Lessons on Leadership

What Draws You to Positions of Leadership?

N.R.D.: When you join an organization, you should try to help that organization accomplish its mission and maybe do it even better. Participating in organizations and working with that goal in mind are good things. A position of leadership allows you to leverage those efforts to help move the organization faster, more efficiently, better, and so on. It also gives you the opportunity to empower those you represent. For example, being a leader of a society makes it a little more likely that those in your charge will be appointed to committees, have leadership positions in those committees, and be able to exercise their own ideas and further improve that organization.

Did You Always Plan to Be a Leader?

N.R.D.: No, I must admit I never really thought about it. When people came to me and asked if I would like to do something, I almost always said yes. I think they may have looked at me as somebody who is likely to accept a responsibility and to discharge it as best I could. One thing led to another, and now here I am.

If You Believe Saying Yes Got You Here, Should Burgeoning Leaders Always Say Yes?

N.R.D.: What we have to ask ourselves is where are we trying to go. If we can make that decision—and it’s often a difficult one—then the decisions we’re asked to make become much easier. Now we have a road map telling us where we’re trying to go. When considering whether to say no, be careful not to burn bridges. Unfortunately, if you decline an offer, the person making that offer may think you’re not interested. They don’t usually think, “Well, they’re probably really busy right now, so perhaps I’ll ask later.” They will assume you are disinterested, and that opportunity may be permanently lost. I would tend to err on the side of saying yes too often and stop only when you are running out of time to do the jobs to the best of your ability.

Why Is Timeliness So Important to You?

N.R.D.: If you call a meeting, you want people to come on time. If you don’t start on time, you’re telling them that their time isn’t important. I think everyone’s time is important. It’s important for us to respect one another, to arrive on time, and to not expect that the meeting will wait until you come. I think it’s a matter of respect, and I notice that when I have that expectation, people are pretty good about following through, and timeliness becomes a mutual expectation.

What Leadership Lessons Did You Learn from Michigan Head Football Coach Bo Schembechler?

N.R.D.: Coach Schembechler had many popular sayings, but I think my favorite is “The team, the team, the team.” Life is a team sport. Everything we do is within a team. The radiologist may have interpreted the image, but it was the technologist who performed the study, the imaging company that built the equipment, the nurse who injected the contrast material, the clerk who scheduled the patient, the referring physician who sent the order, and the patient who decided to come to our hospital. We’ve got to get the entire system working well together. It’s not about one person. It’s about the team.

Why Do You Commonly Ask Your Faculty What They Want to Be Doing in 5 or 10 Years?

N.R.D.: I’d like to know what makes people tick, what makes people happy, what gives them joy, and why they come to work in the morning. These things are important because people do a better job if they are doing what they enjoy and pursuing their goals. If I can understand their ambition and help them achieve it in a way that also helps the department, we’ll have a win-win situation. Leaders should try to align the interests of their employees with the interests of the institution. Doing so will grant cultural and positional advantages that enable the attainment of mutual goals. That being said, many people don’t necessarily know what they want to be doing in the future. I didn’t—at least not in a specific sense; but asking the question gets people thinking, and thinking about the future is very important. Understanding where you’re going creates synergy in decision making and reduces the chance that you’ll end up somewhere you don’t want to be.

Do You Need a Title to Lead?

N.R.D.: I think titles are often misconstrued. You don’t get power from a title. You get power from what you do. If others see you behaving appropriately, doing good work, and leading by example, you will find that the influence you hold may equal that of a leader with a title. In fact, I think actions may be more powerful than titles. Leadership is what we do. It is getting things done through people. You can leverage your title and demand that someone should do something, but if they don’t believe in it or don’t believe it needs to be done, then they will do it halfheartedly, and it will more likely fail. You really have to get people to understand what it is you want done and why, and how its implementation will help the organization and the people in it. Once they buy in to the reasons why and agree that it is necessary, they will do a much better job than if you had forced the action upon them with an authority-based directive.

How Do You Negotiate Conflicts with Multiple Points of View?

N.R.D.: This is one of the most difficult challenges. Here I find it helpful to remind myself of our priorities and to consider them in order of importance. Would this decision benefit our patients? The university? The medical school? The faculty? And so on. At the very bottom of that list is me. If I ever find myself moving up the list of priorities (in other words, anywhere but the bottom), then it’s time to step down. Good leaders prioritize the mission and the people they represent above themselves. Thinking about the effects of a decision and prioritizing who and what are important are critical. In medicine, the patient is most important. Keeping this in mind will help you resolve difficult challenges because you will always know where your foremost priority resides.

What Do You Do if You Believe a Decision Is Morally Correct but Most Disagree with It?

N.R.D.: That’s a tough question to answer because the premise of the question is that something could be both morally correct and also globally opposed. I have great respect for group wisdom—with the caveat that the group must be up to speed on the issue. If we can get the team to engage in a discussion so they really understand what the decision is all about and if we can come to a consensus, I’m happy to go along with their opinion. It would be arrogant to assume that I was correct and the rest of the group was wrong. When the majority is opposed to something I am considering, it usually implies that the group has a point of view I haven’t considered or that they are missing information I may need to share with them.

What Do You Do When the People You Lead Flatly Disagree with You?

