Lead, Follow, or Get Out of the Way: Leadership vs. Management in O&P

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By Judith Philipps Otto

Consult any Internet search engine: Enter the word Leadership and prepare to be overwhelmed. You'll quickly discover that there is no shortage of self-proclaimed experts willing to share their concept of leadership, and--for a nominal fee, of course--wave their wand and turn even the unlikeliest of candidates into a leader.

Is it really that easy?

More Important, is it really necessary?

Bruce P. "Mac" McClellan, CPO, president, Prosthetic-Orthotic Associates, hints that leadership is not always all it's cracked up to be. "Some people really truly have a desire to be out front, to be at the head of this and the top of that--I think a lot of it is just egotistical, quite frankly. From my perspective, it's more useful to have people standing shoulder to shoulder with me with a common goal and a common interest and a common work ethic. I don't need to stand out in front of the crowd. " I tell people I'm just a foot soldier who's full of ideas--and I'm not afraid to implement them or share them."

And yet, McClellan is an acknowledged industry leader who also heads his own business--how did that come about? "I started it," he shrugs modestly. "You can become a leader by default. You really can."

How does one recognize a leader, as differentiated from a manager?

Denise Altman of the Altman Initiative Group Inc., Matthews, North Carolina (www.altmaninitiative.com), has presented seminars and written books on developing personnel skills and addressing "people" issues in order to achieve business success. Her topics include a definition of management and leadership.

"Leadership is more the managing of ideas than the managing of tasks," she explained. "The ideas have to be forward-looking, where tasks are current-based. Thus management, in my view, is very much 'the here and now.' Leadership is concerned with where we want to be and how we're going to get there.

"She recalled a favorite Wayne Gretzky quote: "He claimed that the reason he was so good at hockey was that he didn't go where the puck was, he went where he felt the puck was going to be.

"To take that parallel a step further, possibly we could identify Gretzky as both a leader and a manager: Leadership guided him to anticipate and plan his strategy; management of his skates and the stick carried him to the puck and enabled him to follow through successfully.

Several O&P industry leaders aired their views on management and leadership, among other topics, in an O&P Management Forum conducted as part of the PrimeFare Seminar presented in June by the PrimeCare O&P Network.

Thoughtful comments and insights emerged from the discussion.

Motivation and Vision

Leaders have motivation and vision. Said Dale Beckham, CPA, director of operations, Prosthetic-Orthotic Associates, Tyler and Lewisville, Texas, "Motivation is important. Before we can lead others, we need to ask the question: 'Why are we doing what we're doing?'" He asked, "Do your employees know what your vision is? What is your dream?" He pointed out, "If you want to build a team and have leadership within that organization, you need to let employees know what your vision is.

" Do your employees know why you're in your business? "I know my boss' answer," Beckham continued. "Mac [Bruce "Mac" McClellan], CPO, has reiterated it often to us, so I know why we're there: Number one--for patient care. And we're going to do it right. We want to get paid for what we do, but we want to serve the patient and do what's best for the patient, even if it means cutting into the dollars and doing work over if that's what's required." Beckham added that McClellan has captured that vision and conveyed it to his employees.

"Part of leadership is& being able to define the corporate mission and goal of the company," said Keith Senn, COO, Center for Orthotic & Prosthetic Care, based in Louisville, Kentucky.

John Reynolds, CPO, Reynolds Prosthetics & Orthotics, Maryville, Tennessee, sees his role as leadership and patient care. Both managers and leaders have their place. "I think most of the P&O field basically enjoys patient care--it allows us to put people's lives back together. [And] if I'm not providing care for the patients, there's really no revenue stream coming, so it doesn't matter how good my manager is. That's been my spin on the issue. If you're credentialed, you see the patients. You don't need to work on facility accreditation and other clerical chores. Let somebody else do it--pay them to do the managing while you provide the leadership."

Wearing Two Hats

Sometimes, however, in an O&P business, the owner must wear both hats. "You may begin in a leadership position, but you still have to manage every day if you want to be profitable and keep a patient population satisfied," said M. Kale Hinnant, CP, FAAOP, president, W.T. Hinnant Artificial Limb Co.Inc., Charlotte, North Carolina. He cites the example of keeping tabs on billing. "If you don't check periodically on your billing specialist to see if she's doing it right, you could be in big trouble. It doesn't take but one degree of inaccuracy per day. That leads to 30 degrees in 30 days. And in six months, you're 180 degrees off center! It doesn't take long.

