Lead By Example : You are being watched

 Everyone is a leader. None of us are born leaders or incapable of leading. Even as some of us have a kind of nature which makes us natural leaders it is not that one cannot cultivate qualities which make us leaders. There are books written about Leadership but one's success or failure as a leader is determined by the attitude, commitment and willingness to learn.

Personally, I have not considered myself as a natural leader, in fact I have generally been an introverted person, who prefers to remain a follower and take instructions and be led rather than lead. However, the training at TISS in Hospital Administration made me realize that if were to get outcomes, I would have to learn to lead. 

Left with not much choice, I embarked on my leadership journey at Masina Hospital Trust with a great amount of trepidation and a tinge of nervousness. I started reading a book called 5 Levels of Leadership by John Maxwell and while these are typical Self Help books, I needed a quick guide to help me navigate the leadership puzzle. The book was preceded by an article by the same name gave me a framework to work on. https://www.maxwellleadership.com/blog/the-5-levels-of-leadership/.

Joining an institution which was leaderless and facing a crisis, was both a blessing and a curse. Blessing in that one could not make anything worse that what was existing and curse because of the sense of despair and the existence of people wanting me to fail. However, the early days were quite traumatic and both among the leadership managers, staff and workers there were supporters and detractors. I had to judge people and decide whom to trust and believe and whom to be wary of. There were fence sitters and indifferent persons and flatterers who were out to curry favours. Along with all this I had to battle the widespread perception of the hospital closing down and being taken over by a corporate giant and the feeling that I was just a stop gap arrangement before the inevitable happened. 

First Level of Leadership is called the Leadership by position and to be honest requires no effort. I was selected to lead Masina Hospital by the board of trustees, on the recommendation of a few senior consultants and on account of my being born into the Parsi religion. I had behind me some experience of leadership as a teacher in Orthopedics and stop gap medical superintendent of an ESIS hospital (Government Sector). My reputation of being an honest ethical doctor also prompted the trustees to give me the job. Except for a few managers and consultants who knew me I was an untested unknown entity for most people at Masina Hospital Trust. Therefore the advantage of Leadership by past record or position was hardly there. All I saw was either unconcealed hostility or disguised flattery to try and fool me. However, I had to pretend that I was in control and ensure my managers became my allies. The workers saw a level of involvement which was rare in the recent history of the hospital.  

Second Level of Leadership is called Permission to Lead. In this task,perhaps my genuine  honesty and open office atmosphere and ability to tell stories and build relationships made me more acceptable in a shorter period of time than expected. I refused to be tied down to my chair and was constantly on the move trying to understand the departments and their working patterns.  This in turn helped me to use first principles and solve problems. I was able to distinguish the Analysers, Drivers and Pretenders and learnt to use the strengths and weaknesses of these to my advantage. Since, there was a continuous crisis and very few processes were in place we had a lot of catching up to do. I got reasonable cooperation from my team and we made steady progress. 

Third and Fourth Level of Leadership required success and people development. No matter how good ones relationship developed one needed success for the employees and the organization to respect and accept my leadership. The pace and speed of progress was very rapid and for many old timers it was unprecedented. The challenge was to remain grounded and sustain this progress. Infrastructure development, getting new doctors hungry for success on board, negotiating outsourcing deals, fundraising and improving services from Nursing, RMO's and achieving quality accreditation in Masina Hospital within less than 3 years was certainly a challenge. Besides, the total revamp and cleanup of the department of Psychiatry was done to clean up the hospital's image. Our leadership team and staff did this and without realizing I had slipped into the fourth level where I could delegate and depend on my team to deliver. Many in my team progressed and developed and started realizing their potential, as I was willing to take their suggestions, give them responsibilities and empowered them to take decisions. Even if they made mistakes I gave them my support and helped them navigate their problems. I was in the meanwhile navigating the challenge of realizing that I had erred in trusting some of my key and senior team members. While there were a few signs and information regarding their wrong doings, I thought merely having a word and requesting them understand that my credibility was linked their incorruptibility. At this stage, I realized that I needed help lead the organisation, the trustees asked me to suggest a person and the trustees brought in a person of reasonable experience to play a leadership role. 

At this juncture the Covid pandemic struck and I can say this was the greatest challenge we faced and even though we had selected a person to share my responsibility as a leader, the Covid crisis was overwhelming. However, with great backing and support from our trustees along with a major fund raising effort our team rose to the occasion and again managed to give services and clinical outcomes better than the city average. We played to our strengths and in the midst of severe staff shortage and lack of full time physicians we overcame the crisis and then continued to prosper. The entry of more professional help and improvement in processes we started getting some financial stability, even though the fundamental problems of lack of money and outsourced departments remained. Our new trustees set about correcting these and put in place a hybrid model of full timers and consultants to reduce our dependence on the consultants with no great loyalty to Masina. A massive overhaul of infrastructure to bring the hospital on par with the competition was undertaken and completed successfully.

If there is one critical factor which was overlooked by me was that across the organization both internally and externally there was not enough clarity in the understanding of the Vision, Mission and Value statements of the trust. The brand of Masina Hospital as a unique hospital which had a legacy of compassionate care which came from the founder and his daughter extending from 1902-1966 was never built on. While personally I had internalised this and realized that the differentiators of this hospital. We are running departments which were excluded from all hospitals on account of low revenue, high risk operations were part of this commitment to serve. These were centers of excellence relating to specialized burns care and mental health departments. I can say with a sense of satisfaction that we ran these two departments and  and yet found a way to remain sustainable. For me scaling down or diluting the focus on these departments was not desirable. Besides, this the adolescent and child therapy departments were also differentiators worth talking about. The development of skin bank, the employment given to persons with disability as computer data entry staff, the emphasis on greenery, cleanliness and eco friendly initiatives which included empowering rag pickers to help in solid waste management and installing a bio gas plant were initiatives which made our hospital different and unique. 

As a leader, I led by example and set highest ethical standards and ensured that nobody could cite an example of breach of honesty and integrity. This example ensured that donors had full faith in ensuring funds were utilized for the purpose allocated and staff would think again before cheating or breaking rules. The social milieu of a general fall in ethics and standards is so prevalent that the sense of right and wrong is blurring, I tried my best to ensure that the hospital retained its reputation as an ethical organization led by an ethical leadership.

The last Level 5 of leadership is utopian and cannot be achieved till this critical gap of total alignment with Vision, Mission and Values is achieved. However, with all humility I feel that history will judge me and I have done my best for the institution and wish that the present leadership takes the hospital to greater glory and achievements. 

Change is the only constant in life and even though it is hard, I feel the maxim that "Live life as though you my die tomorrow and learn in  life as though you have to live forever". Finally, to all leaders remember the Dharma of leadership is to obey your conscience and remember that even when you are alone, someone is watching you.

Vispi Jokhi