B (3:20)

Why is it that you think in our society that we. We tend to conflate rank or position with leadership?

A (3:29)

Well, I think it's a natural tendency. It's the default circuit that we go to because it's easier, meaning just hang around, just do the work, just stand in line, and someday it will be your chance. And so to me, when I hear people say future leader, it really rankles me. I think it's demeaning. I think it's demonic. I think it's incredibly silly to talk to people about future leaders. The reason is we're all leaders all the time.

B (4:05)

Yeah, I agree. And oftentimes when I talk with our medical students or our residents, I try to get all of them to see that they are leaders and they are all going to be leaders. I think we often have this thought that in the medical world, unless you want to be the department chair, the hospital CEO or president of a society, that you're not really a leader. But in reality, every single one of us is leading every single day.

A (4:26)

Look in the mirror. That's the leader you're looking for. The answers are not above us in an organization. They're within and among us.

B (4:35)

And another term I want to get a little clarification on is the term of a manager. So, you know, we talked about being the boss or being in charge. We talked about being a leader. But there's also this concept of being a manager. So somebody who has to oversee and execute, make sure certain tasks get done. Is that the same thing as a leader, or is that different in your mind as well?

A (4:58)

Completely different, and here's why. And John Cotter at Harvard did a lot of good work on this, which is what's the role of a manager? A manager is to keep their current system functioning well, according to metrics, according to strategic plans, according to tactical plans. Whereas the leader's job is to envision a new future, to innovate. Often in our organizations, we have to be able to toggle back and forth between managing, keeping a current system functioning. And why do we do that? Because it adds value. If it doesn't add value, we have to change the system. That means if it either adds value or causes waste. One of the two. If it causes waste. Now I got to toggle into my leadership, my envisioning, my motivating, you know, my Ability to help others see why we need to move from where we are to some other place. So I think both skills are necessary, but understanding that they're different and understanding in the moment what am I doing and which skills do I need to manage. Keep the current system functioning versus lead, meaning think, act and innovate in a radically different way.

B (6:11)

That's great. So I think hopefully it's fair to say somebody needs to be the manager. Somebody has to do the job of keeping things functioning and keeping them moving forward. It's an important job. Not, not trying to take away from that role in any, any respect. Hopefully the person who is the manager is also a leader. But everybody else who's not a manager

A (6:33)

can be a leader 100%. And a simple example from your sphere of influence, when you look at the OR supervisor, she is managing the whole playing field. She is responsible for making sure that the right tray is in the right room at the right place at the right time, that the scrub nurses who are going to scrub with you are people you're familiar with and part of a team as opposed to just somebody who shows up. But she also has to, as things adapt, you get a trauma that comes in. Now the whole schedule is blown up. That's leading. So the first part is managing. Checking the box, the checklist manifesto, if you will. But leading is required almost every day in everything we do. Not just in health care, but I speak to banking, to financial management, to sales, corporations, same deal. You got to read and react just as you did as a baseball player and I did as a linebacker.

B (7:31)

Let's talk a little bit about what happens when that person who's in charge, so we'll call him the boss. When, when the boss is not a good leader. What's the impact that has on the organization? What about on the team? And then what about on the person themselves?

A (7:48)

It's a devastating impact. And the reason is too much in health care, too much in life. We're the, the, the boss. The being in charge is a combination of prescriptive and prescriptive, meaning prescriptive do this, do that, and once you finish, come back and I'll tell you what else to do after you do that. It used to be a sheet of paper, now it's electrons in the ehr. But there's a page that says doctor's orders. It doesn't say doctor's suggestions, doctors, what do you think? So healthcare in particular has that issue, or proscriptives don't do that. So it's kind of the Old Testament, I was a theology major in addition to being a linebacker, which is some kind of satanic combination right there. But, you know, Old Testament, thou shalt, Thou shalt not so effect on an organization. It assassinates innovation, it completely stifles innovation because I gotta do what the boss tells me to do. These prescriptives and prescriptives for a team, it demoralizes, you know, and, and how many times in a team boss tells you to do X and you think, really, you think that's the right thing to do?

