Reflections on leadership in dentistry

Context

I was fortunate to hold many different leadership roles during my 50 years in dentistry. These roles included presidencies of national bodies (the General Dental Council, the British Dental Association and the College of General Dentistry) and societies (such as The British Society for Restorative Dentistry), deanships (the University Dental Hospital of Manchester, the Faculty of Dental Surgery of the Royal College of Surgeons of Edinburgh and the Dental Institute of King’s College London) and, among other roles, editorships (the Journal of Dentistry, the ‘Quintessentials of Dental Practice’ series, and Primary Dental Journal). Once into senior leadership, there was no going back. The more leadership roles I held, the more I enjoyed being a leader. If I had my time again, I would seek to be a leader, knowing that success involves a substantial element of being the right person, in the right place, at the right time, commitment and a multiplicity of balanced judgements, many of which can be vexing. In addition to the enjoyment (‘buzz’), I got a great deal of professional fulfilment from being a leader.

How did I get into leadership?

As an early career dentist, I realised that leadership is an everyday professional responsibility. In frontline clinical practice, clinicians must provide chairside leadership in administrating patient-centered care and, in the process, lead their dental team. Not having received any instruction in leadership, it became part of my self-directed professional development. The more I learned and put into practice, the more I came to appreciate the value and benefits of carefully considered, well-planned leadership or, put another way, not to try to provide leadership using a ‘shoot from the hip’, ‘fly by the seat of your pants’ approach. As with many things in my life, the more I learned about leadership, the more I realised there was to be learned, together with new skills. Ultimately, in the later stages of my career, much as I enjoyed providing advanced restorative dental care, teaching, scholarship and research, I came to the conclusion that my most meaningful contribution to dentistry could be through leadership, specifically leadership aimed at hitting so-called ‘leadership sweet spots’. A leadership sweet spot is the point where a leader’s strengths and actions are aligned with the needs of the team and the goals of the organisation; essentially, the leader finding and controlling the ‘spot’ where leadership is enjoyable, drawing on the leader’s strengths, resulting in the organisation flourishing, with team members benefiting individually and collectively. Achieving this leadership sweet spot – which I was fortunate to have done on a number of occasions in my career – is a fantastic experience; times when a leadership role, albeit demanding, is more fun than hard work.

Leadership vs management

Another realisation early in my career was the difference between leadership and management. Seeing, or worse being in a team or organisation headed up by someone who manages rather than provides leadership and, in the process typically fails, is a salutary experience. Often in such circumstances, the person providing management rather than leadership may show great commitment and make good management decisions, but in the absence of leadership the ‘ship’ slows and loses direction, begins to drift and may founder on the rocks. When asked by a colleague when in one of my leadership roles, which involved a great deal of overseas travel, “Who runs the place when you are travelling?” I am pleased, on reflection, to have responded “The same people who run it when I am back at base.” Leaders must delegate (and expect to be kept up to speed on) day-to-day operational matters, creating time and ‘space’ in their role to, first and foremost, keep ‘a finger on the pulse’ of the environment in which their organisation operates. Networking, head-hunting for ‘new blood’ appointments, succession planning, getting to know more about competing organisations and, very importantly, time to reflect, think and devise strategic plans are all things successful leaders must make time for in their typically busy schedules. That said, my reflections emphasise the importance of concurrently maintaining the trust and confidence of those you are leading – a multifaceted process which involves activities ranging from simply saying “Hello” and enquiring how things are going when you meet a team member to leading by example and being open, consistent and transparent at meetings. Leaders rightfully and properly get drawn into some elements of management, specifically the management of budgets and, for example, human resource issues which set policy or may impact the reputation of the organisation. A good leader must understand the trials and tribulations of management in their organisation, but the temptation to get involved in management issues must be resisted. If things are being mismanaged in an organisation (often the result of focusing on problems rather than solutions) new management is required. This is a better course of action than a leader getting embroiled and thereby conflicted through involvement in routine managerial issues at the expense of leadership activities.

Qualities

A review of leadership literature leads one to believe that successful leaders are superhuman. The strings of adjectives used to describe successful leaders include: visionary, trustworthy, resilient, empathetic, decisive, articulate, accountable, confident, inspirational, empowering, insightful, consistent, reliable, motivational, exemplar, principled, self-aware, respectful, appreciative, charismatic, self-managing, reflective, effective, good communicator, multi-tasker, strategist, creative, team-builder, responsible, emotionally intelligent, and so on. Looking back, the successful leaders I have worked for, became acquainted with or was fortunate to have as a mentor shared a number of what I consider to be key qualities: trustworthy, approachable, effective, motivational and inspirational, in addition to being highly motivated, professional individuals. Also, successful leaders need to be able to relate to the members of their team but in ways which do not compromise their position as leader or authority in executive leadership roles – acquainted and engaged, but not friends with team members. As such, senior leadership positions can be isolating, some would say lonely, specifically in problematic times when leaders have to make challenging decisions which may impact on the careers and lives of team members, let alone the future of the organisation. Teams celebrate success, failures belong to leaders. Successful leaders need to be prepared and able to deal with such issues.