"The number one thing is to take care of your patients. Number two is to make sure that you survive and have some degree of profitability," Hinnant continued. To succeed, you must combine leadership and management, he pointed out.

Holding people accountable is an aspect of management, said Beckham, since policies and procedures have been established that employees are expected to follow.

Terry Shaw, CP, BOPO, FAAOP, Shaw's Prosthetics Plus Inc., Owensboro, Kentucky, agreed. "That's right. You're seeing that the implementation is being carried out, while leadership is establishing goals and principles."

Lead by Example

Leading by example and letting people know they are respected and are a valued part of your organization are hallmarks of excellence in leadership. Being willing yourself to do what you ask of others can be very effective. Said Beckham, "Sometimes you need to lead by example. Sometimes picking up a broom and sweeping makes a significant impression on the person that's at the bottom of the rung, who thinks, 'Look, if he does it, I guess I can do it--it's not a big deal.'"

This comment led into other definitions of leadership versus management. "Management pushes people, and leaders pull people," said Joel Mitchum, manager, Alabama Artificial Limb & Orthopedic Service, a multifacility company based in Montgomery.

Beckham mentioned a book on leadership that he recommends: The Way of the Shepherd by Kevin Leman, PhD, and William Pentak, MBA. "The Way of the Shepherd suggests that in order to lead people and get them to go where you want them to go, do it by persuasion rather than coercion. I think that's the difference between leadership and management." He adds, "You persuade people by showing them, demonstrating with your own life that you're willing to get down there and do even the unpleasant jobs yourself."

Betty Hamil Lolley, vice president, Dothan Brace Shop, Dothan, Alabama, agreed. "That's exactly right. If you treat people with respect, you'll earn their respect in turn. But you have to be willing to set the example for them." McClellan tells each of his employees when he hires him that there is no one in his practice or on this earth that is any more important or less important than he is. "This is an attitude that I believe is vital to good leadership at every level," he added.

McClellan likens his practice to a three-legged stool: "We have front office staff, technical staff, and professional staff. If any one of those three legs isn't working, that stool isn't balanced, and your business isn't right." For instance, he tells his telephone receptionist, "I could be the greatest orthotist and prosthetist in the world, but if you don't come across well to someone on the phone, they may never come to see me."

Beckham agreed, "I think we need to let our people know that every one of their positions and everything they do is important."

Mike Russell, Lexington Prosthetics & Orthotics, West Columbia, South Carolina, added, "And we need to say 'thank you' for what they do. 'Thank you' is a simple thing, but often people won't say it."

Senn also pointed out the importance of leading by example and letting people know how important they are to the company. He adds, "But if you don't demonstrate that by your actions, they're not going to believe what you say to them. When you take care of your patients, and you treat other people the way you want to be treated, and they see you delivering good quality care, you're leading by example and you're demonstrating the very best in leadership--and it will show: Good companies need good leaders."

Mitchum noted that his company spends thousands of dollars on marketing to referral sources, such as doctors, case managers, and physical therapists. "We try to explain to our people that all those thousands of dollars and all the time we spend on marketing are useless unless that patient 1) feels comfortable walking into our facility, and 2) also feels comfortable when he or she walks out. Our receptionist is probably one of the most important people in our office because she's the first person patients are going to see." Everyone has a part in ensuring that the patient has a positive experience, he added.

Hinnant nips another problem in the bud: "I've had certified prosthetists come in saying, 'Where's my tech?' And I say, 'We don't have techs. These are your associates--they're not techs." Otherwise, a class system begins, Hinnant said, "and once you start it, you don't have any communication, because it's this class against the other class."

Tackling the Hard Stuff

Leaders aren't afraid to tackle controversial issues. "In his book Winning, Jack Welch talks about candor and points out that people often do not want to talk about important issues," pointed out Robert Leaber, CPO, Adaptive Prosthetics & Orthotics, Gulfport Mississippi. "You might not want to offend people by letting them know how you feel, what you want for your company, and all those other things that really need to be verbalized. And I think that's leadership--addressing those issues in a candid, straightforward manner.

"Part of leadership involves finding solutions for those difficult subjects that come up--for example, the Region C audit," Leaber continued. "How is your company going to attack that problem?" Just letting problems happen and trying to bumble through them doesn't leave much hope: companies need someone to lead them through difficult times and decide future directions. Managing is sort of a secondary aspect of leadership, I think. Leadership is finding solutions and managing is deciding how to accomplish them."

On the lighter side, a comment that brought forth general laughter from the forum was, "The impulse that compels you to take over when others in your group are doing it wrong is-- frustration!"

