The Role of Followership - Leading a Heart Center
You are interviewing for a top Leadership role in a terrific Heart Center – it’s your dream job and you want to look sharp. Your interviewer asks a simple question: “Which is more important for your role - Leading or Following?” If you are like most of us, you will have read extensively about Leadership, talked about Leadership, taken courses on Leadership, and seen Leadership as the prime characteristic of successful people in movies, television, popular media etc… Who would ever say that Following is more important than Leading?
When we talk about improving care in Heart Centers, we typically focus on Leadership as the prime determinant of outcomes. Leadership skills are the topic of innumerable books and taught through a wide variety of educational opportunities hosted by coaches, consultant groups, hospitals, and major academic societies. A PubMed search lists 92,578 citations for the word “Leadership”. As a profession we are clearly focused on Leadership. Despite abundant focus on Leadership, however, we rarely focus on an important skill required by ourselves and the great majority of our colleagues, specifically “Followership”. (In fact, searching for the term “Followership” in PubMed reveals only 215 citations…).
A real-life example of the power of Followership:
My academic career was initially driven by a belief that if I mastered enough Leadership skills, I could ‘lead’ a team to accomplish whatever I set my sights upon. It was quite a surprise to eventually recognize that my greatest accomplishments depended more upon Followership than Leadership. This recognition arose through the opportunity to work with Glen Van Arsdell at the Hospital for Sick Children from 2003-2018. Glen is one of the truly technically gifted congenital heart surgeons in our field and, as the Chief of Congenital Heart Surgery, he had an inspirational combination of surgical talent, self-effacing humility, and ‘true North’ clarity in always (ALWAYS) doing what was best for the patient. This wasn’t lip service, he lived it – and the example rubbed off on most of us. Through some good fortune, my academic career (with Glen’s support) was favorable and at one point Glen and I had the interesting distinction of each being able to fire the other (!) - I was the University Division Chair and Glen was the Hospital Division Chair. One might think that fireworks were possible between two high-achieving surgeons reaching this level of accomplishment and working in close proximity.
There were, however, no fireworks. Instead, we each learned to actively seek to understand our respective objectives and find ways to support each other. We hatched plans to achieve initiatives, sometimes publicly, sometimes behind the scenes, but always in synch. (In fact, we occasionally staged disagreements in conferences just to make sure that our colleagues didn’t think we always agreed on everything.) My children joked that we were like an old married couple.
Importantly, we did not always agree and had some very major philosophic differences on how to attack problems. These differences have persisted throughout our entire careers, but when a decision was required we spoke critically and openly and the ultimate decision was deferred to the person with the most ownership of the domain of interest. After a decision was made, we maneuvered into actively supporting roles (Followership). Support was not passive, we actively searched for opportunities to achieve our (now) mutual objective - even when we didn’t always fully agree with the plan. This was not blind obedience, but willingness to accept a decision, commit to a plan, and work towards achieving our objective through independent or collaborative action. One important aspect of this process was the clarity of the mission. It is much easier to actively support an initiative when it is clearly aligned with an easily understood and resonating overall mission. In contrast, malalignment of a mission degrades one’s incentive to demonstrate optimal Followership (see below).
Imagine the power you might have in your Heart Center if you had an entire team composed of highly intelligent, motivated, and skilled colleagues who are fully dedicated to every nuance of your mission and capable of acting independently - or in synch - as conditions dictate?! Of course, this sounds great, but how can you achieve it? Building Followership skills into your Leadership profile is a great starting point.
Followership is not the opposite of Leadership
Optimal Followership requires clear understanding of the mission, an action-oriented stance, a hunger to overcome obstacles, humility, and self-reliant participation. High quality Followership is associated with deeply rewarding satisfaction in contributing to a team’s success. Following should be seen as legitimate, valuable, and even virtuous. Interestingly, there can be many variations on the theme of effective Followership. The accompanying diagram (modified from a terrific manuscript by Robert Kelley, Harvard Business Review, ‘In Praise of Followers’) depicts the relationship between two axes: Mission Engagement and Empowerment and is divided into quadrants.
Optimal Followership Relates to Empowerment and Mission Engagement
Optimal Followership is seen in combination with mission engagement and strong empowerment. Intelligent, talented individuals with self-reliance and dedication to the mission fill this quadrant. These individuals are great leaders, but are also so attuned to the mission and dedicated to its success that they fall into line when needed, and take independent initiative when needed. They are like cruise missiles, you plug in the coordinates and they navigate the terrain to get to the objective. As a leader, YOU want to spend as much time as possible in this quadrant – because being led by your team is a metric of successful Leadership. Your team will see this behavior as a demonstration of optimal Followership (and, paradoxically, will improve your effectiveness as a Leader)
In contrast, strongly empowered colleagues with a lack of mission alignment are often nonproductive or subversive (e.g. snipers). These are individuals with power and the internal capability of ‘making things happen’ but they are not aligned with the organizational mission. Perhaps you have failed to articulate the mission in a manner that they can buy into. Perhaps their actual mission is directed at self-advancement, non-productive competition with colleagues, or simply surviving in an environment that they see as toxic. Whatever the reason for malalignment, these individuals often have influence over many colleagues and have great potential to contribute to (or corrode) a culture. Finding a way to get these individuals in line with the mission can transform an organization.
The two disempowered quadrants include those who are aligned to the mission (lower right) and those that are not aligned to the mission (lower left). In the lower right quadrant (aligned but not empowered), the individuals are typically easy to manage and can be characterized as the supporting cast. They do not initiate action to solve new problems, but will steadfastly follow instructions to support a mission that they truly believe in. Improving these individuals sense of empowerment through supportive training, building trust, and developing a culture of deference to expertise can elevate these individuals to the optimal Followership quadrant.
In contrast, individuals in the lower left quadrant have poor mission alignment and are poorly empowered to solve problems. Individuals in this quadrant are often blindly obedient, poorly motivated, and incapable of creatively solving problems with self-initiative. Improvement in this quadrant involves aligning their perception of the organizational mission AND improving empowerment through training, trust, and deference to expertise. Without these interventions, these individuals typically come to a complete stop at any sign of any obstacle.
How can you improve your Followership skills?
The best way to improve Followership in your Heart Center is to…. be a great Follower. The recipe is simple:
Model Followership by leading with humility. Get yourself publicly in the Follower role whenever possible. Your team will follow your example.
Empower your team by:
Demonstrating deference to expertise – quite often members of your team will have more expertise than you have. This is not a threat- it is an opportunity. Harvest expertise at every opportunity, and build deference to expertise into your culture.
Empower your team to speak critically and openly – ask for critique, actively listen, and modify your plans when appropriate. Active listening is the key to developing an atmosphere of safety. Unsafe environments leave untapped talent on the table.
Be crystal clear about your overall mission and come back to your mission as a foundation for every decision.
Conclusion
The greatest form of Leadership is excellent Followership. So back to our original scenario: How do you answer your interviewer’s deceptively simple question: “Which is more important for your role - Leading or Following?”. The best answer may be “Following - because Leadership skills are entry criteria”.