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Leadership Essentials for the Chest 61
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Physician 63
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10 Models, Attributes, and Styles 65
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Q24 Q1 James K. Stoller, MD
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In the context that leadership matters and that leadership competencies differ from those 70
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needed to practice medicine or conduct research, developing leadership competencies for
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physicians is important. Indeed, effective leadership is needed ubiquitously in health care, both
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at the executive level and at the bedside (eg, leading clinical teams and problem-solving on the
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20 ward). Various leadership models have been proposed, most converging on common attributes, Q6
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21 as described by Kouzes and Posner, of envisioning a new and better future state, inspiring 76
22 others around this shared vision, empowering others to effect the vision, modeling the expected 77
23 behaviors, and engaging others by appealing to shared values. Attention to creating an orga- 78
24 nizational culture that is informed by the seven classic virtues (trust, compassion, courage, 79
25 justice, wisdom, temperance, and hope) can also unleash discretionary effort in the organiza- 80
26 tion to achieve high performance. Health care-specific leadership competencies include: 81
27 technical expertise, not only in one’s clinical/scientific arena to garner colleagues’ respect but 82
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also regarding operations; strategic thinking; finance; human resources; and information 83
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technology. Also, knowledge of the regulatory and legislative environments of health care is
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critical, as is being a problem-solver and lifelong learner. Perhaps most important to leadership
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in health care, as in all sectors, is having emotional intelligence. A spectrum of leadership styles
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33 has been described, and effective leaders are facile in deploying each style in a situationally
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34 appropriate way. Overall, leadership competencies can be developed, and leadership devel- 89
35 opment programs are signature features of leading health-care organizations. 90
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KEY WORDS: change; emotional intelligence; leadership Q7
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40 Leadership matters. Consider our recent faire leadership bore greater disease 95
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history with the coronavirus disease 2019 burden and sequelae. Recognizing that
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pandemic. In general, states whose leadership and followership are Q8
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governors acted both early with full complementary attributes and are
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awareness of the epidemiology and risk, intertwined, and that organizational 100
46 and definitively (eg, by closing schools, performance also reflects the strength of 101
47 mandating masks, socializing the concept organizational culture, effective leadership 102
48 of social distancing, implementing testing is characterized by discrete, teachable 103
49 and contact tracing), experienced flattened competencies coupled with formative 104
50 curves while states with more laissez experience.1 105
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54 Q3 AFFILIATIONS: From the Cleveland Clinic Lerner College of Medi- Copyright Ó 2020 American College of Chest Physicians. Published by 109
Q4 cine, Cleveland Clinic, Cleveland, OH. Elsevier Inc. All rights reserved.
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Q5 CORRESPONDENCE TO: James K. Stoller, MD; e-mail: stollej@ccf.org DOI: https://doi.org/10.1016/j.chest.2020.09.095

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111 The current article first reviews the rationale for great with formal leadership titles such as department chair, 166
112 leadership and then discusses a leadership paradox in dean, hospital president, or chief executive officer). 167
113 168
medicine; that is, that the predominant leadership
114 Characterization by Bohmer6 of the “small l” leader also 169
styles—commanding and pacesetting—that have been
115 invites considering the difference between leading and 170
traditionally celebrated in health care are actually
116 managing. Leading and managing are complementary7,8 171
antithetical to best leadership practices. Attention then
117 and share some common attributes; both encompass 172
118
turns to a brief summary of various leadership models, 173
deciding what needs to be done, creating networks of
119 emphasizing that despite using widely varying 174
people to accomplish the stated goals, and establishing
120 vocabularies, these models all converge on some core 175
accountability to assure that the work gets done. At the
121 principles and attributes of effective leaders, including 176
same time, leading and managing differ in that
122 the classical virtues. Finally, leadership styles and the 177
managing is about predictability and order and
123 model of situational leadership are reviewed, 178
124
leadership is about envisioning a future state that 179
emphasizing the need to pivot one’s leadership style to
125 disrupts the status quo. Similarly, Schein8 has 180
the context and to the characteristics of those being led.
126 characterized the distinction between managing and 181
The discussion focuses on the applicability of leadership
127 leading: “If one wishes to distinguish leadership from 182
principles for the chest physician, whether practicing as
128 management or administration, one can argue that 183
a clinician leading a team of caregivers or serving in a
129 leadership creates and changes cultures, while 184
formal, titled leadership role.
