Leadership and Followership

March 2017

“The best is he who calls men to the best. And those who heed the call are also blessed.

But worthless who call not, heed not, but rest.”

Hesiod, 8th Century B.C. Greek poet

Having just come through another college application season and the completion of another medical school match, one cannot help but be impressed with the dialogue revolving around the concept of leadership. In fact, there is so much dialogue around leadership in the halls of hospitals, health systems and other healthcare facilities that one could be led astray, should one be looking in from the outside. As we work with many healthcare-related clients across the country, and especially when working with physicians and nurses, I fear we may be valuing “leadership” at the expense of “followership”. Indeed, both are equal in terms of success and teamwork. A well-functioning organization or team needs followers as well as leaders. This is not to say that leadership is unimportant in selling vision and undertaking the implementation and execution of strategies to accomplish goals and objectives. However, especially in healthcare, the need is for a leadership consisting of those who are called to service in preference to status.

The appropriate quest is for leaders who desire to make a difference and a positive impact that results in making something better. All too frequently I believe this quest for leadership, in some individuals, is tainted and tinged by some desiring authority and prominence. All of this is understandable in the context of a digitized world touting the glamour of position and the corporatization of healthcare due to the spate of mergers and acquisitions which have occurred. Consequently we emphasize the need for clinical leaders in our dialogue to assist in bringing order to a chaotic environment, one strongly emphasizing clinical knowledge and credibility, because many feel this is the solution to our current challenges. Yes, leadership is necessary, but not sufficient.

Organizational psychology has also studied and promoted the concept of “followership” which is just as necessary as leadership. The term was coined in a 1988 Harvard Business Review article by Robert Kelley in which he listed the qualities of the good follower, including being committed to “a purpose, principle or person outside themselves” and being “courageous, honest and credible”.  Those of you who have had military service will probably recognize that the idea of followership has been taught for a long time.

It is inaccurate and we do a great disservice to attribute the success of any organization or medical practice solely to its leadership, ignoring the importance and responsibilities of followership. Many ineffective medical practices and healthcare organizations have multi-factorial reasons for their challenges and some of it may be leadership, but there also resides, especially among physicians, a lack of understanding of the obligation and importance of followership. One sometimes may get the impression that the bestowal of the MD degree makes one instantaneously a leader. Again, don’t misunderstand. The type of followership I reference is not blind followership, but one that includes those who know their responsibilities and accountability as part of a team with a noble cause and reasonable and respectable goals and objectives. It is linked with a leadership motif that is anchored on communication and trust and a leadership that has engaged the organization to make its followers knowledgeable and encourages support of goals and objectives through communication. As any leader knows, there is nothing lonelier than charging the proverbial hill and having no one coming behind with support.

Additionally, there is a risk associated with glorification of leadership skills at the expense of followership. It is a risk that empties leadership of its meaning and purpose. Over glorification may attract those who are motivated more by the spotlight rather than by the ideas and the people they should serve.

One could make the case that the value structure of leadership is the same as we would see in followership; namely excellence, passion and a desire to contribute. Those anchors will incorporate people with various skill bases and some of them will indeed be leaders and some will be followers – both are important and should be recognized and appreciated as such.

Ronald N. Riner