Learning Leadership in the City

Ten TwelveOn a clear, breezy summer Saturday morning in the Sandtown-Winchester neighborhood of Baltimore, 10:12 Sports Director Jeff Thompson speaks to a young player about character in the context of a flag-football game. In the background, the Ravens and the Bengals play the fifth game of their season.

In this neighborhood, 60% children live below the poverty level, 80% of households with children under 18 are female-headed, unemployment is 17% and a quarter of kids never finish high school. The field where the young men play is half a mile from the scene of the uprising and violence surrounding the death of Freddie Gray in 2015.

This is the neighborhood where Jeff Thompson and his volunteers work with young men teaching the fundamentals of character and leadership from a Christian perspective. The lessons are framed against the backdrop of a flag-football league that also employees local youth on weekends as referees, linesmen, and statisticians.

Character is the foundation of almost any leadership model. The ability to “lead self” is crucial before one can attempt to apply almost any other leader competency. There’s much that a developing leader can read about the importance of character and no shortage of books on the subject. But no book can teach what we learn from credible mentors who serve as examples and who listen to understand.

Albert Schweitzer said, “Example is not the main thing in influencing others, it is the only thing.” Leadership guru Michael Useem took that same idea one step further: “Leadership is best learned from example and best communicated through example.”

Still a relative newcomer to Baltimore, I have joined the search for the magic, missing ingredients that once applied will cure the city’s woes. I know already that there isn’t any single thing. But on this Saturday morning these young men – in the context of a community who loves and cares for them and who holds them accountable for their actions – were experiencing the closest thing I have found to a foundational first step.

“Leadership is character in motion” (Les Csorba).

For these young men on any given Saturday there is more in motion than the football and the players on the field.

Chuck Callahan Henry V 4.3 – Lead from the Front      https://henryv43.wordpress.com/

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“Remember to look into their eyes”

Remarks to the graduating residency class, Eisenhower Army Medical Center, Augusta Georgia, June 9, 2017. Some of the material will be familiar to regular readers but struck me as the most important thing I could share with these accomplished clinicians, officers and leaders. 

Thirty years ago this June I graduated from my pediatric residency at Walter Reed Army Medical Center in Washington. That was a while ago. For reference, it was the last years of Reagan’s second term, the year the first Simpson’s episode was aired, the year Tim Tebow and Zack Efron were born. It’s practically ancient history. Many of the residents graduating this June weren’t born yet.

The ceremony was held on the great lawn in front of the main entrance of a building that has since been closed and abandoned. I was one of several hundred graduates and the highlight of my memories from the day are the few minutes in the crowd of graduates standing around at the veranda after the ceremony drinking punch and eating cake when we were briefly separated from our three year old son. We found him as quickly as we realized he was gone as we saw one after another of the men standing nearby startle and look down as someone tugged at their green polyester, black striped pant-legs and a little blond haired boy looked up and asked: “Daddy?”  “Daddy?”  “Daddy?”

I am certain that there was a speaker at my graduation ceremony. And I suspect that he probably gave a speech. But for the life of me I can’t remember who it was or what he said.  So I know what I’m up against. I also know the competition. I watched Will Farrell on YouTube as he give the graduation speech at USC this year. Three years ago when my daughter graduated from nursing school at the University of Miami Jimmy Buffett gave a great graduation speech. I wish I could remember what either of them said.

I do remember they made three or four points and I planned to do the same. But I thought about the risk of the audience remembering any of them let alone me remembering as I tried to speak without notes. Instead I decided to leave you with one. One point I’d like you to consider; something I don’t remember anyone mentioning to me when I was in medical school or residency but something that proved pivotal when I was practicing primary care, specialty care, as a hospital leader and also as father of seven, grandfather of four (almost five) and husband of 37 years this summer.

One early morning while I was working at the Ft. Belvoir hospital my daughter called me from Miami where she was attending nursing school. She was riding her bike (without a helmet I am sure) in the predawn darkness on her way to the train station. Her pediatrician father wasn’t happy about the circumstances. But she was heading to her first day of clinical rotations and had a question for me: “Dad, what advice do you have for me on my first day with patients?”

It caught me off guard, in part because I was a little worried about her on her bike in the dark on the phone. But it didn’t take me long to come up with an answer:

“Remember to look into their eyes.”

As a general pediatrician at Ft. Hood Texas in the late eighties (before the days of computers and electronic medical records) we were scheduled for acute patients every five minutes. A typical morning or afternoon seeing patients with acute problems included 36 encounters in three hours. The clinic was open every day of the year. Weekends and holidays one pediatrician worked for six hours and saw 72 patients and the other saw 36. There wasn’t much time to establish rapport.