130 management and administration act within a culture.” 185
131 This article is the first of a four-part series that
2-4
Table 1 summarizes the difference between leading 186
132 discusses essential leadership competencies for the chest vs managing.7 187
133 188
physician. Subsequent articles address emotional
134 189
intelligence and its primacy as a leadership competency,2
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change management,3 and teambuilding.4 Another Evidence that Physician Leadership Matters in
136 191
137
important leadership competency (conflict and Health Care 192
138 negotiation strategies) has been previously nicely 193
Beyond the importance of “small l” leadership in health
139 discussed by Nguyen et al.5 194
care,6 leadership by physicians also matters at higher
140 195
organizational levels (eg, at the executive level). Several
141 196
The Ubiquity of the Need for Leadership observational lines of evidence support this view.9-11 As
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The need and opportunities for leadership are part of her “theory of expert leadership,” Goodall9,10 has
143 198
144
ubiquitous. Bohmer6 has framed the concepts of “small shown that top-ranking US News and World Report 199
145 l” and “big L” leadership to cement the idea that hospital status is significantly associated with having a 200
146 leadership is needed broadly throughout health care. physician (vs a non-physician) chief executive officer. 201
147 The concept of “small l” leadership emphasizes the Similarly, in an analysis of the 115 largest US hospitals 202
148 importance of leading in clinical “microsystems”; for in 2015, Tasi et al11 showed that the only significant 203
149 example, solving a care delivery challenge on a ward correlates of high-quality ratings and of hospital 204
150 with the ward team or improving reporting on “near- efficiency (ie, inpatient days per bed per year) ratings 205
151 miss” events to enhance patient safety. “Small l” leaders were having a physician chief executive officer. Although 206
152 207
can be the bedside nurse, the pulmonary consultant, the these data are correlational and therefore cannot
153 208
nurse clinician, or the medical student. “Small l” leaders establish causality, widely recognized benefits of hospital
154 209
may lack a formal leadership title but articulate a vision physician leadership regard the “street credibility” that
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for providing high-quality care that goes beyond the physicians may uniquely enjoy, the enhanced
156 211
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transactional steps of writing orders and reviewing test followership that may result from this “street cred,” and 212
158 results. They lead by “being and doing.”6 Like all leaders an enhanced understanding of the clinical quality issues 213
159 (both “small l” and “big L” leaders [ie, those with formal that are core to organizational mission and success. 214
160 leadership roles and titles]), “small l” leaders envision a Further evidence supporting Goodall’s “theory of expert 215
161 better future state and create a culture; they act in ways leadership” includes concordant observations from other 216
162 that are consistent with their espoused values. They also sectors. For example, universities in which the president 217
163 manage, by establishing accountability and monitoring is an accomplished research scholar have higher degrees 218
164 performance. “Small l” leadership emphasizes that of scholarship. Formula 1 racing teams in which the 219
165 220
leadership is not limited to “big L” leaders (eg, those principal was a driver himself or herself with at least 10

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221 TABLE 1 ] Attributes of Managing vs Leading (After Kotter7) 276Q19
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Managing Leading
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Aim is predictable, orderly results Aim is to produce change
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225 Involves planning and budgeting Involves vision and setting direction 280
226 Involves organizing and staffing Involves aligning people 281
227 Involves controlling and solving Involves motivating and inspiring 282
228 283
229 284
230 285
231 years of driving experience were 16% more likely to gain medical training has cultivated physicians as staunchly 286
232 287
a podium position than those without a driver principal. independent “heroic lone healers,”16 sometimes likened
233 288
In short, when organizational leaders have “walked the to gladiators or Viking warriors. However, gladiators
234 289
walk,” organizations tend to perform better. and Viking warriors can be “collaboratively
235 290
236
challenged”16-18 or handicapped in working easily with 291
237 The Paradox of Leadership in Health Care others over perceived senses of hierarchy. Weisbord17 292
238 Health care is beset by a paradox of leadership. On the cogently made this observation in an article entitled 293
239 one hand, as discussed in the article in this series on “Why hasn’t organizational developed (so far) in 294
240 teamwork,4 outstanding clinical outcomes in health care medical centers,” noting “Science-based professional 295
241 depend on the caliber of teamwork and collaboration work differs markedly from product-based work. Health 296
242 professionals learn rigorous scientific discipline as the 297
among caregivers.12-14 Furthermore, patients judge their
243 ‘content’ of their training. The ‘process’ inculcates a 298
care on the human (not technical) aspects of that care,
244 value for autonomous decision-making, personal 299
especially on how well they perceive their caregivers
245 300
function as a team in service of their getting better. achievement, and the importance of improving their
246 301
However, hospitals are traditionally and own performance, rather than that of any institution.”
