Servant Leadership in the Medical Practice

When many of us think of leading a medical practice, one of the first things that comes to mind is a traditional hierarchical structure. As Lyon1 explains, “Traditional leadership sees the people lower in the pyramid of leadership, lower in this structure, serving the leaders above them.” Traditionally, we may think of leadership as the top position on an organizational chart and as a rank. We assume that leaders, in general, use their power, control, and authority, mixed perhaps with a little bit of persuasion and inspiration, to direct, shape, and drive follower performance. In addition, we may think that the best way to measure leadership success is by the goals achieved and the output produced. It often comes down to numbers. And, as the Servant Leadership Centre of Canada2 suggests, we may think that leadership is mostly about leaders—how to recognize and develop them, and how they can use their authority and influence most effectively. As Lyons puts it, traditional leadership is a “boss-centered” approach. Certainly, we’ve all known, seen, and studied traditional leaders throughout our lives. And, in fact, traditional leadership is alive, well, and still widely used in many organizations today, perhaps even your own.

Servant leadership, on the other hand, focuses neither on a leader’s position in a hierarchy nor on his or her rank, authority, or control. It is a leadership philosophy that, as the name suggests, puts the leader’s main emphasis on being of service to others. In this article, we will explore servant leadership in more depth and consider why and how it can be used effectively in the medical practice.

What Is Servant Leadership?

Although the concept of a leader who serves his or her followers is an old one, the phrase “servant leadership” was coined by Robert K. Greenleaf3 in 1970. Back then, Greenleaf predicted that his servant leadership concept was not one that most people would embrace readily. As he wrote 50 years ago, “My thesis, that more servants should emerge as leaders, or should follow only servant-leaders, is not a popular one. It is much more comfortable to go with a less demanding point of view about what is expected of one now.” Since then, however, Greenleaf’s concept of servant leadership has gained acceptance, momentum, and a great deal of popularity. As Tzimas4 explains, there has been empirical research and evidence to support the idea that leaders should consider servant leadership to “shape their teams and aim toward growth.”

Greenleaf argued that the focus of servant leadership should be on others rather than on the self. In fact, self-interest should not motivate servant leadership at all, Greenleaf said. Rather, leadership should come from a higher, more selfless plane of motivation. In addition, Greenleaf suggested, serving others should be the prime motivation for and the very essence of leadership. As Stone, Russell, and Patterson5 explain, “Servant leaders develop people, helping them to strive and flourish. Servant leaders provide vision; gain credibility and trust from followers; and influence others.”

The Popularity of Servant Leadership

Organizations of all shapes and sizes have adopted Greenleaf’s servant leadership framework. According to Lichtenwalner,6 a list of companies that seek and value servant leaders includes 7-Eleven, Starbucks, Walmart stores, Marriott International, The Container Store, Chik-Fil-A, Kaiser Permanente, Keller Williams Realty, Nordstrom, Southwest Airlines, Wegmans, Whole Foods, and the U.S. Air Force, Army, Marine Corps, and Navy. Furthermore, among Fortune magazine’s list of the top 100 companies to work for, 17 were listed as practitioners of servant leadership. That may not sound like that many until you realize that five of Fortune’s top 10 companies use servant leadership. As the Servant Leadership Centre of Canada explains, “All 17 of those organizations outperformed the market by over 50%, showing that servant leadership has a real impact on performance.”

Servant leadership has gained popularity because it offers clear benefits to organizations. However, as Tzimas warns, servant leadership may not come easily to everyone. In Tzimas’s words, “Leadership can be challenging. It requires you to let go of ego and self-importance and lead for the greater good of the team and business overall. A servant leader requires an even higher ability to let go of self and increase levels of empathy, influence, courage, and focus on others.” However, the extra effort to become a servant leader will be worth it. As Tzimas suggests, “Servant leadership is still the most effective leadership strategy that suits a wide range of organizations and businesses today.”

The Benefits of Servant Leadership

Some leaders will naturally be attracted to the servant leadership concept because it is in sync with their personal values. But even those who don’t initially find the servant leadership concept appealing may be attracted to the many benefits it offers. For example:

A high-performance culture: Tzimas says that a positive culture shift is an inevitable “byproduct” of servant leadership. As Tzimas explains, research suggests that servant leaders promote self-confidence and assertiveness, and that they build the potential of their teams. They also lead their employees to greater productivity. Interestingly, Tzimas notes, servant leaders more often use words like we, our team, and us, instead of I, me, and I think. Such inclusive language encourages an inclusive culture for all members of the team, Tzimas says. It also encourages the team to function as a whole, which, again, leads to high performance.

