Principles of Leadership

I thought what I would try to do in the next 55 minutes or so and allowing time for your questions is talk about some of the principles of leadership that I've found to be important in my leadership career and my leadership experience. Let me just go through and state these five principles now and then spend some time developing them and talking about them.

First is that good leaders listen and learn. Good leaders build diverse teams. Good leaders empower those teams. Good leaders manage and lead. Good leaders plan transitions.

Let's start out with the first one, good leaders listen and learn. Now what about vision? I didn't mention vision in any of those five principles. Well, if you read this statement  and if you agree with it, you're probably thinking omitting vision is a glaring and serious omission.

Am I saying that vision isn't important? No, not by any means. Vision is very important but I think vision is derivative. Really meaningful vision comes from first listening and learning. Listening and understanding and learning an organization, its people, its culture, its opportunities and the broader landscape in which that organization is functioning.

I believe that a good leader is first and foremost a good student. Like every good student, where do you begin as a good student? You begin by asking questions, not by giving the answers but by asking the right questions, asking the good questions. That's exactly what good leaders do. Asking the right question doesn't mean just finding out the right facts, it means asking the questions that really lead to an understanding of what the meaning is of the situation and the organization and the opportunity.

Listening is not just an automatic skill. I mean, how many books, how many presentations have we all seen, read about and heard dealing with making your point, the power of persuasion, how to negotiate effectively, how to get across your views? There's a lot out there. Yet, how much has been written, how much has been said, how much has been developed in a thoughtful way about being a really active and engaged listener? Much much less.

The other thing about being an effective listener and effective learning is it's important to have empathy. Empathy is the way that you understand, it's the way through which you understand the people that you're interacting with, you understand the complexities around you. You may disagree completely with a position that a person takes, and yet you still need to try to understand how that person came to that position because it's through that understanding that you'll learn ... First of all, you may learn that they have more of a point, more of an importance in their point of view than you'd initially thought when you first heard the point of view being opposed to yours. Also, you'll learn if you are convinced that it needs to change, you'll learn where the opportunities for change occur.

The other thing that's of critical importance about empathy is that it helps to prevent the fundamental attribution error. The fundamental attribution error is something that's been described by social psychologists and it can be summarized as follows it's a tendency to attribute errors of other people to being them as a person and to attribute errors that you yourself make as being due to the environment. In other words, when something happens around, well it's because whoever was responsible for it just didn't do it right. When something happens that's in your responsibility sphere, well it's the environment was poison, you couldn't possibly have done anything differently.

If you have empathy, the first problem of attributing an error or a problem to an individual and not seeing it in the broader context of the environment of the organization is much less likely to occur. How many situations can we all think about that have been exasperated by the attribution error?

Another point about listening and learning is that it's important as a good listener and a good learner to have contextual sensitivity, to have contextual knowledge and understanding. Everything that occurs in an organization, almost everything that occurs in an organization occurs for a reason. Very few things occur just totally randomly. Understanding those reasons, understanding the culture of the organization that you're leading is really important in order to enable you to be an effective leader.

Now to return to this point of vision, yes vision is absolutely important. But what vision do you know of, what really meaningful vision do you know of that hasn't changed because of experience, because of exposure to the environment, because of trying and then seeing failures and regrouping and recalibrating and coming back with a more effective vision? What vision that's really effective do you know of that's resulted from one speech, one writing, one event? Almost none, right?

Now speeches, writings, events, forums, seminars, those can play a very important role in catalyzing a vision. Once the listening and learning in the environment has been done but they rarely serve as just a surrogate for what needs to be done first in the listening and learning. The other really important thing about listening and learning and leadership is that as a leader you get multiple chances to get it right. Now I'm an ear surgeon by training and ear surgery is very unforgiving. Your best chance to help the patient is the first time you do the operation. Yes, there can be revision operations, they're rarely as effective as the first operation you do. Nothing can be more different in the situation in the case of leadership. If you're a good listener, if you're a good learner, if you have empathy, if you strive to understand the context in the organization you will get multiple chances to get it right. As a matter of fact, you may get more chances to get it right than you really deserve to have chances to get it right. But there's never just one right vision coming out of the gate, it has to be flexible, modified and listening and learning are the ways you calibrate it and get it right.

The other aspect of my career that's taught me the importance of listening and learning is that I am a clinician-scientist. I spent the first part of my career training for and then developing a scientific and clinical career and I learned an enormous amount from listening to my patients. The discovery that I am probably the best known for bears this archaizing name, Superior Canal Dehiscence. My goodness, what does that mean? Well, we have these three balance canals in our inner ear that detect how we're moving our head angularly. These balance canals perform a very important function. They enable our eyes to move in ways that compensate for our head movements.

