1. Are Great Leaders Born,
or Are They Made?
DAVID A. OLSON, FACHE
THE Q U E S T I O N I N T H E TITLE to this commentary has been debated
for centuries and continues to dominate the study of leadership development,
yet evidence is insufficient to support either answer. The feature article authors
in this issue of Frontiers do not attempt to answer this question, but they do
offer two different perspectives of leadership: one as a personal journey, and
the other as a process for accomplishing an organizational goal.
In her article, Debra Sukin outlines her own leadership successes, high-
lighting such qualities as passion, vision, quality outcomes, strong knowledge
of the industry, the ability to think critically, perspective, adaptability, and
ongoing learning. She describes each of these elements from an intense and
personal perspective. This perspective contrasts with the article by Stephanie
McCutcheon, in which she deliberately outlines her process for leading the
Hospital Sisters Health System through the transformation into a care inte-
gration model. Ms. McCutcheon carefully outlines the elements and specific
steps needed for an organizational transformation of this magnitude.
After reading these articles and noting the contrasts between leadership
as a personal journey and leadership as a process for change, one might con-
clude that leadership must be one or the other. However, my personal experi-
ence—one I am sure many of our readers share—is that leadership is often
both.
MISTRUST AT BAY AREA MEDICAL CENTER
My recent journey at Bay Area Medical Center (BAMC) clearly showed me that
both elements of leadership come into play in transforming an organization.
David A. Olson, FACHE, is president of Columbia St. Mary's Hospital in
Ozaukee, Wisconsin, and executive vice president of Columbia St. Mary's
health system.
DAVI D A . O L S O N • 27

2. In February 1999, BAMC's medical gains that BAMC had made in recent
staff had voted "no confidence" in hospital years were in serious jeopardy.
administration. The mistrust was palpa-
ble. The construction of a competing BRIDGING THE
ambulatory surgery center was on the COMMUNICATION GAPS
horizon, and BAMC faced an inability to In May 1999, as the newly appointed
meet space needs for outpatient surgeries president and CEO of BAMC, I knew I
and diagnostics, resulting in medical staff needed to begin my turnaround quest
and patient dissatisfaction. This opened a immediately. I started with exhaustive
door for the competing center. A not-for- efforts to bridge communication gaps
profit organization with an approximately with the medical staff, community, and
48 percent Medicare population, BAMC county boards. I worked to develop open
could have been devastated by the compe- relationships with honest communica-
tition. The future was uncertain, the anxi- tion. Because BAMC had facilities in
ety level of BAMC's board of directors and Marinette, Wisconsin, and Menominee,
employees was high, and the atmosphere Michigan, this was a double effort. Soon I
was one of non-support. was providing monthly reports to update
Mistrust ofthe hospital was also high both county boards on the hospital's suc-
among the community and county govern- cesses and challenges. I developed com-
munication strategies with local news
The most successful efforts
reporters so they would feel free to partici-
newspapers was consis-
pate in hospital discussions or call with
in beginning this leadership tently negative, and the questions at any time. A new communi-
transformation were Board of Supervisors from cation tool called "Insights" was sent
bridging the communication Marinette County, which periodically to hospital board members,
, , „ ,. leased the Marinette hospi- community leaders, and elected officials.
gap and rebuilding
confidence by developing and felt that the county was All ofthese efforts were aimed at keeping
deploying a strategic plan, being shut out of hospital our stakeholders informed. I made sure
planning. The county that my door was always open to any com-
board was asking for a renegotiation of munity member, medical staff member,
the lease with the intent of gaining more or hospital employee who wished to pro-
operational control ofthe hospital. The vide input or ask questions about the
county had engaged consultants to per- future direction of BAMC. The most suc-
form a community health needs assess- cessful efforts in beginning this leader-
ment that painted BAMC in a poor light, ship transformation were bridging the
insinuating that the hospital was not communication gap and rebuilding con-
meeting the community's needs and that fidence by developing and deploying a
the strategic direction was misplaced. strategic plan.
BAMC would not be able to garner the
necessary support for a building project COLLABORATIVE STRATEGIC
that would allow it to successfully com- PLANNING
pete with a freestanding ambulatory The organization's last strategic plan had
surgery center unless relationships were been developed in 1995. The initiatives it
mended and trust reinstated. Financial outlined were completed in 1998, and
28 • FRONTIERS OF H E A L T H SERVICES MANAGEMENT 26:2

