Cultivate The Leader Mindset

Last week I wrote about Atul Gawande’s Being Mortal.  Gawande deals with what patients and doctors DON’T want to deal with . . . the inevitability of death. The denial of death often results in brutalizing treatments that make life more painful (and sometimes even shorter) than is necessary, and the denial means people make choices without real awareness of benefits, costs, and alternatives.  Even with eyes wide open to mortality, the decisions are anything but easy, for they involve an ever-imperfect guesswork at the effects – good and ill – of various treatments.  And they involve difficult trade-offs.

In his practice, Gawande increasingly came to ask his patients a number of questions to humanize treatment and allow them the best possible choices.  A central question was:  “At this juncture (often of decline), what are your goals?” In leadership, I refer to this as “Always think from right to left.” Facing serious illness, most people seem to “think” “I don’t want to look down the timeline to the right, because that is where death awaits,” and so, they think, “do anything to keep me from that (and even from thinking about that).” And, as a consequence, they fall into a state of dependence and hoping.  Gawande suggests the better question than the unspoken “how and when will I die,” (which no one can answer) is instead:  “Not knowing when death will come, how do I want to live?” This question can not only affect the treatment they get – now, they are no longer purely dependent – but it can also affect how they spend the precious time and energy allotted.

Every great leader I have known, seen or read about does not just put one…foot…in…front…of the other, give their power away to experts, and spend their energy in a combination of hope, denial, and despair.  They ask what matters – in the end.  They set goals! And they stay on purpose.

This week I will share my BCE with my students and assign them to write and share their BCE with me.  BCE stands for “best class ever.”  It is a “thinking right to left,” and it involves the daring of thinking about goals and committing to them.  Best Class Ever is not, as it may have been in the past from them, how clear, interesting, smart, and fair the prof is.  And for me, it’s not about getting 6s and 7s from them when they evaluate me, though they surely matter.  Instead, it is about what each of us wants to say “at the end” of the semester.  What will each of us fix our eyes on, as we look and think from right to left? Circumstances will spring up – like cancer spreads or chemo halts the spread.  But how do we want to live?  What can we fix on now, that will evoke purposeful practice, as we

Lead with our best self.

  • I have followed to a limited extent the work of Atul Gawande, and Haven Healthcare. I have written to him several times through Haven Healthcare and Berkshire Hathaway. At the same time I have started as a board member on a board that follows Carver Governance Model. That model emphasizes the role of the board being to set the ends (goals) and not the means. I would strongly disagree that this model is useful since the means are important. Whether making life and death decisions, or in making management decisions. Ends/ goals can be met in different ways, but not every means is equal, say in quality of life, or in setting the character and efficiency of an organization.

    A major problem with medical care and with management is lack of knowledge/ information by decision makers, or even realizing that the patient or their advocate is a decision maker. I have seen tragedy in my family due to these errors. Doctors, or managers can think they are the decision makers, when it is the patient, the customer, the supplier, the employee, who need to be seen as leaders and decision makers. I have seldom seen this kind of leadership in medical practice. It is more often the case that a doctor will blame the patient, when the patient and their family were no properly informed, or brought into the process.

    The consequences of this trauma is why I still do not so often comment in this blog, but do read and appreciate it.

  • Sorry for the very late feedback, Dan. This column resonated with me for 2 reasons: my mom and dad are, at age 90, in declining health. When I’m with my dad (he’s lives relatively far from me) or speak to him, I’ll ask him that question about setting goals for his future (my mom is experiencing dementia and isn’t able to conduct a conversation anymore). I’m sure my dad will respond with several things he wants to accomplish…he’s always been that kind of person.

    The other reason is that I love the phrase “thinking right to left” (maybe Hebrew and Arabic contain some especially thoughtful facets?), because over the past several years, in the many meetings I’ve led, the first thing I do is ask people, “By the end of this meeting, what do we want to accomplish? How will we know whether the meeting has been worth it?” This results in a shared purpose, focuses our attention and conversation to the meeting goal, avoids going off course too much, and helps us actually achieve our meeting goal.

    • David,
      Love your thoughts. I frequently ask my classes if there is someone who can write in Arabic or Hebrew to demonstrate this point. I ask them what they noticed and they get it, of course. I laugh inside, however, when someone explains what they saw by saying, “he’s writing backwards.” Backwards, of course, to me and him – not to those whose native language moves right-to-left. What I like about this exchange – with students and with you – is that it YOU have developed a habit by becoming intentional. To put it another way, you became “consciously competent” and now are probably “unconsciously competent” in the way that UI’ll bet you hardly have to think about it. And this is perhaps THE most important leadership competency there is, to ask: what matters, and for the reasons you stated: to make sure it makes sense, to clarify what success is, and to unite people around this shared purpose. Bravo.
      Best of luck with your parents on this important-but-not-easy stretch of the road.

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