Principles of Leadership

Stanford Executive Briefings

Transcript of Dean Minor's remarks made at the Stanford Executive Briefings on May 8, 2014.

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.


1. Listen and Learn

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.


2. Build Diverse Teams

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.

3. Empower Teams

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.


4. Manage and Lead

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.


5. Plan Transitions

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. 


Question and Answer Period

How do you derive and implement visions effectively?

First, you look at the core values in the organization. The core values, and this is something you assess before you ever join an organization because if the core values of an organization are different from the core values you want to embrace, unless you're dealing with ... Number one, you're dealing with a start-up in which case you can shape the core values or number two, it's a turnaround situation and everyone recognizes things have got to change. You better be careful with even that assertion. Really, 90 plus percent of the time you need to be comfortable with the core values of the organization before you move into it.

If you're comfortable with those core values and they are imbued within the culture of the organization already then you work with those around you to see how those core values manifest themselves in the mission that has been defined and will be defined for the organization. Now this may differ in different situations. For those of you from industries in Silicon Valley and I don't need to tell you this, the pace of the industries, the pace of the technology is so incredibly fast that the deliberative process that we depend upon in higher ed and in academic medicine may not work in the way I've described it as needing to work at a place like Stanford University and Stanford Medicine.

Then, I think the way derivative vision comes about is by a buy in from everyone that we're in a rapidly changing industry, we want to lead in that industry and we have to be nimble and we have to have an agreed upon structure for shaping vision and morphing vision in a way that may not always seem as deliberative as it would if we didn't have these external pressures and indeed our internal desire to be at the forefront of our industry because those would be the comparisons that I would derive but I think a lot of it comes back to a buy in to core values and then an agreed upon vision or format within the organization. That's how you're going to shape vision and execution based upon that.


How did you change your playbook when you came to Stanford?

Well I started out I really tried to follow the principles that outlined us. I started out by doing a lot of listening and learning. We had a catalyst for those discussions and that catalyst we were in the midst of and were in real time planning a major philanthropic campaign, the campaign for Stanford Medicine. We know that this campaign has the potential to shape our future in very propitious ways. That enabled us very rapidly to convene because we have a goal and we need to convene, we need to define priorities, we need to define what we're going to invest in moving forward if we're going to be successful in our campaign.

We had numerous faculty groups that helped shape the vision. I asked a lot of questions, I learned about Stanford Medicine at Stanford University about the health care delivery system in northern California by asking questions and in real time. In so doing I think that I was able to portray myself as a person wanting to partner with our faculty wanting to partner with the leaders of the hospital to enable our shared goal of making Stanford Medicine preeminent in leading the biomedical revolution, enabling that shared goal to be successful. But it began by listening and learning, by building a team of people around me, by empowering those people around me to be successful, by managing and leading and making sure we were be responsive.

The differences in culture, we could spend the next hour on that. I think one thing that's highly valued at Stanford is discussion and deliberation and it's wonderful that it is. Compared to many of our peer institutions, certainly compared to Johns Hopkins we're actually small. In the school of medicine depending upon how you count and medical schools counting faculty is actually kind of complex but depending upon how you count we have about 1,600 faculty. An institution like Johns Hopkins has, depending on how you count, 2,800 or north of that. It's a smaller place, 1,600 is still pretty large but getting out, meeting with people, having town hall meetings, engaging regularly in discussions with faculty and students has helped me to calibrate to the Stanford culture and to respect and understand what a rich and diverse and valuable culture it is.


What do you think about LEAN methodology and what kind of impact it is having on care delivery?

I think that it's done a lot to add valuable process to important decision making apparatus that had not had much process associated with it in the past. What is involved in getting a patient safely discharged before noon? Why is that important? Well it's important because if a patient is ready to go home it's good for them to go home. If they are ready to go home it's good for them to go home so that the hospital bed can be occupied by the person who's waiting in the recovery room to get a room. What's involved, actually the steps involved in safely discharging a patient by a given time? There are multiple steps. The nurses have to be informed, the house staff have to have written orders, the attending physician has to have the conversation with the patient, there has to be a follow up appointment available, the prescriptions have to be written for the discharge.

Before we kind of all knew that, right? I mean it was quote common sense, which Mark Twain said is that sense which is so uncommon. But through LEAN you make a process around it, you have a flow chart, you have ways of affirming that things are being done and checking up and correcting problems when they're not being done. I think it's been a value added. Now as to whether or not you call it LEAN or there are multiple different ways of approaching it, LEAN seems to be as effective as any as I've seen and we have a number of experts here who are effective and quite skilled at using LEAN. Most importantly, there is a growing culture that this is good. This is good because the nurses, the unit cart, the house staff, the attending physicians, the patient, the family are all engaged together. Isn't that what patient care is all about? Yes, certainly.


