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Know yourself, in order to lead others.

With over 35 years of healthcare leadership under my belt, and an uncountable number of paid and complimentary presentations on the subject, you would think

I should have no problem penning some thoughts about leading fellow healthcare professionals. The truth is, there may be nothing more daunting than trying to stand out among the throngs of authors already writing about leadership.

In December 2012, Amazon books had over 96,000 hits for the keyword leadership, while the Harvard Business School listed 370 articles on the topic (http://hbswk.hbs. edu/topics/). Within our own healthcare profession, the wide range of options can be just as unwieldy. Amazon books listed 1,258 hits for healthcare leadership, while the American College of Healthcare Executives' own Health Administration Press listed 50 titles (http://www. ache.org/hap.cfm). On a narrower front, the American Organization of Nurse Executives, in conjunction with the American Hospital Association, offered 70 titles on its webpage (http://ams.aha.org/eweb), and the American College of Physician Executives offered a dozen (http://www.acpe.org/publications). The topics run the gamut of models as authors try to teach us the way to succeed based on the leadership traits of Attila the Hun to those of Bob Hope, based on skills learned on the golf course to those learned on the battlefield, and based on secrets from Star Trek and from Santa Claus.

In my opinion, most of the authors of leadership books, articles, and checklists assume that their readers have a well-formed concept of themselves as a leader. But, in the rush to lead others, it appears that many early-, middle-, and late-career leaders have yet to develop that sense of who they are relative to being a leader. Too many of us try to emulate Attila the Hun or Santa Clause before we know who we are and what we are about. Would it not be wonderful if more of us, me included, had a much more accurate understanding of ourselves as leaders so that we could better excel at the responsibility of leading others?

How do we proceed to know what we are about? The foundation for knowing about ourselves as a leader is being able, in a private conversation before a mirror, to describe what we strive for as our own personal leadership mission, vision, and values.

MISSION

Private Dwayne Turner was a combat medic in the 101st Airborne Division. In 2003, he and his unit were violently attacked by insurgents south of Baghdad, Iraq. At the onset of the attack, Turner was wounded when hit by hand grenade fragments. He saw a wounded Soldier and "checked him out, and tried to get him into a building.'' He then left the relative safety of the building to continue "assessing the situation, seeing who was hurt, giving them first aid and pulling them into safety." In the process, Turner, already wounded with grenade fragments, received additional fragment wounds and was further hit with gunshots that injured his left leg and broke his right arm. He remembered someone telling him he was wounded and, when seeing the blood, thinking "oh hell, if I'm not dead yet, I guess I'm not dying.' Despite the realization that "it would have been really easy to just stay in that corner.... I realized I could let them continue to get hurt--and possibly die--and not come home to their families, or I could do something about it.' He chose the latter and continued to leave the relative safety of the building to bring in the wounded until his injuries forced him out of action. Despite receiving multiple serious wounds himself, Private Turner repeatedly moved openly around the battlefield to care for 16 fellow Soldiers. He was credited with saving at least 2 lives. When he received the Army's Silver Star his reply was to profess that "other people may see me as a hero; I see myself as doing my job." (1)

Turner's job as a combat medic--his mission--was to keep his fellow Soldiers healthy and to care for them when they became ill, injured, or wounded. He well understood his mission and did not allow external influences to dissuade him from accomplishing it. What is instructive is that Turner's mission, though nested within his unit's mission, was unique to him. It helped accomplish the organizational mission, but was not a mirror of it. Private Turner serves as a springboard for each of us. He had the benefit of having platoon sergeants and instructors repeatedly drill into him his mission as a medic. Most of us do not have the benefit of that direct, in-your-face instruction. Instead, we have to develop our leadership mission through study, observation, and practice. Our goal should be the ability to look within ourselves and state our personal mission as a healthcare leader. What is your personal leadership mission?

VISION

Private First Class Monica Brown was awarded the Silver Star for her actions in 2007 while assigned as a combat medic to the 82nd Airborne Division's 4th Brigade and attached to 2nd Platoon, Charlie Troop, 4th Squadron, 73rd Cavalry Regiment. Brown was the only medic in a 5-vehicle convoy returning to the unit's forward operating base from a mission at a nearby village in Paktika Province, Afghanistan. One of the trail vehicles triggered a roadside bomb which was followed by an insurgent attack with mortar and machine gun fire. "They stopped the convoy. My platoon sergeant got out of the truck and said, Doc, let's go," Brown recalled. After running 300 meters with her aid bag, Brown went into immediate action to care for the 5 Soldiers injured in the attack while the battle raged around her and ammunition started exploding in the vehicle that hit the bomb. She first assessed the situation, and then rendered immediate care to the most severely injured. While she was treating the most compelling injuries, the enemy attacked with mortar rounds that endangered Brown and the casualty she was treating, so she "dove over him. [I made] sure he didn't get any shrapnel or anything from it," she recalls. With the casualties triaged and immediately treated, Brown and her fellow Soldiers loaded them into vehicles and moved out of harm's way to continue treating them and to meet a medical evacuation helicopter. After the wounded were flown away, Brown stopped to consider what had just happened. Then, she has admitted, "I threw up." Brown has also said of her actions "I wasn't scared for my life. I was scared because I was afraid I wasn't gonna be competent and able to do my job." (2)

Brown's vision of the future of her role was that of a focused, competent, and able combat medic. Her actions in the face of this combat operation certainly allow her to look back at what she did and compare it very favorably to the vision she had of herself as a combat medic. We each have a vision of what we want to see about ourselves when we look back on our career. As leaders, we work in organizations where leaders, both us and those above us, have identified a vision for the organization. From a personal perspective, though, our vision as a leader is something different. Our personal vision is one that describes what we want to have accomplished when we look back on our career or on a segment of that career--an assignment, a project, or a specific effort. What is your personal vision of yourself as a leader?