1. High employee engagement: Servant leadership builds a fast-growing environment of trust and mutual cooperation. People know what to expect and trust that their leaders care about them. As Tzimas suggests, “They do not feel utilized or mistreated.” Servant leadership balances professional skills with personal warmth and empathy, resulting in more highly satisfied employees. Tzimas adds that increased employee satisfaction squelches backbiting and unhealthy competition. It also helps everyone potentially to achieve a better work-life balance, Tzimas says.

2. Increased employee loyalty: Servant leadership increases employee engagement and satisfaction, which, in turn, makes employees more loyal to their employers. As Ontime Staffing7 suggests, “A loyal workforce can reap numerous rewards for your organization as a whole—including better retention and optimal performance.” Loyal employees also are more likely to refer their friends and family to work in your organization, Ontime Staffing says.

3. High morale: Employees led by servant leaders feel highly valued. As Sherman8 explains, “They know you’re looking out for them.” That inspires them to work with more enthusiasm, which in turn boosts morale.

4. Better collaboration: Servant leaders emphasize collaborative decision-making, rather than a more traditional model in which decisions come from the top down. As Sherman explains, “Listening to your employees instead of assuming you have all the answers can teach you a lot. Workers on the front lines often understand what they need much better than upper management.”

5. Bigger picture thinking and results: Servant leaders rarely are interested in immediate gains. As Tzimas says, “They have the power to foresee the long-term profits.” Many surveys from all over the world have clearly proved that organizations that have servant leadership principles grow faster than others, in the long run, Tzimas says.

6. Better role models: Servant leaders often are shining examples of how to treat others with empathy. As Luthor9 suggests, they model respect and genuine caring, which others will recognize, admire, and emulate. Servant leaders also model how to behave ethically, Luthor says.

7. Increased personal and professional growth: Servant leaders empower others to recognize their inner potential. As Tzimas suggests, they give others space to “nurture their creativity and talent.” They also do what they can to help others develop and grow. They surround themselves with positivity that enables them to maximize their own abilities as well.

8. Authentic leadership: Servant leadership is hard—if not impossible—to fake. As Sherman
   suggests, “Living up to this model is a serious commitment.” Insincere servant leaders will have a difficult time fooling their employees for long, because they’re easy to spot, Sherman warns.

9. Better understanding: Servant leaders build relationships with employees primarily by listening closely and by asking many questions. However, the questions go both ways. As Tarallo10 explains, “Employees should feel comfortable asking the servant leader questions without worrying that the leader will feel badgered, threatened, or implicitly criticized.” The combination of asking questions and listening actively ultimately reduces misunderstandings and increases understanding, Tarallo suggests.

Getting Started with Servant Leadership in Three Steps

Although becoming a servant leader may sound straightforward, that is not the case. As Spiro11 says, “As with most things, it’s far easier to talk the talk than walk the walk.” Ideally, it would have been best if servant leadership had been woven into the core founding values of your medical practice. But even if that didn’t happen, you can take three steps right away to begin your servant leadership journey.

Put your patients at the top of the chart and everyone who serves them below.

First, revise your organizational chart. If yours looks like a steep pyramid or tree with you at the top, upend it and put your team above you. You will still retain final say on things. However, as Spiro suggests, an upended or “flatter” organizational chart will illustrate your commitment to serving the needs of your employees. Next, be sure that all of your stakeholders are represented in your organizational chart. Most importantly, put your patients at the top of the chart and everyone who serves them below. A service-oriented organizational chart such as this will be the most efficient and powerful way for you to express the concept of servant leadership to everyone in your organization. Keep your revised chart handy and consult it regularly. Use it to keep your primary focus on serving the needs of others.

Second, focus more on listening and less on telling. Remain as open as you can to new ways of thinking about yourself and others. As Zisa12 explains, “We all have personal biases and prejudices even if we’d like to believe otherwise. Listening helps us serve by exposing prejudices that filter select words, warp messages, and prevent us from considering another point of view.” Be prepared to discover new things about yourself and the way you lead. Brace yourself—because some of those discoveries may be uncomfortable or even painful. As Zisa writes, “I had a great teacher who once said she loved to discover a prejudice because then she could work to overcome it.” Zisa says that she deeply admires this mindset because it accepts the fact that we don’t always listen and we’re not always open-minded. Yet, Zisa says, “We have the power to consciously change how we listen and interact with others.”

