What must you do well to be a great doctor?

Like me, you have sat with doctors who related to you as a live human being, vulnerable and anxious… and also with others who just honed in on your specific health problem and confined themselves to the technical task of solving only that. You have experienced the whole spectrum from medics possessed of a wonderful bedside manner to those with no awareness of even where the bedroom is.

With the disconnected technical kind you will have wondered how such highly trained professionals, people who wanted to be healers of the sick and who have studied for so many years, can have missed out on so much. Neither do they examine us holistically nor do they relate to us as emotional entities. What was going on when they were selected for medical school? Should they have been admitted at all? And how is it that those selecting the topics covered in these schools didn’t think it necessary to fill in such glaring gaps?

Increasingly however, programmes to develop medical practitioners, like ones producing other technical professionals – be they accountants, engineers, lawyers, technologists or others – have been including subjects that were hitherto beyond the narrow technical scope of their studies. More and more it dawned on curriculum developers that they urgently needed to broaden the development of their students.

One good example is business schools, traditionally renowned for churning out mere number-crunchers, heartless folk who lacked soul. Many B-Schools – but by no means all – have come to appreciate that “the new hard is soft”. In other words, however necessary it is to be financially literate, such skills are far from sufficient in a rounded business professional. Not before time, B-School leaders realised that the major challenge of the day is to mold individuals who combine technical with interpersonal skills, men and women who can lead responsibly and humanely, taking care of their staff and their customers as well as of the society in which they live. This indeed is the bigger challenge, the one that requires courage and imagination.

I was delighted that when I studied at the London Business School in the early seventies my courses included one on leadership as seen through the lens of literature, in which we studied great – not to mention flawed – leaders as portrayed by the likes of Socrates and Shakespeare, Machiavelli and Moliere. (This, by the way, thanks to the influence of my favourite management guru, Professor Charles Handy.) Likewise, in my economics undergraduate programme I was able to select political thought and French existentialist literature as two of my options. These courses provoked deep and broad reflection at a critical stage in my evolution as a person, and through them I learned much about myself and how I related to those around me.

These thoughts came to my mind as I read a recent Wall Street Journal article on the revamping of the American Medical College Admission Test. “One hundred years ago, all you really needed to know was the science,” commented Dr. Catherine Lucey, a member of the committee that reviewed the test. “Now we have problems like obesity and diabetes that require doctors to form therapeutic alliances with patients and convince them to change their lifestyle.”

So a quarter of the heavily revised test – taken for the first time last month by 8,200 aspiring doctors in America and by more than ten times that number globally – covers psychology, sociology and the biological foundations of behaviour, together with concepts such as social inequality and class and ethnic discrimination. Other new sections test critical-thinking and statistical reasoning, and background material covers concepts such as “power, privilege and prestige”.

“Change is hard,” said Dr. Lucey. “We are trying to send a message that in order to be a highly effective physician you need to have a foundation in a broad variety of domains.” An important message to absorb, and not just for physicians.

Too many young people were only attracted to their profession by its technical challenges. Their aptitude lay there, and when they absorbed themselves in the wonders of science or the grandeur of the law or the intricacies of accounting they felt at home, becoming stronger and stronger in their chosen domain.

As they complete their studies and enter the workplace, at first this can work well for them. Just as it was in their studies, it’s just them and their technical task. But the more they progress in their field, whichever it may be and before very long, the more they must interact with other people and the more they must understand the financial context within which they operate. Yet for many it is not what they were expecting, and it is not what they were prepared for.

Some find it possible to expand their comfort zones, overcoming earlier assumptions that such non-technical matters were simply not for them. For others however, the realisation comes too late. They get stuck, and are unable to develop their careers further. It’s a sad scenario, one that readily leads to frustration and bitterness.

As a talented software engineer once put it to me, “When I was at university I did a great job building my technical muscles, but I neglected building those needed for communicating with my colleagues and customers.” Having left the realisation so late he knew it was going to be much harder than had he been introduced to such skills as a young man.

I don’t know how many professors read Business Daily. But for those who do, along with members of professional associations who influence the ground that is covered by the generation that will take over from them, I hope they take this issue very seriously. The future of the young men and women who will soon be following in their footsteps depends on it. Let them not end up feeling inadequate and bewildered, as too many of their predecessors did.

