Leading with PURPOSE

Learning Outcomes

After this course, participants will be able to:

• Describe the importance of leadership in physical therapy.
• Compare leading people with managing people.
• Define the essential elements of leading with passion, understanding, representation, patience, openness, servitude, and empathy (PURPOSE).
• Develop their ability to lead with PURPOSE.

Introduction

I want to start by discussing an image that resonates with the concept of leadership. In Figure 1, black paper planes move in one direction while yellow planes move in the opposite direction. It reminds me of a quote by John Maxwell, a renowned author, coach, and speaker on leadership. He once said, "He who thinks he leads but has no followers is simply taking a walk." This quote struck a chord with me because it highlights that as leaders, whether in a formal or informal capacity if we perceive ourselves as driving change or guiding people within our organization while they are moving in a different direction, a problem arises.

Figure 1. Paper Airplanes, one headed in a different direction.

Being a leader goes beyond merely having followers; it's about mobilizing people. It entails recognizing their potential and capacity for growth. In the context of physical therapy education, we strive for excellence in teaching. Similarly, in clinical facilities, we aim to enable our staff to provide optimal patient care. True leadership inspires individuals to act, evoking positive emotions and aligning with their values. Contrary to common belief, rank or title alone does not make someone a leader. Leaders understand that regardless of their position or accomplishments, leading entails guiding people in the right direction. They want everyone to be united, working towards a shared goal. A true leader inspires people by appealing to their belief systems, values, and emotions, invoking excitement, joy, and happiness.

Importance of Leadership in Physical Therapy

Let's lay the foundation for leading with purpose by discussing the significance of leadership in physical therapy. Throughout this course, I will define key terms related to leadership. However, instead of relying solely on standard dictionary definitions, I'll share quotes from famous individuals. Sometimes, the words of celebrities or notable figures hold profound meanings that can resonate with you.

Defining a Leader

According to Brene Brown, a professor, author, and speaker on leadership, a leader is "Anyone who takes responsibility for finding the potential in people and processes and has the courage to develop that potential." True leadership involves recognizing the capabilities and potential of others and fostering their growth and advancement. It's not about exerting authority or dictating terms. Another definition of leadership by Brown is: "Leadership is not about titles or the corner office. It's about the willingness to step up, put yourself out there, and lean into courage."

Some individuals in leadership positions often hide behind their titles and ranks, lacking a clear understanding of the principles of leading with purpose. They may have assumed their roles and begun performing tasks without considering the underlying reasons for their leadership. As a result, they may not know their team members individually or understand what uniquely qualifies them to achieve organizational goals, execute strategic plans, or fulfill missions. Additionally, they may lack an understanding of how to lead effectively and what outcomes their leadership should aim to achieve.

Genuine leadership starts with self-leadership, a concept increasingly discussed in professions like physical therapy. Self-leadership is the process by which individuals influence themselves to achieve self-direction and motivation, which is crucial for assessing leadership outcomes and inspiring others. Effective leadership extends beyond individuals to encompass systems and organizations as a whole.

While numerous leadership theories and associated styles exist, it is vital for leaders to grasp the foundational concepts. These include the Great Man theory, which suggests that leaders are born, often focusing on men. Behavioral theories emphasize actions and behaviors over inherent traits as defining leadership qualities. Contingency theories explore how situational factors shape leadership approaches and effectiveness. Understanding these theories can provide valuable insights into effective leadership practices.

There are newer models of leadership, such as transactional leadership, which entails a managerial approach with contingent rewards. Followers who comply with the leader's directives are rewarded, while those who fail to do so face punishment. Another prevalent style is transformational leadership, which involves aligning leadership actions with broader societal benefits. Laissez-faire leadership, on the other hand, adopts a hands-off approach, allowing followers greater autonomy until intervention becomes necessary.

Furthermore, there's a focus on diversity and social justice leadership, which considers the sociocultural identities of leaders and their impact on equity and fairness. In the realm of physical therapy, Tschoepe et al. (2021) emphasized that leadership is a responsibility shared by all physical therapists and physical therapist assistants. Developing leadership skills is crucial, particularly in educational settings, to realize the profession's vision of transforming society and enhancing the human experience.

To achieve this vision, it's essential to cultivate leaders who can lead themselves, others, educational institutions, and clinical facilities. This necessitates fostering leadership skills at the grassroots level to advocate for the profession's needs and effect positive change in healthcare. The development of a leadership competency framework is crucial in this regard, guiding the cultivation of leaders who can drive transformation in physical therapy and healthcare overall.

Associations/Professional Organizations

Different entities or groups within our professional organizations emphasize leadership and the need for us to develop and refine our leadership further. 

Within the American Physical Therapy Association, the Academy of Leadership and Innovation (formerly the Health Policy and Administration Catalyst) seeks to transform physical therapy culture through professionalism, leadership, and advocacy initiatives. Additionally, APTA's Fellowship in Higher Education Leadership develops current and aspiring leaders' skills to promote innovative, influential, visionary leadership. Outside APTA, the LAMP Leadership Institute assists any healthcare professional, including educators and clinicians, in self-understanding and leading others through its Leadership, Administration, Management, and Professionalism programming. For physical therapy educators specifically, the American Council of Academic Physical Therapy's (ACAPT) Leadership Academy supports leadership development. ACAPT also offers the Leadership Compass, an online leadership growth platform for administrators, academics, clinicians, clinical affiliates, and students. Multiple organizations thus emphasize leadership advancement within physical therapy via targeted training and mentorship.