Third, revise your meetings. As Percy13 suggests, “Remember that the core ethos of the servant leadership style is the wellbeing and the development of people.” Therefore, broaden your regular progress meetings with your medical practice staff. Focus on delivery of tasks as usual, Percy says, but also devote time and energy to discussing work–life balance and personal development. Likewise, expand the agenda of your performance evaluations and other one-on-one meetings to include career progression and lessons learned, and to exchange valuable feedback, Percy says.

Increasing Your Servant Leadership Skills

There are many resources to help you learn more about servant leadership. Of course, a good place to begin is by reading Greenleaf’s 1970 essay, listed the reference list at the end of this article. You can also read Greenleaf’s books on servant leadership or those by other authors such as Ken Blanchard and John C. Maxwell. In addition, you may find it useful to visit the website of the Robert K. Greenleaf Center for Servant Leadership (www.greenleaf.org) and take advantage of their excellent blog posts and podcasts. Or, conduct an online search and find your own articles and videos about servant leadership. If you’ve not done this before, you will be amazed by how much good material is available.

Servant leadership also is the focus of many educational programs. The Robert K. Greenleaf Center for Servant Leadership offers courses, as do many other organizations. Servant leadership also is a topic of study in several degree programs. For example, Gonzaga University offers a servant leadership concentration as part of its online M.A. in Organizational Leadership program. Shorter academic programs also focus on servant leadership, such as the servant leadership certificate programs at the University of Wisconsin Continuing Studies and at Cornell University’s eCornell.com. Modern Servant Leader14 has created a list of degree, non-degree, certificate, non-certificate, online, and campus-only programs that focus on servant leadership.

Finally, a good way to increase your servant leadership knowledge and skills is to learn and gain support from other servant leaders. Identify like-minded leaders locally or through your professional association who are willing to meet regularly and share challenges, resources, and best practices in servant leadership. If possible, find and work with a servant leadership mentor. The best way to keep your commitment to servant leadership will be through learning and support.

References

1.    Lyons A. Servant leadership vs. traditional leadership. Communication Skills Coach (video). May 5, 2018. www.communicationskillscoach.com/home/servant-leadership-vs-traditional-leadership. Accessed January 24, 2020.

2.    Servant Leadership Centre of Canada. So what is servant leadership anyway? Servant Leadership Centre of Canada. www.servantleadership.ca/servant-leadership-defined. Accessed January 24, 2020.

3.    Greenleaf RK. The Servant as Leader. Indianapolis, IN: The Robert K. Greenleaf Center; 2008.

4.    Tzimas E. Top 5 reasons behind the popularity of servant leadership. StepChange. January 23, 2019. www.stepchangelearning.co.nz/top-5-reasons-behind-the-popularity-of-servant-leadership-today/. Accessed January 27, 2020.

5.    Stone AG, Russell AF, Patterson K. Transformational vs. servant leadership: a difference in leader focus. Regent University: The School of Leadership Studies. August 2003.
https://regentparents.regent.edu/acad/global/publications/sl_proceedings/2003/stone_transformation_versus.pdf. Accessed January 27, 2020.

6.    Lichtenwalner B. Servant leadership companies list. Modern Servant Leader.
www.modernservantleader.com/featured/servant-leadership-companies-list/. Accessed January 27, 2020.

7.    How a servant leadership style can benefit your business. Online Staffing, February 21, 2019. www.ontimestaffing.com/2019/02/21/servant-leadership-style-benefit-business/.
Accessed January 28, 2020.

8.    Sherman F. The advantages of servant leadership style. Chron. October 23, 2019.
https://smallbusiness.chron.com/advantages-servant-leadership-style-11693.html. Accessed January 28, 2020.

9.    Luthor J. The advantages of the servant leadership style. AZ Central. August 5, 2019.
https://yourbusiness.azcentral.com/advantages-servant-leadership-style-5282.html. Accessed January 28, 2020.

10.   Tarallo M. The art of servant leadership. SHRM. May 17, 2018. www.shrm.org/resourcesandtools/hr-topics/organizational-and-employee-development/pages/the-art-of-servant-leadership.aspx. Accessed January 28, 2020.

11.   Spiro J. How to become a servant leader. Inc. August 31, 2010. www.inc.com/guides/2010/08/how-to-become-a-servant-leader.html. Accessed January 30, 2020.

12.   Zisa J. Listen to serve: servant leadership and the practice of effective listening. Robert K. Greenleaf Center for Servant Leadership. June 20, 2013. www.greenleaf.org/listen-to-serve-servant-leadership-and-the-practice-of-effective-listening/. Accessed January 30, 2020.