It seems like physicians don't listen to their patients as much as they should or even as much as other health care professionals. What are your thoughts on that?

I think you're spot on in the observation and I do think that we as physicians as technology in medicine, as medical knowledge, as our ability to use sophisticated treatment protocols for the most complex and sick patients has grown there has been a de-emphasis on doing exactly what you said and that is listening to the patient, understanding what's important to the patient and in so doing as I mentioned before the affirm listen to the patient because the patient is trying to tell you their diagnosis. As a result of not listening sometimes diagnosis are not being made correctly because there's been a leak, too much geared by a radiographic study by a laboratory value without really understanding what's going on with the patient therefore understanding the more complete diagnosis.

Your observation was that I probably was going to answer, well that's changing. It's going to be different in the future. Well let me say this, it has to change in the future. We're not doing our responsibility as physicians, we're not as an educational institution as a medical school we're not fulfilling our responsibility to our medical students and our residents and fellows unless we're actively engaged in changing it. How do we change it? I think one of the things we have to look at very carefully is the incentive systems surrounding compensation. How health care is paid for in America and in particular how physicians are paid for?

Right now, this is probably a whole separate talk in it's own, but health care in the United States is 18 percent of the GDP and yet on so many measures health care outcomes in America don't measure up to other OECD countries. When you have the most serious conditions when you need an organ transplant, when you've got a complicated cancer, there's no better country in the world to get your treatment than right here in the United States. When you're wanting to prevent an illness, when you're wanting to treat something that is complex, multi-factorial but not necessarily tertiary or quaternary in terms of the care that has to be delivered. We're falling short in terms of what we're doing in the United States in delivering that kind of care.

The difference I see in the last say five years and particularly since the debate and discussion and implementation of the affordable care act, the difference I see is that now we're having these conversations. We're having these conversations about where we're falling short. I wouldn't say that we've come up with a solutions and I think the solutions are going to be multi-factorial but I think there's a universal embracing for the observation you made, obviously specific to your conditions and where you've been treated generalizes on a much broader basis.

Now I view our responsibility at Stanford in terms of our desire to lead the biomedical revolution and be preeminent to change that.  We've begun specifically in cancer because cancer care is often times it's complex, it occurs over the course of weeks, months or years, the multiple different doctors involved in the care, multiple clinic visits and hospitalization. Lots of opportunities for things to fall through the cracks. One of the things we're doing in cancer is hiring a cohort of oncology nurses so that every new cancer patient coming to see us for cancer care has assigned to him or her a nurse specialist who will be there with the patient and his or her family at every clinic appointment, at every hospitalization. Making sure that things don't fall through the cracks, making sure that the patients concerns are addressed.

We also have a lead physician for every cancer patient so these are beginnings, they're certainly not in full bloom age yet but it's a challenging opportunity that we want to embrace.


How would you spread what we've talked about today to other branches and facets of an institution?

I think that's something that's very much a work in progress. Communication is absolutely key. I've tried to do that through town hall meetings, through periodic newsletters, through meeting with faculty at our faculty meetings through staff meetings, through empowering those around me in the dean's office to be effective communicators. There are many different things that go in an effective communication strategy and I would say it's still a work in progress. But what I've tried to project from the very beginning is that I want to hear from people around me, around us in the organization.

We've tried very hard to do that as we shape the structure of the campaign for Stanford Medicine, as we roll that out and as we explain what we believe to be the unique opportunities we have here and how everyone can be a part of that. We have the slogan, sort of tagline for the campaign for Stanford Medicine is, we're all a part of the equation and I believe that. I firmly believe that not only for the campaign but for what we are as an academic medical center. Each one of us plays an important role in enabling us to do the things we know we're capable of doing.

Communication in large and decentralized organizations which academic institutions are and academic medical centers is a particular challenge and it's one that we work on constantly.


What are your views on uniforms?

Uniforms there are areas within the entities that have moved forward with uniforms. I think they're effective if people in those units feel that they are effective. I don't think that we can or should mandate some standard appearance but certainly broadcasting who we are is a way of demonstrating the pride we have in who we are and representing to the outside world who we are. I think they can be effective.


How do you build and empower a diverse team of individuals?

I think it first comes from getting to know the organization, finding talent within the organization, asking the current leaders in the organization to introduce you to the people they most admire and respect who share the shared mission of promoting diversity and empowering people of diverse background. Meeting those people and then enabling them, putting them into leadership roles so that they have the opportunity to have impact. It comes through interacting with other leaders, such as one of the ... I'm very very fortunate in the school of medicine to work with Dr. Linda Boxer who's the vice dean of the school of medicine. We work together very closely, in particular we work together in interacting with our department chairs, our clinical and our basic science department chairs.