Traits of Healthcare Leaders

• Technical knowledge of insurance and reimbursement issues
• How to balance expense with quality of patient care
• Healthcare regulations (including the Affordable Care Act)
• Legal issues in health care and public policy
• Problem-solving skills
• Communication skills
• Commitment to lifelong learning

Now, let's examine the traits of healthcare leaders, including physical therapists (PTs) and physical therapist assistants (PTAs). Above, we have aspects related to positional leadership responsibilities. These encompass knowing the technicalities of insurance, understanding various reimbursement systems, and balancing expenses with the quality of patient care. It also involves being well-versed in healthcare regulations, such as the Affordable Care Act, and being able to navigate legal and public policy issues affecting physical therapy.

Problem-solving skills are crucial in this domain, particularly concerning fiscal responsibility and staffing challenges in clinical settings. Effective communication is another essential skill for leaders to ensure transparency and clarity, especially amid the current financial climate, which impacts patient care and organizational finances.

Traits associated with leading people rather than processes or positions are the following: 

• Emotional intelligence
• Equity
• Justice
• Role modeling
• Work ethic
• Balancing work and personal life
• Organization
• Prioritization

This is emotional intelligence, often referred to as EQ, which is the ability for you as a leader to understand and manage your own emotions, recognizing how they impact those you lead—your faculty, students, staff, and patients. Equity involves allocating resources to clinical staff or faculty on an individual basis, discerning their needs at different times. Leading with justice ensures fairness in your leadership approach. Role modeling is essential for healthcare leaders and physical therapists, requiring us to be effective teachers, mentors, and leaders. Having a strong work ethic means leading by example matching the expectations we have for our team. Balancing work and personal life is challenging, but setting boundaries is crucial, knowing when each deserves priority.

Aligning people's values with the organization's values and prioritizing people over processes are key traits of effective leadership within an organization. Desveaux et al., in 2016, explored leadership characteristics of academics and clinical managers in Canada using the Clifton Strengths Finder. 

The Clifton Strengths Finder assesses natural leadership talents alongside one's investment in leadership development, determining overall leadership strengths. In the Clifton Strengths Finder, there are four major domains of leadership. One is executing, or the leader's ability to make things happen. Another is influencing, which involves knowing how to take charge. Relationship building is another domain focused on holding your team together. The last domain is strategic thinking, which involves analyzing information to make better-informed decisions.

Academic leaders tended to exhibit more empathy and intellectual traits, aligning with relationship-building and strategic thinking and showing an introspective nature and an ability to sense others feelings and appreciate intellectual discussions. 

Conversely, clinical managers were characterized by harmony and connectedness, seeking areas of agreement between things. These traits, such as harmony and connectedness, suggest clinical managers prioritize relationships, ensuring cohesion within their teams to enhance productivity.

Lack of Leadership

However, we know it becomes a significant issue if there is a lack of leadership or poor leadership. That's why conversations about leadership and how to lead people are crucial. It's important for leaders, whether informal, formal, or self-leaders, to understand that an absence or gaps in leadership contribute to occupational stress. Occupational stress, defined by the World Health Organization as a global pandemic, is a common denominator for a range of physiological problems such as high blood pressure, diabetes, and obesity, as well as psychological issues like poor mental and emotional health.

Stress within organizations, whether academic institutions or clinical facilities, leads to decreased productivity when leaders fail to mobilize their workforce effectively. Morale drops, conflicts arise, and employees may show up to work without their hearts fully engaged. Lack of effective leadership results in unmet needs among clinical staff and faculty. Unclear expectations, lack of guidance, and ambiguity regarding outcomes create dissatisfaction and poor retention rates. As the saying goes, "People tend to quit managers or leaders before they quit their position." Even if employees enjoy their work, ineffective leadership may prompt them to weigh the decision to stay or leave.

Poor leadership also affects customer satisfaction, as patients and students can sense when their healthcare providers or instructors are stressed or disengaged. This dissatisfaction has a trickle-down effect, ultimately leading to burnout. Addressing these issues requires effective leadership that focuses on purposeful leadership. By centering leaders in a framework that brings out the best in their team members, we can mitigate the effects of burnout and improve outcomes for both employees and those they serve.

I developed this framework to center leaders, empowering them to lead and bring out the best in their teams effectively. We recognize that the culmination of occupational stress, low morale, conflict, and poor satisfaction often leads to burnout. The more our clinicians and faculty experience burnout, the worse the outcomes for ourselves and our patients and students. Addressing these issues through purposeful leadership is essential to prevent burnout and improve overall outcomes.

Leadership v. Management

Before we explore leading with purpose, it's crucial to distinguish between leadership and management. While they share some similarities, they differ significantly in their motivations, methods, and desired outcomes. Both involve working with people, but leadership primarily focuses on inspiring and guiding individuals toward a shared vision. On the other hand, management tends to concentrate on organizing tasks and ensuring that processes are in place to achieve organizational objectives. Managers are typically responsible for implementing procedures, enforcing regulations, and maintaining existing initiatives to sustain productivity and relevance within the organization.

Managers often prioritize systems and structures, placing greater emphasis on processes. Additionally, they may place significance on titles, as progression through various managerial titles is often seen as evidence of success. In contrast, leaders tend to detach themselves from the organization itself and focus more on the individuals within it. They center their vision on guiding change, reforming systems, and ultimately impacting society. Leaders are characterized by their innovation and their refusal to accept the status quo; instead, they continually seek new ways to unleash the potential of individuals, thereby enhancing organizational and institutional effectiveness.

Furthermore, leaders prioritize the development of people, striving to enable individuals to utilize their skills and knowledge to the fullest extent. This approach fosters a sense of belonging and engagement within the organization or institution. Unlike managers, who may focus more on processes, leaders prioritize people-centric strategies aimed at driving meaningful change. They place emphasis on cultivating the quality of individuals and their success, with the ultimate goal of facilitating growth and fulfillment rather than mere survival.

