Literature Review

Management vs. Leadership

By Phillip M. Kibort, MD, MBA

IN THIS ARTICLE

Efficiency is doing the right thing, effectiveness is doing things

right. Peter Drucker

What makes a good manager? A review of recent

literature finds its the person who deftly works
behind the scenes, juggling many tasks and living in
the world full of contradictions.

For at least the past decade, there has been a

preponderance of articles discussing leadership and all its
attributes, and a dearth of articles on traditional management and the role of the manager.
This may be a manifestation of our societys attraction to stars and hero worship, and the lack of interest in
the less-than-thrilling role of managing the show.
A recent article on leadership by Philippe Kahn1
discusses his view on leadership requiring a clear vision.
According to Kahn, leaders turn that vision into success
by building winning teams, by not ignoring problems that
wont go away, by focusing relentlessly on innovation
and by taking risks.
David Spitzer writes in the same journal about The
Energizing Leader,2 who is capable of producing energy
in an organization by creating contacts that will foster the
maximum release of focused energy. He believes that
great leaders listen to their employees and insist on
employees telling the truth.
Leaders seem to instill a sense of significance in the
workforce by giving employees the power of their vision
and values. Spitzer also believes that leaders need to
instill a sense of ownership in employees, allowing them
to keep score of how the company is doing and by
building confidence and recognizing good work.
A third author, Mark Shaeffert, writes in his article
Whats Leadership3 that great leaders have vision,
honesty, passion, authenticity, great communication skills,
and competencies.
He believes that true leaders seek leadership because
they want to make a positive difference in the lives of
others. Bearing the burdens of leadership is worth it
both for the impact you have on the lives of others and
for the meaning it gives your own life.

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THE PHYSICIAN EXECUTIVE

Managers
Talking about leaders is the easy partlets turn our
attention to the manager. Managers are constantly told to
deal with opposing ideas.
An excellent article, The Five Minds of a Manager4
by Jonathan Gosling and Henry Mintzberg, describes
what it takes to be a great manager. The authors explain
that managers live in a world of paradox and cognitive
dissonance. Managers are told to be global and local, collaborate and compete, change perpetually but maintain
order, make the numbers and nurture people. Managers
have to work in this world of contradictions.
These McGill University professors organize these
management paradoxes around five tasks, each with its
own mindset. Everything that every effective manager
does is sandwiched between action on the ground and
reflection in the abstract. As these authors note, Action
without reflection is thoughtless. Reflection without action
is passive. Those same statements could hold true for
clinical practice.

Mindsets
Here are summaries of these five manager mindsets,
according to Gosling and Mintzberg:

1. Managing selfthe reflective mindset

Reflective managers have a healthy respect for the
history of their organizationsnot only the grand history
of the big deals and disasters, but also the everyday history of the little actions that make organizations work.

They must be able to understand

the past to use the present to get to
a better future.

2. Managing the organization

the analytical mindset
The authors believe this mindset
is like being in a tennis match with a
crowd around you. You must appreciate the score and the crowd, but
always keeping your eye on the ball.
It is important to know how to analyze situations not with simple solutions, but with the ability to evaluate
diligently and thoroughly.

3. Managing contextthe
worldly mindset
Great managers need to be
able to think outside the box, to
look at the world around them, to
think globallynot just how the
business has always been done.

4. Managing relationshipsthe
collaborative mindset
This is where management
does not involve managing people
so much as managing the relationships among people in teams and
projects, as well as across divisions
and alliances. Managers need to get
beyond empowerment, according
to the authors. Empowerment
implies that people who know the
work best somehow receive the
blessing of their managers to do it.
Great managers move employees
into commitment, away from the
currently popular heroic style of
managing and toward a more engaging style. Engaging managers listen
more than they talk. They get out of
their offices to see and feel, rather
than remain in them to sit and figure. And they do less controlling,
allowing other people to be in
greater control of their own work. If,
I deem, so that you do,
is the implicit motto of the heroic
manager, then the engaging manag-

Managers are told to be global and local, collaborate and compete, change
perpetually but maintain order, make the numbers and nurture people.
Managers have to work in this world of contradictions.

THE PHYSICIAN EXECUTIVE

NOVEMBERDECEMBER 2004 33

ers motto is, We dream, so that we

do. To be in a collaborative mindset means to be inside and involved.

5. Managing changethe action

mindset.
Imagine your organization is a
chariot pulled by wild horses. These
horses represent the emotions, aspirations, and motives of all the people in the organization. A managers
job here is to develop a sensitive
awareness of the terrain. We tend to
believe that everything is changing
around us. But these authors
emphasize that not everything is
always changing; in fact many
things stay the same. Its important
to realize that change has no meaning without continuity. (There is a
name for everything changing all
the time: anarchy!) Accordingly, the
trick in the action mindset is to
mobilize energy around those
things that need changing, while
being careful to maintain the rest.
Action and reflection tend to blend
in a natural flow.
In light of all these mindsets,
managers need to have certain
other basic rules. An excellent book
on leading and managing your
organization is Its Your Ship, by
Captain D. Michael Abrashoff. 5 He
converts management techniques
from the best ship in the Navy.
This captain took one of the
worst-performing ships in the Navy
and made it into the best through
the use of some basic rules:
Lead by example
Listen aggressively
Communicate purpose and
meaning
Create a climate of trust
Look for results, not salutes
Take calculated risks
Go beyond standard procedure
Build up your people