B (9:05)

I think in a lot of areas and a lot of different domains and professions, sometimes we mistake high performers who are great technically at their craft. We mistake that high performance for leadership ability. And so oftentimes we see folks that because they were technically good at a given job, career vocation, end up getting promoted into leadership roles that they may or may not be ready for. Do you see that commonly? And why is that such an issue?

A (9:38)

Oh, it's pervasive, Chris. Pervasive everywhere. It's pervasive in education, every level of education. It's understandable that, particularly in your case as an orthopedic surgeon, in my case as emergency medicine, sports medicine, Doc, we're both sports medicine, just two different pieces. And you know, it's not easy to be as good as you are in the operating room. It's not easy for me to be as good as I am at resuscitating a patient, or more importantly, figuring out the subtle gestalt not of a cardiac arrest, but of a patient has chronic pain or chronic problems. And so that technical expertise, expertise is hard won, acquired over a period of time. And understandably, we take pride in that as we should. And now someone says, well, oh, by the way, you're going to be the chief of sports medicine, you're going to be the chairman of the emergency department. Oh, you mean it's not enough?

B (10:41)

And I think that that pursuit of technical excellence often encourages us to pursue titles and authority as well. And so sometimes those that drive and motivation can, some sometimes work against us. So I'm going to use that to transition to our second section where we're going to talk about why this, this can be such a struggle for people. So why is it that being in charge is sometimes more seductive or attractive than actually doing the work of being a leader?

A (11:16)

Well, first of all, it's understandable if I only do those things, then I'll get there. I have to bide my time. I have to stand in line. I have to progress through. If you Think about the titles. We have an intern, a JA A junior resident, a senior resident, a chief resident, a fellow, an attending, and now I start at an and assistant associate all the way to professor. And, you know, it. It can be attractive in that all I have to do is follow the rules.

B (11:53)

I think you're exactly right, because oftentimes the pathway to the corner office or the pathway to being the boss or the pathway to holding the title is very clearly laid out and elusive. You know, okay, I need to get this promotion, and then that will lead to this next promotion, and that'll lead to the next. And, you know, the boxes you have to check along the way. And so I think that because it is relatively clearly laid out, it becomes very alluring and our ego creeps in a little bit because then we get the recognition society brags on you a little bit. You get that positive affirmation. It's somewhat measurable. And so I think that that tends to draw us into that. And I think for a lot of people, true leadership is not as prescriptive or it's not as clear on what exactly to do, because it's complicated and it's messy and it's difficult and it's challenging. And one of the things that I think that we don't do a very good job of is putting people in those roles, you know, giving them the title, making them the boss, without actually giving him the help and instruction they need to become a leader. So my question to you is how, if we know that we want somebody to be a leader, how do we train them to do that, to handle that responsibility that inevitably come with the role?

A (13:10)

Well, Chris, think about the. How we select medical students. I, for reasons that surpass imagination, do a lot of speaking, increasingly, a lot of coaching, consulting, things like that. I always show a slide of a bunch of kids playing in a sandbox, and there's no words on that slide at all. And my question is, is that how we choose medical students by their ability to play in the sandbox? Well, together, the answer is no. We choose medical students by their ability to crawl over the backs of other students to get higher scores, to get better exam scores, to write better essays. And, you know, we say, okay, you look like a great medical student, and then we put them through medical school. They don't get trained on how to be a leader. They get trained on how to score, how to get higher on the in service exam, and all that's involved. We don't. We don't teach them in teams. This is Insane comparing people to other people. Everyone should be able to get an A, and everyone should get. Be able to get an A today by how they lead.

B (14:21)

I think you're right. So some of us don't do a good job of playing in the sandbox with others. Some of us are far too focused on our own achievements and accolades and success to be thinking about other people and bringing them along. Some of us are. Are after our own ego. But I also wonder, to what level does insecurity play in this? Because I think there's probably a lot of folks out there, whether you're the boss or not, who struggle to be good leaders because they're insecure or that they don't feel worthy of leadership. Do you see that commonly?