It's been said that sometimes managers can become leaders if they truly understand and want to develop the ability to lead, and I'll say on purpose. Not all managers can achieve this. They're stuck in the management realm, but true leaders know how to lead, and they may have some of those management qualities. Overall, then, when we're looking at leaders versus managers, we're looking at processes versus visions. This means that you are counting the value of people, like how they do things and when they do things, versus trying to create value with that vision and focusing on why people are doing things and what they're doing. Consider again the organizing versus the aligning. Are you organizing to influence people or aligning to influence people, or are you organizing to exert your power or your dominance as a manager with a particular title? Then, look at position versus quality. Are you managing people based on where they rank within your organization, or are you leading people to focus on the quality of what they contribute to the organization? And sometimes you have to do a little bit of both, as I said earlier, because as a true leader, you do have to don a management hat every now and again. But as a manager, you don't necessarily have to don a leadership lens, and so whether you, how much you manage, or how much you lead depends on people, and it depends on context. Steve Jobs has a quote that says, "Management is about persuading people to do the things that they do not want to do, while leadership is about inspiring people to do the things that they never thought they could." I thought that quote differentiated the management philosophy versus the leadership one.

Leading with P.U.R.P.O.S.E

I'll discuss each element of Leading with P.U.R.P.O.S.E and will define those elements. 

P.U.R.P.O.S.E. stands for the following: 

P – Passion
U – Understanding
R – Representation
P – Patience
O – Openness
S – Servitude
E – Empathy

You will note that there are overlaps, such that you can't just lead with passion and not have a little bit of patience in there, or you can't lead with servitude without having some element of empathy in there.

Passion

The first principle I want to examine is leading with passion. When you lead with passion, essentially, it's harnessing energy. "Feel the power that comes from focusing on what excites you," as Oprah Winfrey once said. These two keywords, "energy" and "excites you," illustrate what a leader can achieve when they focus on generating that energy to mobilize people behind them and get things done. When you're passionate about what you do as a leader, you take pride in bringing out the best in those you lead. Knowing the "why" of your leadership is essential. Understanding the "why" allows you to fulfill your purpose, beliefs, and passion while also helping others comprehend the purpose behind your leadership and support you as you support them. Recognizing the "why" of your leadership means understanding the impact you'll have on people and processes. It's not just work; it's your passion. Passion is a crucial ingredient of leadership and motivation.

When leading people, the aim is to motivate them to achieve their own success and that of your clinic or academic institution. You want individuals to be intrinsically motivated to pursue goals such as excellence, education, or optimal patient care. Passionate leadership creates a following. Faculty and clinicians seek guidance, mentorship, and effective leadership from passionate leaders. Leading with passion entails a commitment to something you deeply care about, leading to a bias for action. This means exercising your own willpower through energy, excitement, and focus while also unlocking those same qualities in your staff and faculty. Leading with passion involves optimistic enthusiasm that motivates people and instills belief in the desired outcomes.

Guiding Principles

Passion: 

• Demands total personal commitment 
• Requires constant adaptation
• Focuses on success
• Engages with others as valued partners
• Motivates leaders to be stewards

Guiding principles of leading with passion include a total personal commitment to those you lead, prioritizing their needs and well-being. Leading with passion necessitates constant adaptation, especially during adversity, and a focus on learning from failures. Success doesn't always come from doing everything right; it often stems from learning from missteps and moving forward. Passion keeps you engaged with others as valued partners, be it clinicians or faculty, fueling your motivation to serve as a steward and leader.

Understanding

Understanding is the next concept of leading with P.U.R.P.O.S.E. I will use the working definition for this: understanding is much deeper than knowledge. There are many who know you, but very few who understand you. I don't know who said this; I found this on a Dr. Google search, and I wish I could claim this because to me, this is pretty profound. Think about this for a second. In your own life, and not as a professional, but just in your own life, how many of you have people who are around you who know you versus people around you who truly understand who you are, who truly understand your perspectives, your lived experiences, your sociocultural identities, and how these shape who you are and why you do the things that you do? Think about that for a moment, and then think about the people you lead, whether you are an informal leader or a formal leader with a title.

Do you truly know the people you lead, or do you merely have surface-level knowledge of them? Consider the clinicians in your clinical facility or hospital setting and the faculty members in the academic setting—are you familiar with them, or do you genuinely understand them? Leading with understanding goes beyond mere acquaintance; it involves establishing a deep emotional connection. Through active listening and empathy, you internalize their words and grasp how their experiences and perspectives impact both your goals and their well-being.

When you lead with understanding, you approach interactions with empathy, seeking to comprehend rather than advise, counsel, or judge. You strive to grasp the complexities, pains, needs, and desires of each individual on your team—every clinician, faculty member, patient, and student. Understanding their sociocultural backgrounds and lived experiences helps you appreciate how these factors shape their actions within the team.

Aligning personal values with organizational values fosters motivation and persistence among team members. By remaining mindful and attentive in the present moment, you purposefully focus on the individuals before you, considering both their emotions and your nonverbal communication cues. This approach reflects the principle articulated in Stephen Covey's book "The Seven Habits of Highly Effective People"—specifically, the fifth habit: "Seek first to understand, then be understood."

As leaders, embracing this habit entails prioritizing understanding—grasping why individuals think and act as they do, their perspectives on various issues, and their emotional states. Covey's discussion of ethos, pathos, and logos underscores the importance of appealing to individuals' authority and character as part of the process of understanding them.

