• Minimize unnecessary rules
• Foster diverse relationships
• Enhance information flow, embrace paradox, and surface tensions
• Focus on action instead of plans and designs
• Build incrementally from simple systems that work
• Recognize and engage diversity in expertise, values and perspectives
• Decrease centralized control and support self-organization
• And Trust the Process!

We often hear about the need for leadership in health care practice. Yet for many, the word leader is just another buzzword. We often think leaders are born not made, and leadership is for others with important titles, nice offices and assistants at the door.

Our experiences with the Dorothy Wylie Nursing and Health Leaders Institute, now in its 10th year with over 2300 alumni, provide us with a different mental model. We believe that building leadership skills and developing leadership competence and confidence is important for every health professional. We believe leadership makes a profound difference in the quality of care patients receive. We believe that health professionals who see themselves as leaders will make a difference in every patient and family interaction.

The Leadership Institute uses Kouzes and Posner’s 5 Practices as the basis of its development programs, the keys to leadership that health professionals need to understand, value and acquire. The 5 Practices are: Model the Way; Inspire Shared Vision; Challenge the Process; Enable Others to Act and Encourage the Heart.

Good leadership is an essential ingredient in creating high quality workplaces for health professionals and safe care places for patients. Strong leadership benefits patients in a number of ways. Leaders who model the way by focusing their attention on high quality care and patient safety will create a workplace where safety consciousness is the norm. It takes leaders promoting it, and encouraging and rewarding health professionals who improve it, to make awareness of patient safety part of the fabric of patient care units.

The key to understanding the role of leadership – despite the models of generals, presidents prime ministers, and sports heroes ingrained in our consciousness – is that leaders are not just the people at the top. Leadership in the workplace needs to be much more broadly defined. It’s not an instinct some of us have and others don’t. It should be an expected part of every professional role. We have to find the level at which every health professional is comfortable leading, and then we need to grow and stretch that mark.

Professionals who feel like leaders are more likely to have the courage to stand up in an unsafe situation or take a risk and challenge the status quo when they think there is a safety risk to patients. Leadership is too important to be left to develop by chance as professionals gain experience. Instead, leadership must be an integral part of education and training and an expectation in the jobs professionals do from the beginning of their careers.

Here are some important steps for developing leaders:

• Begin leadership development at the undergraduate level. Start from the notion that every student is a potential leader by virtue of being in a program that leads to being a health professional.

• Introduce leadership concepts in lectures across the curriculum, and encourage students to use them in group projects, then emphasize them during fieldwork with mentoring and coaching to expand development.

• Explore leadership expectations during the job interview process. Employers can pose a scenario requiring leadership and ask what the candidate would do. Candidates should ask what the employer will do to support them in developing leadership skills.

• The message that leadership comes from everywhere should be part of new employee orientation. Leadership can be encouraged throughout course work and experiences can be tailored to enable professionals to take the lead, with mentoring and coaching from managers and clinical specialists.

• In practice opportunities can be provided for direct care professionals to strengthen their leadership skills (e.g., coaching them on participating effectively in multidisciplinary rounds).

• Formal and informal opportunities can be created for every professional to lead a care team, a research project and other professional activities.

• Managers, advanced practice specialists and clinical educators can support leadership development as part of daily interactions and through the performance management process.

• Experimentation and risk-taking should be recognized and rewarded (e.g., staff members who take calculated risks and make difficult decisions when help is unavailable).

• Managers can identify and appreciate the things people are doing to promote patient safety and provide meaningful recognition and rewards.

• Leaders can remember that an important part of leadership is modeling behaviour to encourage leadership in others.

• Organizations can develop a formal mentorship program that engages senior staff and proven leadership skills to set the bar and coach newer staff.

**The paper was adapted from an interview with Beverley, Julia Scott and Judith Skelton Green that appeared in the Canadian Health Services Research Foundation’s Stories for Safety.

Morgan Freeman and Clint Eastwood have created another very special movie now playing across North America. Invictus is the story of Nelson Mandela’s early days as President of South Africa, and particularly how he viewed the country’s Rugby team, the Springboks, and an upcoming World Cup event to be held in South Africa, as an opportunity to bring the country together.

