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The attributes of effective leaders have been described thoroughly in the comprehensive report by Swensen, et.al.1 According to Swensen, an effective leader strives to “be a regular, authentic presence at the front line and a visible champion of improvement.” What he means, I believe, is that effective leaders instill a sense of purpose, establish the culture and set the parameters and expectations for improvement efforts. They do this by measuring the pulse of an institution, by valuing and intimately understanding the challenges staff face in their efforts to do their jobs and to accomplish not only the institution’s goals, but also their own professional goals. Highly effective leaders earn and receive respect by sincerely extending cordiality and respect.

Authenticity includes multiple dimensions: legitimacy, genuineness and realism. Leaders who convey an authentic presence are those in whom we believe, we hold in high esteem and we follow. What distinguishes these leaders is that others are drawn to them, not because they may be charismatic, some are and others are not, but because they reach out to let people know that their needs and perspectives matter. They convey through their actions, not merely their words, that what is important to front-line staff is ipso facto important to them. Authentic leaders work hard to deliver on their promises and to exceed expectations whenever possible.

Higher-reliability healthcare organizations are those where leaders particularly value the contributions of front-line staff, those employees who enable, support and/or provide clinical services at the bedsides, in the operating rooms and clinics. Safe, highly reliable healthcare is thus facilitated by the authentic presence of effective leaders valuing the contributions of the “front-liners”. These leaders earn respect by extending respect – a distinct professional ethic within a moral construct of mutual obligation.

Case Study:

One of the most effective leaders I worked with was a nursing executive, a woman who had an exemplary professional bearing, one that conveyed trustworthiness and mutual veneration. When she walked into a room, her presence was comforting and reassuring, stability within a storm.

One hectic, challenging day after three auto accident victims had died in her hospital’s emergency department, she sat quietly with the staff and listened to their voices, their concerns, their dismays and frustrations over logistical issues they felt had interfered with their ability to save lives. She conveyed empathy and compassion that was palpable – and she took notes. After a period of silence, she thanked all for their efforts. Then she got up, walked around the room and softly touched each member of staff and whispered into each one’s ears a personal message and a specific thank you. She promised that things would improve and she delivered on her promises.

If this were the only example of her authenticity, one might pass it off as an anecdote attributable to the emotion of the moment. But as I came to know her, I realized her behavior was a clear example of who she was all the time. She had a way of carrying herself that projected responsibility, accountability, diligence, and also compassion and an interest in the individuals on her team. It wasn’t so much that she projected personal power or that she was immaculate in her appearance, although she certainly did and was, but rather that she conveyed sincerity and commitment toward the vision and goals of the organization, and most importantly, toward the staff and their efforts to achieve the institution’s goals and their own goals. Regardless of how busy her day might have been, when she was there, she was fully present. She had a calming and reassuring presence. She was authentic and staff knew she was always there to support them, even when things went wrong.

Authenticity, as a crucial element of leadership, may be an inherent personality characteristic for some individuals, like my colleague, the nurse executive. Even if it is not, authenticity is a characteristic that can and should be taught in leadership development courses and simulation training may be an effective educational tool. Leaders who convey an authentic presence, who listen and take comments and suggestions for action and then deliver on them, will themselves be listened to and what they say will matter very much to many. They are the change agents for a culture of quality improvement and enhancements in patient safety!