13.   Percy S. Are you ready to become a servant leader? Forbes. August 2, 2018.
www.forbes.com/sites/sallypercy/2018/08/02/are-you-ready-to-become-a-servant-leader/#53cbac57bc7d. Accessed January 30, 2020.

14.   Modern servant leader. Academic programs for servant leadership. www.modernservantleader.com/academic-programs-list/. Accessed January 30, 2020.

15.   100 best companies to work for in 2016. Fortune.
https://fortune.com/best-companies/2016/. Accessed January 27, 2020.

16.   Fox M. Trying to grow servant leaders? Here’s 3 myths that can get in the way. Berrett-Kohler Publishers. May 9, 2019. https://ideas.bkconnection.com/trying-to-grow-servant-leaders-heres-3-myths-that-can-get-in-the-way. Accessed January 27, 2020.

17.   Riley J. The myths of servant leadership. Robert K. Greenleaf Center for Servant Leadership. September 26, 2013. www.greenleaf.org/the-myths-of-servant-leadership/. Accessed January 27, 2020.

18.   Blanchard K. Let’s clear up some misunderstandings about servant leadership. How We Lead. February 7, 2018. https://howwelead.org/2018/02/07/lets-clear-up-some-misunderstandings-about-servant-leadership/. Accessed January 27, 2020.

19.   Rosetta Technology Group. Yes, servant leaders do actually lead. Rosetta Technology Group, May 4, 2018. www.rosettatg.com/blogtoon/2018/5/2/yes-servant-leaders-do-actually-lead. Accessed January 27, 2020.

20.   Spears L. Ten characteristics of a servant-leader. The Spears Center for Servant Leadership. www.spearscenter.org/46-uncategorised/136-ten-characteristics-of-servant-leadership. Accessed January 30, 2020.

Servant Leadership: Ten Popular Misconceptions and Myths

Some leaders wrestle with or reject servant leadership because they don’t understand the concept fully or they dislike the sound of it. As Lichtenwalner 6 explains, “The term servant itself disturbs many people otherwise advocating these principles.” Here are 10 of the most popular misconceptions and myths about servant leadership:

Servant implies subservience. A popular misconception is that servant leaders give their support to and obey others unquestioningly. However, servant leaders are not blindly obedient. They ask questions before they will support anyone or anything, and they don’t give their support until their questions have been answered satisfactorily. They also are willing to make difficult decisions. As Lichtenwalner explains, “In order to effectively serve others, you must often do what is unpopular with followers.”

Servant leadership is a utopian concept that does not exist in the real world. Skeptics believe that servant leadership sounds too good to be true, or that it is just a theory that can’t be applied to real-life leadership challenges. However, as Lichtenwalner, Fortune,15 and others have demonstrated, servant leadership currently is being used with great success by some of the largest and most successful organizations.

The focus is entirely on followers. Many opponents of servant leadership mistakenly assume that servant leaders serve only their followers. However, as Lichtenwalner points out, a servant leader must focus on serving all of the organization’s stakeholders. These will include
not only your followers or employees, but also your patients, partners, associates, colleagues, investors, community, and governing bodies.

Servant leaders are upbeat all the time. As Tzimas4 explains, many people incorrectly assume that servant leaders “have smiles on their faces 24/7.” However, servant leaders are not endlessly cheerful. They are fully developed people who express a wide range of human emotions.

Servant leadership is a religious concept that has no place in business. Some servant leadership concepts are taught throughout the Bible. A similar outlook is found across most major religions. However, as Lichtenwalner argues, “The concept of servant leadership alone is secular in nature.”  

Servant leaders are pushovers. As Tzimas suggests, a popular misconception is that servant leaders live to “take orders and fulfill demands of both peers and stakeholders.” People often assume that servant leaders can be manipulated and pushed around. However, as Fox16 explains, “A servant leader isn’t weak, but uniquely strong because he or she has made the effort to understand and prioritize the employee . . . Placing others’ needs first doesn’t make servant leaders pushovers, but rather earns them respect that employees thrive upon.”

Servant leaders focus too much on the present. Servant leadership focuses more on the present and the future than on the past. However, as Fox explains, that does not give employees a “free pass” when they fail to meet expectations. Servant leaders motivate with love, trust, and respect, Fox says, but they also tell others what they need to hear to grow, even when they can’t admit it themselves.