247 302
248
Q9 characteristically siloed organizations. As an example, The net effect of this paradox is that traditional selection 303
249 the traditional organization of hospitals by “guilds” into and training of doctors produce physicians who may 304
250 departments of medicine, surgery, pediatrics, and so carry their “heroic lone healer”16 phenotype to their 305
251 forth, with subspecialties subsumed within the leadership roles, whether “small l” or “big L,” thereby 306
252 departments reflects longstanding organization around 307
potentially undermining their leadership performance.
253 the doctors’ pedigrees and traditional training 308
Simply put, the paradox is that although teamwork is
254 trajectories. Of course, silos notwithstanding, even in the 309
crucial to produce the best health-care outcomes,4,14
255 310
predominant traditional structure, in the ideal situation, physicians have not been traditionally selected nor
256 311
physicians across disciplines work in a “matrixed” trained to be team players. Clearly, change is required
257 312
fashion15 (eg, in service lines, in which care is directed to here3 and thankfully change is occurring, both in
258 313
specific clinical needs). Alternative structures that are undergraduate and graduate medical curricula, which
259 314
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organized around the patient include models which increasingly recognize how important collaboration is 315
261 couple surgeons and internal medicine specialists for clinical success. Furthermore, physicians who aspire 316
262 together in a single institute; for example, a heart and to leadership are increasingly seeking and receiving 317
263 vascular institute that includes both cardiac surgeons formal leadership training, whether within their 318
264 and cardiologists (who frequently overlap in their care of organizations, from professional societies, or from 319
265 patients with cardiac needs), a genitourinary/kidney 320
business schools.12
266 institute that includes both nephrologists and urologists, 321
267 or a dermatology/plastic surgical institute that couples 322
268
Leadership Models and Attributes 323
dermatologists and plastic surgeons.
269 Many different leadership models have been described, 324
270 Silos in hospitals of any sort (eg, department structures, each model offering a distinctive lens and vocabulary. As 325
271 separation of research from clinical care, separation of a tiny sample of the myriad models and their 326
272 education from clinical care) can pose unintended but vocabularies or leadership taxonomies, there is “servant 327
273 formidable barriers to collaboration among physicians. leadership” proposed by Greenleaf,19 “technical” 328
274 The final element of the aforementioned health-care vs “adaptive” leadership proposed by Heifitz and 329
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leadership paradox involves the fact that traditional Linsky,20 the five levels of leadership proposed by

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331 TABLE 2 ] Replication of the Five Leadership Commitments of Kouzes and Posner by President Abraham Lincoln 386
332 387
Leadership Commitment (From Kouzes and Posner23) Lincoln on Leadership (From Phillips27)
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Challenge the process “Choose as your chief subordinates those people who
334 389
Search out challenging opportunities to change, grow, innovate, crave responsibility and take risks”
335 and improve “If you never try, you’ll never succeed”
390
336 Experiment, take risks, and learn from the accompanying 391
337 mistakes 392
338 Inspire a shared vision “You must set.fundamental goals and values that 393
339 Envision an uplifting and ennobling future move your followers.” 394
340 Enlist others in a common vision by appealing to their values, “When you extinguish hope, you create desperation” 395
interests, hopes, and dreams
341 396
342 Enable others to act “Delegate responsibility and authority by empowering 397
Foster collaboration by promoting cooperative goals and people to act on their own”
343 398
building trust
344 Strengthen people by giving power away, providing choice, 399
345 developing competence, assigning critical tasks, and offering 400
346 visible support 401
347 Model the way “One of the most effective ways to gain acceptance of a 402
348 Set the example by behaving in ways that are consistent with philosophy is to show it in your daily actions” 403
349 shared values 404
Achieve small wins that promote consistent progress and build
350 405
commitment
351 406
Encourage the heart “Remember, everyone likes a compliment”
352 407
Recognize individual contributions to the success of every
353 project 408
354 Celebrate team accomplishments regularly 409
355 410
356 411
357 Maxwell, and “level 5” leadership proposed by
21
means. Without justice, our relationships suffer and 412
358 413
Collins.22 Although each of these models and the many commitments decline because people feel they are
359 414
others unnamed here highlight distinctive attributes of treated unfairly. Consider what happened to everyone’s
360 415
effective leaders, this author’s “lumping” tendency life when a Minneapolis policeman killed George Floyd
361 416
362
suggests that all these models converge on several core by leaning on his neck. Without wisdom, we make 417
Q22 Q10 features of effective leaders. These core features have
363 flawed decisions. Apathy goes up and so does risk. 418
364 been succinctly captured in five leadership commitments Without wisdom, our life is devoid of meaning and 419
365 reported by Kouzes and Posner in their seminal work purpose. Without temperance, we rush to judge, and we 420
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366 The Leadership Challenge and in the seven classical take unnecessary risks. We abandon our convictions, 421
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367 virtues : trust, compassion, courage, justice, wisdom, and we lose credibility. Finally, without hope, despair, 422
368 temperance, and hope. The classical virtues provide a cynicism, and fragility define who we become. How can 423
369 time-honored common vocabulary that undergirds we be effective as doctors without conferring hope? We 424
370 strong character, great leadership, and the strong recall the famous quote from the late 19th century TB 425
371 426
organizational culture that invites engagement and physician, Edward Livingston Trudeau, “To cure
372 427
discretionary effort. Simply put, who wouldn’t want to sometimes, to relieve often, to comfort always.”25 Hope
373 428
be led by or live in a culture in which trust and provides comfort.
