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The Science of Leading Yourself: A Missing Piece in the Health Care Transformation Puzzle

Open Journal of Leadership
2013. Vol.2, No.3, 45-55
Published Online September 2013 in SciRes (
Copyright © 2013 SciRes. 45
The Science of Leading Yourself: A Missing
Piece in the Health Care Transformation Puzzle*
Wiley W. Souba
Geisel School of Medicine at Dartmouth, Hanover, USA
Received June 10th, 2013; revised July 18th, 2013; accepted August 8th, 2013
Copyright © 2013 Wiley W. Souba. This is an open access article distributed under the Creative Commons At-
tribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the
original work is properly cited.
Personal transformation is a prerequisite for sustainable transformation of our health care system. Inte-
grating research from the language sciences, phenomenology, psychology and neurobiology, this article
reviews the science of leading oneself. Because this “inward” journey can be alien and disorienting, the
Language Leadership Performance Model is helpful in illustrating the relationship between the circum-
stances the leader is dealing with (the leadership challenge), the context (point of view) the leader brings
to that challenge, and the leader’s way of being and acting (the definitive source of the leader’s perform-
ance). Using language, effective leaders reframe their leadership challenges such that their naturally cor-
related ways of being and acting provide them with new opportunity sets for exercising exemplary lead-
ership. Using a house metaphor (The House of Leadership), a foundation for being a leader and a frame-
work for exercising leadership are constructed. Laying the foundation of the model involves mastering the
four pillars of being a leader. Erecting the framework entails building a contextual schema, which, when
mastered, becomes a construct that in any leadership situation gives one the power to lead effectively as
one’s natural self-expression. Both of these activities—laying the foundation and erecting the frame-
work—involve a deconstruction of one’s existing leadership paradigm. Finally, A Heuristic for Leading
Oneself is offered as a useful guide or owner’s manual as one embarks on this inward journey. Leading
oneself is a uniquely human activity—studying it and how it works is a vital piece in solving the health
care transformation puzzle.
Keywords: Leadership; Language; Health Care Reform; Ontology; Phenomenology; Academic Medicine
“Progress is impossible without change,” wrote George Ber-
nard Shaw, “and those who cannot change their minds cannot
change anything” (Shaw, 1920). This is, perhaps, our greatest
leadership challenge in medicine. Virtually everyone acknowl-
edges that the status quo isn’t working and that a radical over-
haul of our health care system is needed. But when it comes to
changing, we often overlook a fundamental truth: systems don’t
change in any meaningful kind of way until and unless people
change first (Wind & Crook, 2006; Souba, 2009; Souba, 2011a).
In Peter Block’s words, “If there is no transformation inside
each of us, all the structural change in the world will have no
impact on our institutions” (Block, 1996). We cannot solve our
quality, cost and access challenges with technical solutions
alone. We, too, must change. We must change how we think
about health care, how we speak about its future, and how we
work together to correct its failings. In order to reframe how we
approach our health care challenges, a renewed context for lea-
dership is needed, one that distinguishes being a leader as the
foundation for what leaders know and do (Souba, 2011a; Souba,
2011b). If you’re not being a leader, it is impossible to act like
a leader. Goss (Goss, 1995) explains:
Transformation and change are different phenomena. Change
is a function of altering what you are doing—to improve some-
thing that is already possible in your reality (better, different,
more). Transformation is a function of altering the way you are
being—to create something that is currently not possible in
your reality.
Most approaches to leadership development are based on the
assumption that inculcating people with specific characteristics
and traits will make them effective leaders (Zaccaro, Kemp, &
Bader, 2004). However, effective leaders know that leadership
does not come from imitating certain styles or memorizing an
article on the attributes of successful leaders. Barker (1997) re-
minds us that “we have become mired in an obsession with the
rich and powerful, with traits, characteristics, behaviors, roles,
styles, and abilities of people who by hook or by crook have
obtained high positions, [yet] we know little if anything more
about leadership.” Leading oneself is less about styles and traits
and more about discovering one’s natural self-expression. This
is a key prerequisite for leading others. Parikh (2005) explains:
Unless one knows how to lead one’s self, it would be pre-
sumptuous for anyone to be able to lead others effectively…
Leading one’s self implies cultivating the skills and processes
to experience a higher level of self-identity beyond one’s ordi-
nary, reactive ego level…
*Funding/Support: None.
Other disclosures: None.
Ethical approval: Not applicable.
To get beyond their “ordinary, reactive ego”, effective lead-
ers relentlessly work on “unconcealing” the prevailing mental
maps that they carry around in their heads (Souba, 2011a;
Souba, 2011b; Erhard, Jensen, & Granger, 2011; Erhard, Jensen,
Zaffron, & Granger, 2011). This unveiling is critical because
leaders are more effective when they are not limited by their
hidden frames of reference and taken-for-granted worldviews.
This new way of understanding leadership requires that leaders
spend more time learning about and leading themselves. Erik-
sen (2008) expounds:
Too often, leaders of organizational change see the organiza-
tion as an object separate of themselves… To be an effective
leader, one must understand the nature of leadership, one’s self,
and [the] organization within the unfolding of one’s day-to-day
experience… [It is] clear how important it is for a leader to be
the organizational change he or she seeks.
Socrates reminds us that the unexamined life is not worth
living (Plato, 1998). To lead effectively, we must begin by exa-
mining ourselves. In this essay, I review the science of leading
oneself, integrating research from the language sciences, phe-
nomenology, psychology and neurobiology, disciplines that
have advanced our understanding of this inward aspect of lead-
ership. Leading oneself is a uniquely human activity—studying
it and how it works is a vital piece in solving the health care
transformation puzzle.
The Connectome You Are Today Determines
the Leader You Are Today
Research in neuroscience has made it unambiguously clear
that every aspect of our life experience and every choice we
make is generated by neuronal patterns in our brain (Pascual-
Leone, Amedi, Fregni, & Merabet, 2006; Kolb, Gibb, & Rob-
inson, 1995; LeDoux, 2003; McGilchrist, 2012; Tse, 2013).
MIT professor Sebastian Seung (Seung, 2012) contends that
who you are, moment to moment, situation to situation lies in
the specific connections between your neurons, which change
as you learn and grow. The term connectome refers to the total-
ity of connections between neurons in a nervous system. While
your neural networks at any given moment encode your
thoughts, feelings and perceptions, you also have a “typical”
way of being our think of as personality, which is the self in-
voked by the idea that you are your connectome.
Both your genome and your experiences shape and mold
your connectome, acting as critical determinants of the “way
you wound up being” at any point in time in your life. While
your genome is determined at the moment of fertilization, your
connectome changes throughout your life. Your life experi-
ences (in particular the stressful, traumatic ones) change your
connectome by rewiring, reweighting, reconnecting, and/or re-
generating synapses (Seung, 2012). Because of the plasticity of
the brain in children, the wiring that occurs during childhood is
an especially important landscaper of brain structure and func-
tion (Teicher, 2002; Bluck & Habermas, 2001; Miller, 2008;
Staudinger, 1999; Brownlee, 1996). While we are not born with
a neural network that is code for “I am inadequate”, over time,
such networks can become reflexive and automatic in children
who are consistently humiliated and shamed. When these neu-
ral circuits are triggered by certain events later in life, the fa-
miliar feelings of anxiety, ineptness, and fear are re-activated.
To some extent, all children develop feelings of inadequacy
that are the result of their brain’s misinterpretation of some-
thing someone said or did that was misconstrued as meaning
they were unacceptable, didn’t belong or fit in, or didn’t meas-
ure up (Souba, 2006). These errors in prospection occur be-
cause simulations are unrepresentative (we tend to remember
our best and worst experiences), essentialized (we omit features
that can influence our experience), abbreviated (we select only
a few moments of a future event), and decontextualized (we
exclude contexts that can shape our experiences) (Gilbert &
Wilson, 2007). The brain’s account of an event (I got a “D” on
the test so I’m stupid) is an inaccurate version of what really
happened (I got a “D” on the test), but the brain’s interpretation
becomes our reality and our truth. These erroneous thought
constructs originate in childhood when we are impressionable,
vulnerable and lack the cognitive maturity to reason logically.