One thing we've asked them to do as they develop their goals for the year and the metrics by which the outcomes of those goals are judged. We've asked for each of them to develop a diversity plan for their department or unit and how they empower people from diverse backgrounds to be successful in their department or unit. It can't work top down. What the role of leadership is to state the opportunity, to state the expectation and that's particularly an important role of leadership in decentralized organizations. It's to establish accountability.

In decentralized organizations it can almost run independent of any sort of, at least on a day to day basis run independent of any sort of convened central structure. A critical role of leadership is to establish accountability. Otherwise, all those things may run smoothly on the individual unit level you'll never realize that opportunity for interactions between and among units and you'll also never promote agenda items that could perhaps be more conveniently pushed into the background by individual units.


How does Stanford's School of Medicine develop mentorship?

Every new faculty member, every new junior faculty member who is recruited needs to have a mentor assigned to them at the time they come on board. In addition, our office of academic affairs directed by Dr. Boxer, the vice dean, has a group of associate deans who meet with our new incoming faculty at junior faculty levels to make sure that they have a mentor, that they've met with their mentor and that they're okay with their mentor. Because sometimes things don't click, in which case we want to make sure we have an opportunity to find another mentor. We've got lots of people who are talented mentors and they want to mentor.

Then periodically that junior faculty member will have follow ups. Regular follow ups with their mentor but also periodically we at the level of the office of academic affairs will check the progress to make sure that that mentorship is taking place. That's important in terms of how it gets co defined, specified and how the expectations are stated. Also it's important that we have an atmosphere of collegiality and collaboration, and we do here at Stanford. That's one of the many many remarkable feature of the university. It is an inherently collegial and collaborative place.

There are many many things that encourage that but I'll just mention one and that is that on our university tenure line track, which the faculty track that is focused on research, research and teaching. Some clinical care activity but looking at those people who are going to be the research and academic leaders in their fields on our university tenure line track the tenure rate at Stanford is high. It's 85 percent or perhaps even a little higher, much higher than our peer institutions. We have such an incredibly talented faculty. The reason it's high is that we're hiring the right people when they come to Stanford. We spend a lot of time doing searches and some searches we do we don't do a hire because we simply don't see a person in the field that we think is going to be able to succeed here at Stanford.

When do we do hire a person it's our expectation that they're going to succeed and we make that point to them at the time we hire them. Now does it work 100 percent of the time? No. But when it doesn't work we want to look back and reflect and see what happened. Were there problems in the way we supported the person? Was there misalignment of the expectations? Sometimes peoples careers just don't advance in the ways that we think they're going to advance in the time we hire them, that's a minority of the situations.

I think the fact that we can make that statement at the time we hire our faculty that we've hired you to succeed, we haven't hired you to sort of be one of five and we're going to promote one of the five, that's not at all our attitude. That promotes that collegiality and collaboration so there's no reason for people to have to engage in sort of overt competition because they feel like well if he or she is promoted then I'm not going to be promoted.


Could you share an example of a time when you implemented change in an organization?

I'll mention one that is probably going to sound humorous but I learned a lot from it. When I became the department chair at Johns Hopkins there's a tradition at Hopkins, goes back to Sir William Osler, the first professor of medicine at Johns Hopkins of necktie or a scarf that people in a department wear on a particular day to signify their membership in that department. The Department of Otolaryngology – Head and Neck Surgery had a tie and these ties had periodically, episodically I should say, changed over the years. We had a tie. It was a tie, it's still there, I'll show it to you and you can be the judge but we decided, some faculty said well we should redesign the tie. Okay well we redesigned the tie. We had a committee of course to redesign the tie. We brought in a tie consultant for a very low fee because she had other connections in the medical school.

We came up with some designs and we talked with the faculty meeting and it was like what are you doing? This is a part of the culture. I mean, we may think it's ugly or whatever but it's a part of the culture. How did I earn the right to make that change? It was like, whoa. First, it caused me to say to myself, it is a tie. It's not the end of the world. Fine, I said you know you're right. You're absolutely right. Every week on the Thursday when we wore ties I wore that tie, even if it didn't match the suit I wore the tie. Because I hadn't studied that ... Even though people were complaining about them, it was a part of the culture and it is a tie.

That's one example. Perhaps humorous but I drive a lot of meaning from it. Again, as an academic leader surrounded by highly talented people every day you have to earn the right to make changes. You have to re earn that right and recheck it.

Thank you very much for being here. Have a great day.