The Danger of Check-List Leadership

No matter what the credibility, credentials, or competency real leadership is about how the one in authority communicates with and treats others; not just the client, patient, or customer, but all team members.

After a surprise announcement that my husband was going to need open-heart surgery due to a 99% blockage, we got immediately introduced to Dr. Dali, a cardiothoracic surgeon, specializing in the treatment of diseases with the heart, lung and esophagus. This post is inspired by my experience of watching Dr. Dali’s as a physician and surgeon leader.

Dr. Dali’s communication is the best I’ve ever seen. Period. End of story. He was confident, straight forward, and compassionate. He set the proper expectations, not just once but over and over again.

It will be the most difficult surgery you will ever go through. You will feel like a freight train ran over you. You won’t feel like following directions, but if you do, you will recover,” he said.

His communication didn’t stop with his patients.

We saw him educating his nursing staff on how to read X-rays, or how to think critically when more than one option presents itself.

Not a check-list-leader, Dali shows up as a mentor and teacher, patiently quizzing his nursing team to understand their critical thinking.

The nursing and support staff raved about how wonderful it was to work with Dr. Dali. “He cares about us and knows that statistically patients get faster recovery if the support team can do their job adequately.”

Surgeons face tremendous pressures, and often help with self-management to avoid taking out their frustrations out on subordinates and treating them with disdain. This is unfortunate because disruptive physician behavior compromises patient health and safety and contributes to a toxic culture, lead by what I call Check-List Leadership:

  • Do as you’re told
  • Don’t question authority
  • Check the boxes
  • One-way communication
  • Status rules
  • Accountability means punishment

One nurse told me about a vascular surgeon who yelled at her condescendingly assuming she made a mistake that she didn’t make. She had to retrieve her nurse manager to handle the conflict. Interestingly, this nurse told me that this vascular surgeon was great with his patients, just not his team. “He treated the staff like crap. Eventually he was asked to leave.”

(I acknowledge the hospital administrator for making this call. If a nurse is too intimidated to work with an aggressive surgeon, the patient’s life is at stake.)

Unfortunately it’s common for high performers and rain makers to be allowed to bully people below them. A blind eye is turned for the sake of convenience, fear of conflict or profit.

The personal lesson: If you have to have surgery pick a physician who is not only competent and credible, but one who treats the staff like valuable team members. Supported team members are less likely to make serious mistakes, and more likely to speak up when they notice something is wrong.

The leadership lesson: Leadership is not a check list but an ability to see the bigger picture and lead others to the same vision. Disruptive behaviors don’t just contribute to a toxic work environment, unresolved conflict can mean the difference between life and death.

Article originally published in The Marlene Chism LinkedIn Newsletter. Subscribe here.

Marlene Chism