In conversation with Professor Jamie Stoller, Cleveland Clinic, USA.

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Hi I’m Domhnall MacAuley and welcome to these BMJ leader interviews. Today I’m talking to Professor Jamie Stoller, but Jamie is more than just a clinician. He’s a physician, an author, and a thought leader in leadership. Jamie, maybe you tell us a little bit about your background.

JS:  Well, thank you, I’m delighted to be here. I’m a pulmonary critical care doctor, I practice at the Cleveland Clinic and I serve as the chairman of our Education Institute. That’s the part of the organization that oversees all of education; undergraduate medical education; graduate medical education; continuing education, etc. I’ve had a long-standing interest in leadership, based on a background of a graduate degree in organizational development, which is the predicate for my interest in leadership both as a leader within my organization as well as an academic interested in leadership concepts.

DMacA: That sounds very academic, but, actually, what really caught my imagination were your books because you talk about a totally new concept and that’s this business of ‘Virtue”. My experience of leaders is they are supposed to be tough hard-nosed folk, driving the organization. This concept of virtue is very different.

JS: Fair enough. The concept of virtues is actually quite old and the interesting part is that we keep rediscovering these ancient concepts- in some ways, they are hidden in plain sight. The virtues go back, of course, to Aristotle. They are classic Greek concepts of the seven classic virtues: trust, compassion, justice, hope, wisdom, temperance, and courage. And the premise here, and the evidence, would support the observation that when leaders create cultures that are anchored in the virtues, with trust and compassion being foundational,  they release discretionary effort in the organization. What does that mean? Discretionary effort means people will do the right thing when no one is watching. And virtue-based leadership is an alternate way of leading compared to the more conventional, if you will, compliance-based approaches of leadership – carrots and sticks. I reward you if you do something well (carrot), I punish you if you do something badly (stick). There’s a tremendous amount of literature that suggests that compliance-based approaches can work I some contexts, but usually are associated with suboptimal performance. This goes back to the work of Frederick Taylor at the turn of the industrial era. You know, in the industrial era when coal miners were harvesting coal from the coal face, you pay them more if they harvested more but, that approach really doesn’t work organizationally in the current world, and certainly doesn’t work with knowledge workers. Thus, a discussion about how to unleash discretionary effort by creating virtue-based cultures is particularly relevant to healthcare in that regard.

DMacA: One of the difficulties with us in healthcare, us as clinicians, is that we tend to have this tunnel vision, this health drive. Your co-authors are very different; one from business and one from philosophy. Tell us what can we learn from these other disciplines.

JS: We like to think, just as in science, that truth is related to replication of results across various experiments and investigators. So part of the enthusiasm for developing our two books with my friends and co-authors Peter Rea and Alan Kolp is the opportunity to share a vision of leadership that traverses multiple sectors. Peter Rea spent 30 years as the dean of a business school and now works as a senior leader at a Fortune 200 Technology Company, and Alan Kolp is a Professor of Theology. What really was the genesis of the book was our observations from our different respective sectors – healthcare, technology, and academics – that the same concepts about virtue-based leadership apply across all sectors. So it was this collision, if you will, of a common awareness that was the predicate for thinking about the book and writing the two books that we’ve done.

DMacA: Bringing this into everyday practice, how do you get those concepts across to young doctors, or young doctors who are trying to lead departments, or academic departments?

JS: A couple of things come to mind. The first is that developing a common language is important. One of the things that the virtues do is to develop a common language. Which of us doesn’t know what trust and compassion and justice looks like? And we can imagine the power of these things by imagining being in organizations that lack them. In the absence of trust, we can’t operate right. Things slow down because we’re constantly looking behind us and checking. In the absence of compassion, we all feel alienated and separated from one another. So the common language of the virtues is quite clear because most of us clearly recognize when virtue is being practiced. And of course, it isn’t a virtue until you act. So these principles are very much grounded in action not theory. By developing a common language, and then modelling behavior, leaders must speak the language of virtues and then behave in ways that are consistent with the espoused values. This is a basic principle of leadership, of course. In whatever leadership philosophy one is executing, one must be consistent in your actions with your stated objectives, and the virtues are simply a way of surfacing and making more explicit how we’re behaving towards one another. So, that’s the premise.

DMacA: At what stage in our careers should we be learning, should we be taught this? Is this a medical school, is it postgraduate, is it when you take a leadership position? When should we bring these virtues into practice?

JS: It’s a great question. One would hope that one would learn this in elementary school. In fact, interestingly, there are curricula, elementary school curricula, that are using these principles. But certainly within the health care context, this should be introduced as early as possible. We actually teach the virtues and derivative principles of effective teamwork, etc. at the Cleveland Clinic Lerner College of Medicine. This language is embedded in our curriculum and, hopefully, our Deans and our teachers are modeling these behaviors as well. But we use the language. As early as possible, I guess, is the direct answer to your question.

DMacA: Jamie, it’s been fascinating talking to you. Have you got one final message, one 15 second message, for people who are listening or reading?

JS: Yes, thanks. Simply to say that virtue-based leadership is perhaps a novel way of thinking about leadership, but it’s age-old and time-honored. Thinking about leading through the lens of virtue, and creating cultures that are virtue-based is  a performance amplifier. This is how one mobilizes discretionary effort to achieve high performance. So I’ll stop there. Thank you.

DMacA: Thank you very much Jamie, it’s been a real pleasure.

JS: My honor, thank you so much.

 

Contributors

Professor James Stoller 

James K. Stoller, MD, MS serves as Professor and Chairman of the Education Institute at Cleveland Clinic, where he has been a pulmonary physician for 37 years. He holds the Jean Wall Bennett Chair and the Samson Global Leadership Academy Endowed Chair at Cleveland Clinic. He holds a Master’s degree in Organizational Development and is Adjunct Professor of Organizational Behavior at the Weatherhead School of Management of Case Western Reserve University and Honorary Visiting Professor at the Bayes School of Business, City University of London. He has a longstanding interest in developing physician leaders and is co-author of “Exception to the Rule” (McGraw Hill, 2018) and “Better Humans, Better Performance” (McGraw Hill, 2023), both of which develop the concept of virtue-based leadership as a way to achieve high performance by unleashing the discretionary effort in the organization.

Declaration of interests

I have read and understood the BMJ Group policy on declaration of interests and declare the following interests: none.

 

Professor Domhnall MacAuley

Domhnall MacAuley currently serves on the International Editorial Board for BMJ Leader.

Declaration of interests

I have read and understood the BMJ Group policy on declaration of interests and declare the following interests: none.

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