Style

No single style of leadership is perfect or appropriate in all situations. Indeed, one of the skills of successful leadership is determining which style of leadership to adopt in different situations. Also, in the event of a change of role, successful leaders must be able to adapt to different circumstances and responsibilities. For example, the leadership that someone in an executive leadership role needs to provide is different from that expected of an individual in a role such as figurehead president of an organisation – academy, college, association, etc. A successful military leader is unlikely to be a successful leader of, say, a dental hospital or school if they apply the hierarchical, military-style approach to leadership to lead a staff of consultants or faculty of professors – individuals who typically don’t take kindly to being issued commands. In the event of a crisis, a leader who normally leads using a consultative approach, may have to adopt a militaristic-style approach to quickly and efficiently deal with the necessary logistics and related decision making. A successful leader needs to be adaptable, like a fast, colour-changing chameleon, to provide the right leadership at the right time.

Planning

Time spent planning leadership is time well spent. As indicated above a ‘shoot from the hip’, ‘fly by the seat of your pants’ approach is folly. Indeed, such an approach invites failure. In considering and accepting leadership roles individuals, in my experience, are well-advised to give detailed consideration to the style of leadership required. To resolve any problems which the new leader may inherit, or to reform and set an organisation off on a new direction, the style of leadership may be different from that subsequently required. Such leadership, specifically transformative leadership should be carefully planned, and, in common with all good planning, include a ‘plan B’ to be implemented if ‘plan A’ runs into difficulties. In some cases, job or role descriptions give an indication of what is expected of a new leader, for example, “to streamline. . .”, “to build on. . .”, “to stimulate. . .”, “to raise the profile of. . .”, “to continue. . .”, etc. Effective leadership planning, notwithstanding budgetary considerations, may involve managerial assessments of feasibility and consultation with key stakeholders. What is required may be contrary to what a leader would prefer, or instinctively do, i.e. staying within their ‘comfort zone’. What needs to be achieved must remain the focus of the planning. Above all else, it requires the leader to be open-minded, reactive and adaptable and, in my experience a good team builder.

Inherited or acquired?

Individuals may be born with the wish and confidence to be a leader, but knowledge, training and acquired skills are required to change that wish into reality. In pursuing a path to success, locally, regionally, nationally or internationally, an aspiring leader needs to commit to self-directed learning, attend relevant courses, observe the approaches and techniques adopted by established leaders, and find one or more effective mentors to help guide them on their way. As with most things in life, the more you learn about leadership, the more you appreciate there remains to be learned. Typically, successful leaders graduate from success in a local leadership role to assume a regional or possibly a minor national role, prior to moving on to a major national or international role. Indeed, successful local or regional leadership is often a major factor in being elected or appointed to a national role, and those elected or appointed to major national and international roles typically have a history of success in one or more previous leadership roles – success breeds success.

Sustaining success

Once a student, always a student of leadership. Leaders should stay on the crest, or preferably ahead of the leadership ‘curve’, which is constantly shifting in our ever-changing world. To achieve this all leaders should reflect on their success, be aware of how others see and value their leadership, partake in relevant continuous professional development, learn and act on lessons learned from failures, and observe and, where possible, work with leaders who enjoy greater success. In various roles I held, I greatly valued objective 360° feedback and good quality appraisal both to remind me of my biases and weaknesses (no leader being perfect) to be suppressed, and my strengths to be played to best possible advantage. Also, appointing, appraising and helping to train other leaders was a constant source of new awareness and inspiration.

A hard lesson to be learned in the world of leadership is that, irrespective of how successful you may have been in a role, when your term of office comes to an end, the role is over – “The king is dead, long live the king!” Uninvited lingering, let alone interventions can quickly tarnish a hard-won reputation of being a successful leader. Fixed terms of office, or time-limited contracts for leaders, often favoured by organisations, tend to be extended in exceptional circumstances only. Accepting an extension to a leadership role may quickly become frustrating, as the leader becomes viewed as a ‘nightwatchman’ tasked with ‘just holding the fort’ until a successor is elected or appointed.

In my experience, sustaining success in a leadership role over an extended period of time, as befalls a practice principal, can be challenging. There’s nothing worse than getting into a rut of ever-increasing depth on a road that can end up going nowhere, if not round in circles, with success turning into failure. Long-serving leaders should endeavour to find ways to reinvent and reinvigorate themselves, thereby avoiding criticism over time of ‘same-old stuff’ from the all too predictable top. In open-ended leadership roles, leaders who get weary and find it difficult to continue to meet the needs of their team and orgainsation are strongly advised to move aside while the ‘going remains good’ – ‘jump before being pushed’. Rumblings in the ranks about ‘stale’ leadership are bad enough; uprisings, desertions, constructive removals and coups, from what I have observed, are all very unpleasant – not a fitting end to a period of successful leadership, and very damaging to teams.

To conclude

Effective leadership, which doesn’t necessary go ‘hand in glove’ with popularity, is very rewarding and fulfilling. A team with an effective leader is productive, empowered and inspired, with the members of the team individually and collectively realising their potential. Also, individuals – ultimately patients – served by the dental team or organisation will benefit, helping to enhance the standing and status of the profession. Effective leadership creates a win–win situation at all levels.

Successful leadership produces new, equally, if not more effective leaders, not followers. With success, over time an effective leader should anticipate challenges for succession, possibly by an up-and-coming acolyte, mentee or former team member. There’s no greater compliment than one of your own vying for your position and wishing to emulate your success – a situation a leader needs to ‘see coming’ and be prepared to deal with empathetically.

Finally, a John Maxwell quote which captures the essence of my reflections and approach to leadership: “A leader knows the way, goes the way and shows the way.” ¹