A (14:56)

All the time. And think of it in two buckets, if you will. One is vulnerability and the other is imposter syndrome. They're highly. Brene Brown has written and spoken beautifully about both. But there's always a sense of imposter syndrome for everyone because there's a sense of doubt. And will I fail? And the answer is, yes, you'll fail. There's no question about that. The question is, are you going to make failure your fuel? Are you going to say, okay, this went generically right or in the right direction, but what are the things that we can do differently, whether it's baseball or football? Break the film down. You break the film down and you say, you know, yeah, that was great. That was great pitch. You know, that was a great tackle. But, you know, could I have been in a better position? Could I have tackled him in the backfield instead of in. At the second level? And so understanding that is important. When I first got started in this job, I was hired by Gene Upshaw, executive director of the nflpa, because Corey Stringer, a tackle for the Vikings in Minnesota, died of heat stroke. And so I took the job. And shortly into the job, a very complex issue came up. And I took the unusual step of going down to Gene's office, and I said I was smart enough to know, don't walk in and say, what do I do? Give them three options. Here's the things I could do. And so I did that, you know, 1, 2, 3. Gene just looked at me and said, just go be Tom Mayer. That's why you are Tom Mayer. That's why I hired Tom Mayer. And I walked out of the office and called my wife, Maureen, and she said, what did Jean say? And I said, I don't have a clue. I don't have any idea. But I do. What he was saying is, I trust you. That's why I hired you. And so I walked in, I think, with a little vulnerability and imposter syndrome, and I walked out with the sense of just do the best you can.

B (16:55)

That's a sign of a good leader, too. I think he probably recognized what you needed, what you were looking for, recognize that you had the skills and abilities to do it, just needed to be given permission, and then he didn't give you the advice, he gave you the permission.

A (17:08)

Exactly. And if you think about it, whether it's in our case, in health care, whether it's in business, whether it's in industry, our middle son was a Marine infantry officer. It's all the same. And that is, who are the people along the way that you thought to yourself, in the moment, in the moment, I want to be like him. I want to be like her. I want to. When it's time, I want to do it that way.

B (17:44)

I'd like to, you know, jump into our third section now where we can tell people how they can start doing that in their everyday life. So my first question online, just to set the stage for this, do you genuinely feel, after your years of experience in working with folks from all different walks of life, do you genuinely feel that anyone can be a leader, even if they're not technically in charge?

A (18:08)

Somewhat to your surprise, no, I don't think everyone can be a leader. I think everyone already is a leader. And understanding that is critical, absolutely critical, because it goes to that future leader, someday versus today. I am leading. I'm leading my part of what I do. So that's when I say, you know, don't aspire to be a leader. Embrace the fact you are, and then inspire others to understand you're already there. It's not a future state. It's a present state.

B (18:41)

Perfect. It's not about earning the title. It's about refining the one that you already have. So everybody needs to see themselves as leaders and then make the effort to improve it. And I would argue that it doesn't matter how. How good or bad you are at it. There's always room for improvement and that every bit of improvement is helpful. And ultimately, I think leadership really comes down to a correct mindset. So your mind has to be in the right place, and you have to understand things mentally, but then you also have to do the actual behaviors or actions of a leader. So it's sort of both mindset and behaviors, in your opinion, for if we want to get better at this, where do we start. Do I need to start fixing my mindset or I need to start fixing my behaviors?