As we learn what’s acceptable and what’s important (and
what’s not), we label ourselves with certain life-long deficien-
cies and imperfections. Perhaps our accomplishments in school
didn’t live up to our parents’ expectations and we decided that
we’re “not smart enough.” Such “self-diagnoses” are invariably
“terminal”; if, at a young age, you indict yourself as inadequate,
try as you might, you can never quite measure up (Souba,
When children believe that something is wrong with them,
they instinctively develop survival strategies. They “design”
themselves to have a set of thought processes, behaviors, and
ways of doing things that seemingly give them some measure
of success. These coping strategies shape our personality and
contribute to “the way we wound up being.” For example, one
of the ways virtually all human beings “wound up being” is
averse to change. It is not changed per se that we are opposed to;
rather, it’s the associated loss and fear that we (understandably)
resist (Souba, 2008).
These underlying default “survival” circuits are genetically
programmed and designed to respond unconditionally to stimuli
arising from challenging life circumstances (Atkinson B., At-
kinson L., Kutz, Lata P., Lata J., & Szekely, 2005). While all of
us are born with these neural response programs, they become
wired uniquely in each of us, based in part upon the emotion-
ally significant experiences we’ve had in our lives. In John
Green’s words, “You don’t remember what happened. What
you remember becomes what happened” (Green, 2006).
Self-defeating stories are difficult to rewrite because they are
deeply rooted in neural operating systems that are encoded to
carry out their instructions automatically when activated. For
new, more positive (constructive) narratives to become suffi-
ciently wired into our neural circuitry we must first become
aware of the encumbering narratives that tend to run our lives.
Without this expanded awareness, our programmed (and coun-
terproductive) ways of being and acting will routinely be trig-
gered whenever we are confronted with a stressful leadership
I am belaboring the point about these limiting “ways we
wound up being” for two reasons. First, we do not wind up
being the way we are solely by chance. As we inevitably be-
come acculturated and indoctrinated, we erect barriers to the
full range of possible ways of being. These ways of being are
reinforced by our parents when we’re young (“You’ll never
make it if you don’t get good grades”) and later in life by our
profession (“You’ll never earn credibility unless you get pro-
moted”). Paradoxically, our attempts to overcome our perceiv-
ed imperfections result in ways of being and acting that further
widen the gap between our inauthentic and true selves.
Copyright © 2013 SciRes.
Second, we tend to overlook that we are not stuck with our
automatic ways of being and acting when we are confronted
with a leadership challenge. The plasticity of the adult brain is
indisputable, allowing us to “go beyond” the way we wound up
being (Buonomano & Merzenich, 1998). Until you have re-in-
vented yourself to be free from the constraints of your past
(including your past successes), you will not have the power to
deal effectively with what is the source of resistance to change,
either your own or others (Goss, 1995).
This is critical as expanding our portfolio of possible leader-
ship strategies will allow each of us to exercise more competent
leadership under a more comprehensive range of situations.
Thus, we must be willing to transcend the way we “wound up
being”, rather than simply tweaking it. We must expand our
opportunity set of ways of being, thinking, speaking and acting
rather than being stuck with a narrow repertoire of leadership
Flipping the Prevailing Paradigm of Leadership
At the core of most models of leadership lies the premise that
knowledge is the foundation for leading effectively (Figure 1)
—the more the leader knows about goal setting, strategy, and
change management, the more effective he or she will be. This
implicit leadership theory—leadership equated with a person in
charge who has answers—is pervasive. It is the way most ex-
ecutives, deans, and department chairs think about leadership.
We learned to think this way from our superiors and role mod-
els. This way of thinking about and exercising leadership hap-
pens without much conscious intent and thus is difficult to
challenge or even discuss. It has become woven seamlessly into
the fabric of academic medicine’s culture.
This way of teaching leadership, which is anchored in theo-
ries and explanations, is not wrong but it is no longer adequate.
Theories of leadership, while useful for analysis and discussion,
do not confer what it is to be a leader and to exercise leadership
effectively. Theories do not grant the “boots-on-the-ground”
being and actions of effective leaders. Moreover, human beings
do not lead from a theoretical approach; we lead from the per-
spective of the way leadership is experienced. Explanations
alone don’t teach what is required to be a leader much as text-
books don’t impart what it is to be a doctor or chef or pianist.
Knowing is not enough.
By contrast, an emerging, new model anchors effective lead-
ership in the leader’s way of being (Figure 1). What is distinc-
tive about this ontological phenomenological perspective is that
it provides access to ways of exercising effective leadership
as-lived, in the first-person, in the real world, in real time and
with real results (Souba, 2011b; Erhard, Jensen, & Granger,
2011; Erhard, Jensen, Zaffron, & Granger, 2011). Neuroscience
tells us about what happens “in here” but we can’t actually ex-
perience our activated neural networks in vivo; we can only ex-
perience what is generated “in here” out in the world, that is,
“out here” where leadership and life happen. Most of us are not
clear about this so we encounter life through a set of beliefs or
theories or concepts. In Noë’s words, “You are not your brain.
Your brain is in your head but you are not. Where you and I
are—where we exist—is out here in the world” (Noë, 2009).
The inimitability of the ontological phenomenological in-
quiry resides in its capacity to disclose the actual nature of be-
ing a leader and exercising leadership by revealing hidden ways
of being and acting that limit our freedom to think strategically,
Figure 1.
Flipping the prevailing model of leadership. In the current prevailing
(epistemological) model of leadership, knowing is the anchoring foun-
dation of leading effectively. By contrast, the emerging model anchors
effective leadership in the leader’s way of being. Said somewhat poe-
tically, if you’re not being a leader, it is impossible to act like a leader.
innovate, and execute (Souba, 2011a; Souba, 2011b). Once
these constraints are revealed, options for leading more natu-
rally and intuitively become possible. When we exercise lead-
ership as our natural self-expression, we invariably perform at
our best (Box 1).
In this emerging leadership paradigm, the leader’s knowl-
edge and expertise are not the foundation for leadership but
they do play an essential role by illuminating and informing the
circumstances and challenges he or she is confronted with. This
“advising/apprising” role involves a conversation, in a literal
sense, in which the situation can “talk back” to the leader. The
resultant wisdom is essential to achieving mastery.
Becoming a More Effective Leader
Every system, including the human operating system, is built
to get the results it gets. Moreover, every system has a design
limit, which when reached cannot be surpassed unless it un-
dergoes transformation. For human beings, reinvention means
new ways of being, thinking and acting. Not surprisingly, rein-
vention and mastery are tightly linked.
All of us, regardless of our talents, must learn to lead our-
selves. “Conventional thinking”, writes Lee Thayer, “always
and inevitably leads to conventional results” (Thayer, 2004).
Slowly but surely we are learning that the process of trans-
forming ourselves and our organizations is not just about ac-
quiring more knowledge or changing our business strategy but
also about exposing the hidden contexts that shape our ways of
being and acting and limit our opportunity set for leading our-
selves and others more effectively. Change resides in new ways
of being, talking, and acting, which are shaped by our underly-
ing yet hidden beliefs and assumptions (Souba, 2009). The kind
of learning required to shift our worldviews is enormously
challenging, but it is essential for effective leadership in health
care given the enormous disequilibrium and turbulence in the
Leading ourselves begins by discovering who we are. “Be-
coming a leader,” writes Warren Bennis, “is synonymous with
becoming yourself. It is that simple. It is that difficult” (Bennis,
1994). This may sound like a cliché but if we don’t look at
ourselves realistically, we will never learn from our experiences
and we won’t be able to crystallize what we truly care about
and what we are willing to take a stand for. What it is to be
Copyright © 2013 SciRes. 47
Copyright © 2013 SciRes.
performance is firstly a function of his or her way of being (and
acting) with those circumstances. The model stresses the im-
portance of shifting certain of our prevailing (yet hidden) con-
texts in order to become more effective leaders.
human is inextricably linked to the way in which we lead. What
gets in the way of (constrains) our being human also gets in the
way of our leadership.
Leverage the Power of Language The LLPM highlights three key interdependencies. First, our
effectiveness as leaders is first and foremost a function of our
moment-to-moment, situation-to-situation way of being and
acting. Second, our way of being and acting is always consis-
tent with (correlated with) the way in which the circumstances
we are dealing with occur for us. Since many of the circum-
stances (leadership challenges) we are confronted with are in-
evitable (e.g., decreasing reimbursement, new payment models,
a reduced NIH salary cap), recontextualizing (reframing) them
—rather than resisting them—is essential to tackling them.
