As I picked up Leaders Eat Last, with its preface written by a retired Lieutenant General and its focus on business, I wondered if its contents would connect to those of us in health care. However, as I read the book I was struck by the similarities. As academia becomes “more like a business” and medicine becomes increasingly businesslike, the challenges discussed and insights offered seem very relevant. A key statement in the forward was particularly resonant, “Organizations where people share values and where people are valued succeed over the long term in good and bad times.” Mr. Sinek's description of leaders of great organizations, who “do not see people as a commodity to be managed to help grow the money,” but instead, “see money as the commodity to be managed to help grow their people” also was insightful. Hospitals, schools of chiropractic, and outpatient practices all are organizations that require excellence from every person within them, making this admonition very relevant. In chiropractic education this impact is magnified further as young professionals build their professional identities, and the values that will guide their care of others throughout their careers. Thus, the relevance of this book to us.
The book was divided into eight sections, labeled Parts 1 to 8. Each part provided a specific focus and message, as well as provocative questions and challenges for the reader.
Part 1 “Our Need to Feel Safe” focused on the concept of the “circle of safety.” Employees (and even more so, students) require protection from above to feel safe, and to be productive and satisfied in their roles. In organizations that extend this circle to include all employees, a strong sense of safety and belonging can develop. The author states that, “Absent a Circle of Safety, paranoia, cynicism and self-interest prevail.” However, he goes on to state (page 24), “When the Circle is strong and that feeling of belonging is ubiquitous, collaboration, trust and innovation result.” The provocative question asked in this section is, “How safe do you feel where you work?”
Part 2 was entitled “Powerful Forces,” and was for me the most thought-provoking of the sections. In education we frequently discuss student-centered education and learner motivation. This section focused on the role of our body's chemistry, and its interconnection with our motivation and action. The author declares that hom*o sapiens are designed through biology for cooperation, “Every single human being on the planet, regardless of culture, is naturally inclined to cooperate.” Five chemicals then are discussed, endorphins, dopamine, serotonin, oxytocin, and cortisol, along with the role each has. “The selfish chemicals, endorphins and dopamine, give us short-term rewards to which we can, under the right circ*mstances, become addictive. The selfless chemicals, serotonin and oxytocin, take time to build in our systems before we can enjoy their full benefits.” There is an extended discussion of the dangers to our health of environments where we feel unsafe and can produce too much cortisol, which can harm health. He ends this section with a reminder about our responsibility for the working/learning environment, stating (page 71), “We can not motivate others, per se. The only thing we can do is create environments in which the right chemicals are released for the right reasons.”
Part 3 “Reality” and Part 4 “How We Got Here” are both quite brief and lay the groundwork for the later sections where his rules and lessons are laid out. The primary message of Part 3 is a reinforcement of the circle of safety where the leader should be providing “cover” for those below so that they feel they “have the control to do what is right” (page 75). The discussion provides positive and negative examples of environments where there is trust versus those ruled more by fear, noting on page 78, “Trust is like lubrication. It reduces friction and creates conditions much more conducive to performance.” Part 4 provides a discussion of the role that baby boomers have had in removing society's safeguards, and in moving organizations away from the focus on the people first and a circle of safety, toward a focus on the numbers, with incentives that rely on fear (cortisol producing) and on immediate rewards (dopamine producing).
Part 5 “The Abstract Challenge” examines the results of seeing people as abstractions and the bottom line as real. In this circ*mstance people can, instead of doing what is right, end up doing what is right for them. There also is a risk in our society for what was labeled as destructive abundance, which (page 122), “… happens when selfish pursuits are out of balance with selfless pursuits. When the levels of dopamine-incentivized behaviors overwhelm the social protections offered by other chemicals. When protecting the results is prioritized above protecting those who produce the result.” The author then provided some suggestions (5 rules) for managing the abstraction. As you read this section, you may have the same reaction I did as I experienced concern about how well our health care system is doing in its treatment of providers, workers, learners, and patients.
Part 6 “Destructive Abundance” used positive and negative examples to explore the differences among organizational cultures. The author provided 5 leadership lessons that focused on the importance of: (1) a strong positive organizational culture, (2) leaders who serve and share authority, (3) integrity – building of trust requires nothing more than telling the truth, (4) getting to know each other in our workplaces – to humanize each other and to listen to each other, and (5) leading the people, not the numbers. Teams led by empowering leaders do better (page 169), “… because of higher levels of team-learning, coordination, empowerment and mental model development.”
Part 7 “A Society of Addicts” explores several challenges. First, the impact of the incentive structures used by many organizations concluding that most provide (page 186), “… little positive reinforcement when it comes to behaviors and actions critical to maintaining the Circle of Safety,” and “…not only allow dopamine addiction to happen, but cultivate and encourage it,” by focusing on the numbers instead of people. Other challenges include the steady dismantling over the 1ast two decades of regulations intended to protect Americans at all levels, which makes us more vulnerable to economic crises and mass layoffs. Finally, the challenges that Generation Y will need to face in themselves if they are to be able to addresses the current challenges in our organizations and society are presented. The author describes Generation Y as, “… a Distracted Generation, living in a world of abstraction, that thinks it has ADHD but more likely it has a dopamine-fueled addiction to social media and cell phones.”
Leaders Eat Last: Why Some Teams Pull Together and Others Don't was very provocative and could stimulate each of us to examine our own organizations and our roles within them. In Part 8 “Becoming a Leader” Simon Sinek reminds us that confronting the threats we face in the world is best done together. We all need mentors to please and learners to encourage. Also, it is the shared journey and shared struggles that most of us remember with more fondness than the work itself. The author provided a reminder in the final paragraphs on page 216. “Leadership, true leadership, is not the bastion of those who sit at the top. It is the responsibility of anyone who belongs to the group ... each of us has a responsibility to keep the Circle of Safety strong.” I encourage you to read this book, and consider the perspectives offered and finally to accept the author's challenge, “To be the leaders we wish we had.”
