Thoughts on servant leadership: Fostering a collaborative culture
Over the years, I have met with many hospital leaders who embrace different management styles. Some of the most memorable have been executives who dominated their management teams and stifled independent thought.
I can only liken this type of management style to kudzu, the sweeping green vine that grows along highways. It appears peaceful and harmonious, like one giant piece of thick green carpet — but if you look closely, the vine's heaviness smothers the flora underneath in an epic oxygen grab.
I recently learned of a management philosophy that is the exact opposite of kudzu. Servant leadership — developed by Robert K. Greenleaf and articulated in his 1970 essay, "The Servant as Leader" — has been embraced by numerous leaders of not-for-profit organizations and U.S. companies for decades. Greenleaf was an executive at AT&T whose job was to trouble-shoot management problems throughout the massive communications company.
Using his vast experience, he centered his theory of the servant leader on the executive who embraced employees' contributions and sought their input to build forward-looking and innovative organizations. The servant leader fostered an environment where collaboration was strongly encouraged, with management often standing in the background. It would seem like not-for-profit hospitals that adhere to the mission of providing excellent healthcare to all would be a natural epicenter for servant leadership.
I recently had the chance to spend a few minutes with Nancy Howell Agee, CEO Emeritus of Carilion Clinic headquartered in Roanoke, Virginia, to talk about servant leadership. Nancy began her 50-year career at Carilion (then Roanoke Memorial Hospital) as a nurse. She then became a hospital administrator and chief operating officer and ascended to president and CEO in 2011. Along the way, Nancy served on several civic boards and was chairperson of the American Hospital Association in 2018. Nancy is arguably one of the best leaders in not-for-profit healthcare, in part due to her years of experience working at the system she later led.
As the leader of Carilion, Nancy adopted the idea of servant leadership by abiding to the simple principle that leaders are here to serve. As a leader, she embraced putting others first. "Leading from behind" is how she described it. She reminded me that among the most important people in a health system — in addition to the patients — are the individuals who manage the patients' care. Servant leadership in not-for-profit healthcare demands group dialogue and discussion, in part because the stakes are so high. Lives are at risk.
A servant leader needs to be intellectually curious and strive to learn more from their employees as they lead. Every moment spent with caregivers and colleagues is a learning and a teaching moment. Nancy gave the simple example of making rounds on one of the patient floors and having the nurse manager ask for more blood pressure cuffs for the unit. Instead of immediately approving the request, which would have been easy enough, Nancy talked through the request to understand why more supplies were needed. The teacher became the student. It was an opportunity for Nancy to learn about operations from the manager, and then use those learnings for a teaching moment. It wasn't simply a question of "need" but a "why" moment to find a solution together. Looping back with the nurse manager to ensure that the unit had the supplies was part of that servant leadership.
The same discussion took place on a much larger scale when Carilion began planning for the construction of its new Crystal Spring clinical tower: Again, the focus of the discussion was on learning what was desired versus what was needed and affordable over the longer term.
While these are two small examples, the point was made. We make better decisions for tomorrow when we engage employees today. At the same time, Nancy pointed out, leaders must lead, making decisions that will move an organization forward, sometimes taking a less desired pathway to get there when needed. These two are not mutually exclusive, but leading an organization forward may be easier when the employees know they've been heard.