Common Sense

What Does Leadership Look Like? (Part 2)

Issue: May/June 2021

Author: Lisa A. Moreno, MD MS MSCR FAAEM FIFEM
President, AAEM


  1. Great leaders learn from great leaders.
  2. Great leaders surround themselves with brilliant, trusted experts. Trust means not just that they know their stuff, but that they will tell you the truth and guide you with love and wisdom to do what is best for the organization.
  3. Great leaders listen to all voices.
  4. Great leaders think about their legacy.
  5. Great leaders recognize the responsibility to create other great leaders. 
  6. Great leaders make decisions, knowing that they will make enemies. 
  7. Great leaders know it’s about the organization first. 
  8. Great leaders do not engage in personal attacks. 
  9. Great leaders accept the ultimate responsibility for everything that happens in the organization. 
  10. Great leaders give responsibility for success to those around them. 

Welcome to Part 2 of “What Does Leadership Look Like?” Part 1 (Common Sense 28:2, March/April issue) covered the first five of the qualities of a good leader that emerged from the discussions taking place during Leadership Academy. Today, we look at the other five.

6. Great leaders make decisions, knowing that they will make enemies. 

During a discussion, a few nights ago with Dr. Juan Nieto, Dr. Nieto commented to me that great leaders emerge in times of crisis. This reminded me of Dr. Amal Mattu’s talk, in which he told us that none of the U.S. presidents who held office during times when no war, no depression, no crisis existed have become renowned. Leadership emerges out of the need to make tough decisions. And tough decisions can make or break a leader. The famous physician, Maimonides, once said, “The risk of a wrong decision is preferable to the terror of indecision.” Yet how many people flounder in the waters of indecision, paralyzed by the need to “look good,” to not make a mistake, to please those around them. Madame C. J. Walker opened her factory to celebrate the beauty of the Black woman and to provide jobs for Black females at a salary that was four times that which they were earning as laundresses and domestic servants. Booker T. Washington told her she got it wrong; that the Black man needed to be lifted first. W. E. B. DuBois called her work magnificent. Did she make the right decision? Did Robert the Bruce make the right decision? King Edward thought not. Did President Abraham Lincoln make the right decision? Jefferson Davis thought not. Warriors coach Steve Kerr said in an interview with Sports Illustrated a few years ago that a leader needs to be prepared to be criticized. He explained that a coach needs to know each player and what they need, what the team needs, what the owners expect, what the Association’s rules are, how the crew chief is likely to call a play, what the opposing team is likely to do, and what their coach is thinking. So, he said, you’re going to be criticized. With all those moving parts, someone is bound to call you wrong, to say you should have done better or different. “But they don’t see what we see; they’re not out there.” So you make the best decision you can, knowing what you know. You stand behind your decision, take the criticism, and keep it moving. As President Lincoln said, “You can’t please all of the people all of the time,” and if that’s what you’re trying to do, you’ll end up pleasing no one and being a mediocre leader. 

7. Great leaders know it’s about the organization first.

I mentioned in my last column that three generations after we leave this life, no one will remember our names, but we can leave a legacy that will endure. Even when names are remembered, in the cases where professorships and chairs, buildings and wings of buildings, endowed foundations, and awards are named after people, we don’t usually know who those people were. What endures are the principals they embodied, the causes they supported, the good work that they did. Very few people know the name of Nellie Bly, but everyone has benefitted from the work that Bly did to catalyze the reform of psychiatric hospitals.1 Wise leaders like Bly’s editor, Joseph Pulitzer, who himself is the namesake of one of those eponymous awards, know that creating an environment where every member can achieve to their utmost ability creates an organization with impact. Vince Lombardi, who knew a lot about how teamwork makes the dream work, once said, “The achievements of an organization are the results of the combined effort of each individual.” It is not true that every individual must succeed if the organization is to succeed. We know that every organization has individuals who are members in name only. But it is true that every individual who puts out effort for the organization can improve its impact. The old Vidal Sassoon ads, which were punned on SNL for years, used to say, “If you look good, we look good.” The Emory University Department of Emergency Medicine is a great example of this axiom. This is a department that for years has had a culture of developing each of its members towards excellence in a niche area, understanding that the entire department benefits when people think of them when needing an expert in a particular area of emergency care, such as education or palliative care or toxicology. The American University of Beirut Department of Emergency Medicine is led in the same way. Dr. Eveline Hitti will send a young faculty member away to do a fellowship in an area that needs development in her department so that the department will grow in strength through growth in expertise. “An important part of leadership is being able to hold two things in your mind at once: Dealing with the reality, whatever it may be, and focus on hope for the future. Any leader helping an organization through challenges needs to be able to do both.”2 That balance is critical. It’s not about me; it’s about the organization. And to grow the organization, to create an organization that is legacy making, the leader needs to see where we are and what we need and have an eye to developing the future. The leader must weigh what is good for the individual member (or a small group of members) against what is good for the organization and strike that elegant balance between the two.