Somehow – I think because of Grace as prayer was a part of my patient care – I realized that if I sat down in every visit, leaned forward, made eye contact and then mirrored the parent’s face with my own the patient’s perception of the visit was more positive and they were more satisfied that they had been heard. I also found it was a discipline to help me to really listen. I have since become aware of the research confirming all of these but especially the relationship of eye contact during a physician encounter.

Direct eye contact or intentional gaze is positively related to the patient’s assessment of the clinician’s empathy. Eye contact is significantly related to patient perceptions of clinician attributes, such as connectedness and liking. The shorter the visit, the more the percentage of eye contact time is an important indicator for the patient’s perception of empathy (Montague E, et al. Nonverbal interpersonal interactions in clinical encounters and patient perceptions of empathy. J Participat Med. 2013 Aug 14; 5:e33). Lots more could be said about the importance of eye contact with patients and families in the intensive care unit as well as the impact of the electronic record on our ability to make and maintain eye contact. And even when I was in West Africa caring for patients with Ebola where there was little language in common there was eye contact and touch – through three layers of gloves – to communicate empathy and compassion in the face of tragedy and loss.

As a pediatric department chief I also found eye contact to be critically helpful. I think the most important thing about morning report or morning huddle for a leader is that it gives you regular, repeated time to look into the eyes of your peers and subordinates and to become sensitive to subtle changes in affect or mood. One morning report one of the residents teased another of her peers in the audience during a presentation. After the laughter subsided, I glanced back and looking into the affected resident’s eyes I saw she was fighting back tears. I quietly picked up the phone on the wall next to me and paged her out of the meeting, then met her out in the hallway to allow her time to compose herself (which she did quickly). It meant a lot to me and must have meant a lot to her. I heard about the event from a friend of hers a decade and a half later.

As hospital CEO I found that looking into the eyes of patients, families and subordinates was an important part of the culture we were trying to create. We had a rotating “Focus Five” that our leadership team worked on and for a long time we concentrated on getting staff to only use their iPhones or Blackberries when they were “off stage” and not with patients. Specifically staff was encouraged not to look at their phones when they were moving through the organization or working at reception areas but to greet patients and peers and make eye contact instead.

Rushing to a meeting with a few deputies one morning we passed a young mother pushing her baby in a stroller. She was an acquaintance of my wife’s whom I had met once or twice before. Eye contact told me that something wasn’t right. “How’s it going?” I asked her. She said “Fine” but I could tell it wasn’t. I asked the “second question” (the one we don’t always take time to ask): “You don’t seem fine…?” Tears followed. Her husband was hospitalized and she was worried about him. We spent time together and I was late for the meeting I had been rushing to. It was time well spent.

We could spend hours talking about the importance of this principle to our families, especially in the age of iPhones. One of the most profound lessons I have learned in my life was taught to me by my three year old daughter when she was trying to talk to me while I was distracted doing something; reading the paper or some computer screen.  She took my face in her little hands, turned it towards her, made eye contact and said, “Daddy, wisten to me!” She knew if she had my eyes, she had my ears and my attention.

There is a phrase from the Northern Natal region of South Africa that I first read in a book by business guru Peter Senge.

“Sawubono” – “Sikhona”

“I see you” is the greeting. “I am here” is the reply.

I see you. I am here.

I have to tell you that being present with our patients and peers has never been more important. But I wouldn’t have stayed in military medicine, wouldn’t still be a patient in the system and wouldn’t support it if I didn’t believe that there was something unique about it. There is something our patients need that can be found in military medicine that may not be a part of the way our civilian colleagues think. It’s not what they normally see.

On any given day there is a woman on the labor and delivery unit of your military hospital having her second or third child, trying to raise her children while her husband recovers from his third or fourth deployment. He did not come back the man she knew and she wonders if he ever will.

If you pause for a moment and look into her eyes you will see something that our civilian colleagues might miss because you have seen it before. You have been there yourself. She needs something more than her baby delivered: “I see you. I am here.”

There is a soldier in our military orthopedics clinic with a painful knee that has seen far too much for his 28 years. He has lost his brothers in battle and he has lost a part of himself. If you look up from his knee for a moment and you look into his eyes you will see something that our civilian colleagues might miss because you have seen it before. You have been there yourself. He needs something more than his knee taken care of: I see you I am here.

Perhaps the most important thing we can take away from this day, from this graduation celebration at the end of one life-phase and the beginning of another is this commitment that will make us better physicians, better friends, better bosses, parents, spouses – for our patients, our peers, our family members and to those we will have the privilege to lead:

I see you. I am here.

