True Leadership: Hearing the Littlest Voice

Hearing Small Voices

Leadership comes in all shapes and sizes. It shows up in every aspect of life. It really hits home when it becomes a life and death situation. 

Especially when the life and death situation is a family member.

My Story

In 1988, my family faced a medical situation that even I, as a doctor, couldn’t fix.  My wife, Mary, awoke with a lightning-sharp pain in her leg; she couldn’t bare the weight of the sheet upon her foot.  A physician we visited indicated that Mary was suffering from a nerve injury, and gave her pain medication.

As her health worsened, we were unable to reach him or contact him in any way.

After several days of pain that ended with bruises across her body, we got an internist to see Mary.  She found clots in Mary’s legs, and sent us to the hospital.  Mary’s blood work there showed that she could be suffering from an allergic reaction; I’d given her penicillin for strep throat a week earlier.

Was this the cause?

  • Five days into Mary’s hospitalization, she began coughing up blood.
  • The clots from her legs had dislodged.
  • Her blood thinner had failed; the dosage she’d been prescribed was too low.
  • The attending nurse acknowledged this, but said she couldn’t report the error for fear of losing her position.

Mary developed chest pain two days later, and tests confirmed she’d suffered a heart attack.  Her new cardiologist diagnosed her with inflamed blood vessels and prescribed new medication.

What else could possibly go wrong?

  • Mary’s lungs filled with liquid.
  • She was drowning in her own body.
  • She was placed on a ventilator and went into shock as her organs began to shut down.
  • Her heart stopped beating.

We’d sought help for a nerve injury, and we were now facing death.

Why Top-Down Leadership is to Blame

Hierarchy over Health

To cut to a long story down to size, miraculously, Mary recovered.  But she never needed to suffer as she did.

Unfortunately, most healthcare systems – and many other types of businesses – follow a command-and-control model.  This philosophy forces everyone to wait for the boss to make a decision, inevitably resulting in delays and frustration for everyone involved.

Most of those on the front line give up trying to make permanent changes.  They stop speaking up.

Imperfect Example

Our bedside nurse was a perfect example of the insanity.  She knew the intern wasn’t using the correct dosage, but she didn’t want to appear to be questioning the authority of the physicians.

And, although I was a physician myself, I was treated with disapproval when I spoke up about the issues I noticed.

There was, ironically, no room in this dynamic for a second opinion.

Top-down leadership structures emphasize compliance, and exclude the customer’s or patient’s viewpoint.  Autonomy is stripped from workers as they endeavor to fulfill specific performance measures.  Altruism and a real sense of purpose are extinguished.  The people who best understand the customer’s perspective – the front-line workers – are effectively silenced.

When people lose sight of the importance of their work, morale goes down and turnover goes up.

How Leadership Can Empower

A Great Example

Better environments can be created where all levels of our workforce can be heard.

Effective organizations, like Toyota, encourage everyone to make suggestions.

At Toyota, employees receive extra pay when they contribute a suggestion for improvement that gets implemented.  This allows front-line employees to feel like they’re making a difference, and it forces those at the top to acknowledge the contributions of those below them.

Power structures need to be flattened

While we need people to administer, these people should be working alongside lower-level employees – not over themRespectful communication and teamwork need to be the guiding rules in each business.

Effective teams value the contributions of each and every member.

If each person feels charged with the task of improving his environment, each staffer will also gain a new sense of identity.  His job will increase in significance as he takes a new level of ownership over it.

The bottom-line is this:

When people feel empowered and their morale is high, they’ll help us build better systems and provide better care for our clients.

They’ll report incorrect dosages.

Everyone is a Potential Leader 

Simply Seeking Improvement

It’s easy to assume that the leaders in each company are those who hold the loftiest positions.  This is simply not true.  A leader is anyone who influences others to improve.  Therefore, anyone can, and should, become a leader.

This includes everyone from janitors to IT professionals to doctors.

Treating everyone as a potential leader – and encouraging them to do the same – cultivates a problem-solving culture.  Rather than simply complaining, personnel are emboldened to point out how problems impede them from providing the best customer service they can – and they’ll actively work to solve the problems.

They view problems as their issues, and they view themselves as people capable of fixing them.  By always focusing on what’s best for our customers and patients, we remove the worry of being perceived as troublemakers for addressing problems.

We also eliminate concern of job loss for being good at our jobs and recognizing issues.

A Culture of Encouragement

In a culture where leadership at every level is encouraged, every point of view is taken into account.  The test of a true leader is one who can share authority with others because his eye is on doing the right thing – not on being right.  As this view of leadership is embraced, trust and cooperation develop.

When an error occurs, everyone will come to the rescue.

When everyone feels responsible, everyone is willing and eager to help.  And when everyone is involved, even the littlest voice is heard.

So, does your work environment encourage leadership at all levels? Have you lost sight of the importance of your work? Are you treating or being treated as a potential leader? Does your company make everyone feel responsible for your success or failure? 


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Dr. Frederick Southwick is a Professor of Medicine at the University of Florida
He is the author of “Critically Ill: A 5 Point Plan To Cure Healthcare Delivery”
Email | LinkedIn | Twitter | Blog

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4 responses to “True Leadership: Hearing the Littlest Voice

  1. Autocratic leadership had been the standard in the military. But, the military has realized, gradually over the last couple of decades, that kind of leadership style is somewhat archaic. I have a post discussing this very thing entitled, “Decision-Making in the New ‘Leadership Organization.’” I invite you to read it –>

    It is becoming less top-down and hierarchical leadership structure. Think about the military, in total, as a leadership organization where you invite participatory involvement in decision-making; where people at every level, from the sides and the bottom, have a voice and a view, and are permitted and encouraged to provide feedback. If you delegate more, if there is more distributed decision-making, then you see an organization that is a ‘leader organization.’ That is exactly what is happening in today’s military.

    In the private sector, more leadership organizations will find that transforming to a more ‘democratic’ leadership style, where everyone is a leader, everyone has a voice, and leadership at every level produces better, timely and more successful results.


    • Dale,
      I agree. The special forces are a prime example. Everyone has everyone else’s back. These teams stay together for years and understand each members strengths and weakness. Together they are far more talented than any one individual. When one person autocratically makes all the decisions much of the talent in the team is lost.


  2. A very moving story with a happy ending. I am glad your wife is doing well. I went through many thoughts re: leadership as I was reading your post. The command and control style is still alive unfortunately despite all we have learned regarding its ineffectiveness and its harm to people. Your design makes a lot of sense. Some years back there was a book “Every Employee A Manager” that argued many of the same ideas.

    Leaders have to get over themselves to execute a system like you are recommending. Doable but not easy as ego, power, fantasies of control and fear based value systems are widespread (my opinion) within the leadership community. Your post is a good “wake up” call for all of us. Thank you. – Doug


  3. Doug,
    Thank you for your kind words. In my experience many of the command and control leaders were raised in a command and control family. When picking leaders, questions concerning parenting and family style should be part of the evaluation. Once an autocratic leader takes control they usually will not share their power and decision making. Witness the upheavals taking place in the Mideast.


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