A ship is safe in harbor, but that is not what ships are made for.

—William G. T. Shedd

The first five parts (twenty-six chapters) of this book are dedicated to building the foundation for implementing transformational change. However, Lean principles, systems, and structures cannot be delivered in the absence of leadership demonstrating courage to withstand adversities along the transformational change journey. Leadership takes courage! As Winston Churchill said, “Success is not final, and failure is not fatal: it is the courage to continue that counts.” In this section, I am going to share excerpts of leadership and courage, and contextualize their role in an organizational excellence and culture transformation journey.

In their book, Bringing Leadership to Life in Health: LEADS in a Caring Environment, Graham Dickson and Bill Tholl describe leadership as energy, influence, perseverance, dedication, strategy, and execution, applied in the world of people to create change. Leadership works through activities, approaches, and strategies to engage the will and commitment of individuals and professional groups to work together to bring meaningful change.

Stephen Covey differentiates between “Management” and “Leadership.” He says, “Management is efficiency in climbing the ladder of success; leadership determines whether the ladder is leaning against the right wall.” Management is working “IN” the system. Leadership is working “ON” the system. Management cares about efficiency. Leadership cares about people. Simon Sinek says, “Leadership is not about being in charge. Leadership is about taking care of those in your charge.” In the same note, Sheryl Sandberg says, “Leadership is about making others better as a result of your presence and making sure that impact lasts in your absence.” Leadership is about humanity and humility, and in the words of Michael Jordon, “You have to earn your leadership every day.”

The LEADS in a Caring Environment leadership capabilities framework (Table F1.1) represents the key skills, abilities, and knowledge required to lead at all levels of an organization. It identifies twenty capabilities under five domains for transformational leaders. Leaders tailor action on these capabilities and exemplify behaviors according to their own individual strengths, weaknesses, and character. Embodying the collective wisdom of the current literature on leadership and leadership development in the Canadian health sector, the LEADS framework is comparable to the top leadership competency frameworks in the private, public, and health sectors around the world.

Lisa Dungate and Jennifer Armstrong in their blog Lion’s Whiskers (www.lionswhiskers.com) categorize courage into six types (Figure F1.1).

1.Physical: Facing a challenge involving the risk of physical injury or death

2.Social: Standing up for oneself or others despite the risk of alienating others

3.Moral: Doing the right thing, despite the risk of opposition or loss of status

4.Emotional: Opening oneself to unpleasant emotions

5.Intellectual: Opening oneself to ideas that differ from one’s own opinions

6.Spiritual: Facing up to the uncertainty of the purpose for one’s existence

Paul Zygielbaum, author of Management Lessons from Oz, is also influenced by Lion’s Whiskers. He defines courage as willingness to act, despite fear. Fear delimits our ability to lead. Courage, hope, and conviction drive leadership and action.

Peter F. Drucker, founder of modern management, wrote that the purpose of strategy is to enable an organization to achieve its desired results in an unpredictable environment. Contrary to what “everybody knows,” strategy is not about achieving results in a known and foreseeable environment, but in an environment that is unknown and unforeseeable. Therefore, in business and in healthcare, leaders need moral, social, emotional, and intellectual courage. I am sharing below select content on these categories of courage from the exceptionally informative and well-researched blog Lion’s Whiskers.

While leaders can fall into any category, the most challenging situations are those that call for moral courage. In his book The Mystery of Courage, William Ian Miller, a professor at the University of Michigan Law School, writes, “The thing that distinguishes moral courage from all other forms of courage is that it is usually a lonely courage.” Leaders, especially those at the top and those who are called upon to make bold, crucial, unpopular, and often brutal decisions that impact the lives of many people, sometimes find themselves lonely and challenged. Courage is having the strength of conviction to do the right thing when it would just be easier to do things right.

Courage is what it takes to stand up and speak; courage is also what it takes to sit down and listen.

—Winston Churchill

Social courage is standing up tall, being able to greet the world with your head held high, feeling comfortable in your own skin. Social courage means not conforming to the expectations of others, being willing to show your true self even if it means risking social disapproval or punishment. It means being able to express opinions and preferences without checking to see if they are in line with “everyone else’s” opinions and preferences. Mahatma Gandhi said, “It’s easy to stand in a crowd. It takes courage to stand alone.”

Emotional courage is the willingness to be vulnerable, truthful, and aware of your conscious experience of core emotions, which you think about and express often in language as feelings. When we choose to ignore, suppress, or deny our emotion, we risk a reduction of insight, leading to faulty decision making and inaccurate mental representation of our experience. Emotional courage also means loving yourself, being proud of yourself, and believing that you are worthy of love and happiness. Essentially, it is related to self-acceptance, coupled with a willingness to move outside of our comfort zone, to explore new ways of being that may not be familiar. Barbara A. Trautlein, author of Change Intelligence, believes that powerful change leaders start with the heart, engage the brain, and help the hands move in positive new directions.