A (19:25)

Well, it's like all things important. It's a dynamic tension between mindset and behaviors. And so, you know, it's critical to think of. Of leading as important because it's actions, it's what you do. People say to me, you know, hey, let me. I come on site, they want me to help them, and they say, here's our culture. Here's our mission, vision and values. Here's our organizational chart. My answer is, you know what? That's fine. Appreciate it. Am I going to read it? Not before I get there. You know what I'm going to do is watch you. Give me about 15, 20 minutes. I'll tell you what your culture is. I'll tell you what your org chart is. I'll tell you who the influencer are in that organization, because I see it. And what I mean by that is culture is what we were. Aristotle said this centuries ago, thousands of years ago. We are what we repeatedly do. Excellence is not a virtue, it's a habit. So we're creating a culture every single day. Our culture, our team's culture, our organization's culture. Now that requires a mindset to say when it's my turn, and today it will be my turn to be a leader, to create a culture to help people along the way and to show them that my job is not just to make the patients lives better, but to make their lives and their work better. Easier in the course of having done that.

B (20:55)

Yeah, absolutely. All right, so now I'd like to take this and, and put it into some real, like, practical, actionable steps for people and maybe why don't we start with folks that are, we'll say, leading from the middle or leading up the chain of command or however you want to phrase it. So this is somebody who maybe you don't have the title. You know, you're, you're not the CEO, which is okay, but you're, you're a regular leader like the rest of us. What steps can that individual start to take to improve on their leadership journey? And I'm going to start it. Actually. One you' already said is step one is really recognizing that you are a leader, because I think a lot of people haven't made that leap yet. So I'm going to say step one is you recognize that you are that leader, and then after that, what comes next in your mind.

A (21:38)

Second is actually a bit of a proscriptive, and that is to recognize the terrible Toxicity of I'm just. Because it demeans yourself and it demeans others. I think when you say, I'm just an emergency physician, you know, I'm just an orthopedic surgeon, or I'm just a, you know, a nurse, that. So get, let that fall away and say, that's just not going to help me in any way, shape or form. Understand that you and everyone around you is an innovation entrepreneur. And so wait a minute, I'm an employee of an organization, a Larton Mayo Clinic or, you know, wherever it is that you work. No, you're an innovation entrepreneur because you're doing your job, but at the same time, you're making patients lives easier, other people's lives work easier. But you're also seeing how could this be changed, how could we innovate to do it better? And innovation in the best organizations, including yours, I've been there at all three campuses, doesn't come from the C suite. It comes from the we suite. It comes from the people who do the work, because the people who do the work know what works and what doesn't work. So understanding that, you know, you say lead in the middle. I got it. I understand that term. No one's ever in the middle. You're at the top of your game today, doing your part of what the organization is doing. And part of that is identifying stupid stuff and inventing smart stuff as you move along and understanding that that excellence is everywhere, but so is failure. So seeing how people interact, you know, a subtle way that you talk to people, a subtle way that someone interacted, does the doctor come in the room and they have their arms crossed and stand at the foot of the bed, or do they walk to the head of the bed, sit down and establish physical contact with open arms, open body language. So it's everywhere. The ability to be an astute observer of excellence is critical to being alone later.

B (23:49)

That's an amazing list. So I was sort of taking notes as, as we did. I'll run through it again at the end, but you gave us a, a whole host of, I think, helpful tips and tricks there on things we can actually start doing to improve. One of the things I think is important is recognizing we talked about this at the outset, is that leadership is a journey, it's not a destination. You know, you never get to the, to the end and say, I did it, I made it, I arrived, I'm a leader, I'm finished, I don't have to work on it anymore. So I think a lot of this Requires us to continuously sharpen the saw, which on one hand, I think is. Is encouraging and forgiving because that tells you you're not going to get it right all the time, just keep improving. But on the other hand, for some folks, that might seem a little exhausting to think, oh, I got to keep doing this forever. So how do you approach that sort of concept of continual improvement and continual striving towards betterment as a leader?

