Anesthesia Business Consultants

Discover Practical & Tangible Professional Articles &
Advice Dedicated to the Anesthesia Community

800.242.1131
Ipad menu

Fall 2017


Leading Leaders: Building Influence in a High-Talent Group 

Will Latham, MBA
President, Latham Consulting Group, Inc., Chattanooga, TN

In despair at the way its programs were organized, the business school at one university recruited as the director of programs a successful businessman, who had made a modest fortune in his own business and wanted to move on to a new career. “I will soon put some order in this place,” he thought and said. He wrote memorandum to the academics laying down new procedures. No one read the memorandum. He called a meeting. No one came. In frustration, he asked for an explanation.

“These are independent individuals,” he was told. “You cannot command them to come to a meeting at your convenience; you have to negotiate a time and a place convenient to them all; you had better send around a list with possible alternatives.” He did and they came, or most of them did. He explained the new procedures, which, he said, would be introduced the next month. At that point, one of the older faculty members said, gently, “Bill, in this kind of institution, you cannot tell us to do anything; you can only ask us and try to persuade us to agree.”

“Well then,” Bill said, “let me ask you what you think we should do to put some sense into this place.”

“No, Bill,” the elder replied, “that’s what we hired you for, to come up with those sort of ideas. But they will only work if we agree with them. If we don’t, why then you will have to persuade us or come up with some better ideas. This is, you see, an organization of consent, not of command.”

– Charles Handy, The Age of Unreason

Many leaders of anesthesia groups face challenges similar to the ones that Bill faced. Their organizations:

  1. Are often in need of significant change because of the rapid and severe evolution of the healthcare industry.
  2. Are high-talent entities composed of individuals who are smart, talented and powerful (at least in terms of their organization). Such high-talent individuals have many employment options, and, therefore, have a strong sense of independence from both the organization and its leader. They often require leadership of the “consent and not command” type.

High-Talent Organizations

In his important book, Leading Leaders, Jeswald W. Salacuse notes that high-talent organizations (such as anesthesia groups) are composed of “elites”—individuals who, because of their “education, talents, wealth or power, are able to exert significant, usually disproportionate influence within their organization.”

One of the key characteristics of high-talent organizations is that the persons designated as leaders have limited authority over the people they are supposed to lead. “Authority,” in this instance, is defined as the right, by virtue of one’s position, to direct the activities of another person—in short, to tell them what to do. Most anesthesia group leaders don’t have that level of authority. They can’t say “just do it.”

In addition, these elites often:

  • Have had a role in choosing the leader, and consequently feel the leader is beholden to them, not the other way around.
  • Don’t see themselves as followers, and, therefore, are quick to challenge or belittle anything that suggests they are being led.

How to Lead Leaders

So how do you herd these cats?

Over the years, many authors have sought to explain leadership. Some feel that it is a skill honed through practice and study. Others believe it is a rare natural talent, like artistic ability, that a person is born with. For others, it is situational—an effective leader in some situations might be a disaster in others.

But any successful leader of a high-talent organization relies on two key elements:

  1. A focus on the relationship between the leader and the person being led. It’s that relationship that causes a person to act in ways the leader wants them to.
  2. An in-depth understanding of the interests and goals of each elite follower, and the ability to effectively communicate that the elite follower can achieve their goals through the organization.

Building Relationships

Let’s look first at relationships. Relationships are based on a perceived connection between leaders and followers, and successful leaders work very hard to create that connection because they know that effective leadership depends on it.

Different leaders use different methods to create relationships. Some rely on their personal dynamism and charisma, using their special ability to articulate visions, grand designs or glowing futures in which their followers would share. Others use quiet methods of reason and logic. The common thread among successful leaders is their ability to communicate. Communication is fundamental to relationship-building, and, therefore, to leadership.

That said, communication with the “masses” differs from communication with elite followers.

The most effective way to influence elite followers is to build the necessary relationships with them—not in crowds, but one-on-one. Smart, talented, powerful people require one-on-one, tailor-made leadership, delivered up close and personal. That doesn’t mean that it always has to be face-to-face. It could be a phone call, an email exchange, a memo, a letter, a hand-written note. These vehicles will suit different situations. However, the communication must be delivered on a one-on-one basis.

Communication is only one piece of the puzzle. Even if you communicate well, you will only be able to lead if you understand and accommodate your elite followers’ interests and goals. You must remember that people don’t follow you because you claim to be leader, because others have designated you as leader, or because you have charisma or charm. People usually follow you because they believe it is in their best interest to do so. Effective leaders understand this and seek to engage other leaders, understand their interests, listen to their objections and concerns, and look for means to accommodate their interests while pursing their own overriding goal of building a coalition to move the group forward.

What If All Don’t Agree?

Groups often find that, even with effective leadership, not all group members will agree on a unified goal for the future. Some groups are stymied by the fact that all don’t agree, while others have developed a culture in which:

  • All physicians are offered the chance to have input on an issue (either directly or through their leaders). 
  • If all don’t or won’t agree on a specific plan, the group votes and all agree in advance to support the group decision, whether they like the decision or not.

You can help your group make an important leap to the next level of performance by discussing and answering the following three questions:

  1. How will we make decisions as a group? In our experience, the best decision-making approach tends to be “seek consensus first, but if it cannot be reached, vote.”
  2. What is expected of each physician once the group has made a decision? The answer to this question is crucial. An unstated thought of many physicians is, “If I didn’t vote for it, I don’t have to support it.” Groups can’t function with this mindset. The group should agree that once a decision has been made by the agreed-upon decision-making method, all physicians (whether they agree with the decision or not) will support it. That means they will do what has been agreed to, not sabotage it, and continue to follow the agreement unless they can change the decision by working through the proper channels.
  3. What do we do if someone doesn’t meet the agreed-upon expectations? Here is where the rubber meets the road. At a minimum, the group can remind outliers that they all have agreed to support group decisions. We also recommend that groups set up a formal process to deal with those who don’t live up to their commitments.

A few years ago, I worked with a group that had this discussion at the beginning of its planning retreat. One of the physicians said, “So, if we make a decision, we are really going to do it?” I responded in the affirmative, to which he replied, “Well, I guess I will have to pay attention at this meeting!


Will Latham, MBA, is President of Latham Consulting Group, Inc., which helps medical group physicians make decisions, resolve conflict and move forward. For more than 25 years Mr. Latham has assisted medical groups in the areas of strategy and planning, governance and organizational effectiveness, and mergers, alliances and networks. During this time he has facilitated over 900 meetings or retreats for medical groups; helped hundreds of medical groups develop strategic plans to guide their growth and development; helped over 130 medical groups improve their governance systems and change their compensation plans; and advised and facilitated the mergers of over 120 medical practices representing over 1,200 physicians. Mr. Latham has an MBA from the University of North Carolina in Charlotte. He is a frequent speaker at local, state, national and specialty-specific healthcare conferences. Mr. Latham can be reached at (704) 365-8889 or wlatham@lathamconsulting.com.