Courage makes change possible. Intellectual courage is necessary to challenge conventional wisdom and imagine new possibilities: a new way to lead and a new way to manage in a completely new business model. Intellectual courage means grappling with difficult or confusing concepts, asking questions, struggling to gain understanding, and risking mistakes. Integrity and authenticity are interwoven with intellectual courage. As Mary Anne Radmacher says, “Courage doesn’t always roar. Sometimes courage is the little voice that says I’ll try again tomorrow.”

Steve Jobs, cofounder of Apple Inc., articulated, “You can’t connect the dots looking forward; you can only connect them looking backwards. So you have to trust that the dots will somehow connect in your future. You have to trust in something—your gut, destiny, life, karma, whatever. Because believing that the dots will connect down the road will give you the confidence to follow your heart, even when it leads you off the well-worn path.”

David Silverstein, CEO of Lean Methods Group, highlights in Figure F1.2 the zone where courageous leaders are comfortable taking action despite the lack of all information.

Arlene Dickson, managing partner of District Venture Capital, says, “There are no perfect answers to business and life’s questions. Sometimes you just gotta pick your best possible guess answer. If you wait for everything to be perfect before you decide you will be waiting a long, long time. So take smart leaps of faith. Arm yourself with the best info you can gather at the time, a bit of gut instinct and a belief that if your choice doesn’t work out exactly how you want it to, you can take another run at it. This time a bit smarter.”

Missed opportunities lead to regrets later. As Wayne Gretzky said, “You miss 100 percent of the shots you don’t take.” Every industry has a Kodak moment, when disruption radically changed their business model. Nokia could have innovated its way to dominance in smartphones. Yahoo could have sold to Microsoft. But they didn’t. In the words of Yogi Berra, “When you come to a fork in the road, take it.” Facebook, Google, Airbnb, and many other web-based firms are only a few years old and worth billions of dollars. In fact, Airbnb founded in as recent as 2008, is now the world’s biggest accommodation provider with 1.5 million individual properties around the world. The answer lies in being nimble and fast. Robert Frost said, “Two roads diverged in a wood … I took the one less travelled by, and that has made all the difference.” As a leader, are you watching and prepared?

Margie Warrell, in her book Stop Playing Safe, provides a simple yet powerful framework (Figure F1.3) on how leaders lead in today’s increasingly competitive, accelerated, and uncertain world. First, the leader engages authentically with people to build trust. Second, the leader enlarges the context and helps employees understand the bigger “why.” Third, leaders demonstrate courage to unleash the human potential within their teams and organization, tap ingenuity, raise the bar on innovation, and optimize the value their organization contributes to all of its stakeholders. She says, “It doesn’t take the brains of an Einstein to do that, but it does take the heart of a lion.” In the words of Alexander the Great, “I am not afraid of an army of lions led by a sheep; I am afraid of an army of sheep led by a lion.”

Needless to say, all leadership is a function of time, place, and circumstance, so a leadership framework has to be adaptable and responsive to the situation. Also, leadership is not a function of the power of an individual’s position in an organization but rather of the power inherent in an individual’s ability to influence others. In his book, The Circle of Innovation, Tom Peters writes, “We are all Michelangelos—Michelangelos of housekeeping; Michelangelos of parking; Michelangelos of accounts receivable; Michelangelos of plumbing; Michelangelos of selling; Michelangelos of hairstyling; Michelangelos of _ _ _ _ _ _ _? (You fill in the blanks.) Choose to come to work with a Michelangelo attitude.” Likewise, in the story of the barnyard breakfast which the chicken and the pig agree to co-host, the chicken suggests that they serve bacon and eggs. The pig replies, “For you it means involvement. For me it’s total commitment.”

In an organization needing turnaround, or pursuing excellence and culture transformation, you need Michelangelos with pig commitment. In short, Gung Ho employees committed to success. Leaders have the responsibility to create an environment for the Gung Ho Michelangelos to thrive. Leaders decide what position team members play but then get off the field and let the payers move the ball. The Lean management system provides the structure to create such an environment. Courage provides the fuel in leaders that makes them resilient to repeated failures and persistent in driving implementation. Matthew Syed, in his book Bounce, writes, “Excellence is about stepping outside the comfort zone, training with a spirit of endeavour, and accepting the inevitability of trials and tribulations. Progress is built, in effect, upon the foundations of necessary failure.” Transformations and excellence journeys fail because one of these two essentials, namely, the environment and courage, are either missing or lacking. Some begin with all the right ingredients but lose momentum along the way, mostly because the fuel of courage in leadership became depleted during tough times or while facing resistance to change.

To disrupt the status quo, to create success in an uncertain, ambiguous, volatile, and complex business environment that increasingly demands speed to respond, to take action, to say no, to make decisions, to be compassionately assertive, to have the tenacity to hold people to high standards, to create value, and to engage stakeholders in constructive and meaningful ways, while being patient, humble, respectful, resilient, and confident in the process, courage is needed. Period.

Only when employees see “improving the work” as their work, integrate Lean management principles into their daily operations, and build trust with their leaders who back their daily experiments to make things better will an organization experience transformation to a Lean culture. Courageous leadership is, therefore, “The Missing Link to Creating a Lean Culture of Excellence.” A roadmap to creating an organizational excellence culture is shared in Figure F1.4.