Pathos is the act of evoking emotions in people, while logos is the act of appealing to people's logic or reasoning. The best way to understand how someone feels is to ask them simply. But how often do we, as leaders, assume things about people without asking them? We might assume they didn't show up to work on time because they didn't feel like it or were upset about something, but did we ask them? We have to ask them; we should pose open-ended questions when we do. For example, we might ask, "Tell me how you feel about what we discussed yesterday in the clinic," or "How does my leadership affect your ability to teach students effectively?" Listen with the intent to understand people. Reflect on what they've said. Reflecting on what someone says as a leader reminds me of what I teach students about subjective examinations. When you reflect on what someone says, repeat it back to them to demonstrate that you were actively listening and trying to understand their perspective.

Representation

When we, as leaders, think about representation and leadership together, there's often a disconnect. Representation is about demanding that we're all seen and affirming that we all matter. I took this from a person named Pilar in Brooklyn from a site we have, hashtag, we have stories. When you lead with representation in mind to fulfill leading on purpose, then you understand that diversity, equity, inclusion, and belonging should be at the foundation of leadership because we lead people. Leaders have to understand the impact of their implicit or explicit biases, how that impacts the people they lead, and how these biases if left unchecked, turn into isms. Biases toward race turn into racism, biases toward age turn into ageism, biases toward disabilities turn into ableism, and how that affects how you lead people but also how people perceive you as a leader.

Leaders have to lead with self-cultural awareness. When you lead with self-cultural awareness, you know who you are. You understand the intersectional realities of your sociocultural identities, how they impact those you lead, and how you respond to them. So that leads to cultural humility and responsiveness, enabling you to recognize and appreciate people's identities and how those sociocultural identities inform how they interact with each other and with you as a leader. When we lead with representation, we have a duty and obligation to elevate the path for historically marginalized and excluded groups. Engaging in cultural responsiveness is how we elevate the path of historically marginalized and excluded groups, including race, ethnicity, or gender. When we lead with representation, we recognize that there are ceilings, whether they're glass or concrete, and there are still barriers for the people we lead. We need to work with them to break these glass and concrete ceilings. As leaders, we have a responsibility to cultivate other leaders and ensure leader succession. We recognize the skills, knowledge,, and aspirations of those on our team and help them achieve the same leadership that we have. When we lead with representation, we're mitigating implicit and explicit biases. By doing this, we prevent biases from turning into isms, which could undermine facilities, organizations, and institutions.  I have included some APTA 2020 workforce data analysis statistics focusing on race and ethnicity. Even though we know that diversity is multifaceted and encompasses various aspects, a lot of the statistics within our physical therapy profession focus on race and ethnicity. When we think about leadership and elevating historically marginalized and excluded voices, it's essential to remember that it's hard for people to be what they can't see.

APTA 2020 Workforce Analysis:  

•White 84.3% (76.7% in the USA)

•Black 2.5% (3.6% USA)

•Asian 6.9% (12.9% USA)

•Native American 0.4% (0.2% USA)

•Hispanic 3.5% (5.3% USA)

When considering the racial and ethnic diversity within the general workforce of physical therapy, it's evident that white physical therapists and physical therapist assistants constitute 84.3%, surpassing their representation in the US population at 76.7%. This overrepresentation highlights a disparity. Black individuals make up 2.5% of our profession, Asians 6.9%, Native Americans 0.4%, and Hispanics 3.5%. While these figures pertain to the workforce, data on leadership diversity is lacking. However, given the workforce demographics, it's reasonable to assume that white individuals predominantly hold leadership positions. This raises questions about representation and the pathways for historically marginalized and excluded voices to ascend to leadership roles.

Considering the adage "It's hard to be what you cannot see," we recognize the importance of representation in leadership. To address this, we can draw insights from Brown et al.'s book "Identity Conscious Supervision" and apply them to leadership. Supervision entails leadership, so we can reframe the concept to focus on leading with an identity-conscious lens. Leading in this manner involves developing a profound understanding of our own identities and how they shape us. Additionally, it requires intentional efforts to comprehend the sociocultural identities of our colleagues and team members. We create a more inclusive leadership environment by fostering identity exploration through open dialogues about race, ethnicity, personal biases, and gaps in understanding. 

As leaders, we create spaces and opportunities to have conversations about these identities. When we lead with identity consciousness, we engage in conflict against the status quo. This means checking our biases and assumptions and being open to correction. If we don't manage conflict regarding our perceptions of someone based on their identities, biases can turn into isms, and employees may begin to feel like they don't belong. When this happens, productivity decreases, and they may eventually leave. Identity-conscious supervision influences educational institutions and clinical facilities, driving change. Identify-conscious supervision is an important aspect of representation in leadership as it allows leaders to change systems of dominance and inequity.  

Patience

Transitioning to leading with patience, patience becomes paramount if we're striving to lead with P.U.R.P.O.S.E.  A functional definition of patience suggests that it's not merely about waiting but maintaining a positive attitude while doing so. I'll openly admit that waiting for students to arrive punctually or for my patients can test my patience, and I'm sure many of you can relate. Consider this: When you're in a leadership role, perhaps in a clinical setting, and a clinician arrives late, how does it affect your demeanor? Or when patients are tardy or deadlines are missed, how do you react? 

Furthermore, what's your response when someone requests an extension on a project despite having ample time to complete it? Are you patient, and if so, does it come with a genuine good attitude? Patience, often considered a virtue, is the ability to endure without becoming angry or upset, a quality I'll openly admit I'm still working on as I strive to lead with purpose. 