A (24:42)

Yeah, so stick with me. I'm going to start with a broad concept, and that is Bob Waldinger, Tyler Vanderweel and a couple others. And I are working on a paper that talks about the difference between lifespan, how long you live. It's pretty clear you were born, you pass away. Healthspan, how relatively healthy you remain during the course of that lifespan. But the missing piece in life these days is joy. Spanish, your ability to feel joy in what you do. And so, as you say, do I have to keep doing it? The answer is yes. The discipline of joy, the discipline of taking pleasure in helping others. Again, whether that's a highly technical procedure that you do, repairing a rotator cuff, for example, or in my case, you know, it could be a resuscitation, or it could just be making a diagnosis that no one particularly saw. And seeing the joy in that and how that sustains us at the same time, a dynamic tension between loving what we do and yet creating something better, Finding different ways to say, oh, we could do this a little different, we could do that a little different. And that's not only gonna be easier for me, it's gonna be easier for other of our colleagues, and it's gonna be better for the patient in the long run. So the ability to see that and take delight, to take joy in what we are doing while at the same time creating others. That's the difference, I think, between Aristotelian Eudaimonic joy, the joy of seeing your child, the joy of seeing a sunrise, a flower, an eagle soaring over a head, in our case, grizzly bears in our backyard. But there's also generative joy creating joy in others. And that's where I think it ties to that deep joy, deep need. How do I have generative joy in pursuing what for me was the joy I sought to have in the first place? Does that make sense?

B (26:47)

A hundred percent, and I love it. And it really is in sync with everything we talk about here in regards to human optimization, that what you're describing is process satisfaction. So allow yourself to enjoy the process and enjoy the journey. I think One of the issues with goal setting is, and you could see this in sort of professional climbing, climbing the ladder, so to speak. If you say, okay, the corner office is my goal, one of the problems is you often will spend years and years and years grinding away try to get that corner office and you won't let yourself enjoy it until you actually get there. And the problem is you're, you're sort of making a deal with your future self saying, all right, I'm going to get there in 10 years and that, that version of myself is really going to enjoy that. But you actually don't know the you that's going to exist in 10 years. And so you're almost making a promise with a stranger that you don't know or haven't met yet. And so I think it forces us to delay our gratification it. We set ourselves up for things that we may or may not even enjoy when we get to that time. So instead, I agree, I think we're much better off focusing on the process of getting better, of improving and watching the impact that we can have on a, on a day to day basis. All right, I've got one final question for you before we wrap up here. I think sometimes it can be hard for us to recognize leadership in the moment when we're actually doing. It's often you don't see it until you reflect back and think, oh, that was great leadership, either that I gave or received. Do you have anything that people can use where they can sort of check themselves and say, all right, wait, in this moment right now, am I just being in charge or am I actually being a leader? How can I be reflective of myself in this very moment to know which of the two I'm doing?

A (28:36)

Well, fortunately, the training I had was hugely helpful. And the reason is I was a linebacker, read and react, you know, constantly seeing what's, what's happening. And you know, I can call whatever play we have, we may be in, you know, are we in cover one, cover two. But all it takes is a snap of the ball and all of a sudden you got to react and you got to adapt to that. The same is true in theology, in life. So becoming an astute observer of others, astute observers of subtle, sometimes subtle inflection points and how someone reacts, body language, tone of voice. We've all been explaining things to patients and we realize, oh, I don't know what I'm saying, but it's not getting through the skills of active listening, having someone repeat back what you said to them. So watching in the moment. So you have a sense of, am I connecting? And am I connecting in a way that helps people? As you know, every patient comes into your office and to my waiting room in the emergency department carrying their own private concierge medicine physician, whose name is Dr. Chat GPT. And they've already looked up everything that they thought, well, how do we react to that? Do we say, well, where did Chat GPT go to medical school? What residency did he do? Or do we say, well, this is great, tell me what you've learned so far. Let's sit down and talk about this. And so seeing those things, being an observer, read to lead. And what do we. What do you read? You read the. The lives of great men and great women. How did they decide? What did they do? What did they face? How did they make their decisions? How did they make other people feel? Keep a list mentally, but then also write it down of inspirational leaders. Why? What did they do? What did they say? How did they do it? How did they make you feel? But conversely, keep a list of not so great leaders. Why? What did they say? What did they do? Was it tone of voice? Was it body language? Was it. Did they make you feel demeaned? Or did they make you feel better? Did they constrain you? Or did they liberate hope? Because the final goal of every leader is to create hope in a world that's very confusing for a lot of different reasons these days. But a coach, as you know, is not going to tell you to be prescriptive. They're not going to be declarative if they're very good, they're interrogative, they're asking questions, and what else? And why did you think that? Why did you choose that? What other options did you have as opposed to, oh, you shouldn't have done that, you should have done this. That's not coaching.