Best to you always. To my military colleagues: Take care of our Army, our military.

Take care of our Warriors and their families.

Chuck Callahan Henry V 4.3 – Lead from the Front      https://henryv43.wordpress.com/

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Reflection: The Leader’s Gift – Presence

If the currency of the economy of relationship is trust, the currency of leadership is presence. To “be there” at the critical moment for an individual, a team or an organization is the essence of a leader’s effectiveness. Presence requires of the leader attention and intention. Good leadership is always intentional and “attentional.”

When I was helping to lead a community hospital in Virginia a decade or so ago I decided to count through the course of day every single human interaction I had – in person, in the hallway, in an executive or hospital meeting; by phone, email or text. I carried a 3×5 card and made little pencil tick-marks throughout the day. At the end of the 18 hours or so of measurement I counted 283 pencil marks: 283 encounters. The requirement for me as the leader to be present, attentional and intentional was not daunting or infinite. It was in fact finite and consisted of scores of opportunities to be present, to be listening, to be attentive – to “be there.”

The Egyptian philosopher Ptahhotep wrote in the 24th century BC, “Those who must listen to the pleas and cries of their people should do so patiently, because the people want attention to what they say even more than the accomplishing for which they came.”

Being there is a privilege bestowed on the leader never to be taken for granted.

There is a greeting among the people of Northern Natal in Africa when they meet someone, make eye contact and resolve to be present: “Sawu Bona – I see you.”

The reply is an equal commitment to attention and intention: “Sikhona – I am here.”

I see you. I am here.

These are perhaps the most important words we can live by for the men and women we have the privilege to lead.

Chuck Callahan Henry V 4.3 – Lead from the Front      https://henryv43.wordpress.com/

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First person, singular.

When I was a fellow one of the senior physicians at the children’s hospital where I trained approached me with a question:

“Dr. Callahan,” (she was always pretty formal). “Does your colleague Dr. Christopher have his own lab?”

“No ma’am” I replied (formal, too). “He works in the same labs we all do. Why do you ask?”

“Well in speaking with him he often refers to ‘his lab’ and I was just wondering whether the fellows actually had their own labs.”

We didn’t. I started to listen more carefully and noticed that Dr. Christopher (not his real name) had a tendency that afflicts many in leadership: the over-use of the first person (“I, me, my”). I acknowledge it is nowhere near as grating as referring to oneself in the third person (“Bo Jackson has to do what’s best for Bo Jackson”). But it is something I have noticed through the years, possibly a function of my own fear that I might sometimes lean in the same direction. Certainly positions of leadership can foster that way of thinking. People pay a great deal of attention to leaders wherever and whatever they are doing. They even notice and may comment on what the leader’s wearing (“Sir, I notice you wear Tom’s”). Perhaps that is why General George Patton said that leadership was theater. The leader is always on stage.

But it is too easy to succumb to the cult of the first person and increasingly cast our shadow over all we’re associated with: my team, my assistant, my hospital, my staff, my directorate, my lab. Pay attention to your own patterns of speech and see how many times you refer to yourself.

It would only be a bad habit if it weren’t for one thing. We may have bought into the traditional “heroic” model of leadership. The model is common in ancient literature. Leaders were known for their physical size, strength, or looks; individual personality traits or charisma. For example in Homer’s epic poem Achilles was a leader because of his demigod warrior status, Ajax as a result of his size and strength, and Hector because of his courage and dedication to his people. Early leadership theory focused on the leader and the leader’s persona.

Scottish writer Thomas Carlyle wrote in his book (the title is telling): On Heroes, Hero-worship, and the Heroic in history (1840), “For as I take it, Universal History, the history of what man has accomplished in this world, is at the bottom the History of the Great Men who have worked here.” His emphasis on the individual leader gave rise to the “Great Man” theory of leadership.

The problem is that we have entered an era of horizontal leadership where the best leaders are the best listeners; they are willing to relinquish power to accomplish goals, have the greatest ability to form and facilitate teams, and have the greatest emotional intelligence. The sun is setting on the great person theory (the traditional messianic or apocalyptic view we hold towards the occupant of the White House seems to be a persistent exception).

We should check ourselves. Excessive use of first person pronouns may reveal a tendency toward seeing ourselves in the “great man” or “great woman” spot light, to the potential detriment of our relationships with peers and subordinates who comprise the teams who really do the work.

The leader without a crowd following him; traveling and working with him, is simply taking a walk. We can too easily end up thinking “first person, singular” when we need the entire team – “first person, plural” – to get the job done.

