005), point to seven competencies of Effective Leaders, including: emotional intelligence, integrity, drive, leadership motivation, self-confidence, intelligence, and knowledge of the business.

Of the qualities cited by these publications, the single common thread is integrity, defined as "The leader's truthfulness and tendency to translate words into deeds" (Kirkpatrick and Locke, 1991). It stands out for two reasons. Firstly, it is feasible that an organisation can produce outcomes that are the function of pejorative politics and misused processes. Accepting the premise of "Gods and Monsters", the cynic would draw a biological analogy with a hierarchical form of Darwinism: an organisation is composed of layers of survivors, selected by their environmental adaptability. Secondly, leadership tends to require both leaders and followers. An unattributed quote, however, existing in many forms, states that to be a leader you have to have people standing behind you. Yet, this can be, at best, a point-in-time snapshot, and, at worse, liable to the production of 'leaders' pandering to popularist opinion, rather than defending that which they hold certain. It becomes apparent that in these times of 'collaborative teams' and knowledge workers that the core skills of a leader are in the realms of influence and inspiration. General Montgomery summarises, thus: "My own definition of leadership is this: The capacity and the will to rally men and women to a common purpose and the character which inspires confidence."

Integrity is therefore utterly crucial in the direction and intent of the leadership; the "capacity and the will" of a leader's influence is a powerful tool when directed externally. Guided by the personal values of the leader as well as the environment in which he operates, this power yields from an internal source: the leader's integrity.

These issues are particularly relevant to healthcare. It has been a sort of 'taboo' for Health services to co-exist with Business – as practitioners of Medicine, we are mobilised by a united sense of purpose regarding the welfare of our patients. For a long time, those in healthcare have shied away from the operation of their organisation along business principles or practices that they would normally attribute to 'for-profit businesses'. The market or economic environment in which health care (and, therefore, health practitioners) operate continues to have pervasive operational and resource restrictions (limits on supply) and a growing and ageing population with a growth in chronic, health-intense conditions including diabetes, obesity and mental health conditions (an increase in demand). We now stand in an era that has seen health economic and business practices pervade our health practices - from the evaluation of a medication's marketability and efficacy to the selection and provision of a health service's surgical skill set. Understandably, there thus exists a natural tension between the philanthropic origins of Medicine and the pressures of Administration - most apparent in that ghastly bear-pit of 'resource allocation'. Hence, whether this altruism now must manifest as ‘improved patient outcomes’, ‘reduced bed days’, or ‘resulting patient functionality’, the practitioner is forced to stand at the divide between Health and Business. Business, it appears, has taught us much about dealing with the practical function of Healthcare. And yet, Healthcare remains in one of the best places to lead in the new dawn of Business leadership values and skills.

There is a delicious symmetry in the present and the past, personally: that at the end of both degrees (my current being in a Graduate Medical Program), it seems to be a rite of passage to write an essay on any of the vast topics concerning leadership skills. Yet, despite almost a decade separating the essays, the issues regarding the essence of good leadership and great outcomes continue to beguile. My experiences since graduating from my first degree were in business, but have now been coloured by age, contact with a more diverse range of personalities, witnessing people in any part of the range of human emotion and experience, and, finally, education in the principles and practice of Medicine.

Combining these thoughts, it appears that the leaders in Medicine are at the forefront of the new wave of thinking about Leadership - particularly, how central Integrity is to its practice. We, as doctors, are trained as advocates of patients' health and welfare, have been tempered by the resource crises and forged by the clinical and scientific rigour demanded in our roles. We are taught to make decisions, run teams, manage time, make decisions and deliver presentations on our feet. We hold at our core belief that we must do no harm and value our patient's autonomy at its premium. Integrity is at the core of our 'leadership skills', which we practice every day and it is that practice that we can restore to our fellow colleagues in business.


References

Australian Financial Review (AFR), BOSS Magazine, True Leaders 2008 - The List, Vol 9. 2008.
Einstat R, Beer M, Footed N, Fredberg T and Norrgren F. The Uncompromising Leader, Harvard Business Review (HBR), July-August 2008
Kets de Vries K. and Miller D. (1984) The Neurotic Organisation
Kets de Vries K. (1991) Organisations on the Couch
Ed. By Navarro P., What the Best MBAs know, Part 4, Ch 10, Organizational Behaviour.
The seven competencies and definition of 'integrity' is attributed by the authors to Kirkpatrick SA and Locke EA "Leadership: Do traits matter?" Academy of Management Executive 5 (May 1991) pp 48-60.

Whatever the Skill, Lead with Integrity was authored by Grace Lai in October 2008 as part of her AFMW Leadership Scholarship.

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