3. they were largely effective in achieving center has won back the support ofthe
progress and capturing additional market medical staff, the county government, the
share. However, I realized when I became community, and its own employees. The
CEO that these gains were in jeopardy, management team is strong, and a vision
and future successes would not occur and plan for the organization's future is
unless we developed a solid new plan. in place and is continually updated. The
Civen the climate of mistrust, the plan results so far have been positive. Net
needed to be a collaborative effort with a patient revenue and operating margins
large sphere of input and buy-in. The only continue to grow each year. Days cash on
way to bring back the confidence ofthe hand has grown to the highest levels ever,
organization's key stakeholders was to and the organization compares favorably
engineer a completely inclusive strategic with its competition.
planning process. Finally, others have noticed and recog-
This process began with interviews nized our transition to success. The hos-
with over 50 community members, repre- pital has been recognized twice in the
sentatives of other community healthcare last four years as one ofthe "100 Top
Hospitals" by Thomson Reuters and four
organizations, community leaders, gov-
ernment officials, members ofthe news
media, and medical staff members to
times in the last four years by Health-
Crades for patient safety and clinical
n
hear their concerns and solicit their input excellence. As the leader ofthe organiza-
regarding BAMC's direction. Over 50 tion, I have been recognized as ACHE's O
additional people were invited to a public Wisconsin Young Healthcare Executive
meeting to hear an outline ofthe plan- and won the Robert S. Hudgens Memorial
ning process, to learn about the chal-
lenges facing healthcare in our country in
Award for Young Healthcare Executive of
the Year.
2
general and BAMC in particular, and to We achieved these results primarily by
offer input. We collected and shared the
data. We held meetings with our employ-
putting the right pieces in place for the
organization, developing a strong strategic
2
ees for the same purpose. Membership plan, and executing that plan precisely.
on the strategic planning steering group,
developed to design the plan, included
We also created a culture of efficiency,
cost management, quality outcomes, and
m
key medical staff leaders, hospital board best practices achievement.
members, members from both county
governments, and BAMC's administrative LEADERSHIP PRINCIPLES
Z
staff Progress reports were provided reg- There are indications that certain princi-
ularly to ensure a high level of trust in the ples are always present in a strong leader
process. or in an organizational leadership trans-
formation. I believe that these principles
TRANSITION TO SUCCESS are apparent in the stories the feature
Nearly ten years have passed since those authors outline and in my own experi-
initial, decisive steps. In that time, the ence. In his article "Great Leaders Are
organization has had its ups and downs, Made, Not Born," William A. Cohen
but the core elements of our transforma- (1998) lists the following eight principles
tion have remained in place. The medical or "Universal Laws of Leadership":
D A V I D A . O L S O N • 29

4. Maintain absolute integrity. Leadership your people, your people will take good
is a trust, and others must trust you care of you.
completely in order to follow you. • Put duty before self Strong leaders
Know your stuff. All leadership always put the rewards ofthe organi-
requires a set of competencies in your zation ahead of any rewards for them-
particular area. Sukin's article indicates selves. Only by putting the organization
that industry knowledge is essential for and its mission first can you ever
a healthcare leader expect to receive personal recognition.
Declare your expectations. Strong • Get out in front. This principle clearly
leaders always state their expectations indicates the need for leadership in
in measurable ways. In her article, action to be visible and to set the ex-
McGutcheon clearly outlines the ex- ample for others to follow.
pectations that were necessary for
her leadership transformation to take My personal experience in successful
place. leadership through organizational trans-
Show uncommon commitment. Both formation is that it requires not only a
authors' articles indicate that the lead- strong process, but also a high level of
ers expected more of themselves than personal commitment from the leader.
of others. So the answer to the initial question "Are
Expect positive results. My own experi- great leaders born, or are they made?" is
ence is that a leader must expect to that they are both: Great leaders are born,
win. Those who follow need to see that and then they are made.
expectation to achieve that result.
Take care of your people or customers. REFERENCE
Cohen, W. A. 1998. "Great Leaders Are Made,
Strong leaders always ensure that their
Not Born." Network World, December 21.
followers are recognized, honored, and [Online document; accessed 9/19/09].
well taken care of This supports the www.stufFofheroes.com/Great%20Leaders%20
principle that if you take good care of are%2oMade,%2oNot%2oBorn.htm
30 • FRONTIERS OF HEALTH SERVICES MANAGEMENT 26:2

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