Leading with patience is challenging, especially for us as leaders, who are often inclined to solve problems quickly. We expect immediate results and sometimes overlook the need to wait. However, it's essential to recognize that patience involves responding deliberately. Just because something comes easy to us doesn't mean it's the same for others. So before approaching someone with expectations, we must pause, consider their perspective, and carefully choose our words.

Responding deliberately entails recognizing the reasons behind someone's actions: why they're doing what they're doing, in the manner they're doing it, and at the time they're doing it. Many leadership tasks necessitate patience, such as strategic planning in academic institutions or clinical facilities and negotiations, particularly when hiring new faculty or staff, navigating salary discussions, and addressing benefit concerns.

Many leadership tasks require patience:

• Strategic planning
• Negotiations
• People development
• Program management 

Patience is also vital in developing individuals, as each person is unique in processing and interpreting information. As leaders, we must be patient in guiding them, whether it involves adapting to new processing methods or adjusting to different work paces. Additionally, patience is essential in program management, where deliberate and intentional organization and structuring are required to facilitate advancement toward our goals and missions.

Deliberate and intentional patience leads to success, whereas impatience can result in failures. Therefore, as leaders, we must exercise patience in understanding situations, establishing facts, and addressing conflicts, especially concerning faculty, staff, students, and patients. Recognizing the importance of each issue and handling them patiently is key to effective leadership.

These insights are drawn from Doug Moran's book titled "If You Will Lead," which provides valuable perspectives on leadership and the significance of patience in leadership roles.

Leaders need the patience to (Moran, 2011): 

• Understand the situation and establish facts
• Create a plan
• Build support  
• Execute the plan  
• Be prepared to respond to the unexpected

How urgent is it to find a resolution, especially whether it's imperative to resolve issues immediately versus in the future? We need patience to devise a plan, to understand what we will do as leaders, and to have confidence in both creating and executing that plan, relying on the support of our team. Sometimes, the most effective way to alleviate team stress and pressure is by fostering mutual support among team members, ensuring everyone is equally invested in the task.

Leaders require patience to implement their plans, trusting that the chosen course of action, whether devised collaboratively or individually, will prove successful. They must possess the fortitude to persevere, even in the face of challenges, particularly when dealing with team members who consistently oppose the plan. Additionally, leaders need the patience to respond to unforeseen events, which frequently occur in leadership roles and test our ability to remain composed.

Reflecting on our experiences as leaders, we can likely recall numerous instances where our patience was tested, whether yesterday or earlier today. These challenges serve as reminders of the importance of patience in effective leadership.

When things don't unfold according to our initial plans, it's a testament to the unpredictability of leadership. A hallmark of effective leadership, characterized by patience and purpose, is the ability to adapt and respond with contingency plans. It's essential to recognize that having a Plan B doesn't imply that Plan A failed or that Plan B is inferior. Rather, Plan B serves as a viable alternative, prepared in anticipation of unforeseen circumstances.

In fact, Plan B may even prove to be superior to Plan A in certain situations. Sometimes, it becomes necessary to explore alternative options, extending all the way from Plan C to Plan Z. Being equipped with multiple contingency plans ensures that leaders are ready to address unexpected challenges efficiently.

Openness

When it comes to leading with openness, a quote from Mahatma Gandhi resonates: "Openness of mind strengthens the truth in us and removes the dross from it if there is any." Reflecting on this quote in the context of leadership, I often consider the behavior of students during my teaching sessions or clinical practice, particularly in patient interactions.

Observing students with their arms folded while engaging with patients reminds me of the importance of openness in communication. Just as our parents or guardians advised us to uncross our arms to appear more approachable, I emphasize to students the significance of body language in conveying openness and receptiveness. As future physical therapists, they must approach patient interactions with empathy and understanding, demonstrating their willingness to listen and engage.

Similarly, as leaders, we must embody this openness when approached by team members seeking to discuss issues or problems. Even when pressed for time or preoccupied with other tasks, creating space for open dialogue and active listening is crucial. Being receptive to others' perspectives fosters trust and collaboration within teams, ultimately contributing to more effective leadership.

How often do you, when tapped on the back, for instance, turn around with just your head while your body remains facing the intended direction? This gesture conveys a lack of openness, suggesting to others that although you stopped momentarily, you're not fully engaged in the conversation. As a leader, demonstrating openness is essential by physically turning your body to face the person seeking your attention. This simple act communicates that you are receptive and willing to listen to whatever they have to say, whether it's a question, concern, or idea.

Leading with openness makes you approachable as a leader. People feel that they are working with you and not for you. When you show openness to your clinical staff and faculty, you're open to new perspectives and ideas from them. You don't have this mentality of "because I'm the leader and because I'm in charge, that is my way or the highway." When you lead with openness, it helps you to develop empathy. Empathy is one of the other concepts of leading with purpose, but as I said earlier, there's overlap. When you lead with openness and develop that empathy, you're able to put yourself to a certain extent in that person's shoes to try to figure out, if this were happening to me, how would I feel about this? When you lead with openness, you understand that as a leader, this is the key to building strong connections with your clinicians, faculty, patients, and students. You understand that openness builds trust, and openness builds confidence. Those on your team trust you because they know that you're transparent, you're open, and you're not hiding things from them that will stifle their development and their growth within your facility or your institution. They feel confident enough to come to you to tell you about positive things in your life because they know you'll celebrate with them or to come to you with concerns or issues because they feel confident that you will have their best interests at heart and that you won't talk about them.

