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What the Ebola Crisis Can Teach Us About Leadership

Wednesday, November 5, 2014

What the Ebola Crisis Can Teach Us About Leadership

“You’ve got to pick a fight with some musician,” gruffly declared my conducting teacher. “Otherwise the orchestra won’t take you seriously.” And so, once in every other rehearsal, I’d watch him attack some defenseless player. You could hear a pin drop, the atmosphere was so tense. Then, after a seemingly interminable silence of collective fear, he’d crack a very clever joke and the tension burst like the popping of a balloon. He was totally in control and relishing his power. Because he was very intelligent, had an excellent memory, a very good ear, and knew his stuff really well, he drew very energetic performances from the orchestra.

I admired him enormously and learned so much from him, but I just couldn’t embrace his ideas about leadership. Behind his bullying was the conviction that most people are inherently lazy and careless, and need to be policed by someone who knows better. I was inexperienced at the time, but I believed that an orchestra could be motivated by leveraging the players’ collective artistry and finding inspiration in the music. It took me decades to bring to fruition my own way of accomplishing this, and this approach forms the core of The Music Paradigm.

But what, you may ask, does this have to do with ebola?

The current panic about the ebola virus has made us all question how safe we really are in our overstretched healthcare system. But the central issue is not only ebola, but patient safety in general and all the time. And, with regard to patient safety, my teacher’s ideas about leadership may be a big part of the problem.

There is no way that even brilliant, tenured, or the most experienced medical professionals alone can contain the epidemic of ebola. The simple act of a nurse donning a protective garment, if not perfectly executed, can allow the virus to leak beyond the quarantined zone. Controlling the ebola outbreak is a highly collaborative endeavor that challenges everyone involved to take ownership of the entire process, sharing information and insight. It highlights the importance of relying on one another. That can only happen when the leader inspires a culture of openness and trust, where skilled listening is as crucial as any complicated medical procedure.

Let’s imagine my conducting teacher chairing a meeting at a hospital to decide the most basic questions: through which entrance to the hospital should a potential ebola patient enter? Should it be on a stretcher in the ambulance bay, or through the normal walk-in area, or through the emergency triage area? My teacher, feeling that he has the most experience and knows the hospital best, makes his wisest decision, and then announces it to the team. The meeting is only about how his orders should be implemented. Because he doesn’t really believe that anyone could come up with concerns he hasn’t thought of, he sees discussion and dialogue as a waste of valuable time. Decision over, let’s get moving.

Here’s why he is a big part of the problem: as brilliant as he is, he cannot be on every floor of the hospital or in the emergency department every day. There may be important factors that are in his blind spot. By refusing to listen to discussion, he leaves the hospital vulnerable to tiny imperfections in his plan. But let’s suppose that his plan is perfect. Even then his approach is flawed and dangerous.

His meeting conveys a hidden messages to his team. It says, “I don’t really value what you have to say. I value you only as the workforce who implements my plan. And therefore until further notice just keep your mouth closed.” He certainly doesn’t want to impede the flow of information. But at the outset he must establish a culture of trust that encourages truth telling (especially when it’s bad news), or else people will not come forward for fear of blame and punishment. His power is so obvious to everyone that he needs to counter-balance it with repeated communication about his openness to hearing others’ reactions, and especially their concerns. He needs people to not only implement his plan, but also to own it. Only then can they invest their own energy and intelligence, which may be decisive in protecting a patient or one of their own colleagues.

In The Music Paradigm I sometimes role play my teacher’s worst behavior and then ask musicians to describe their experience. Many of them speak of how their attention can no longer be devoted to listening to their colleagues, but must be distracted by protecting themselves from the conductor. The audience, seated inside the orchestra, draws fresh insights about what might be going on inside their own organizations. This lesson of “bad behavior,” in particular, seems to resonate deeply in healthcare institutions where hierarchical culture has often been the norm.

You can click here to read more about a recent Music Paradigm session we did for the nursing leadership at New York Presbyterian Hospital, who sought to dramatize how enlightened leadership can improve effectiveness in today’s complex healthcare systems.




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