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Creating Leaders and Leadership

At the Geisel School of Medicine at Dartmouth, we are committed to creating a new TYPE of physician leaders who exercise the kind of superb leadership required to tackle our most vexing challenges in health care. We believe that current leadership models, which are based largely on theories and explanations, provide limited "actionable" access to being an effective leader in healthcare. In other words, effective leadership does not come from knowledge about what leaders do, or from emulating the styles of famous leaders, or from memorizing some "5 easy steps to leadership" monograph. Knowing is not enough.

Rather than teaching leadership from a theoretical vantage point, we teach it as it is lived and experienced. When one exercises leadership "as lived" and as one's natural self-expression (concurrently informed by theories), one performs at one's best. Our approach, which is grounded in the branch of philosophy called ontology (What does it mean to be a leader?), help reveals our human ways of being and acting that limit our natural self-expression and our freedom to lead expertly.

Ontological leadership emphasizes that our worldviews shape the way we lead and are constituted in and accessible through language; thus, leading "as lived" and as one's natural self-expression requires mastery of a new conversational domain of leadership. When this new "conversational domain" is mastered, it provides leaders—physicians, scientists, educators, executives—with new opportunity sets (previously unavailable) for exercising more effective leadership.

By "conversational domain" we mean, for example, in the case of medicine, the kind of discipline-related terms that are networked together in a specific way to form the special linguistic domain through which a physician perceives, comprehends, and interacts with her patient's body, history, illness, and suffering—and which conversational domain is required to be a master physician and for the expert practice of medicine. Mastery of the conversational domain particular to any discipline—biomedical informatics, astrophysics, quantum mechanics, etc.—is essential if one is to effectively communicate, perform, and innovate in that particular domain.

There is a prevailing conversational domain of leadership that has existed for years. It includes words like vision, strategy, value, culture, and accountability, terms that are familiar to most everyone. This conventional leadership model explains performance (e.g., value) as an effect of some cause (e.g., improving quality, reducing costs) and assigns that cause to some combination of the leader's physical and mental characteristics and attributes as well as the external circumstances of the performance situation. This dominant worldview of leadership is deeply embedded in the mental maps of most individuals and organizations. This view is not wrong or ineffective. But, unlike the ontological orientation, it provides us with nominal access to our human ways of being and acting that limit our leadership effectiveness. It grants us limited actionable access to create for ourselves what it is to be a leader and what it is to exercise leadership effectively as our natural self-expression.

We contend that leading expertly requires mastery of a new language of leadership, one that complements the prevailing language of leadership. What is created by this new language provides physicians, scholars, educators, and managers with new perspectives and opportunity sets for tackling healthcare's most difficult challenges.

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