374 429
375
compassion, wisdom, justice, and hope were the 430
Consider some examples of practicing the classical
376 prevailing values? 431
virtues in Pulmonary/Critical Care. Courage, trust, and
377 432
Consider the alternatives. Without trust, all human its corollary psychological safety allow the first-year
378 433
relationships deteriorate. We spend more time Pulmonary/Critical Care fellow to interrupt the
379 434
defending ourselves than flourishing. Without attending’s participating in a central line placement
380 435
381
compassion, we are all alienated from one another. Our when she observed that the attending’s gloves were 436
382 goals and our lives are empty and incomplete. Without inadvertently soiled. Psychologic safety, as discussed by 437
383 courage, we wilt in the face of challenge. We choose the Edmondson in the book The Fearless Organization: 438
384 “easy wrong” rather than the “hard right,” and we live in Creating Psychological Safety in the Workplace for 439
385 a Machiavellian world in which the ends justify the Learning, Innovation, and Growth,26 is the ability to 440

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441Q20 TABLE 3 ] Leadership Competencies for Health Care independently validated by great thinkers and great 496
442 leaders over time. 27,28
For example, the five leadership 497
Technical knowledge and skills
443
Operations commitments that Kouzes and Posner23 derived in their 498
444 499
Finance and accounting grounded theory research—challenge the process,
445 500
Information technology and systems
inspire a shared vision, enable others to act, model the
446 501
way, and encourage the heart (Table 2)—are uncannily
447 Human resources (including diversity) 502
448
similar to observations made a century earlier by one of 503
Strategic planning
449 America’s great leaders, President Abraham Lincoln.27 504
Policy
450 Similarly, Aristotle and philosopher Will Durant’s Q12
505
Knowledge of health care
451 comments about the virtues (“We are what we 506
Reimbursement strategies
452 repeatedly do. Excellence then is not an act but a habit” 507
Legislation
453 and “moral excellence is the result of habit or 508
454 Regulation 29 509
custom,” ) replicates Heraclitus’ observation that
455 Quality assessment and management
“Character is destiny,” Plutarch’s comment that “What 510
30

456 Problem solving we achieve inwardly will change outer reality,”31 and 511
457 To resolve organizational challenges and manage Confucius’ statement that “All people are the same: only 512
458 projects 513
their habits differ.”32 None knew one another but all
459 Communication 514
converged on common truths about excellence and
460 Leading groups 515
461
about what makes great leaders. 516
Negotiation
462 517
Conflict resolution
463 Leadership Competencies for Health Care 518
Commitment to lifelong learning (in context of rapidly
464 519
changing environment and need for new skills to Just as there are multiple models of generic leadership
465 520
cope and manage) competencies, so too are there many constructs for
466 521
Emotional intelligence specific leadership competencies in health care. For
467 522
468 example, the National Center for Healthcare Leadership 523
469 model33 bundles 26 individual competencies into three 524
470 domains: transformation, execution, and people. At the 525
speak up without fear of retribution or humiliation.
471 author’s institution, the Cleveland Clinic,34,35 the 526
Every health-care organization seeks psychologic safety
472 leadership model and curriculum is organized around 527
in pursuit of the highest possible quality and patient
473 four pillars: leading change, developing self and others, 528
safety. Without it, no one calls near-misses, we lack a
474 fostering teamwork, and demonstrating character and 529
475
just culture, and we do not get better. 530
integrity. A more granular construct of leadership
476 531
Another virtue, compassion, hopefully underlies competencies for health care suggests that six
477 532
everything we do in Pulmonary/Critical Care practice competencies are critical (Table 3).