Third, recontextualization is always a linguistically-mediated
process. Language provides direct access to the context you
bring to the circumstances you’re dealing with and direct access
to the way in which those circumstances occur for you. As such,
language provides access to the source of your way of being
and acting.
What is distinctive about the human world is that it is con-
stituted in, shaped by, and accessible through language (Souba,
2011a; Souba, 2011b; Erhard, Jensen, & Granger, 2011; Erhard,
Jensen, Zaffron, & Granger, 2011). In other words, access to
any phenomenon is granted by language. Language acts as a
lens (a context) through which we “see” and understand life’s
challenges, other people, and ourselves. More relatedly, the
way any leadership challenge occurs for us is through language.
Making sense of our leadership challenges and crafting solu-
tions is a linguistic process.
Alfred Korzybski, a Polish engineer and philosopher, main-
tained that our ability to solve complex challenges is limited by
the architecture of our brain and the structure of our languages
(Korzybski, 2008; Korzybski, 1995; Korzybski, 1990). He
wondered why structures built by engineers rarely collapse and,
if they do, the underlying defect can be uncovered, whereas
social systems (health care systems, economies, governments)
not infrequently collapse but the basic defect is often unclear.
Korzybski (Korzybski, 1990) drew the following conclusion:
Stated slightly differently, the way in which the world, others,
and you yourself occur for you is a function the conversation
(your listening) that uses you. “We, mankind, are a conversa-
tion,” wrote Heidegger. “The being of men is founded in lan-
guage. But this becomes actual in conversation” (Heidegger,
1979). This conversation (with yourself and others) is inevita-
bly biased by your beliefs, filters, and assumptions, thereby
acting as a context (a point of view) that skews your perception
and your interpretation. At a young age we begin to acquire an
already-always-listening that filters and distorts what we see
and hear. Some people listen through a “life is difficult” head-
set. They lug this listening around with them to the various
challenges that show up in their lives. They are this listening. It
is the space inside of which life occurs for them. Hyde (Hyde,
1994) elaborates:
What do engineers do neurologically when they build a
bridge? … The engineers use a special, perfect yet restricted
form of representation called mathematics, similar in structure
to the facts they deal with; use of such symbolization yields
predictable empirical results.
In contrast, architects of social systems employ languages
that are often structurally dissimilar to the facts and have dif-
ferent meanings for different constituencies. As a consequence,
when these systems collapse, the basic structural flaw is diffi-
cult to identify. Our leadership challenges are similar. Because
every leadership challenge we deal with “dwells” in language,
what we need when leadership is called for is a language (a
conversational domain) that creates a context that uses us such
that we are left being a leader and exercising leadership effec-
tively as our natural self-expression (Souba, 2011b; Erhard,
Jensen, & Granger, 2011; Erhard, Jensen, Granger, & Dimag-
gio, 2010).
[E]ach of us at every moment is always already listening in a
particular way, listening from… the particular set of values and
concerns that constitute our identity. Our way of being and our
understanding of the world, given by these values and concerns,
constitute the listening that each of us always already is, the
listening that determines the way the world occurs for us.
I am stressing the importance of language because it is the
most powerful and underutilized resource leaders have at their
disposal. We all know people who are quite articulate, but, as
Denning (Denning, 2008) points out, if people aren’t listening
to you, you’re wasting your voice and your time. Changing
people’s entrenched thought constructs and behaviors that have
been successful for decades often requires a story about the
future that engages them. That future, which is only a possibil-
ity today, must be appealing enough to produce the necessary
The Language Leadership Performance Model (LLPM) de-
scribes the relationship between the circumstances the leader is
dealing with (the leadership challenge), the context (point of
view) the leader brings to that challenge, and the leader’s way
of being and actions (the ultimate source of the leader’s per-
formance) (Figure 2). In contrast to the popular model of lead-
ership, which assumes the leader’s performance is due largely
to his or her knowledge, the LLPM proposes that the leader’s
Figure 2.
The Language Leadership Performance Model (LLPM). The model describes the rela-
tionship between the leadership challenge (the circumstances the leader is dealing with),
the context the leader brings to that challenge, and the leaders being and acting (the ul-
timate source of the leader’s performance). In contrast to the popular model of leader-
ship, which presupposes the leader’s performance is due largely to his/her knowledge,
the LLPM proposes that the leader’s performance is firstly a function of his/her way of
being and acting with those circumstances. The model stresses the role of language in
shifting certain of our prevailing (yet hidden) contexts as key to exercising more effec-
tive leadership. Adapted from Souba, 2011b.
courage in people to challenge the status quo. And, it must be
inspirational enough to unite and align them so that their deci-
sions and actions can be coordinated efficiently and effectively.
Master leaders use language to prompt cognitive shifts in others,
jarring them loose from their entrenched worldviews, so they
can recontextualize their leadership challenges in such a way
that their naturally correlated ways of being and acting provide
them with new opportunity sets (previously unavailable) for
exercising exemplary leadership (Souba, 2011b).
The House of Leadership Foundation
The House of Leadership (HOL), a metaphorical model, pro-
vides an anchoring foundation for being a leader and a practical
framework for exercising leadership effectively (Figure 3).
Laying the foundation of the model involves mastering the four
pillars of being a leader. Building the framework entails con-
structing for yourself a contextual schema, which when mas-
tered becomes a structure (construct) that in any leadership si-
tuation gives you the power to lead effectively as your natural
self-expression. Being (the foundation) and action (the frame-
work) are distinct but inseparable. Both of these activities—
laying the foundation and erecting the framework—will require
that you deconstruct, at least in part, your existing leadership
The foundation of the HOL is anchored by four ontological
pillars: awareness, commitment, integrity, and authenticity
(Souba, 2011a). Awareness refers to mindful presence, which
involves bringing your full concentration to the situation at
hand and paying attention purposefully, non-judgmentally and
with curiosity. A key aspect of awareness is being mindful of
the distortions created by your already-always-listening, that
pervasive running commentary (inner critic) that’s thinking for
you and biasing you. When you are aware of this self-talk, its
tendency to “control” you diminishes, opening up possibilities
for new ways of being, thinking and acting. Burrell and Morgan
(Burrell & Morgan, 1979) explain:
In order to understand alternative points of view, it is impor-
tant that a [leader] be fully aware of the assumptions upon
which his own perspective is based. Such an appreciation in-
volves an intellectual journey which takes him outside of the
Figure 3.
The House of Leadership. The house metaphor provides the leader with
a solid foundation for being a leader and a practical framework for
exercising leadership effectively. The leader’s know-how and know-
what serve to inform the leader in making choices and decisions.
realm of his own familiar domain. It requires that he become
aware of the boundaries which define his perspective. It re-
quires that he journeys into the unexplored. It requires that he
become familiar with paradigms which are not his own. Only
then can he look back and appreciate in full measure the precise
nature of his starting point.
For humans (and teams and organizations), integrity has to
do with one’s word being whole and complete (Erhard, Jensen,
& Granger, 2011; Erhard, Jensen, Zaffron, & Granger, 2011;
Christensen, 2009). By “keeping your word” we mean doing
what you said you would do—keeping your promise. There
must be clarity about what one is giving one’s word to, to
whom it is being given, and by when the promise given by the
word will be completed. Research by Sull (Sull, 2003) suggests
that when strategy implementation falters, broken or poorly
understood promises are usually the reason.
Authenticity means being the accountable author of one’s ac-
tions and behaviors (Souba, 2011a). Being authentic is being
and acting consistent with who you hold yourself out to be for
others (to include who you allow others to hold you to be), and
who you hold yourself to be for yourself. To live authentically
means to be, regardless of the circumstances and predicaments
we find ourselves in, responsible for creating our future—i.e.,
“cause in the matter” (Erhard, Jensen, & Granger, 2011). As
humans, we always find ourselves dealing with something that
matters to us in some way; and, in dealing with it, we’re always
“being” some way. For example, if I’m being cynical in dealing
with medicine’s challenges, the world of health care reform
could occur for me as hopeless. While we presume that we, in
our day-to-day lives, display (reveal) our way of being, that
way of being actually reveals us—who we are, what we stand
The term commitment means being “committed to something
bigger than yourself” such that who you are being and your
actions are in service of realizing something beyond your per-
sonal concerns for yourself (Souba, 2011b; Erhard, Jensen, &
Granger, 2011; Erhard, Jensen, Zaffron, & Granger, 2011). The
future is always the context for the present and a bold, compel-
ling future provides you with the resolve and intestinal fortitude
(in the present) to deal with whatever breakdown may occur
along the way to creating that future. Fulfilling on your com-
mitments often creates something to which others can also be
committed, and have a sense that their lives are about some-
thing bigger than themselves. When people are operating inside
these commitments, their tolerance for uncertainty increases,
and their enthusiasm, vitality and ingenuity are enhanced.