Leading with openness makes you more humble. Leading with openness means that you have an open-door policy, not just in theory but in practice. Let's put this in context: many of us have offices. As academic faculty, we have our offices; as clinicians, some of us may have our own offices. But when someone walks through, and your office door is open, and they have an issue to talk about, how many of us leaders secretly wish that the door was shut? Even though we say we have an open-door policy, sometimes, when people come to us, we actually don't want to be bothered.

It doesn't mean that leaders always have to have an open-door policy or always be readily available because we do have to set boundaries. But if you tell your team your door's open, you are here for them; you must truly mean it. You must want to remain approachable and available for your team and those who follow you, whether in good or bad times.

Leading with openness means being courageous, vulnerable, daring, and authentic. I took this from a page in Brene Brown's book, "Dare To Lead." She says, "The courage to be vulnerable is not about winning or losing. It's about the courage to show up when you can't predict or control the outcome." Leadership, sometimes you can't control the outcome; sometimes the unthinkable, unpredictable happens. But if you're open, are you courageous enough to be kind to your faculty and clinicians and ensure you're transparent? Do you tell the truth and not engage in gossip or talk behind people's backs? Are you courageous enough to expect your team to engage in the truth and not partake in gossip and to call them out when they do? Are you courageous enough to seek out the truth even if it means you're uncomfortable?

Openness means being vulnerable. Vulnerability is that emotion that we often feel as leaders when we're expected to know everything. But then, when times of uncertainty happen, we start questioning ourselves and why we take this risk.

Leading with openness means being daring, knowing that the things you do with your team should yield positive outcomes and success, but being daring with certain things, knowing that you might not get that positive or successful outcome. Being daring, knowing that you might fail. Some ideas, some things that we plan, may not come to fruition. Some ideas that we pitch to our faculty or staff might not be the best thing. It might not be the worst thing, but if it fails, the question is, what's your response to that failure?

How do you pick yourself up and pick your team back up and say, Hey, we tried, we put our best effort forward, let's regroup and try again? And then leading with openness means that you are authentic, that you are true to yourself as a leader, that you know what your strengths are, you know what your weaknesses are, that you know how to guide people based upon your truths and what you value, that people truly matter to you. That you're not a leader, whether formal or informal, you're relishing in that position that you are a program director, that you're a clinic director, a clinic manager, know that you're truly an authentic leader because you value people and you want people to do better. 

Servitude

Leading with servitude means that "Truly effective and inspiring leaders aren't actually driven to lead people; they are driven to serve them." This quote is by Simon Sinek, who is a very well-known author, leader, and speaker on leadership. This quote essentially flips leadership on its head and dispels the notion that leaders must drive their teams and the organizations forward. We're here to serve people. People aren't here to serve leaders. Robert Greenleaf, who was the father of servant leadership, says servant leaders put others' needs, aspirations, and interests above their own. The main goal of servant leadership is to serve others first, recognize what they need what they want, and lead them toward accomplishing their goals. When the main goal is leading with servitude, first, you're listening to people, and you're displaying empathy. You're able to help heal people, and you're aware of who they are and what they bring to the table. You're able to persuade them to step outside of their comfort zone, to actualize their potential, and to tap into their abilities and their capabilities. You are able to have foresight, you have a commitment to the growth of individuals and teams, and you're striving toward building community. When you lead with servitude, you know that the well-being of the team is the most important aspect of your leadership. Focusing on the well-being of people and teams facilitates growth. That's important because, as leaders, we're here to inspire, empower, and engage our team toward growing, toward becoming something that they never thought they could be. When they do that, your clinical facility and educational institution thrive because of the people in it. Of course, we know that leading with servitude aligns perfectly with one of our APTA core values, altruism, which is the primary guard for our devotion to our patients or clients and placing that above the needs of our self-interest as physical therapists and physical therapist assistants. There are several basic tenets of leading with servitude. One of them is seeing things from the perspective of others. Of course, that's the empathy we'll discuss in a moment. The other is honoring others. Honoring those on your team, individuals or collectively, is being able to honor them before yourself so that you acknowledge when they do something well, praise them, reward them, and advance them when they do something well.

Leading with servitude means that you are able to empower other people, prioritizing their empowerment before seeking your own personal gain. For instance, you should focus on developing the skills of your clinicians before being concerned about the productivity they bring to your clinic. Leading with servitude means privileging people over the tasks they perform. For example, when people have a financial investment in their work, they may ask, "What's in it for me?" However, when people are emotionally invested, they want to contribute. By privileging people and appealing to their emotions, you can ensure their commitment to your company, institution, or organization.

Serving with humility involves maintaining a modest or lower view of your own importance as a leader. While you are there to lead and may have a title or rank associated with your leadership role, it doesn't define your leadership abilities. Be modest and avoid flaunting your leadership title everywhere you go. Humility is important because you're not seeking to be proud or arrogant.

I remember years ago, when I was a facility outpatient manager, even though I held a managerial position, I made a conscious effort to treat everyone within the organization equitably. After several weeks of physical therapy, one memorable incident occurred when a patient expressed surprise upon learning that I was the clinic manager. When I asked why, she explained, "Because you're not flaunting it." She assumed that the manager was always offsite and didn't realize it was me. This made me feel good because it meant that despite being responsible for overseeing the clinic, I wasn't perceived as someone who dictated orders or expected my staff to serve me rather than focusing on patient care.

Leaders who lead with servitude must prioritize developing leadership qualities in others, empowering, motivating, and inspiring them. Of course, embodying the other elements of leading with purpose is essential when leading with servitude.

Empathy

Empathy is a significant topic in physical therapy, often discussed at conferences like the Combined Sections Meeting or the Education Leadership Conference, within the context of professionalism. Simon Sinek defines empathy as being concerned about the human being and not just about the output.