478 533
and is surely in evidence when an intensivist engages in
479 Leading effectively in health care requires satisfying so- 534
a thoughtful and caring discussion with a nonagenarian
480 called “threshold” competencies; that is, in addition to 535
481
about end-of-life choices. Similarly, both justice and 536
clinical/scientific competence that commands the
482 wisdom underlie how we optimally and holistically 537
respect of one’s peers, having technical knowledge of
483 select incoming Pulmonary/Critical Care fellows for our 538
operations, strategy, finance, and human resources.
484 programs. These virtues are leadership competencies 539
Health-care leadership also requires understanding the
485 that create character; when we are good at who we are 540
regulatory and reimbursement environment of health
486 (ie, our actions and informed by and abide by the 541
487
care, including: quality and process improvement 542
virtues), we become better at what we do. Furthermore,
488 strategies; having a problem-solver and growth mindset 543
when organizational culture is crafted around the
489 of continuous learning36; and knowing how to negotiate 544
virtues, engagement and discretionary effort blossom
490 and to communicate in multiple forums (to large groups 545
and high performance follows, including in health
491 and one-on-one in difficult conversations). These 546
care.24
492 “threshold” competencies establish one’s candidacy to be 547
493Q11 The robustness of the concept that the seven classical considered for leadership positions. They “bring you to 548
494 virtues and the five leadership commitments of Kouzes the table” for consideration to be a leader, and these 549
495 550
and Posner are core to leadership lies in their being threshold competencies complement what have been

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551 TABLE 4 ] Leadership Styles (After Goleman et al38) Q21 606
552 607
Style Type Leadership Style Features, Impact, and Exemplars of This Style
553 608
Resonant Visionary Moves people toward shared dreams
554 609
Examples: Martin Luther King, Jr.; Mahatma Gandhi
555 610
Resonant Coaching Connects what a person wants to do with the goals of the organization
556 611
Example: Green Bay Packers coach Vince Lombardi
557 612
Resonant Affiliative Creates harmony by connecting people with each other, emphasizing people’s
558 613
emotional needs to garner commitment and engagement; emphasizing culture
559 of empathy 614
560 Example: Barack Obama as community activist 615
561 Resonant Democratic Values people’s input and gets commitment through participation; especially 616
562 helpful when the leader is uncertain and needs to harvest the wisdom of the 617
563 group 618
564 Example: Louis Gerstner, Jr., Chairman of IBM during its turnaround 619
565 Dissonant Pacesetting Leaders who expect excellence and exemplify it; can work when all members of 620
the team are highly competent and motivated. Can also de-motivate when
566 621
others feel belittled by the constant showcasing of the leader’s talent
567 622
Example: The surgeon doing a case with trainees who has them retract throughout
568 while she or he does the whole case, showing the trainees how to do the surgery 623
569 Dissonant Command and control “Do it because I say so”; the exercise of pure power
624
570 (commanding) Examples: Military commander in a moment of great urgency; physician running a 625
571 code 626
572 627
573 628
574 629
called “differentiating competencies” (ie, the attributes people in the room and driving the group in a
575 630
that distinguish capable leaders from remarkable downward spiral from frustration to resentment, rancor
576 631
leaders). These differentiating competencies, the to rage”). Although each style has its place in specific
577 632
578
attributes that cause leaders to be selected and to conditions, leaders with primarily pacesetting and 633
579 perform superbly, are those of emotional intelligence.2,3 commanding styles (otherwise called “command and 634
580 In brief, emotional intelligence comprises four broad control”) tend to produce dissonance, whereas those 635
581 competencies: self-awareness; the ability to self-manage; with the other four styles tend to create resonance. Being 636
582 to be aware of one’s relationship with others; and to keenly aware of the various styles, and which one to use 637
583 manage those relationships in service of greater when, is a requirement for the emotionally intelligent 638
584 effectiveness.2,37 leader. 639
585 640
586 The notion that leaders should adapt their leadership 641
587 Leadership Styles style to the context in which they are leading has also 642
588 Beyond the common attributes that effective leaders been developed in a model called “situational 643
589 largely share, effective leaders may also exhibit leadership.”39 Hersey and Blanchard framed a Q13 644
590 situationally different leadership styles, depending on situational leadership model in which the leader should 645