The House of Leadership Framework
The four foundational building blocks for “being a leader”
support the five-part framework for exercising effective lead-
ership: relationality, actionality, symbolicity, temporality, and
locality (Figure 3). Leadership isn’t routine (management can
be) and in order for the work of leadership to get done, 1) rela-
tionships are critical; 2) there must be action; 3) language is
essential; 4) it must live in the domain of a created future, and;
5) we must lead “out here” from an as lived perspective rather
than “in here” from a set of theories.
Relationality conveys that leadership is born out of relational
spaces created by building high-powered human interactions.
Effective leadership today entails building connections and
networked relationships that foster creativity, promote collabo-
Copyright © 2013 SciRes. 49
ration and enhance resource exchange (Souba, 2007). Using
fMRI to record brain activity, Stephens and colleagues (Ste-
phens, Silbert & Hasson, 2010) found that during successful
communication, speakers’ and listeners’ brains exhibit tempo-
rally connected response patterns, a “mind meld” of sorts. This
neural coupling abates substantially in the absence of good
Actionality—the state of action—is essential for effective
leadership. There is no mental state, or thought process that
alone effects change—only action does. Interestingly, we tend
to judge others by their actions, while we judge ourselves by
our intentions. All too often, we let ourselves off the hook if we
believe our intentions are good. It is a useful exercise to verify
for yourself that, in the absence of an interceding action, the
future that unfolds will be one that is largely a continuation of
your past. Given the natural correlation between the “occur-
ring” and your way of being and acting, without a shift in the
way in which your leadership challenge occurs for you, your
actions and the results they produce (the future) will be the
Symbolicity refers to our natural propensity to organize our
perceptions and experiences into symbols and symbol systems.
Language (spoken and written) is the major medium leaders use
to make leadership happen. Language is the vehicle we use for
making decisions, resolving most disputes, and conveying pos-
sibilities. While language converts events into “talkable” ob-
jects, it is inevitably associated with variable meanings and dif-
ferent interpretations; thus, “to claim that one’s own viewpoint
is “objective”, that is, valid in all contexts, is clearly a misappro-
priation of the truth” (Mey, 2003).
Things—ideas, conversations, people—become intelligible
to human beings through a process of linguistic distinctions.
Speaking is less about transmitting words to someone else and
more about participating in a “saying” that is a showing. “What
unfolds essentially in language is saying as pointing… The
saying grants those who belong to it their listening to language
and hence their speech… [This saying] lets what is coming to
presence shine forth…” (Heidegger, 1971). In using language
as a “showing” that clarifies priorities or shows the way, good
leaders help themselves and others “see” differently. This
property of language, its ability to bring forth, out of the un-
spoken realm, new ideas and possibilities, will determine the
future of our health care system and our world.
Temporality, as used here, does not refer to clock time.
Rather, it refers to the fact that you have a future that you are
living into. All of your experiences (perceptions, memories, etc.)
have a common temporal structure: a reference to past experi-
ences, a current openness or clearing to what is present, and an
anticipation of the moments of experience that are just about to
happen (Gallagher & Zahavi, in press). Humans can also con-
ceptualize far into the future. If you look for yourself, you will
see that the future is the context for the present. In other words,
both what is so in the present, and the possibilities for dealing
with what is so, occur for you in the context of the future you
are living into (Erhard, Jensen & Granger, 2011). Given the fu-
ture-oriented nature of leadership, temporality is why leader-
ship can happen in the first place.
Locality refers to where leadership happens. Because our
brain generates our life experiences, we tend to believe that
where we (our ways of being) are “located” is in our brain. For
example, if we want to understand someone’s motives, we’ll
often say, “I need to get into his head.” It is not surprising that
we often identify our brain at the center of who we are and
where our “I” resides. But leadership does not happen in your
brain. Your brain generates your ways of being and your ac-
tions, but leadership happens out here in the world. Carol Stei-
ner (Steiner, 2002) explains:
Our fundamental nature [is] to be practically rather than
theoretically open to the world. To be practically open means to
do things with the world, to be active, to be engaged in human
pursuits, to be hands on, to get our hands dirty, rather than “liv-
ing in our heads”… Interpretation does not happen in our heads.
It happens in the world.
Martin Heidegger (Heidegger, 1962; Dreyfus, 1991) recog-
nized the phenomenological nature of leading “out here” a cen-
tury ago when he characterized human being as “being-in-the-
world.” Life as lived happens “out-here” in the world. And
exemplary leaders lead “out-here” rather than “in-here.” The
“in-here” work of thinking, formulating theories, and generat-
ing explanations informs their leadership “out-here.” As life is
lived, how could we be anywhere else? Anton reminds us that
“we are always already in various concrete social relations with
the world; never are we in need of first making contact. Hu-
mans are always already outside themselves, co-caught-up in
various intentional relations and involvements” (Anton, 1999).
I am belaboring this point about where life is lived because,
as physicians and scientists, we spend much of our time ana-
lyzing data, writing grants, and thinking about diagnostic di-
lemmas. Such activities are cognitively intense—we have a ten-
dency to “be in our heads”, so to speak. We might use familiar
expressions such as, “I’ve been racking my brain all day” or
“My brain is fried.” Associated with this tendency to “be in our
heads” is a listening that opines in the midst of our thinking. It
usually shows up for us as a subtle voice that asks questions
and makes judgments like: “Do I agree with that? Am I right? I
don’t believe that.” Understandably, we may come to believe
that who we are is our thoughts, impulses, and urges.
Neuroscience allows us to learn about what happens “in-
here” (in our brain) but we can’t actually experience our acti-
vated neural networks. We can only experience what is gener-
ated “in here” out in the world, that is, “out here” where leader-
ship and life happen. Parker Palmer (1999) eloquently express-
es the importance of the inward journey:
Why must we go in and down? Because as we do so, we will
meet the darkness that we carry within ourselves—the ultimate
source of the shadows that we project onto other people. If we
do not understand that the enemy is within, we will find a thou-
sand ways of making someone ‘out there’ into the enemy, be-
coming leaders who oppress rather than liberate others… Good
leadership comes from people who have penetrated their own
inner darkness and arrived at the place where we are at one with
one another, people who can lead the rest of us to a place of
“hidden wholeness” because they have been there and know the
Creating a New Context
Our dilemmas in health care, as vexing and problematic as
they are, must be confronted. We can’t, in Barbara Shelly’s
words, “go back to the old way, in which the only real guaran-
tee of being able to afford health care was to never, ever get
sick” (Shelley, 2013). As you take on your leadership chal-
lenges, the LLPM and the HOL will provide you with a user’s
manual of sorts. These tools are not intended to be rigid pre-
Copyright © 2013 SciRes.
Copyright © 2013 SciRes. 51
scriptions since, in practice, leadership in not linear or formu-
laic. A heuristic for leading yourself (Table 1) can also be a
useful guide as you take on this work.
Recontextualization is a process that extracts content from its
original context and embeds it into a new context. This refra-
ming process, which is always a linguistically-mediated event,
entails a change of meaning—in other words, a change in the
way in which your leadership challenge occurs for you. How-
ever, before you can create a new context, you must first “un-
conceal” your prevailing context. Exposing your reigning (hid-
den) context(s) involves identifying your unexamined beliefs,
taken-for-granted assumptions, and already always listening
relative to what it is to be a leader and what it is to exercise
effective leadership so as to free yourself from the confines
imposed by them (Souba, 2010; Souba, 2011a; Souba, 2011b;
Erhard, Jensen, & Granger, 2011; Erhard, Jensen, Zaffron, &
Granger, 2011). When your contexts become revealed, you will
begin to see the inadvertent process by which they were created
and the degree to which they govern your leadership decisions.
You will discover that you have a choice about who you can be,
independent from these contexts.