The year is 1995. Mandela (Freeman) is in his first term as President. He recognizes the tremendous challenges facing his government in a land torn apart by apartheid. Racial tensions are at an all time high, people are struggling with the effects of crippling unemployment, and a new black government has shifted the balance of political power.

The World Cup is to be held in South Africa. Mandela senses that this might be a great opportunity to attempt to bring blacks and whites together with pride in a winning home team. Traditionally whites cheered enthusiastically for the Springboks at every game. The black population cheered for anyone else but the home team because they felt the team, and even the game itself, represented all that was white and oppressive in South Africa.

The Leadership Challenge and the 5 Practices deeply permeate Freeman’s portrayal of Mandela. In several scenes Mandela’s quiet reflective confidence, his commitment to lead from values, the personal connection he makes with everyone he meets, are all evidence of his skill in calmly Modeling the Way.

One iconic scene features Mandela in his first meeting with Francois Pienaar, a white Africaaner and the Springboks captain, played beautifully by Matt Damon. Pienaar is invited to meet the President and arrives at Government House with trepidation, uncertain of the reason for the meeting. Mandela’s personal style, his warmth, the way he treats everyone around him with great respect and appreciation completely charms Pienaar who leaves with the realization that something very significant has just happened to him. During their brief but meaningful time together Mandela has skillfully Inspired a Shared Vision about the importance and meaning of a Springboks win to South Africa.

The title of the movie Invictus comes from the Latin meaning Unconquered. We are led to believe that Mandela had a poem written on a scrap of paper in his prison cell while he was incarcerated. In the movie, Mandela gives the poem to the team captain Pienaar, before the start of the World Cup. At one point in the story the Springboks are touring Robbin Island and Pienaar spends a quiet few minutes in Mandela’s old cell contemplating the kind of moral courage it would take to spend 27 years there. He is transformed.

Mandela Challenges the Process beautifully in several scenes. He consistently challenges his staff to think differently about issues and policies. For example he challenges his black head of security to ensure his black staff works collaboratively with their more experienced white colleagues. How they learn to work together as a single team, both cheering for the Springboks, provides one of several great sub-texts to the story.

Mandela challenges Pienaar to think positively and creatively about the possibility of a win even though the odds are stacked against them. His challenge, his personal commitment, his quiet leadership enable Pienaar to begin to see the long shot as a possibility, thus Enabling him to Act to lead his team to train harder than ever.

A scene where the local (all black) sporting organization passes a motion to change the name of the team to suit a different blacker South Africa is a study in Challenging the Process when Mandela, despite the cautions of his aides to not get involved, appears just after the vote to ask them to think differently. When he gets only a small minority of the group on his side, he sees it as a small win rather than a defeat.

There are several scenes where Mandela demonstrates his expertise in Encouraging the Heart. For instance, there is great love for him among his staff who affectionately call him Mandiba, the name of the clan of which he is a member. Mandiba is the name of a Thembu chief who ruled in the Transkei in the 18th century. It is considered very polite to use someone’s clan name because it is much more important in this culture than a surname, referring as it does to the esteemed ancestor from which a person is descended.

In turn, Mandela is always interested in each of his staff members as individuals; he knows everyone by name, asks about their families, appreciates everything they do for him. In one of the scenes Damon’s character watches him with admiration as he introduces and speaks with a woman who has brought in the tea.

In another memorable scene, Mandela quietly memorizes the names of each of the Springboks players so he can give them each a personal greeting.

Matt Damon is well cast as the captain of the team. Francois Pienaar is an Africaaner whose father plays the redneck card saying things like “these people will ruin our country.” Pienaar must reconcile his growing admiration and respect for Mandela with what he is hearing at home. Obviously he was successful as it is said that today Mandela is Godfather to one of Pienaar’s children.

Like many others who have seen it, I was totally captured by this movie and all it can teach us about leadership, courage, building and sustaining relationships. It is not so much a movie about a team that comes from behind to win the championship as it is about a process of leadership, vision, courage and commitment to build a unified country against steep odds.