It's defined as genuine concern for the human being, not just their output. Simon Sinek's quote, which emphasizes prioritizing people over results, resonates strongly in this regard.

Consider our interactions with our teams, whether in clinics or educational institutions. How often do we focus solely on productivity metrics? Have we met patient quotas, billed correctly, and ensured student success without considering the individuals behind these tasks? Can we empathize with the challenges they face in meeting these standards and understand the accompanying frustrations or anxieties?

Similarly, have we considered the efforts of faculty members in educating students and how they impact them mentally, physically, or emotionally? Are the students passing? Are you making sure that no one's left behind and that no one's failing?

Empathy, the ability to see things from another's perspective, is crucial, especially considering how societal issues like racial tensions or financial strains affect individuals differently. It's essential to recognize and respect these differences as leaders.

Empathy fosters inclusion and a sense of belonging. When leaders recognize their team members' struggles, especially during tough times, and offer support, it strengthens bonds and reduces turnover. Conversely, the absence of empathy can lead to "quiet quitting," where employees disengage and eventually resign due to feeling unappreciated or undervalued.

Leading with empathy is a cornerstone of emotional intelligence (EQ), which involves understanding and managing one's own emotions while recognizing their impact on others. By cultivating empathy, we create supportive work environments where everyone feels valued and understood. 

Empathy has the ability to foster inclusion. When you, as a leader, are able to recognize, especially in those bad times, that a member of your team or someone who follows you, whether a clinician or a faculty member, is going through something, then you're able to approach them with an attitude of, "Hey, it's not just your problem, it's our problem. How can I help you? Would you like me to help you?" Empathy from leaders has been linked to a reduced intent for employees to leave. This means that when an employee, such as a clinician or a faculty member, recognizes that the person who is at the helm, the one leading them, is truly concerned about what they're going through, especially in bad times, a connection is formed. They feel like they belong and that someone genuinely cares about them. 

However, when this connection is absent, we see the phenomenon of "quiet quitting." This term, though relatively new, describes when people you lead feel unappreciated, undervalued, and uncared for. In such situations, they'll show up to your clinical facilities or educational institutions and do the bare minimum required by their job description. But quiet quitting can eventually lead to outright quitting. At a certain point, employees start thinking, "I don't want to do this anymore because I'm still producing for the company, clinic, or educational institution, but I'm not gaining anything in return. I want to leave." And so, they resign.

Leading with empathy is a key dimension of emotional intelligence. It involves understanding and managing your own emotions, as well as recognizing the emotions of others and how they influence those you lead. Emotional intelligence, sometimes referred to as EQ, is about self-awareness.

Leading with empathy as part of emotional intelligence entails self-awareness, recognizing your strengths, weaknesses, and emotions, and understanding how they influence others. It also involves self-management, effectively regulating your emotions, particularly in stressful situations, and maintaining a positive attitude despite setbacks.

Furthermore, being socially aware is crucial. It means being able to read the room and understand the emotions and concerns of team members, allowing you to communicate and collaborate more effectively. Emotional intelligence allows you to manage relationships within the team and the broader institution, positively influence team members, and help resolve conflicts.

Several practices are essential to strengthen empathy as leaders. First, being curious and listening deeply fosters understanding and connection. Spending time with staff and faculty actively listening to their thoughts and feelings, both positive and negative, demonstrates mindfulness and a genuine desire to engage with their experiences.

Additionally, showing humility and self-awareness is crucial. Being aware of how your emotions and actions impact others allows for more authentic and meaningful interactions. It encourages openness and trust within the team, facilitating better communication and collaboration.

How to Strengthen Empathy: 

• Be curious and listen deeply
• Show humility and self-awareness  
• Invest in connecting with people and building relationships
• Set expectations and give feedback
• Build a culture of empathy 

Strengthening empathy involves investing in connecting with the people on your team and nurturing those relationships. It means caring about both their happiness and their struggles and understanding how these emotions impact their daily presence at work.

Empathy also entails setting clear expectations and providing feedback. Understanding faculty members' or clinicians' abilities and limitations allows you to set realistic expectations for their performance. Offering positive feedback when things are going well and constructive feedback when there are challenges helps to keep them motivated and fosters growth.

Building a culture of empathy is crucial. It's not enough for leaders to embody empathetic principles; the entire team should be encouraged to exhibit empathy. A culture of empathy reduces workplace stress and fosters a positive, effective environment where individuals experience increased job satisfaction and achieve collective goals.

When leading with empathy, it's essential to prioritize empathetic listening and questioning. These practices build trust, teamwork, and cooperation while creating a safe space for team members to share their thoughts and experiences.

Encouraging people to share both the good and the bad events in their lives fosters a culture of open communication within your team. Empathetic listening plays a crucial role in gaining a deeper understanding of your team members and their circumstances. When you listen empathetically, you improve communication and enhance your ability to negotiate and collaborate effectively with your team.

Empathetic Listening:

• Builds trust, teamwork, cooperation
• Greater understanding  
• Enhanced communication and negotiation
• Listen with a virtuous heart 
• Fully present in the moment
• Acknowledge feelings

Empathetic listening goes beyond simply processing what others are saying; it involves connecting with them emotionally, being fully present in the moment, and acknowledging their feelings. Each individual reacts to situations differently, so it's important to validate the feelings of those who come to you for mentorship or guidance, especially when they're struggling to manage what's happening around them.

As leaders, it's our responsibility to respond empathetically to the stories shared with us by our team members. Expressing appreciation for their openness and offering support shows that we care. Sometimes, sharing our own similar experiences can further validate their feelings and strengthen the bond of understanding between us.