Chuck Callahan Henry V 4.3 – Lead from the Front      https://henryv43.wordpress.com/

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Lead from the back?

It was one of the most profound leader-lessons I’d heard in months and I am certain she didn’t mean it to be.  My colleague and I were paired off in an exercise to talk about our personal vision and goals as part of a fellowship in civic leadership I’m attending. She is the leader of a non-profit that focuses on caring for Latino families in our area. She knew that it was critical for her organization to be led by members of the community she was serving, and so she concluded that this was a time when she had to “lead from the back.”

I was nearly dumbstruck (not something that happens to me very often). For someone raised with the Army Infantry motto “Lead, follow, or get the heck* out of the way” and for whom “Lead from the Front” is this blog-site subtitle, her observation about leadership and practice were both profound and timely. We moved to Baltimore with the hope that we might in some way contribute to the community with very little idea what we could do or how.

My wife proposed before we moved that my leadership ethos “Ducere, Docere, Deservire” (to lead, to teach, to serve) might be better considered “Discere et Deservire” (to learn and to serve) during this period of our lives. But I am pretty sure that I was not completely buying it. And when I was honest I had to admit that I chafed at times at not being “in charge.” It had been a difficult transition from hospital director (where people always answered my emails) to hospital contractor (where amazingly my emails were not answered as quickly).

But there are seasons and reasons why leadership from the back of the room is important and I think my colleague’s comments were an awakening. One could argue that the most influential leader in Disney’s movie “The Lion King” was the crazy old baboon Rafiki rather than the brave, sagacious Mufasa or the impulsive, heroic lion Simba. Rafiki led from the back. There are advantages.

You can see the whole room unobserved. While everyone’s attention is focused on the leader, the speaker, or the problem at hand, if we pay attention we can watch the dynamics in the room from the back. We can see who is listening and who is on their iPhone; watch the body language and facial expressions. It is probably a better perspective to appreciate the context than the pressured position of the podium.

You are not responsible for the clock. In fact, the clock is probably behind you and the pressure of Robert’s rules and the timeliness of the agenda are someone else’s problem. (It’s especially relieving to an Myers-Briggs ENFJ for whom timeliness in meetings is a continual challenge anyway.) Instead of focusing on process the observer can notice interaction and outcome in ways you couldn’t from the head of the table or the dais.

You can observe the leader in context and provide feedback when solicited. One of the most valuable assets in leader development is having a “second chair on the balcony;” being able to look down on a set of circumstances with a trusted colleague and with the additional perspective, attempt to better understand sets of feelings or actions. Of course such feedback should in most cases be solicited, and if unsolicited is best left to positive, noncritical comments until more candor and critique is requested.

You can support the leader when the need arises. At ROTC summer camp in the late seventies the cadet physical training leader faltered on a relatively complicated 8-count exercise that I believe was called “the lunger.” I stepped in briefly shouting out the correct count until the leader got back on track and the platoon didn’t miss a beat. The supervising officer highlighted that event in my evaluation that day and I have since recognized it was an opportunity to support organizational success by stepping in briefly to lead from the back.

Finally there is an even greater opportunity nested in this philosophy, especially when I consider our current geographic location. For far too long, leadership in almost every setting has been assumed by people who look like me. Too often men with my “demographic” assume leader roles at the exclusion of women and members of other ethnic or racial groups.

In our West Baltimore neighborhood we are newcomers. And we are the minority. As much as I might think I know about leadership, I do not understand this context or the way the challenges have been shaped by the city systems and circumstances. While I bring perspective, I will never understand it as well as someone raised here. And perhaps there is a question of even greater importance: could my leadership discourage those in the community from leading because they don’t look like me and they don’t see any leaders who do? My role for now is to build and support. “The first duty of a leader is to create more leaders” (General Bill Creech).

I think I am going to have to become comfortable with leading from the back; to become more Rafiki than Mufasa. It is not natural for me, though at least the crazy part comes easy.

Chuck Callahan Henry V 4.3 – Lead from the Front      https://henryv43.wordpress.com/

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The sound of the guns

I probably shouldn’t look at social media during church. But honestly, I was just opening the Bible App on my phone (!) The local “Nextdoor” link on my email was a post from someone living nearby: “Neighborhood too dangerous.” The author wrote, “We were talking about how annoying it is that we cannot walk outside without fear of being held up at gunpoint and it might be time to move to a safer place…”

It has been something of a bad week for our neighborhood. Someone was held up and robbed on the street I walk to work and a young man was shot a few blocks from our home. But none of this is new to West Baltimore or to the city where more than three dozen people have been killed since New Years. Perhaps it was just a little too close to home.