591 the context in which they are leading and the adopt one of four styles (telling, selling, participating, 646
592 647
characteristics of those they are leading. Put simply, and delegating) based on the willingness and capability
593 648
effective leaders adopt one of a range of leadership styles of the individual being led. For the unable but willing
594 649
to be most impactful in a specific context. Goleman follower, the leader should adopt a participating style:
595 650
et al38 have proposed a taxonomy of six distinctive encouraging, coaching, incenting, with a high
596 651
597
styles, what they call a repertoire of leadership styles relationship focus. Put in a medical context, imagine you 652
598 (Table 4). These styles include: visionary, coaching, are the attending on July 2 and helping a newly minted 653
599 affiliative, democratic, pacesetting, and commanding. intern perform an arterial blood gas test. If, as would be 654
600 Recognizing that effective leaders must know how and usual, the new intern had relatively little prior 655
601 when to deploy each of these styles, Goleman et al experience with this procedure, you as an attending 656
602 characterize the styles in default as being “resonant” would be hovering, watching, and coaching throughout 657
603 (being “attuned to people’s feelings and moving them in the procedure. On the other hand, when the follower is 658
604 a positive emotional direction”) or alternatively as highly capable and willing, the situational leadership 659
605 660
“dissonant” (being “out of touch with the feelings of model recommends a “delegation” style; that is, one in

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with a high degree of independence. The medical analog
663 10. Stoller JK, Goodall A, Baker A. Why the best hospitals are managed 718
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664 719
attending in seeing a consult with a fifth year pulmonary 11. Tasi MC, Keswani A, Bozic KJ. Does physician leadership affect
665 hospital quality, operational efficiency, and financial performance? 720
fellow. The patient needs a thoracentesis, and the fellow
666 Health Care Manage Rev. 2019;44(3):256-262. 721
has performed hundreds of thoracenteses and is deemed
667 12. Stoller JK. The clinician as leader: how, why, and when. Ann Am 722
668
to have achieved entrustable professional activity status Thorac Soc. 2017;14(11):1622-1627.
723
by her clinical competence committee. In this 13. Wheeler D, Stoller JK. Teamwork, teambuilding and leadership in
669 respiratory and health care. Can J Resp Ther. 2011;47.1(spring):6-11. 724
670 circumstance, the fellow would likely be entrusted to 725
14. Gittell J, Fairfield K, Bierbaum B, et al. Impact of relational
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675 In the context that leadership matters but that
16. Lee TH. Turning doctors into leaders. Harv Bus Rev. 2010;88:50-58. 730
676 traditional medical training generally does not teach or 17. Weisbord M. Why hasn’t organization development worked (so far) 731
677 confer leadership skills, leadership development is ever in medical centers. Health Care Manage Rev. 1976;1(2):17-28. 732
678 more important for physicians. Effective leadership is 18. Stoller JK. Developing physician-leaders: need and rationale. 733
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679 characterized by clear attributes, including acting in 734
19. Greenleaf RK. Servant Leadership: A Journey into the Nature of
680 ways and promoting cultures that are informed by the 735
Legitimate Power and Greatness. Mahwah, NJ: Paulist Press; 1977.
681 classical virtues of trust, compassion, courage, justice, 736
20. Heifitz R, Linsky M. Leadership on the Line: Staying Alive Through
682 the Dangers of Leading. Boston, MA: Harvard Business School Press; 737
wisdom, temperance, and hope. Developing leaders
683 2002. 738
consists of three key components: offering curriculum 21. Maxwell JC. The 5 Levels of Leadership: Proven Steps to Maximize
684 739
regarding leadership competencies, including emotional Your Potential. New York; Boston; Nashville: Center Street; 2011.
685 740
intelligence,2 teambuilding,4 and change management3; 22. Collins J. Level 5 leadership: the triumph of humility and fierce
686 resolve. Harv Bus Rev. July/August 2005. 741
687
cultivating coaching and mentoring around leadership;
23. Kouzes J, Posner B. The Leadership Challenge. 5th ed. San Francisco, 742
688 and experiential leadership (ie, offering emerging leaders CA: Wiley; 2012. 743
689 successive roles of increasing responsibility to cultivate 24. Rea P, Stoller J, Kolp A. Exception to the Rule: The Surprising Science 744
growth and to assess success, which begets further of Character-Based Culture, Engagement, and Performance. New
690 745
York, NY: McGraw-Hill Education; 2018.
691 opportunities).40 Best-in-class leadership development 25. To comfort always. https://medicine.yale.edu/news-article/17719/
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