34

Generate unity and improve your

peoples quality of life
Further techniques in management can be learned from an article
entitled How to Lead Now
Getting Extraordinary Performance
When You Cant Pay For It by John
A. Byrne.6 This article is about leaders and managers who get extraordinary performance out of people.
Byrne writes about builders in
organizationsthose who instill
self-esteem in workers and build
unflagging support through remarkably tough assignments. Great
managers understand that most
employees feel alienated from companies that spend years trimming
their health benefits and laying off
their friends. Employees today are
no longer loyal to organizations as
much as they are loyal to people.
Great managers need to know this.
Byrne has five fundamental
themes for an effective toolkit for
pride-building in organizations:
1. Always have your compass set
on pride, not money.
2. It is more important for people
to be proud of what they do
every day than it is for them to
be proud of reaching a major
goal.
3. Localize as much as possible.
Dont wait for your organization
or its leaders to instill pride.
4. Make your messages simple and
direct. Dont confuse people with
complexities.
5. Personalize the workplace. Get
involved with your people. Dont
violate human resource rules but
getting involved with your
employees is the single best way
to build an emotional bond with
them. Know things that are
important to them.
Great managers also need to
realize that there are changes in the
makeup of the workforce itself.

NOVEMBERDECEMBER 2004 THE PHYSICIAN EXECUTIVE

Baby boomers are giving way to

generations X, Y, and the new millennium employees. The purpose of
business is not simply to make a
profit, according to Charles Handy.7
As David Packard, co-founder of
Hewlett Packard, once said, A
group of people get together and
exist as an institution that we call a
company so they are able to accomplish collectively what they could
not accomplish separately. They
make a contribution to society.
Great managers know that
reorganizing structurally will no
longer answer whats difficult in
their organizations. Jeffrey A. Oxman
and Brian D. Smith, in their article
Limits of Structural Change,8 review
why so many companies fall into the
trap of believing that simply moving
themselves into new organizational
charts will have impact.
These authors believe that the
widespread malady of structuritis
(the propensity to issue a new organizational chart as the first solution
to any business problem) must
change. In fact they believe that
hierarchy currently plays a significantly smaller role than the nuts
and bolts of how work gets done.
People learn how to work
around organizational structures.
They believe that the rigid anatomy
of structures is being trumped by the
physiology of organizations. Younger
employees tend to ignore hierarchy
in favor of operating within their
own informal networks (as opposed
to within structures).
So, while our society is
enamored by leaders (heroes) and
visionaries whom we need to tell us
about doing the right thing, we also
must cherish the manager who
helps us do things right.

References

2005 InterAct Course Schedule

1.

Kahn P. The Leadership Journey,

Leader to Leader, Vol. 29, Sept. 2003.

2.

Spitzer D. The Energizing Leader,

Leader to Leader, Vol. 29, Sept. 2003.

Courses begin on Fridays

July

3.

Shaeffert M. Whats Leadership Twin

City Business, Aug. 2003.

January

Jul 8 Aug 18
Three Faces of Quality

4.

Gosling J. and Mintzberg H. Five Minds

of a Manager Harvard Business Review,
Nov. 2003.

Jan 7 - 27
Ethical Challenges

Jul 29 Aug 18
Ethical Challenges

5.

Abrashoff M. Its Your Ship, New York:

Warner Books, 2002.

Jan 7 - Feb 17
Financial Decision Making

Jul 29 Sep 8
Financial Decision Making

6.

Byrne J. How to Lead NowGetting

Extraordinary Performance When You
Cant Pay For It, Fast Company, Aug.
2003.

Jan 28 - Feb 17
Health Law

August

7.

Fisher L. The Creative Mind, Strategy

and Business, Fall 2003.

8.

Oxman J. and Smith B. Limits of

Structural Change, MIT Sloan
Management Review, Fall 2003.

Aug 19 Sep 8

Jan 28 - Mar 10
Managing Physician
Performance

Health Law

September

February
Three Faces of Quality

Sep 2 Oct 13
Managing Physician
Performance

March

Sep 9 Oct 20
Three Faces of Quality

Mar 11 31
Ethical Challenges

Sep 30 Oct 20
Ethical Challenges

Mar 11 Apr 21
Financial Decision Making

Sep 30 Nov 10
Financial Decision Making

April

October

Apr 8 28
Health Law

Oct 21 Nov 10
Health Law

Feb 18 - Mar 31

Phillip M. Kibort, MD,

MBA is vice president of

medical affairs and chief

medical officer at Childrens Hospitals
and Clinics in St. Paul, Minn. He can
be reached by phone at 651-220-6165
or by e-mail phil.kibort@childrenshc.
org. Kibort also thanks Audrey
Anderson for editing this article and
Teri Leonard for her transcription.

Apr 8 May 19
Managing Physician
Performance

November
Nov 11 Dec 22
Three Faces of Quality

June

December

Jun 3 23
Ethical Challenges
Jun 3 Jul 14
Financial Decision Making
Jun 24 July 14
Health Law
Jun 24 Aug 4
Managing Physician
Performance

Dec 2 22
Health Law
Dec 2 22
Ethical Challenges
Dec 2 Jan 12, 2006
Managing Physician
Performance

www.acpe.org/InterAct 800-562-8088

THE PHYSICIAN EXECUTIVE

NOVEMBERDECEMBER 2004 35