We can be driving down a bumpy road and we can see the road signs just fine because even though our head is bouncing up and down our balance canals are picking up that motion and causing our eyes to move in the ways needed to stabilize gaze. Now a long time ago back in 1995, patients started coming to my clinic complaining of these bizarre symptoms that when they heard loud noises they could see things moving. They heard the sound of their own voice too loudly in their ears. This really odd symptom of hearing their eye movements.

Now some of these patients were referred to me by psychiatrists who said, well this person seems totally sane and rational but the patient has been told, well it's all in your head. Well, it turns out it was all in their head but just not in the way they'd been told about it when they were referred to a psychiatrist.

What was going on was the bone covering that top balance canal was missing. When that bone was missing and that's what this little slide here shows that that fleshy area is supposed to be covered by white bone, pearly white bone and when it's not then the balance canal responds to sound. We were able to work that out, but we were able to work that out because of the patients, because of their specificity as we listened very carefully to them in telling us what was going on.

There's an old aphorism for physicians and it goes something like this, listen to your patients because they're trying to tell you their diagnosis. Listening and learning plays an important role in all aspects of my clinical scientific career and certainly in my leadership career.

All right then, let's move on. Principle number two: building diverse teams. When I was provost at Johns Hopkins University, we undertook a project on innovation. We interviewed 20 of the most innovative faculty at Johns Hopkins. We wanted to know what was important to them in their innovation, what was the motivator of their creativity.

What we discovered is that there was an enormous diversity in these highly creative and innovative people from science to musicians to artists to composers to writers and an enormous diversity in how they approached creativity and innovation.

Furthermore, each of them had in their own ways embraced diversity in terms of the people they interacted with and the teams that they built. It led us to see that at the heart and core of great research universities is the diversity of our organizations, the diversity of thought, the diversity of training, the diversity of outlook. That diversity is absolutely integral to us being able to perform our mission. That's not just true in academic institutions, I think it's also very much true in our corporate environment today where to lead as so many of the companies around us do lead. To really lead in the industries, these highly forward-looking fast-paced industries to really lead requires an enormous diversity of talent.

Effective leadership means embracing diversity. You know, to be a good leader you need to surround yourself with people who complement you. That's complement with an E and not with an I. By that, I mean you don't need people around you who tell you they like what you're wearing to work that particular day. You need people around you who complement your skills and your knowledge and your abilities. A good leader knows what he or she knows but even more importantly a good leader knows where he or she has areas of weakness. You surround yourself by people who can fill in those areas of weakness and who can complement and add to your areas of strength to make you and the organization far more effective than it would be otherwise. I think probably the worst mistake a leader can make is to surround yourself with people who are exactly like you.

There's another critically important aspect of diversity and that is it's important that organizations embrace and nurture racial, social economic, ethnic, and gender diversity. My views on the importance of diversity were very much shaped by my upbringing. I grew up in Little Rock, Arkansas and as many of you recognize this iconic image, it's a photograph taken in 1957 when President Eisenhower sent in federal troops to enable nine very brave African American students to attend Central High School. Now, segregation by law had been outlawed years before by Brown vs. the Board of Education. But segregation in fact continued to be in place even after 1957 because students went to schools, and this was not just in the south, students went to schools based upon where they lived, based upon their neighborhoods and the neighborhoods were segregated.

When I was entering ninth grade the federal courts ordered busing in Little Rock in order to achieve desegregation of the schools roughly in accord with the racial demographics of the city. I boarded a bus that took me from an almost all-white neighborhood to a junior high school in an almost entirely African-American neighborhood to go to a junior high school that had been a segregated school. What I saw on that very first day was that what we had been told, what I had been told as a white person was separate but equal was certainly separate but it was anything but equal.

There were very few books in the library. The books that were on the lower shelves of the library had had many of their pages and their bindings eaten away by rats. The banisters were missing from the stairways. Plaster was peeling from the walls. These were the bitter fruits of racial prejudice. Society looks to us as leaders, society looks to us in higher education to correct these ills, to make an impact, to change the future for our country. Now, we're a much better country in terms of desegregation and opportunity than we were certainly in 1957 and also than we were in 1971. But there's still a lot of work to be done and it's important that all of us as leaders embrace that opportunity and that responsibility.

It's not just enough to build a diverse team, you need to empower that team to be effective and to have impact. 