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Collaborative leadership and development

Following my visit earlier this year to Jerusalem, where I admired the 16th century walls erected by Suleiman the Magnificent, the then Chairman and CEO of the Ottoman Empire, more recently I was in the city that served as the great man’s corporate head-office, Istanbul. Together with other consultants from around the world, and hosted by the World Bank, I was there to share experiences on how to accelerate the implementation of development projects by complementing the “technical” work of the World Bank through addressing the equally important “people” aspects.

We spent a week discussing what has worked and what has not, the obstacles we have faced and how we have tried to overcome them, and how we can do better in future. The World Bank, in its “Collaborative Leadership, Learning and Innovation” group, has for the last few years been running programmes that work with government clients on such challenges, and as a result it has harvested a great deal of valuable knowledge.

Over the years, its approach has migrated from a teaching and lecturing style to a very practical and interactive way of engaging. And on the first evening, immediately the group gathered, we were ourselves plunged into instant participation through being asked to identify the elements that had made our own engagements taxing.

Many spoke of lack of ownership on the part of one or more of the stakeholders, and this for a number of possible reasons. In some cases it was lack of alignment between them, not unrelated to a lack of trust. We’d seen cases of weak analysis prior to the engagement, including jumping at solutions prematurely. We had experienced resistance to change, thanks to vested interests benefitting from the status quo.

And for these and other factors, we’d all been in situations where no significant impact resulted: business continued as usual, with enough of those involved imprisoned in their comfort zones – which frequently meant isolating themselves within their silos. All too often, even where an initial change initiative succeeded, the possibility of it going to scale proved a step too far.

A predictable list of other obstacles emerged, including procurement heaviness; other sources of entangling red tape; lack of top level support; and what British Prime Minister Harold Macmillan once called the explosion of “events” – unforeseen distractions that drain energy away from the project at hand.

Many initiatives saw inadequate tracking and measurement of the planned change, thanks to such monitoring and evaluation being a mere afterthought; to weak or wrong indicators; or lack of sufficient data to assess the extent of the desired impact. Indeed, often absent was the very discipline needed to manage performance effectively.

Having identified the headaches we then shared stories of situations where we had managed to overcome some among them, to emerge with at least a certain measure of success. The group in which I found myself immediately went for building trust as our theme, appreciating that with it comes alignment, and hence ownership of the goals in question and the will to achieve the intended outcome.

What builds trust in a consultant? Of course they need the technical knowledge and skills to engage with credibility, but what emerged again and again was the need for a good attitude, one that speaks of confidence, coupled with friendliness and humility. The term used by the World Bank team to encapsulate such an emotionally intelligent approach is ‘Adaptive Leadership’, the ability to handle a situation with flexibility, overcoming the numerous unexpected roadblocks that are inevitable in this game.

During our week we drew up a list of competencies needed by leadership and change consultants. An early thought was that they are people who can be parachuted into difficult situations and hit the ground running. They must have broad experience – including of how government works, and in the use of change management tools and techniques. They must have developed excellent communications and mediation skills (not least in active listening); and they must be at ease in facilitating high-stakes, high-level conversations, ones that often include the need for managing conflict. A coaching approach is often part of the engagement process, and a focus on the desired impact is mandatory.

Other strengths mentioned included being – and being seen to be – neutral and objective, transparent and open-minded; and the ability to lead and work within diverse teams. Finally, an almost endless portfolio of other qualities was easily drawn up, including diplomacy, respectfulness, authenticity, patience and calmness, sense of humour, creativity, agility and being a spreader of positive energy.

We heard stories of successful change initiatives from Ghana and Rwanda, from the Philippines and Iraq, from Serbia and the Comoros, yes and from Kenya. And we shared experiences of using different tools to build that vital engagement and momentum which can bring about the breakthroughs in whatever area of development was selected. The term “reform” was used from time to time during the event to describe a change initiative, and while I fully understand the intent of the expression I have never been entirely comfortable with it, speaking as it does of merely overcoming the outdated, the disorganised, the fragmented, the incompetent. My preference is for more positive terms that focus on a more uplifting and less painful process.

Indeed, all of us who took part in the Istanbul event left truly uplifted, encouraged that in so many different parts of the world like-minded people are thinking ever so hard about how to actually bring about development – significantly, sustainably and to scale. The World Bank is much criticised for many aspects of its work, sometimes justifiably and sometimes much less so. In my interactions with its people over the last few years I have come across some of the most informed and thoughtful people I have ever met, including and not least those who led our recent discussions by the shores of the Bosphorus. Long may they continue to bring collaborative leadership, learning and innovation together.

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