N.R.D.: It’s always better to have friends than enemies. In fact, it’s sometimes said that friends come and go, but enemies accumulate; so try to avoid making enemies whenever possible. However, there are times when you just have to say, “This is what we’re going to do.” You should try to explain it so people understand the basis for your decision. Emphasize the why. After hearing your rationale, hopefully they will agree with you. If they don’t, try to communicate the decision from multiple points of view, and emphasize its wholistic advantages, even if certain individuals will be personally disadvantaged by it. Sometimes that doesn’t work either. When I’ve run out of options, if I still believe the decision is the right one and I’m confident I’ve not overlooked some critical detail, I’m not afraid to say, “I’m disappointed that you disagree, but if you decide to leave the department, rest assured I’ll write you a very nice letter of recommendation.”

How Does a Leader Cultivate Loyalty beyond Compensation?

N.R.D.: I would answer that in two ways. There is a culture at Michigan that is very positive. Consider my niece from southern California, who completed her undergraduate degree at Michigan and still maintains football season tickets despite living in another state. When I ask her to explain her team spirit and that of the campus and alumni, her response is, “It’s not fake, it’s real. They’re proud of Michigan, and they’re proud to be a part of it.” The spirit of the university extends far beyond the city boundaries. I have met Michigan alumni in the Red Fort of India and at a bed-and-breakfast in Scotland. When I travel the world, everywhere I go, people say, “Go Blue!” There’s great pride in the institution. Institutional pride begets culture, and culture is the bedrock of a satisfied employee.

The second part of my answer is that job satisfaction cannot be reduced to a single thing like compensation. We spend more time working than any other waking activity. We need to enjoy it. Job satisfaction is coming to work, enjoying what we do, working with people we like, and doing it for a common good—in our case, helping people during very difficult times of their lives. Money is part of job satisfaction, but it is a relatively small part. When I talk with prospective faculty about what they enjoy in life, if they tell me they want a second home with a boat on the lake, I tell them that private practice may be a better option for them; but for people who are intellectually curious, we give them the opportunity to exercise that curiosity. Aligning the needs of the faculty with the needs of the institution is what makes a satisfied employee. Therefore, it is critical to understand what motivates the members of your team and to find a good match between their needs and what you’re offering. A forced fit is unlikely to be successful.

Does Culture Promote Job Satisfaction?

N.R.D.: Yes, I think it does. Culture is critical to department stability. When interviewing prospective job candidates, I try to explain to people who we are and what we’re about—in other words, what our culture is. If they gravitate toward that, they’re going to be happy here. Trying to be as transparent as possible during the interview process protects the culture of the department and helps ensure the happiness of those who are in it.

Do You Believe That Culture Is More Important than Strategy?

N.R.D.: Strategy is a plan we invent that indicates how we want to do something, but if that plan is not consistent with the culture of the institution, it isn’t going to work. One example that I think everyone can relate to is the speed limit. In Michigan, the strategic plan for our highways is that the speed limit is 70 mph, but if you drive 70 mph on I-94, you’re going to get rear-ended. The culture says the speed limit is more like 80 mph. Culture trumps strategy. We see the same thing in our daily lives. Our strategy is that faculty work until 5:00 pm, but our culture is that we take care of patients. If you walk into the abdominal reading room at 5:30 or 6:00 pm, you will commonly see multiple faculty finishing up the daily work and enjoying each other’s company. The emphasis on patient care and the esprit de corps of our team are emblematic of our culture.

What Advice Would You Have for Leaders Who Want to Shape Their Culture?

N.R.D.: This is a very important topic. How do we move culture in the direction we think is best for the institution? The answer is in everything we do. It’s what we put on the walls. We hang plaques to remind us that we give awards for the best research done by residents and fellows. We post names to remind us that we welcome visiting professors who give us new ideas and enable us to learn from other institutions. We hang pictures of our trainees because we’re proud of them and we want to do the best job we can in preparing them for their next jobs. We begin our faculty meetings with kudos. We congratulate faculty for doing the things we prioritize. We continuously advance our culture. We stay on point. We focus—and, very importantly, we walk the talk. Leaders must do what they want others to do. When others see leaders doing the right thing, they will want to do the right thing as well. Leaders cannot inspire a positive culture without being a living embodiment of the culture they wish to advance.

Are Culture Mismatches the Major Reasons That Leaders Fail?

N.R.D.: Yes. The first thing that I tell new chairs is to learn the culture of the institution. Try to make no decisions until you’ve done that. It’s hard to do. There are some decisions that you just have to make, but leaders really need to understand the institution in which they’re working. Come in and learn as much as you can about the institution. Talk to its people. Understand why they’re there, what their goals are, and what they’re trying to accomplish. An important part of the job of leaders is to mentor and help those around them so every one of them can be enabled to achieve their goals. The trick, of course, is to make sure the goals of the individuals are aligned with the goals of the organization. Leaders who do not understand the culture of the place in which they work cannot hope to achieve alignment and will be at much greater risk of failing.

What Advice Would You Give Others Who Are Recruiting a New Leader?

N.R.D.: There are two things I would suggest. First, I would ensure that the leader is a good listener. The people who do the work will know much more about what they are doing than the leader will. The leader will need to be constantly gathering information and learning what people do. Leaders should avoid thinking they know more than others or know all the answers. Leaders should work with their subordinates to enable an informed response to potential problems. Second, the organization should look for leaders who value the organization above themselves. Beware of leaders who seek the position for personal gain. Instead, look for those who are seeking to improve the organization, the field, and the people they serve. Physician-leaders must place their patients and their organization first.