Helping Others Grow

Effective leaders are willing to turn loose and let others spread their wings. Said Reynolds, "We've got very young practitioners, and they're very well educated. They have a much higher education than I had when I got into the field. The younger practitioners really want to know what their future is within the company." If the owner can help plan their future within the company, these young practitioners see that there may be some positive results from their education and passing their exams, Reynolds pointed out. He added, "What you do with it after that is up to you, of course, but I think that including them in the decision-tree and making them a part of it also improves productivity. You'll see the little violations, like coming in five minutes late, improving once they feel they have some impact on how things are run in the business.

"That's been kind of tough for me to do," Reynolds admitted. "I always feel like I have to have my hand in everything that's being done. But letting these younger guys and gals get involved has been a big help for us."

The need to set our boundaries was a point in The Way of the Shepherd, said Beckham. "We need to establish those fence lines, but don't confuse those boundaries with bridles--let the people run free within those boundaries to do what they do best.

"I started up a CPA practice, and my partner and I were doing everything: bookkeeping, tax returns, etc.," Beckham continued. "When it came to that point where we had to hire somebody, it was so hard to relinquish that to somebody and let them go with it and just review their work."

Sometimes a management team is effective, Hinnant noted. "Choose a group of people who can get a consensus of where you're going to try to go. You might have one leader, but you might have several people at the management level, helping guide you through what you're going to do. Each has a separate area of control, and you use those people independently. I find that I do better if I have people manage for me, but I manage with a group. One does a check and balance on the other--and then you provide them with direction."

Hinnant added a word of caution: "Sometimes, the worst thing you could ever do is tell someone he's a manager. The next thing you know, he's telling everybody in the world what to do--and he quits working because he thinks, 'Wow, I'm a manager, now!'"

"I think there's a greater responsibility in leadership than in management," said Beckham. "You call somebody a manager, and there's that little pride issue; but if you call them a leader, they react, 'Oh, I'm responsible!"'

Leaders: Born or Made?

"The problem is that five percent of the world are leaders and 95 percent of the world are followers," Hinnant pointed out. "Maybe they'll be a leader in that one thing you assign them to handle. But leadership is not just something that's given to you and, presto!--you're a leader, now."

"You EARN leadership," the forum participants agreed. Shaw added, "You can't assign leadership. People either follow you or they don't. They either buy into your plan or they don't. You can assign someone to manage--and they'll see that the job gets done. It's different from leadership.

"So leaders are born, not made?

That question brought forth a variety of responses.

"I agree," said Mitchum.

"I think to a point that's true," said McClellan.

Hinnant commented, "I think 75 percent of them are born, but I think the ability has to be nurtured. You can have a leader--like you can have somebody with an IQ of 180 and they still can't tie their shoes--[but] that doesn't make them effective."

"I think the circumstance determines the leadership," Shaw said.

Mike Russell, Lexington O&P, observed, "I think you can determine whether that person will take that mantle and carry it--teaching them, if necessary."

"I don't know if they're born, but leaders will step up," said Senn. "You're not going to know who is a leader in a group, but all of a sudden, if you give the group a project, a leader is going to step up."

"The leader is the one out there doing things when the rest of them are talking about what they do," noted Tom DiBello, CO, FAAOP, Dynamic Orthotics and Prosthetics, Houston, Texas. Beckham expressed it another way: "I think everyone throughout your whole organization can be a leader in their own way." For instance, he recommended The Way of the Shepherd to the company's front office receptionist. "I described it to her and explained that it was about a shepherd leading the flock and how he protects them, and what you do with the sheep, and she said, 'but I don't have a flock!'

"I said, 'Sure you do--your husband, your children!' If you teach people that there's someone they are leading in everything they do, suddenly the desire and the responsibility to perform like a leader starts emerging."

Leadership Hallmarks

Thus, hallmarks of leadership emerging from the forum included 1) Having motivation and a vision; 2) communicating the vision to employees and getting them to buy into it; 3) being a good example; 4) treating employees with respect and appreciation; 5) leading by persuasion rather than coercion; 6) letting them grow and reach their potential, rather than micromanaging everything; 7) setting goals and providing direction; and 8) not being afraid to tackle the hard issues and make tough decisions.

A graduate of the University of Missouri School of Journalism, Judith Philipps Otto has been a newspaper writer and editor and has won national and international awards as a broadcast writer-producer. She also has assisted with marketing and public relations for various clients in the O&P industry.