Master leaders use language to recontextualize their leader-
ship challenges so that their naturally correlated ways of being
and acting can emerge, resulting in effective leadership. When
leaders linguistically unveil limiting contexts, they can create
new contexts that shift the way leadership challenges occur for
them. This is step one in providing you access to a wider range
of ways of being and acting.
Creating for oneself a new context is often one of the most
challenging aspects of becoming an extraordinary leader. Our
obsolete mental maps, which frequently worked in the past, are
exceedingly difficult to revise. John Kenneth Galbraith (Gal-
braith, 1971) reminds us that “faced with the choice between
changing one’s mind and proving there’s no need to do so,
almost everyone gets busy on the proof.” Much as a scientist
must think methodically to gain insights into her research ques-
tions, you must apply rigorous thinking to the puzzle called
“you and your leadership.” But these insights aren’t acquired by
measuring or assaying; they are acquired first-hand as an as-
lived experience, through rigorous, disciplined thinking. Many
people think they are thinking when they are simply reshuffling
their biases. We need a higher quality of thinking from more
people in order to transform our health care system. Heidegger
(Heidegger, 1966) pulls no punches when he writes:
Table 1.
A heuristic for leading yourself.
Step Distinction/Comment
Identify a leadership challenge you are dealing with
where you’ve been ineffective (unproductive) in getting
the results you desire.
A leadership challenge exists when you are not realizing the outcome you want for the
circumstances you’re dealing with and, without some intervention (a different approach or
set of tactics), the same unwanted outcome will persist.
How does your leadership challenge occur for you and
how do you occur for yourself in dealing with it? Include
what it is that’s not working for you as well as your
The term “occur” refers to the way in which “what you are dealing with” (the occurring) is
present (shows up) in some way for you (e.g., frustrating, unfair, difficult, hopeless) and
the way in which you occur for yourself in dealing with it (e.g., confident, incompetent,
What unproductive (limiting) ways of being and what
actions (behaviors) are contributing to your
ineffectiveness (underperformance) and hindering you
from leading as your natural self-expression?
Your effectiveness as a leader is a function of your ways of being and your actions (or
inactions). You must “unconceal” these limiting ways of being and acting that constrain
your freedom to lead effectively as your natural self-expression. What gets in the way of
your natural self-expression are the encumbering ways you wound up being.
Verify for yourself that, in the absence of an interceding
action, the future that unfolds will be one that is largely a
continuation of the past.
Given the natural correlation between the “occurring” and your way of being and acting,
without a shift in the way in which your leadership challenge occurs for you, your actions
and the results they produce (the future) will be the same.
Listen to your leadership challenge. Describe the
conversation that is using you? How does it shape the
way in which your leadership challenge occurs for you?
Who you are being moment to moment is a function of your listening. Each of us is a
listening (a conversation with ourselves) that “uses us” by providing us with a point of
view (a context) from which we make sense of our circumstances and orient our actions.
Separate the facts you are dealing with in your leadership
challenge from your “languaging” (interpretation,
explanation, narrative) of the facts.
When you’re able to separate the facts (e.g., my budget got cut) from your interpretation
(that’s not fair, it can’t be balanced), you’ll discover that much of what you believed to be
the case was just your story. What you thought was unalterable now becomes open to
What intuitive and spontaneous ways of being and acting
(i.e., those that are a manifestation of your natural self-
expression) would grant you the performance and results
you desire (that is, enable you to deal effectively with
your leadership challenge)?
Take into consideration universal, all-purpose ways of being and acting that would leave
you more effective (e.g., optimistic, respectful, curious) as well as more distinctive
cognitive and emotional states and actions (e.g., vigilant, analytical, pragmatic, setting
expectations). Recall that the source of your “as lived” performance is most fundamentally
a product of your way of being, and your matched actions.
In what way(s) would your leadership challenge have to
occur for you and how would you have to occur for
yourself so that your naturally self-expressed ways of
being and acting would intuitively arise?
In order to access your leadership challenge so that it occurs for you as hittable rather than
unhittable, you must reframe (recontextualize) it. Recall that the way you choose to speak
to and listen to yourself and to others (i.e., your language) about the challenge you are
dealing with shapes and colors the way those challenges occur for you.
What can you say (to yourself and others) about the
future you are committed to such that your stand for that
future will grant you the being and acting in the present
required to take on your leadership challenge and the
obstacles you will encounter along the way?
In committing to a future that is bigger than you are, the realization of which fulfills on what
is important to you and what you truly care about, you will “re-wire” neural networks in your
brain in such a way that they generate the correlated ways of being and acting necessary to
realize that future as your natural self-expression. Such a potent relationship with language
will give you the power to speak the future you are committed to into existence.
Let us not fool ourselves. All of us, including those who
think professionally, as it were, are often enough thought poor;
we all are far too easily thought-less… Man today is in flight
from thinking. This flight from thought is the ground of
thoughtlessness… Part of this flight is that man will neither see
nor admit it. Man today will even flatly deny this flight from
thinking… For the way to what is near is always the longest
and thus the hardest for us humans. This is the way of medita-
tive thinking. Meditative [reflective] thinking demands of us
not to cling one-sidedly to a single idea, nor to run down a one-
track course of ideas. [Reflection] demands of us that we en-
gage ourselves with what at first sight does not go together at
Each of us experiences the world through the lenses of our
accrued contexts, which arise in, reside in and are continuously
molded by language. Language is and has been a powerful sculp-
tor of who we are today. It is within this context that opportuni-
ties for transformational change reside. Using our willpower to
strip away the various levels of context so people can discover
other possibilities for their relationships, commitments, and ac-
tions is a critical leadership responsibility (Malpas, 2002).
While neuroscientists such as Sam Harris insist that free will is
an illusion, Harris (Harris, 2012) acknowledges that it has actu-
ally increased his feelings of freedom.
A creative change of inputs to the system—learning new
skills, forming new relationships, adopting new habits of atten-
tion—may radically transform one’s life… Getting behind our
conscious thoughts and feelings can allow us to steer a more
intelligent course through our lives.
On the other hand, cognitive psychologist and neuroscientist
Peter Tse accepts that while we are not free to change the way
we are at any moment, we can, through a process he calls dy-
namical synaptic reweighting, change mental events in the fu-
ture. Tse (Tse, 2013) writes:
Physically realized mental events can change the physical
basis not of themselves in the present, but of future mental
events. How? By triggering changes in the physically realized
informational/physical criteria for firing that must be met by
future neuronal inputs before future neuronal firing occurs that
realizes future mental events. Such criterial causation does not
involve self-causation.
Your connectome changes in response to changes in your
thoughts, speech and behaviors. The words that come out of
your mouth matter, a lot. But before you can create a new con-
text that “liberates” your (naturally self-expressed) ways of be-
ing and acting, you must expose your prevailing context(s) and
limiting ways of being and acting that handicap your perform-
ance. This is no cakewalk as our entrenched ways of being and
acting are invariably frozen solid and exceedingly difficult to
thaw. In order to unfreeze them, there must be a compelling
reason to change. There must be something you are willing to
take a stand for. For example, the associate dean leading a ra-
dical curriculum reform initiative must shift his context from,
“The faculty will never buy into this” to “We’re going to design
a curriculum that sets the standard for preparing physician-
In committing to a future bigger than you are (a future that
surpasses than your own agenda), the realization of which ful-
fills on what is important to you and what you truly care about,
you will change your connectome such that its re-wired neural
networks will generate the correlated ways of being and acting
necessary to realize that future as your natural self-expression.
Such a potent relationship with language gives you the power
to speak the future you are committed to into existence. It begs
the question: What can you say about the future you’re commit-
ted to such that it will grant you the being and acting required
to take on your leadership challenge and the obstacles you will
encounter along the way?
Who are You Really
Nobel Laureate Saul Bellows (Bellows, 1976) reminds us
that, as human beings, we are confronted with “an immense,
painful longing for a broader, more flexible, fuller, more co-
herent, more comprehensive account of what we human beings
are, who we are, and what this life is for.” Our understanding of
what it is to be a leader is inseparable from our understanding
of what it is to be human.
Most of us “see” ourselves and others as objects with proper-
ties, titles, abilities, possessions, which can be measured (Table
2). Most humans are concerned with six properties (attributes)
known as the 6 As (our 6 Achilles’ heels): admiration, achieve-
ment, attention, authority, appearance, and affluence (Souba,
2011b). They are the primary indicators of looking good and
measuring up in our culture.