8. Great leaders do not engage in personal attacks.

Towards the end of a long and accomplished life, Benjamin Franklin stated, “Any fool can criticize, condemn, and complain- and most fools do.” Pointing a finger at others is a very easy thing to do, but it is not at all productive. No one is blameless when a problem exists. Both parties have contributed to the problem. But rather than seeking to apply blame, if our true goal is to resolve a problem, we need to look at the process that created the problem and suggest a way in which that process might be altered. Insightful historians rarely focus on the evil personal qualities of a dictator, but rather on the historical construct in which a dictator was able to rise to power, and the strategies he employed to stay in power. It’s the process that allows the problem to emerge. And the process is not always the “fault” of the person being blamed. The “smear campaigns” we see all too often in organizations are more appropriate to children in a playground calling out, “You said this,” “No, I didn’t,” and “You did this,” “Well, you did that.” Clearly nothing is getting accomplished here. Dr. Theodore Cherbuliez, one of my early mentors, used to say that the only things accomplished by personal attacks are alienation and fostering defensiveness. No one wins this game. As we discussed in last issue’s column, when you try to show strength by pushing someone else down, you lower yourself in the process. I make it a policy never to engage in personal attacks and never to respond to them. I prefer Michelle Obama’s approach: “When they go low, we go high.” In her words, “When I say ‘go high,’ I’m not trying to win the argument. I’m trying to figure out how to understand you and how I can help you to understand me.”

9. Great leaders accept the ultimate responsibility for everything that happens in the organization. 

“Passing the buck” was an old poker term that came to be used in international relations theory during the Second World War. According to Wikipedia, it “involves the tendency of nation-states to refuse to confront a growing threat in the hopes that another state will. The most notable example was the refusal of the United Kingdom, United States, France, or the Soviet Union to confront Nazi Germany effectively in the 1930s. With the Munich Agreement, France and the United Kingdom avoided armed confrontation with Germany, passing the buck to the Soviet Union, which then passed the buck back to the western powers by signing the Molotov–Ribbentrop Pact.” When he was elected President, Harry S. Truman was determined that such behavior would never occur again, and in 1959, he had a sign placed on his desk in the Oval Office reading, “The buck stops here.” Truman told the country that the President has to make the decisions and accept the ultimate responsibility for the decisions. I learned long ago that accepting responsibility creates endless opportunity. As I tell my medical students and residents, if something is the patient’s fault, or someone else’s fault, there is nothing we can do about it because we can’t control other people and we can’t change other people. But if something is our fault, we have the power to change it and get it right. 

When I began running my HIV testing program, I could not keep lab staff on the night schedule. I was frustrated and wanted to figure out what the lab supervisor was doing wrong, but then I remembered my own maxim: If I own the responsibility for the problem, I have the power to fix it. I asked the lab staff to tell me what I could do to ensure that we would have staff on the night shifts. They looked at each other, and then one of them said to me, “Well, Dr. Moreno, you pay fifty cents an hour less to your night technicians than anyone else in the city does, so no one wants to work here at night.” I increased the pay to match the city average and I never had an unfilled shift again. It was a powerful lesson. When you are the leader, you are responsible for everything. If you are responsible for everything, you are empowered to make things right. And when your team knows you take responsibility, they believe that you have their back, and they are empowered to focus all their energy on doing their very best and not give any energy to worry about making mistakes. If they make a mistake, the leader knows it was inadvertent, will have their back, and work with them to fix things. This is precisely the reason that AAEM endorses due process. An employer that gives a physician due process is saying to that physician, “Do what is best for the patients. Take care of them. Don’t worry about retaliation for doing the right thing for the patients. If the administration has a complaint about you, we’ve got your back. You’ll have a right to defend yourself before a group of your peers.” 

10. Great leaders give responsibility for success to those around them. 

One of the many blessings of my professional life was having Dr. Peter DeBlieux as my mentor at LSU- New Orleans. Peter taught me more valuable things than I can ever recount, but one of the most valuable was his personal mantra Praise publicly, correct privately. When I was a medical student, I repeatedly witnessed attendings tell patients about the procedures they had done, when a resident had done the procedure while the attending was in the lounge. I saw Chairs put their names on papers that were written by their attendings. I saw CEOs tell Boards of Trustees about successful projects they had initiated which were really imitated by a Chair. But when something went wrong, it was immediately attributed to the person on the lower rung of the career ladder. We had an expression for that phenomenon: Shit runs downhill. But Dr. DeBlieux taught me that praise should run downhill, and shit should run uphill. It’s a beautiful thing to see the smiles on the faces and the gleams in the eyes of those who are praised for their accomplishments. And anyone smart enough to be a Chair or a Trustee is smart enough to know that if good stuff is being accomplished, there is a great leader at the helm. There is no need to seek praise when your team is doing well. Their excellence speaks for the work that you do, creating a culture of excellence where everyone can thrive. (See # 7: It’s about the organization first. If you look good, we all look good.) 

I admit to using a lot of quotes from coaches. While I do love basketball, coaches of winning teams have a lot of wisdom to share about what makes a team succeed. Steve Kerr aptly describes the ideal leader: “They have this amazing combination of total belief in themselves and their ability and talent yet have a genuine modesty and awareness of how lucky they are.”

At AAEM, we know how lucky we are to serve the membership of the EM organization that embodies integrity, honesty, doing the right thing, and going high when they go low. It is an honor and a privilege to watch the next group of great leaders coming up in AAEM/RSA, YPS, and our Leadership Academy. You are the future of emergency medicine. We hope to serve you well so that you will be well prepared to take us into the future. 


Foot Notes

  1. In 1887, Elizabeth Jane Cochran, pen name Nellie Bly, was a newspaper reporter for the New York World who feigned mental illness and was confined to the Women’s Lunatic Asylum on Blackwell’s Island in New York City. Ten days later, Bly’s editor, Joseph Pulitzer, arranged her release by exposing the ploy. Bly went on to write a book, Ten Days in a Mad House, and to write several news articles that exposed the barbaric treatment of psychiatric patients and the use of these facilities to warehouse marginalized women. Bly’s work resulted in the reform of the mental health treatment system in the United States. 
  2. Alan Mulally, an aerospace engineer who served as CEO of Ford Motor Company. 


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