The post made me think of our pastor.

He was born and raised in Baltimore and despite growing up in one of the city’s toughest neighborhoods in a single parent home he has a college degree and is among the best read men I know. He had every reason and every opportunity to move away from the conditions in a city that Hobbes would likely agree are “solitary, poor, nasty, brutish and short.”

But he didn’t leave. Instead he studied, trained and prayed and with his wife planted a church in West Baltimore within a mile of the highest density of gun violence in the city. He was with the line of pastors at the uprising after the events surrounding the death of Freddie Gray two years ago this spring. He leads by example in the city of his birth that he could easily and justifiable have left behind.

This morning I was stuck by what drew me to his leadership and to this church.

We spent thirty years in the Army where among the highest virtues was the willingness to run toward the sound of the guns.

Now we are serving with this leader and these brothers and sisters who have chosen to do the exact same thing – literally and figuratively – on some of our nation’s most dangerous streets.

A couple commented at a dinner recently that it is not uncommon in our neighborhood to hear gunshots at night. These men and women whose church meets in a local public school; who are led by a courageous pastor and his wife are far more familiar with the sound than we are.

Perhaps I am drawn to this leader by the same qualities I have long recognized in those with whom I served in uniform:

True leaders run toward the sound of the guns.

We have found a community and leaders who live this.

And it feels a lot like home.

Chuck Callahan Henry V 4.3 – Lead from the Front      https://henryv43.wordpress.com/

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The problem with rice bowls

Rice Bowl

  1. A task performed by a specific individual or group in exchange for compensation.
  2. A protected job, project, program etc.

Reaching back a decade or so I remembered an episode that taught me about our tendency to defend our turf and our “rice bowls.”

When I was Chief Medical Officer earlier in my career, I received a late evening email from my CEO while I was away on a business trip. The message informed me that the discharge nurses who were busily working under “my” section of “Health, Plans and Operations” were going to be moved to a new discharge management cell that would be run under the Chief Nursing Officer. The cryptic part of the message was that they were to be combined with the Department of Hospital Social Work, to be run under the office of the Chief Nursing Officer. I replied by email that I was a bit confused.

“Did you mean to imply that you were moving social work as well?” Social work was a department that had been aligned under the Chief Medical Officer – “my job” – for decades. It seemed odd that my Boss would realign a whole department without even mentioning it to me.

I learned by email the next morning that was exactly what she meant.

My first response was visceral. This was a personal affront! To have one of my subordinate departments removed from me span of control without even letting me know ahead of time. Disrespect! The CEO and my peer to whom my subordinates were transferred must have had no regard for me and for my position.

Someone had reached into my rice bowl and extracted rice without the decency of even letting me know!

Moments later I realized I was being ridiculous.

First, I knew my Boss and my colleague. They were no more interested in affronting or insulting me than I would be them. Even if they hadn’t thought of it, how justified would my outrage be without even considering and understanding the circumstances? In terms of “extracted rice” it was not as though I had any shortage. The traditional organization of our hospital placed all clinical activities except nursing under the leadership of the Chief Medical Officer.

No, the problem with this rice bowl was not the rice.

It was much more the idea of someone else reaching into my bowl.

I had reacted to the thought that someone else would reach over and violate the boundaries of my rice bowl, especially without even the decency of asking me first.

What was the cure for this flood of inane emotions? First, I had to choose to give people I trusted the benefit of the doubt they had earned through our relationship together. I also had to remember that my Boss and colleague were in fact acting consistently with the way I knew that they always acted.  They were working on organizational improvement, efficiency and improved patient care.

Perhaps “forgiveness” is too strong a word for the response I needed. They did not mean to insult me. However, if I felt insulted I could certainly forgive them the unintentional affront. It might justify a conversation in the future to avoid this misunderstanding. But she was my boss, after all.

Finally I had to accept a willingness to share the rice as well as the access to my rice bowl. I know that I didn’t have the opportunity to talk about this ahead of time but for the life of me I could not think of any particular reason why it was a bad idea. The difference between “dialogue” and “discussion” is that with dialogue I am willing to consider the possibility that my preconceived notions are wrong. In discussion my intent is to convince you of the error of your ways. I had to approach this decision with the willingness for dialogue and not necessarily the effort to persuade.

There is plenty of rice and work to share. Feel free.

You might just let me know when you would like to reach over toward my rice bowl – if only so that I don’t bump your hand with my own.

Chuck Callahan Henry V 4.3 – Lead from the Front      https://henryv43.wordpress.com/

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