B (31:17)

And I think you have to recognize there's a lot of different ways to do this, a lot of different ways to get better at it. Figure out what works for you. You're right. You got to be introspective, see what clicks with you, connects with you, and then just, just keep going. Enjoy the process. From my notes here, I wrote down different definitions. So being in charge, that's. That's a location, a title, a rank, or a position. It doesn't tell you anything about your importance, the trust you've built, or the contribution you're actually making. On the other hand, being a leader is someone who makes people feel like they're the most important person in the room. It's focused on others. And we are all leaders at all times, regardless of what your title is. We also talked about what a manager is. So a manager is the person that keeps things functioning. You need one. They're great people. We need to have them. Doesn't always mean that they're leaders, but they absolutely can be and should try to be both. We, we talked about some reasons of why we tend to be bad leaders. Some of the biggest mistakes that we make is we don't play well with others in the sandbox. We're often focused on our own ego. We're chasing the wrong metrics. We don't know that we are leaders. I think that's a common mistake. Or we may have too much insecurity. We may not feel worthy to the task. But I like that. Your point? And when we asked, we talked about the steps of how to get better. We said point number one is recognizing, number one, that I am a leader. So everybody has to believe in that themselves. And then your other steps, number two, recognize the toxicity of the phrase, I'm just whatever it is. So don't reduce yourself to that. The third step, we're all innovation entrepreneurs. So there are people all around us. The people that actually do the work are the ones that can actually move things forward. Four, step, you talked about how there's excellence and failure all around us every day, and we're the ones who can help other people see the excellence in themselves and continue to focus on this. And then the last thing I wrote in all caps, enjoy the process. Leadership is definitely a process. You got to enjoy it. So now I'm going to give the challenge or call to action. We always like to end with the challenge to the audience. And so this is going to have a few levels. So I think number one is obviously people need to recognize that they are leaders. That's step one that you gave us. And I think to nudge people in that direction. What I would encourage you to do is to think about somebody in your life who is not your direct superior at work, who has led you in a positive way. And when I think, I mean, I, I see him and honestly, even my kids at times have led me, you know, they, they teach me things all the time. So think about somebody in your life who's not your boss that has led you and how that's impacted you. And I think I'm going to challenge you to go tell that person that you appreciate them leading you or teaching you in that way. Because I think if you do that, you will not only help them recognize that they are a leader, but that that act will then help you realize that you are a leader as well. So I think that's a win win. Tom, thank you so much for joining us. This has been an excellent discussion. I really appreciate it having you on.

A (34:04)

It's been an honor. I appreciate it. You know I'm in the praise from Caesar as they say. Thank you Chris.

B (34:10)

Thank you. If you like this episode, please share it with a friend and leave us a review review on your podcast app. It really helps others find the show. Got feedback, a question or a topic idea? Email us@OptimizeAYO.edu or leave us a voicemail at 507-538-6272. We might even feature your voice on the show. For more human optimization episodes and resources, check us out online at CE. Remember, long term well being starts with the habits you build today. Live Intentionally perform exceptionally. I'm Dr. Christopher Camp. Thanks for listening.

C (35:10)

This podcast is for informational purposes only and should not be relied upon as medical or legal advice. Always consult with a qualified healthcare provider for any medical questions. The appearance of any guest does not imply an endorsement of them, their employer, or any entity they represent. The views and opinions are those of the speakers and do not necessarily reflect the views of Mayo Clinic. Reference to any product, service or entity does not constitute an endorsement of or recommendation by Mayo Clinic.