How we understand ourselves is the foundation of our values,
our choices, and our relationships with each other. A context
that understands human beings as objects with properties is
shallow and limiting. What we lose is our awe that the world
actually exists, that we exist (Heidegger, 1962). To be human is
to be amazed by “being” and to be grateful for the privilege of
being alive. Ratcliffe (2013) writes:
Not knowing everything about a person is integral to our
sense of her as a person. The reason for this is that persons are
not merely experienced as objects within one’s world, a sense
of their being persons involves an appreciation of their potential
to reshape one’s world, to transform to varying degrees the pos-
sibilities it offers.
What makes us uniquely human, then, is not our insulated
knowledge, but our fundamental concern or care about our
condition (Heidegger, 1962). Human beings are those beings
for whom their being matters. Care (as used here) does not
mean attending to one’s needs or wants; rather, it is the require-
ment we each have to choose, to take a stand, to make a com-
mitment. Moment by moment we can choose how to “be” as we
deal with life’s challenges. Yet, choosing authentically is a co-
nundrum because we are “thrown” into a world that we do not
choose, one that often seems indifferent to our concerns.
A different way of understanding who we are most funda-
mentally as human beings is as a “clearing” of conscious intel-
ligibility in which we can choose the way in which the world
shows up for us (Heidegger, 1962). As expressed below, this is
a captivating metaphor.
In the midst of beings as a whole an open place occurs. There
is a clearing, a lighting... Only this clearing grants and guaran-
tees to us humans a passage to those beings that we ourselves
are not, and access to the being that we ourselves are (Heideg-
ger, 1971).
The clearing is at once both a physical space (similar to a
glade in a forest) and a field of consciousness (Edgeworth,
2003). In one sense we are the clearing. In another sense, the
clearing is the space where our being emerges, where we be-
come aware and intentional and where other entities emerge out
of hiddenness. While this metaphor might imply that the
Copyright © 2013 SciRes.
Table 2.
Who are we? What does it mean to be human?
Prevailing Understanding
An Object with Properties
Emerging Understanding
A Clearing of Intelligibility
We live (talk, act) as if we’re objects with measurable properties. We
tend to define people based on their properties (job, title, income)
Human beings are drawn to six properties known as the 6As (our 6
Achilles’ heels)
Admiration; achievement; affluence; attention; authority; appearance
This way of understanding who we are, as objects with properties,
promotes unproductive ways of being and acting
Inauthenticity; out of integrity; poor self-awareness; self-absorbed
(committed only to one’s personal agenda)
Human beings are a clearing of conscious intelligibility in which the
world shows up for us. In this clearing, our way of being and acting
match the way in which the world occurs for us. “Things show up in
the light of our understanding of being” (Dreyfus, 1991).
We dwell in already made clearings that have become littered with
outdated, confining ways of being, thinking and working. The “clearing
out” of these outdated mental maps occurs via distinctions, which
always live in language.
The disclosure of the authentic self is always accomplished as a
clearing-away of our concealments (our hidden biases and assumptions).
process of leading yourself is a passive or undemanding one, it
is not. The breakthroughs in thinking that ensue from the in-
ward journey of leadership are frequently “torn out of hidden-
ness” (Heidegger, 1962) such that we experience the “essential
unfolding as the destining of a revealing” (Soccio, 2007). In-
sights often do emerge out of obscurity into the light. And it is
through wrestling with them as they emerge—with all of their
discord and defiance—that transformation is born (Box 2). No-
where is this need for transformation greater than in health care.
The disclosure of the authentic self is always accomplished
as a clearing-away of these concealments, which leads to a
clearing for action that is an “emergent bounded aggregate of
ways of being and acting that become possible through lan-
guage” (Crevani, 2011). Language allows us to be astonished
by Being (Heidegger, 1979). Once we become truly amazed by
“being” we cannot help but be grateful for the privilege of ex-
periencing the world with a continual sense of appreciation and
wonder. Given this context, we must each ask: In the clearing
that I am, what ways of being and what behaviors will create
the requisite leadership that will ensure a bright future for
health care?
In his Magnum opus, The Master and his Emissary, Iain
McGilchrist (McGilchrist, 2012) argues that the left hemisphere
of the human brain, which thinks in classes and categories, has
slowly come to dominate the right hemisphere, which provides
us with meaning and has “ontological supremacy.” This domi-
nance has resulted in bureaucratization, fragmentation, exces-
sively rigid thinking, and an unhealthy focus on metrics such
that “we’re in danger of forgetting everything that makes us
McGilchrist contends that left brain’s emphasis on represen-
tational language developed because of its practical utility but
at the expense of context and awareness of the inherent. We
must reengage the right brain in the health care reform conver-
sation. The solution is not just a question of better integrating
the two hemispheres. The right brain is both the gatekeeper and
the conciliator, an especially important role when it comes to
tackling leadership challenges. Without this wisdom, our com-
plex challenges will continue to plague us.
The author thanks Meredith Bartelstein, Kathi Becker, James
Borchert, Joe DiMaggio, Werner Erhard, Faith Goodness, Kari
Granger, Aaron Grober, Deborah Hastings, Michael Jensen,
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Copyright © 2013 SciRes.
Box 1. Your Natural Self-Expression
Imagine what it would be like if you met (for the first time)
your greatest hero and you didn’t have to figure out in your
head how to “be” with that person. You didn’t have to concern
yourself with impressing that person or winning him or her
over or looking good as you became acquainted. In other words,
the “you” that showed up was your natural, spontaneous and
inherent way of being and acting. Your natural self-expression
was just there. By “natural self-expression” we mean that way
of being and acting that is an intuitive and effortless response to
whatever set of circumstances one is dealing with (Souba,
Suppose you weren’t limited to those automatic, ineffective
ways of being that often show up when you’re confronted with
a difficult challenge such as a budget shortfall or poor per-
former? What if you weren’t stuck with your kneejerk predis-
position to raising your voice, making excuses, blaming others,
or disengaging when the going gets tough? What if you had
access to a much wider range of possible ways of being and
acting rather than being confined to those default ways of being
that have become so engrained yet are so unhelpful and unpro-
ductive? What if your natural self-expression prevailed regard-
less of what was thrown at you in life? What if you were free to
just “be” at any and all times with no limitations? What would
it be like to always have access to your best self, leading as
your natural self-expression rather than from some compen-
dium of theories or concepts?
In dealing with any leadership situation, what if that thing
(voice) that was already always there watching you, judging
you, keeping score wasn’t there? What if that “I”, your iden-
tity, that you think defines you wasn’t there either? What would
it be like to experience life inside a context such that you were
always fully present to life and your natural self-expression was
one of being fully engaged with whatever you were dealing
with, to include the disappointments, and the defeats?
Your effectiveness (performance) as a leader is largely a
function of your ways of being and your actions (or inactions)
(Souba, 2011b; Erhard, Jensen, & Granger, 2011; Erhard, Jen-
sen, Zaffron, & Granger, 2011). In order to gain access to lead-
ing as your natural self-expression, you must first expose your
engrained beliefs and worldviews about leadership (e.g., I have
to look good; If I fail, I’ll look incompetent; I have to be in
charge) that are holding you back. This will allow you to loosen
up those limiting (and often hidden) ways of being and acting
that have become your automatic go-to winning formulas (e.g.,
micromanaging, avoiding tough conversations, blaming others)
that actually constrain your freedom to lead effectively.
When Michelangelo was asked how he went about creating
his masterpiece David out of a massive block of marble, he said,
“David was inside the rock all along. My only job was to re-
move the unnecessary rock from around him so he could es-
cape.” (Watts, 2011). In a sense, Michelangelo removed the
barriers to the marble’s natural expression of itself. Similarly,
what gets in the way of our natural self-expression is the en-
cumbering ways we wound up being. When we relax their hold
on us, we make room to create a new context (a new, wider
leadership lens) that has the power in any leadership situation to
shape the circumstances we’re dealing with such that our way
of being and acting will be consistent with being a leader and
exercising leadership effectively (Souba, 2011b; Erhard, Jensen,
Granger, 2011; Erhard, Jensen, Zaffron, & Granger, 2011). &
Box 2. Moth or Chameleon Leadership
In the first half of the 19th century, England transitioned from
an agricultural economy to an industrial one. Prior to this, light-
colored moths were able to blend in with light-colored bark and
tree lichens, while the less common black moth, unable to dis-
guise itself, was more likely to be eaten by birds. When the
London countryside became inundated with emissions from new
coal-burning factories, the lichens died and the trees became
black from soot and grime. This provided protection to dark-
colored moths while the lighter-colored moths (which had lost
their survival advantage) were easy targets for birds and even-
tually died off. This kind of directional natural selection, in re-
sponse to changing conditions, highlights the plight of the aca-
demic medical center that is unable to change.