Empathetic Questioning: 

• Five I - Message (Rivers, 2015)
• Focus on the communicator rather than the recipient
  • When you …I feel/think…
  • Because of … I…
  • I would prefer that..

Empathetic questioning is another valuable tool in communication. By focusing on the "I" messages, we allow team members to express themselves, particularly when their distress relates to our leadership or the team dynamics. This approach encourages open dialogue and helps address concerns effectively. For instance, team members might feel unheard or disconnected, providing valuable insights into areas needing improvement.

As a leader, it's crucial to internalize and understand the feedback you receive, being both vulnerable and courageous enough to accept it. When a team member feels invalidated or uncomfortable due to your communication style or actions, listening attentively and empathizing with their perspective is essential.

For example, if a team member expresses feeling invalidated during meetings or discomfort when being called upon, it's important to respect their preferences and adjust your approach accordingly. Empathetic questioning, such as Kleinman's Eight Questions, can be valuable in these situations. These questions allow leaders to delve deeper into understanding how situations impact team members and what their ideal outcomes would be. Asking questions like, "How does this situation affect you?" or "What do you think an ideal outcome would be?" demonstrates empathy and a genuine interest in addressing their concerns.

Developing an Ability to Lead with P.U.R.P.O.S.E

These are the seven main principles of the framework for leading with purpose. Now, you might be thinking, "Okay, I have this concept and framework, but how do I develop the ability to lead with purpose?" Well, leadership is a process. It's not a one-and-done thing. When you consider this framework for developing the ability to lead with purpose, there are a few things to keep in mind.

First, there is no single method of leading with purpose. When you're leading people, you're navigating different contexts and situations at different times. As a leader, as you develop your ability to lead with purpose effectively, you're also evolving yourself. The way you lead today might not be the way you lead tomorrow or three or five years from now. Your circumstances may change, and the people within your institutions are growing as well, so your methods change according to the context.

Leading on purpose is part of leadership development. It's not just about attending numerous leadership courses, seminars, or training programs. While these resources are valuable, it's essential to recognize that leadership is a continuous learning process. Taking a leadership training course and receiving a certificate doesn't mean you're done. Leading people is an ongoing journey because people change, and their demands evolve over time. Therefore, continuous development is necessary if you truly want to lead with purpose.

Be intentional and prioritize leading yourself. Self-leadership is crucial because how can you lead others if you can't lead yourself? Prioritizing self-leadership enables you to lead individual teams and expand your leadership to organizations, clinical facilities, and academic institutions.

Link leading with purpose with people, then outcomes. These concepts are inherently people-driven. When you prioritize people and their needs, the outcomes naturally follow. People drive outcomes, so investing in them as individuals and human beings is essential.

Use a framework that begins with awareness. Understand the why behind your leadership, who you are, and how that informs your leadership. Also, understand those you lead and how they interpret and engage with your leadership. Then, move from awareness to attitudes. How does this awareness change your attitude about leading people? Once your attitude has shifted, move on to leading with action. How do you actualize the mission, productivity standards, or optimize patient care? Finally, focus on accountability. Hold yourself accountable for leading with purpose, and consider how you hold your team accountable for leading within their own teams.

To truly embody the concepts of leading with purpose, you must enjoy the process. Just as people in healthcare are driven by the desire to help others heal and empower patients, if you want to be a leader who brings out the best in people, embrace the process of leading with purpose. Enjoy how it allows you to grow and develop as a leader and how it enables you to cultivate the next generation of leaders within your organization.

Summary

We can summarize today's presentation as follows: 

P – passion: know your why
U – understanding: listen to understand, then respond
R – representation: Be identity-conscious
P – patience: know when to act and when to wait
O – openness: be approachable and vulnerable
S – servitude: demonstrate altruism
E – empathy: see things from others’ perspectives

When you lead with purpose, you understand your passion and your why. Otherwise, if that's absent, you have to rethink your leadership. Are you the best person in your institution or academic facility to lead? You lead with understanding; you listen to understand first, then pause, reflect, and respond accordingly. You lead with representation, being truly identity-conscious, and understanding how your sociocultural identities shape who you are and how you interact with others.

You know who's on your team; you know a little bit about their identities, perspectives, and life experiences and how these drive their success within your organization. You lead with patience; you know when to act and when to wait. Not everything is urgent; sometimes, when you have that patience and step back, good things happen, and success follows. You lead with openness, literally having open arms, being approachable, and making yourself vulnerable by being transparent. Even if being transparent means relaying bad news about an outcome within your organization to your team by saying, "Hey, we tried our best, but we didn't meet performance benchmarks this time," or "We tried our best, and one student wasn't successful, and they're not going to graduate."

Leading with purpose means leading with servitude, demonstrating altruism, and putting the needs of your team above yourself. Leading with purpose means leading with empathy, seeing things from other's perspectives, and recognizing how situations might affect them, even if you can't fully understand their experiences. In fact, you can visualize yourself being in that space.

In closing, I'll leave you with this quote from the former CEO of Popeye's, Cheryl Bachelder: “The point of purpose is to determine how you will serve others. If you don’t have a plan to serve, you don’t need purpose.” -

Questions & Answers 

I understand that you teach DPT students. Do you have a specific class that focuses on leadership and related topics? 

No, many DPT programs are starting to incorporate what we refer to as a leadership track. Currently, we're in the process of developing that track here, where I am now. I discuss leadership and self-leadership, emphasizing the processes involved. However, I envision that at my academic institution and others, there will be a concerted effort to enhance and expand this leadership track. While we have tracks for teaching musculoskeletal and neural content, leadership is an area that, in my opinion, requires more attention from most academic institutions.