Servant leadership can’t work because people can’t be trusted. This misconception is based on the erroneous assumption that most members of organizations are inherently dishonest. However, mistrust does not lead to creativity or initiative. As Riley17 warns, “It leads to closed doors and a silo mentality.” That said, although servant leaders assume that they can trust others, they are not naive. They have their eyes and ears open. They put safeguards in place and are quick to act if trust is breached.

Servant leaders allow employees to decide what to do, when to do it, and how to do it. As Blanchard18 says, “If that’s what servant leadership is all about, it doesn’t sound like leadership at all. It sounds more like inmates running the prison, or managers trying to please everyone.” Although leaders should involve experienced people in shaping a compelling vision, setting goals, and defining strategic initiatives, Blanchard says, the ultimate responsibility remains with the leaders themselves and cannot be delegated to others. Then, Blanchard says, “Once employees are clear on where they are going, the leader’s role shifts to the task of implementation—the servant aspect of servant leadership.”

Servant leaders don’t actually lead. A common misconception is that servant leaders don’t lead but simply hold the space for the team and remove obstacles. However, as Rosetta Technology Group19 explains, servant leaders are very much leaders. They have clarity of vision and a wide span of awareness, and they can help defuse the anxiety of the organization. Rosetta Technology Group says, “People follow leaders because the leader has made them feel like they are in good hands, and the direction is clear.” Leaders also “create or maintain order” when it is needed, Rosetta Technology Group says.

Ten Characteristics of Servant Leadership

Do you have within you what it takes to become a servant leader? Spears20 has identified 10 characteristics that contribute to the meaningful practice of servant leaders. Although Spears’ list is by no means exhaustive, these are all characteristics that can be developed and improved:

Listening: Servant leaders are deeply committed to listening intently to others. They listen receptively to what is being said and notice what is not being said. Listening also encompasses hearing one’s own inner voice. As Spears points out, “Listening, coupled with periods of reflection, is essential to the growth and well-being of the servant-leader.”

Empathy: The servant leader strives to understand and empathize with others. He or she believes that people deserve to be accepted and recognized for their special and unique spirits. As Spears says, “One assumes the good intentions of co-workers and colleagues and does not reject them as people, even when one may be forced to refuse to accept certain behaviors or performance.”

Healing: One of the greatest strengths of servant leadership is the potential for healing one’s self and one’s relationship to others. As Spears points out, “Many people have broken spirits and have suffered from a variety of emotional hurts.” Although this is a part of being human, servant leaders recognize that they have an opportunity to help make whole those with whom they come in contact.

Awareness: General awareness, and especially self-​awareness, strengthens the servant leader.
According to Spears, “Awareness helps one in understanding issues involving ethics, power and values.” The aware servant leader can view most situations from a more integrated, holistic position.

Persuasion: Servant leaders rely upon persuasion, rather than on their positional authority, to make decisions within their organizations. As Spears puts it, “The servant leader seeks to convince others, rather than coerce compliance.” The servant leader also is effective at building consensus within groups.

Conceptualization: Servant leaders seek to nurture their ability to dream great dreams. They think beyond day-to-day realities. However, as Spears warns, “For many leaders, this is a characteristic that requires discipline and practice.”

Foresight: Closely related to conceptualization is the ability to foresee the likely outcome of a situation. This can be hard to define, but easier to identify. As Spears explains, “One knows foresight when one experiences it.” Foresight is a characteristic that enables the servant leader to understand lessons from the past, realities from the present, and the likely consequence of a decision for the future. It also is deeply rooted within the intuitive mind. Spears adds, “Foresight remains a largely unexplored area in leadership studies, but one most deserving of careful attention.”

Stewardship: Stewardship is holding something in trust for another. The servant leader’s role is to hold his or her organization in trust for the greater good of society. Stewardship assumes a commitment to serving the needs of others. And, as Spears explains, “It also emphasizes the use of openness and persuasion, rather than control.”

Commitment to the growth of people: Servant leaders believe that people have an intrinsic value beyond their tangible contributions as workers.

According to Spears, “The servant leader recognizes the tremendous responsibility to do everything in his or her power to nurture the personal and professional growth of employees and colleagues.” In practice, Spears suggests that this can include (but is not limited to) concrete actions such as making funds available for personal and professional development, taking a personal interest in others’ ideas and suggestions, encouraging involvement in decision making, and actively assisting laid-off employees to find other positions.

Building community: In recent human history, there has been a shift from local communities to large institutions as the primary shaper of human lives. Spears suggests that a great deal has been lost through this shift. The servant leader is aware of this and seeks to identify the means for building community within his or her organization. As Sears explains, “Servant leadership suggests that true community can be created among those who work in businesses and other institutions.”