In contrast to moths, the dwarf chameleon uses its real-time
color changing abilities to camouflage and protect itself. De-
pending on the environmental circumstances the chameleon is
dealing with, it is able to change its color palette in millisec-
onds to acclimatize to temperature changes, adapt to stress, and
avoid predators. Said somewhat metaphorically, the chameleon
is able to alter its way of being such that its natural self-expres-
sion matches the circumstances it is dealing with.
When dealing with change, defaulting to our familiar, auto-
matic ways of being and behaving that have worked in the past
is a natural human tendency. If the solutions to the problems
that confront us were straightforward, standard operating proce-
dures might be enough. Increasingly, however, we are con-
fronted in health care with challenges that are unanticipated,
unfamiliar, and complex. In this kind of environment, leaders
must have access to a much broader, more imaginative range of
ways of leading.
Humans do not have camouflage faculties but we do have
language. Whereas biologic evolution was the sole determinant
of change for eons, the introduction of language changed the
possibilities. Language overcomes the protracted and limited al-
ternatives that evolution makes available; it “is exactly what
enables us to change our behavior, or invent vast ranges of new
behavior, practically overnight, with no concomitant genetic
changes” (Bickerton, 1996).
Boje and colleagues (Boje, Oswick & Ford, 2004) stress that
“language is… a way to recontextualize content. We do not just
report and describe with language; we also create with it. And
what we create in language “uses us” in that it provides a point
of view (a context) within which we “know” reality and orient
our actions.” In other words, the way you choose to speak to
and listen to yourself and to others about the leadership chal-
lenge you’re dealing with shapes and colors the way in which it
occurs for you. When language brings about a revision in our
worldview, context or thinking, the way in which our circum-
stances or problems occur for us invariably shift. When this
happens, it opens the door to new thinking constructs, new at-
titudes, and new ways of working together. Master leaders use
language to recontextualize their leadership challenges in such
a way that their naturally correlated ways of being and acting
provide them with new opportunity sets for exercising leader-
ship as their natural self-expression. Indeed, it is this very pro-
perty of language, its ability to change our thinking to modify
behavior, which will determine the kind of health care system
that we will create.
Are you a moth leader with a fixed way of being or a chame-
leon leader who’s not stuck with a single way of being and
cting? a
Copyright © 2013 SciRes. 55
... 101 Patient safety is subject to voluntary participation of every single care provider, and everyone in an organization may become a leader developing new processes or other people's skills with their personality and behaviors. 22,25,95,102,103 The process to be a clinical leader in a specific situation starts with individual motivation. 103,104 "Empowerment is not granted by the organization, people must empower themselves". ...
... 103,104 "Empowerment is not granted by the organization, people must empower themselves". 103 Organizational and contextual factors: cultural change Challenge Studies and reviews regarding effective implementation of patient safety conclude that a culture change is mandatory. 13,17,[28][29][30][31][32] Culture change is a huge operation accompanied by unpredictability and uncertainty over a long period of time. ...
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Background: Aiming for and ensuring effective patient safety is a major priority in the management and culture of every health care organization. The pediatric intensive care unit (PICU) has become a workplace with a high diversity of multidisciplinary physicians and professionals. Therefore, delivery of high-quality care with optimal patient safety in a PICU is dependent on effective interprofessional team management. Nevertheless, ineffective interprofessional teamwork remains ubiquitous. Methods: We based our review on the framework for interprofessional teamwork recently published in association with the UK Centre for Advancement of Interprofessional Education. Articles were selected to achieve better understanding and to include and translate new ideas and concepts. Findings: The barrier between autonomous nurses and doctors in the PICU within their silos of specialization, the failure of shared mental models, a culture of disrespect, and the lack of empowering parents as team members preclude interprofessional team management and patient safety. A mindset of individual responsibility and accountability embedded in a network of equivalent partners, including the patient and their family members, is required to achieve optimal interprofessional care. Second, working competently as an interprofessional team is a learning process. Working declared as a learning process, psychological safety, and speaking up are pivotal factors to learning in daily practice. Finally, changes in small steps at the level of the microlevel unit are the bases to improve interprofessional team management and patient safety. Once small things with potential impact can be changed in one's own unit, engagement of health care professionals occurs and projects become accepted. Conclusion: Bottom-up patient safety initiatives encouraging participation of every single care provider by learning effective interprofessional team management within daily practice may be an effective way of fostering patient safety.
... In closing, Souba posited that transforming health care does not begin outwardly with systemic transformation but rather inwardly with personal transformation. 38 Leveraging the lived experience of resident physicians to teach EI through reflection provides a rich, applicable vehicle for personal transformation. Such personal transformation is critical to creating physician leaders with the requisite complexity to face emerging challenges in health care. ...
The shifting health care landscape in the United States has surfaced challenges related to increased accountability, interprofessional health care teams, and changes in federal policy—all of which compel physicians to adopt roles beyond clinician such as clinical investigator, team leader, and manager. To address these challenges, leadership development programs across the continuum of medical education aim to develop critical leadership skills and competencies, such as emotional intelligence. Such skills and competencies are largely taught through didactic approaches (e.g., classroom). These approaches often neglect the context of learning. From medical residency to a hospital or clinic, the contextual lived experience is habitually overlooked as a vehicle for developing emotional intelligence. This article highlights lived experience, such as medical residency, as an approach to develop emotional intelligence. First, we address the need for developing emotional intelligence as a leadership skill as well as the suitability of medical residency for such development. Next, we discuss the background of lived experience and emotional intelligence. Lastly, we identify future directions for leveraging lived experiences of medical residency to develop emotional intelligence.
... Die Einführung und Anwendung eines CIRS auf organisatorischer Ebene ohne Einbezug aller Mitarbeitenden im Krankenhaus können nicht erfolgreich sein, daher sind kontinuierliche Informationen und Diskussionen mit Pflegenden und Ärzten aller Hierarchiestufen unabdingbar [13,31,37,45,52]. "Systems don't change in any meaningful kind of way until and unless people change first" [43]. ...
Background To record and analyze critical incidents is of paramount importance for any organization dedicated to improving patient safety. Therefore, many hospitals have implemented a critical incident reporting system (CIRS). However, the impact, benefits and use of such CIRS systems on patient safety have often been reported to be unsatisfactory. Aim What have we learned over the past decade about the effective and optimal use of a CIRS? Material and methods Following the Yorkshire contributory factors framework, the potential benefits of a CIRS are illustrated with selected examples from the neonatal and pediatric intensive care unit. Based on a literature search in PubMed from January 2000 to December 2014 this article also describes critical factors and concepts for the successful use of a CIRS. Results A positive mind-set towards errors, high psychological safety and the conviction that a CIRS can be beneficial are important factors to encourage individual healthcare personnel to report critical incidents and learn from errors. On the part of the organization, adequate resources of personnel, systematic analysis of the reported incidents as well as dissemination of the results and implementation of safety improvement strategies are critical factors for the effective use of a CIRS. All incidents with potential relevance for patient safety should be reported. The categorization of the reported incidents facilitates the analysis and identification of relevant conclusions. As an organization dedicated to improve patient safety we have to learn from errors as well as from successes. Conclusion The successful use of a CIRS depends on the motivation of individual healthcare providers as well as on organizational features that encourage critical incident reporting.
... Simply "willing" ourselves to change our unproductive ways of being and acting often fails because our moment-to-moment, situation-to-situation ways of being and acting are determined by neural networks. You do not control your way of being-your brain does (Erhard et al., 2013;Souba, 2013). If you could choose your way of being, you would instantly change it whenever you wanted to or thought you should. ...