Now this is a picture of the New York Philharmonic. I'm a cellist and I love classical music. There's a story in classical music circles going back years that if you were to audition and listen to the individual players in the New York Philharmonic you'd be overwhelmed by their talent, by their skills. In fact if you sort of blindly put them behind a wall and you listen to say a New York Philharmonic player and a player from another major symphony, you might almost always choose the New York Philharmonic player. Yet, on most nights things just don't quite click in a performance. This is more of the past tense and I'll explain why in a moment. Things didn't quite click as a performance. The entrances were ragged, the dynamics between the sections of the orchestra weren't matched. What was it? The individual talent was enormous but the execution, the talent as an ensemble was frequently lacking.

That can be analyzed in many different ways, it can be analyzed based upon the personalities, the aspirations of the individual musicians, the characteristics of the leader, the conductor. I have to say although it's been a few years since I've heard the New York Philharmonic in person of what I read in reviews and what I hear in recordings in the past five years that Alan Gilbert has been the music director there's been great strides this performance as a group.

That's not restricted just to major symphony orchestras, right? We can all think of organizations that have lots of individual talent but that don't quite click together in terms of their ability to really execute and tackle problems together and make a whole that's far greater than the simple sum of the parts.

A critical role of leadership is to understand those who are working with you. To understand their strengths, understand their weaknesses and to find opportunities to build that whole that's far greater than the simple sum of the parts. When you're able to encourage that as a leader, and it has to be through encouragement, particularly in academics it can't be through mandate or fiat. You're able to encourage that, provide incentives that achieve that alignment then marvelous things happen with the organization.

That's very much the goal of what we are doing at Stanford Medicine today. Our goal is to lead the biomedical revolution. Now when I say Stanford Medicine, I'm referring to the School of Medicine, I'm referring to the two hospitals that are right here on our campus, Stanford Hospital and Clinics and Lucile Packard Children's Hospital. The School of Medicine and those two hospitals are all part of Stanford University. I think our greatest strength as Stanford Medicine is the fact that we are a part of Stanford University. What we need to do, what we are doing is to leverage our individual strengths as individual entities, the school, the two hospitals to respect those individual strengths but to find ways to build interconnections, to build relationships between and among those entities in ways that make the whole far greater than the simple sum of the part

In so doing make ways that make us preeminent as an academic medical center. Preeminence requires that. Just being excellent in each of the individual mission areas of patient care, research, and teaching, just individual excellence in those three mission areas will not enable us to fulfill the leadership opportunities that we have in Stanford Medicine. It's only through building those connections both within the organizations that are entities that are right here on our campus at Stanford and also in our related organizations such as the Palo Alto Veteran's Administration Medical Center and other entities that are related to Stanford Medicine. Building those relationships will enable us to achieve preeminence.

We're doing that in cancer, in transforming patient care in cancer. We're doing it in building a learning health care system and gleaning information from the medical records increasingly all electronic medical records on patients and developing the best care delivery pathways for individual patients. Taking knowledge gleaned from populations and applying those to develop the best prevention and treatment methods for individuals. That's our opportunity at Stanford Medicine.

The fourth principle I'd like to discuss with you is that good leaders manage and lead.  This is a statement from Peter Drucker, I hope all of you are familiar with Peter Drucker's work. 

Peter Drucker, everything he's written I have gotten enormous meaning out of and I think this statement really stands out. It's so simple but it's so powerful. "Management is doing things right, leadership is doing the right things." Just a subtle change in words. Effective management is how we do things, it's when we do things. Effective leadership is deciding what we do and why we're doing it.

Often times these two entities, management leadership had been thought about differently and indeed leadership is involved in setting direction and management is involved in execution, coordination and timing. But in fact, to be an effective leader you absolutely have to be an effective manager and you have to understand management and you have to embrace the importance of management. Nothing will get a leader in trouble faster than poor tactics. Emails that don't get answered, phone calls that don't get returned, inquiries that don't get addressed, concerns that percolate because there hasn't been a mechanism to address them. Poor tactics, poor execution will get you in trouble a lot faster than bad strategy or even non-existent strategy.

I think a good leader has to be a good manager as well as a good leader and has to recognize and reward and affirm management talent of those around us. That also means viewing the relationship between leadership and management as being one that has to be nurtured at all levels of the organization. Because at all levels of the organization people who are effectively doing their roles are going to have a blend of management and leadership in their activities.

As I look at my career to date, I think it can best be described as an hourglass, in terms of my education and my leadership. I started out broad as an undergraduate. A course that I took as an undergraduate peaked my interest in the particular scientific discipline that I went on to pursue. Then, through an extended period of training, that narrow period in the hour glass, I focused. I focused on making sure that I had the scientific training needed to make original contributions to the field that I was entering and that I had the surgical skills needed to help the patients that were entrusting their care to me.