VALUES

Private First Class Stephen Tschiderer received no medal. He just did his job. PFC Tschiderer is a combat medic who, in 2005, was attached for duty to 3rd Battalion, 156th Infantry Regiment, 256th Brigade Combat Team, 3rd Infantry Division. He was with his unit on a convoy in the western part of Baghdad, Iraq, looking for someone shooting at Americans. At a stop, Tschiderer dismounted and walked around his vehicle. While engaged with his duties, an enemy sniper team in a van across the street and not more than 75 meters away, took careful aim on Tschiderer. Their aim was excellent, as a bullet from a Dragunova sniper rifle tore a hole in his jacket and embedded in his body armor directly over his heart. After being knocked to the ground by the force of the bullet, Tschiderer bounced up and ran for cover. In his words "It's not a big deal that I got shot, I'm a Soldier, and Soldiers get shot every day." He then directed his platoon's attention toward the sniper's location. During the ensuing vehicle chase, the sniper received wounds that hobbled him, but that did not prevent him from running off. Tschiderer then pursued on foot and was part of the team that caught up with the insurgent and captured him. After capturing and handcuffing the sniper, the same person who had just shot him in the chest, Tschiderer started treating his wounds. "He was hurt and I had to do my job," he said. "I'm a medic. It's my job. It doesn't matter, friend or foe, soon as he's put down his weapons, I've got to treat him." (3,4)

Stephen Tschiderer is a Soldier. As such, he's constantly bombarded with reminders about the values a Soldier is held responsible for keeping. The same is true for millions of men and women over the years who have served the Army as Soldiers or Army Civilians. Each has been held responsible for adhering to the Army Values during the conduct of their professional lives and responsibilities. But, sadly, there is a gulf between knowing one's organizational values and living them. We as leaders need to know more than the values of the organization to which we belong. We need to know what our personal values are, and we need to live those values in our dealings with others. What are your personal values as a leader?

INTERNAL EXPECTATIONS, EXTERNAL REALITIES

I am often asked if all the introspection is really necessary. Do we as leaders really need to know what we hold as important? Can we just wing it? My answer is yes, we need to know who we are, and no, we cannot just wing it. There are a host of reasons for my answers, most of which you could easily recite. Here is the most obvious one, though we may not think about it too often. Being able to describe to ourselves what we strive for as our mission, vision, and values are important because of what those around us see--our internal expectations are seen and judged as external realities. What we strive for is internal. What we actually do is external. And, as we should realize, our people, those around us whom we are leading and affecting every day, know our mission, vision, and values very well. They make this assessment based on how we act, how we behave, how we make decisions, and how we lead.

If we know what we want to be as a leader--our mission, our vision, and our values--we will be better able to provide that leadership to our people and our organizations.

REFERENCES

(1.) American Forces Press Service. 101st Airborne Division Soldier receives Silver Star. February 11, 2004. Available at: http://www.defense.gov/News/ NewsArticle.aspx?ID =27336. Accessed April 18, 2013.

(2.) CBS News. Pvt. Monica Brown and the Silver Star. February 11, 2009. Available at: http://www.cbs news.com/8301-18560_162-4635035.html. Accessed April 18, 2013.

(3.) American Forces Network Iraq. Medic survives sniper attack package. Defense Video & Imagery Distribution System. July 27, 2005. Accessible at: http://www.dvidshub.net/video/11411/medic-sur vives-sniper-attack-package#.UOMorG-1XYY. Accessed April 18, 2013.

(4.) Robicheaux E. 256th Brigade Soldier recalls sniper attack. Defense Video & Imagery Distribution System. August 30, 2005 Retrieved from http://www. dvidshub.net/news/2863/256th-brigade-soldierrecalls-sniper-attack#.UOM8-m-1XYY. Accessed April 18, 2013.

MG David A. Rubenstein, US Army Retired

MG Rubenstein retired from the Army after a 35-year career culminating as Commanding General of the Army Medical Department Center and School and 16th Chief of the Army Medical Service Corps. He is a Fellow, American College of Healthcare Executives, Clinical Associate Professor of Health Administration at Texas State University, and a public speaker on the topics of leadership, mentoring, and ethics.
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Title Annotation:healthcare leadership
Author:Rubenstein, David A.
Publication:U.S. Army Medical Department Journal
Geographic Code:1USA
Date:Jul 1, 2013
Words:2053
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