Full-text available
Teaching people about leadership is different from creating leaders. Teaching leadership uses a third-person approach to impart someone else’s knowledge, which grants learners limited direct access to the being and actions of effective leaders. In contrast, creating leaders entails a firstperson phenomenological methodology, which provides direct access to what it means to be a leader and what it means to exercise good leadership in real time, with real results. The distinctiveness of the first-person “as-lived/lived-through” approach lies in its capacity to disclose the hidden contexts that shape the ways of being, thinking, and acting that are the source of the leader’s performance. When these contexts become unveiled, it allows for the creation of new contexts that give leaders more space and more degrees of freedom to lead effectively as their natural selfexpression. A phenomenological inquiry into leadership does not study the attributes of leaders, but rather the fundamental structures of human “being” that make it possible to be a leader in the first place. Because the phenomenological “facts” of lived experience reside in language, creating for oneself what it is to be a leader entails mastering a special language (that includes terms like intentionality; thrownness; being-in-the-world; clearing-for-action; absorbed coping; hermeneutic; and, break-down) from which leaders can orient their being, thinking, and actions. Learning to be a leader is not first and foremost about the acquisition of knowledge or certain personal attributes. Rather, only when leadership becomes an as-lived/lived-through experience does it grant access to its actual nature and essence.
... As Wiley Souba suggests, the status quo of the United States healthcare system is unsustainable (Souba, 2013), making the role of the public health leader difficult. Albert Einstein defined insanity as "doing the same thing over and over again and expecting different results". ...
Full-text available
The following short report lays the groundwork for rethinking the practice and implications of public health leadership in the context of liberation health. Liberation health reduces to a universal idea:health is freedom. In short, everyone holds a subjective notion of health and, within certain bounds, has the right to promote and maintain that health. This report briefly describes liberation health, discusses the implications of liberation health for public health leadership, and outlines two needed transformations in moving towards a liberation health model of leadership. The report details areas for future research on this topic among public health leaders and within public health curricula.
Human beings are fundamentally future oriented. Most of our decisions and undertakings are for the sake of a future to which we are committed or obligated. This future orientation is essential to effective leadership in health care, especially during this time of significant reform, when people are at risk of becoming cynical and disengaged. Conventional thinking holds that our effectiveness as leaders is primarily a function of what we have learned in the past-our knowledge, expertise, and experience. In contrast, the emerging model contends that our effectiveness is also a function of how the future (outcome) of our leadership challenges "shows up" for us. If, despite daunting circumstances, we can "see" an aspired future ahead, we are more likely to commit and engage. Our story of the future becomes the "narrative frame" through which we see and tackle leadership challenges today. Because organizations are fundamentally networks of conversations, an organization's ability to create new language practices is tantamount to its ability to evolve. What makes the future compelling is the embodiment of our deepest convictions and ideals in our image of the future. Because health care reform has challenged the medical profession along the entire spectrum of its traditional values and roles, working toward a unifying vision of the future has been difficult. To enroll others in creating a better future, effective leaders must underscore the purpose and importance of their work and motivate them with inspiring stories.
Mastery of any discipline entails both the requisite skills and the ability to see things as “hittable.” However, the concept of “hittability,” which, in the context of leadership, refers to whether or not a specific leadership challenge shows up as hittable (or solvable) for those who are responsible for taking it on, is consistently overlooked. Nevertheless, it is a critical determinant of leadership effectiveness. Hittability is a function of the framing lenses—a person’s beliefs, values, and worldviews—which frame the way a person “sees” a leadership challenge. Additionally, the future a person is “living into” is the framing lens for the present. In other words, a person’s view of the future shapes his or her view of the present and his or her actions within it. Because the beliefs, values, and worldviews that constitute our framing lenses are constituted in and accessible through language (i.e., in the day-to-day stories, or narratives, a person tells him- or herself), reframing them to create a new future requires a new narrative. The ability to shift the previously unhittable to the hittable won’t be, primarily, due to some newly acquired knowledge. Rather, it will be the result of reframing our challenges so they show up as hittable.
Most health care transformation efforts are unsuccessful because they overlook the importance of personal transformation in enabling major systemic change. Personal transformation is about creating access to a broader range of ways of being, thinking, and acting in order to be more effective in dealing with those challenges for which conventional strategies are inadequate. As many of the changes that are taking place in health care are inevitable, mastering context is critical to transformation. In moving the organization forward, key thought leaders who embrace new ways of working together can help others recontextualize their challenges, thereby serving as important catalysts for diffusing these innovations into the culture. The ensuing improvement in performance is less the result of having learned some new concept or theory and more a function of having altered the context through which one's challenges are understood. When individual transformation parallels organizational transformation, a tipping point is reached where there is a visible increase in organizational members' effectiveness, a marked increase in organizational members' impact on others' performance, and a collective experience that work is more fulfilling.
Purpose The aim of this paper is to give an account of a self‐evaluation process in a change programme within the US Coast Guard. Design/methodology/approach This is an autoethnographical account as form of reflection on a leadership in position facilitating change within the organization. Findings Adaptive organizational change is a human endeavor, not a scientific application of techniques and skills. Research limitations/implications The authoethnography points mainly only to a change process of the writer and is therefore hardly an abstract model for others. Practical implications Meaningful organizational transformation does not occur without a corresponding self‐transformation, most importantly of the individual leading the change. Originality/value Changing oneself by managing change process as a leader, one has to become the change process in order to be successful.
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This philosophical paper suggests that almost all academic research, including qualitative research, is conducted under the influence of a "technicity paradigm" which values objectivity, generalisability and rationality. This paper explores, from a Heideggerian perspective, the fundamental characteristics of research under the influence of technicity and discusses how these characteristics manifest in qualitative research. It includes a reflection on what qualitative research might be like if it could escape the influence of technicity and realise its potential for inclusive and relevant knowledge making.
The issues of mental causation, consciousness, and free will have vexed philosophers since Plato. In this book, Peter Tse examines these unresolved issues from a neuroscientific perspective. In contrast with philosophers who use logic rather than data to argue whether mental causation or consciousness can exist given unproven first assumptions, Tse proposes that we instead listen to what neurons have to say. Tse draws on exciting recent neuroscientific data concerning how informational causation is realized in physical causation at the level of NMDA receptors, synapses, dendrites, neurons, and neuronal circuits. He argues that a particular kind of strong free will and "downward" mental causation are realized in rapid synaptic plasticity. Such informational causation cannot change the physical basis of information realized in the present, but it can change the physical basis of information that may be realized in the immediate future. This gets around the standard argument against free will centered on the impossibility of self-causation. Tse explores the ways that mental causation and qualia might be realized in this kind of neuronal and associated information-processing architecture, and considers the psychological and philosophical implications of having such an architecture realized in our brains. © 2013 Massachusetts Institute of Technology. All rights reserved.
What makes a great manager great? Despite differences in their personal attributes, successful managers all excel in the making, honoring, and remaking of commitments. Managerial commitments take many forms, from capital investments to personnel decisions to public statements, but each exerts both immediate and enduring influence on a company. A leader's commitments shape a business's identity, define its strengths and weaknesses, establish its opportunities and limitations, and set its direction. Executives can all too easily forget that commitments are extraordinarily powerful. Caught up in the present, managers often take actions that, while beneficial in the near term, impose lasting constraints on their operations and organizations. When market or competitive conditions change, they can find themselves unable to respond effectively. Managers who understand the nature and power of their commitments can wield them more effectively throughout a company's life cycle. Entrepreneurs can avoid taking actions that imprint a new venture with a dysfunctional character. Managers in established enterprises can buttress past commitments that retain their currency and learn to recognize when commitments have become roadblocks to needed changes. The manager can then replace those roadblocks with new, rejuvenating commitments. That doesn't mean you should try to anticipate all the long-run consequences of every commitment-and it certainly doesn't mean you should shy away from making commitments. But it does mean that before making important decisions about, say, operating processes or partnerships, you should always ask yourself: Is this a process or relationship that we can live with in the future? Am I locking us into a course that we'll come to regret?
Many clinical approaches assume that the development of new stories or narratives is at the heart of therapeutic change. But why is it often so difficult for clients to modify the stories that organize their lives? Why do new insights gained in therapy fade so quickly when clients return to their daily living? Provocative new neurological research suggests that self-defeating narratives may persist because they are woven into the fabric of internal states which are automatically activated in daily living, often without conscious awareness. New brain studies suggest that, for changes acquired in therapy to last, they must be integrated into brain states that become active when upsetting situations occur. This paper introduces methods for helping clients identify internal states which perpetuate outmoded thoughts, attitudes, and interactions, “re-wire” these states for more flexibility, and activate alternate states which support new avenues for thought and action.