Blog | Monday, February 24, 2020

The lions for lambs of health care

I just watched the movie “1917” in the theater. Shot in a unique way giving an immersive experience, showing the frontline reality of war through an unforgettable human story, it has to be one of the greatest war movies ever made. I'd encourage everyone to go watch it. I learned a fair bit about the WWI while I was in high school in the United Kingdom. Its stories are often eclipsed by the much larger-scale WWII, which came two decades later, but many historians will argue that it was the WWI which was more horrific and shook the world to a greater degree, because it was the first time industrial-scale technology had been brought to the theater of war.

The horrors of trench warfare are described so vividly by many of the great poets of the time, like Wilfred Owen and Siegfried Sassoon. And unlike WWII, which actually did have an obvious evil enemy and despicable ideology worth fighting against, the WWI was more about stalemate between sides that didn't really know why they were even there. A war that became drawn out because of the sheer arrogance of the leaders. Millions of brave young men from Britain were killed, wounded or maimed. There are monuments all over England, even a large one right in the middle of my small Berkshire village. When you look at the ages of those who died, many are barely men at all; they are just teenagers. Such a waste of young life.

There's a famous quote by a German general who was witnessing wave after wave of brave British soldiers being sent over the top of trenches to their certain death, as they were mowed down by machine gun fire. He remarked: ”Never before have I seen such lions led by such lambs.” That quote came to represent many of the catastrophic leadership decisions of the British hierarchy, who kept making miscalculations and taking needless risks with human life, all for gaining sometimes just a few feet of enemy territory. The British army knew that they were being led badly by their generals, and actually coined a slightly different version of this phrase: Lions led by Donkeys.

I like these quotes for many reasons, because they can be applied in a multitude of different ways today, especially to modern leadership. Needlessly to say, nothing could be as consequential as war and death. And nobody could be braver than a soldier. However, when the frontlines are let down by their leadership, what happens from there is never going to be good.

Leadership is lacking all around us, in so many industries and sectors, and nowhere more so than health care. The consequences are right in front of our eyes: a suboptimal fragmented system, soaring costs, hidden agendas, and a demoralized group of people who work in it. If you have a leader who is not with their frontlines, an earthquake will be felt down the whole chain.

As a physician who has worked in dozens of different institutions in different parts of the country, I have sadly seen some terrible examples of leadership, from mid-level managers all the way up to CEO. Fortunately my experiences have led me to now only choosing the very best-led places to work in, because I can sense in an instant anywhere that doesn't have a good leadership team in place. (I even want to speak with the CEO before I consider signing any contract, to gauge their character and core beliefs.) From what I have seen, these better places are in the minority in the health care world.

There is a scene in “1917” when the soldier who is trying to deliver an important message from high command to a senior colonel, to halt an attack, interacts with a senior British officer, who cleverly tells him, “Make sure there are witnesses when you deliver your message … because some of us just want the fight ….”

That was a very shrewd thing to say, because there are sadly leaders who will always be more interested in advancing their own agenda, and will gladly sacrifice others to do so. We have all seen it, and I'm sure everyone reading has their own stories about managers who are all about numbers, targets, and the bottom line. I have personally seen many leaders gladly throw a doctor group or nursing team under the bus to look good themselves. And all the while the clinicians know that none of them would even last a day, if they ever had to do what we do.

The frontline workers in health care are heroes. There's no other word for them. They are lions. The doctors, nurses, and all other professionals. They will always do their duty no matter what. Moreover, their hearts are in the right place. Sadly, that is often taken advantage of. They could be exhausted, understaffed, or being led badly, but they will never neglect that patient in front of them and always go the extra mile, all of this while their immediate world may be consumed by corporate greed, politics, industrial disputes, and patients who are suffering.

Everyday across this great nation, frontline clinical staff are let down by their leaders. Whether it's the administrators or politicians, it's true in health care too: Rarely will you ever see such lions led by such lambs.

Suneel Dhand is an internal medicine physician, author and speaker. He is the founder of DocSpeak Communications and co-founder at DocsDox. He blogs at his self-titled site, where this post first appeared.