Then I got a job, I got a faculty job in 1993 at Johns Hopkins. I had the opportunity then to build a research laboratory and build a clinical program and to recruit amazingly talented people and to lead as I worked with them and as they developed their careers and their interests. Then, that broadened when I was a department chair and broader still as provost and as dean of the school of medicine. What I would say is that these five principles that I've talked about today, talk about the last one here in just a moment, that these five principles have been important at every stage of my career in different ways. They're not specific to a particular point in a career or I think to a particular career line or career aspiration.

The last principle is planning transitions. This is the principle that in my view you can see really good performance on the first four in a lot of leaders, a lot of organizations. This is the one that sometimes picking academic institutions fall short of the other four. When I became a department chair of the Department of Otolaryngology and Head and Neck Surgery at Johns Hopkins I sat down with Martin Goldberg who had just finished a very distinguished tenure as the chair of the Department of Ophthalmology at the Wilmer Eye Institute at Johns Hopkins. Marty had enormous impact on ophthalmology at Johns Hopkins, ophthalmology as a field. I asked him what was important for you. What have you relied upon in your career? And then, how can I learn how to do this and do it right?

Without missing a beat he pulled a book off of his shelf which is this book, "The Inner Game of Management." It's written in the 1980s by two business school professors at UCLA. He said, read this because your effectiveness as a leader is going to be determined more by your ability to manage the transition you're making than by any external matters. I thought, well that's interesting. If you read the book, the book is a collection of vignettes about managers and leaders who have problems fundamentally for one reason and that is when they move from one role to the next role they use the same playbook that they used in their previous role. Because after all, how did they get the opportunity to move into their next role? It's because they were effective in their previous role. They were good. They did things, they got things accomplished.

Yet, in almost every situation when you move from one role to the next, you have to change the playbook. Even if you're staying in the same organization, the people around you change, the challenges change, and living in your past and thinking, "Well, this is the way I did it before and it worked fine so it has to work now." Living in your past gets you into problems as a leader. It relates back again to that principle that I said before and that is that in leadership you never just get one chance. If you're listening and learning, you have the opportunity to recalibrate and to relearn. But you have to give yourself, you have to make yourself embrace that opportunity and not live by the principles and the playbook that you lived in the past.

Understanding that is really important as you begin to make effective transitions. Also, understanding your role as a leader within an organization to plan for your own transition and to position the organization so that it will be able to continue on moving forward when there are others that move into the leadership position that you have. Those transitions are often times difficult to plan. These transitions are particularly important in higher education and academics because leadership in an academic institution is different than corporate leadership. You don't by and large have a large stash of resources that you can just dole out to enable or to incentivize an organization to move in a different direction. You certainly can't go around telling people what to do. What you have to do as a leader at a great university at an academic organization, what you have to do every day is earn the right to change. You earn the right to make changes in your organization by listening and learning, by empowering, by building diverse teams, by empowering them, by managing and leading. That's the way you'll be able to help the organization to move forward and to change and to embrace the complexions of the future.

Leadership, frankly, in academic medical centers is a step up even from that in terms of its difficulty. That's because of the complexity of academic medical centers. The complexity of the entities that fall under the rubric, under the umbrella of an academic medical center, of health care delivery processes, research, teaching, federal grants, internal grants, lots of moving parts, lots of things going on. Far more than any one individual can come up with a strategy, an approach that just emanates from them. It has to be derivative from the people around you. But the opportunities for achieving benefit are also enormously great in great organizations like Stanford Medicine.

Now in closing, I just want to leave you with a few thoughts. This is a quote that appears on a box that my wife gave me when I moved from being department chair of Otolaryngology – Head and Neck Surgery at Johns Hopkins to being provost. The quote is, "We cannot discover new oceans unless we have the courage to lose sight of the shore."

About a year and a half ago, little over that, I made the decision to move 3,000 miles from Baltimore to Palo Alto. I'd been at Johns Hopkins for 19 years, it's a great institution, we had and have many many friends and colleagues there. It was fine, things were going well, so why move? Why move at that point?

What I saw here and what I've seen and been reaffirmed time and time since coming here is so much enormous opportunity at Stanford, so much already being accomplished at our university, at our medical center and so much opportunity to accomplish even more moving forward. It's that opportunity that led me to believe that this was the right move for us to make at this point in our lives and I'm very grateful that my wife has joined me in that journey.

In closing today, I just want to leave you with this thought. I hope that you will always have the drive to discover new oceans and I hope that you'll always have courage to lose sight of the shore. Thank you very much. I'll be happy to answer your questions. Thank you.