We have all heard the phrase "a natural born leader," but perhaps one way to examine leadership is to look at those who follow the leader. Finding out why people "follow" may be the key to predicting some of the best traits of leadership. An example of "following" behavior can be observed on television survival shows where people are randomly, and often literally, thrown together to survive in a harsh and sometimes dangerous environment.

In living through situations occurring in that environment, both leaders and followers emerge. And although the situations are directly linked with survival, the followers tend to quickly determine who the best leaders are so that they may all work together for the benefit of surviving. The goal of the television series, however, involves game playing, etc, until one survivor emerges, often at the expense of the followers and other would-be leaders.

Is the trauma work environment analogous to a survival game show where many individuals exist in a work setting and over time both formal and informal leaders emerge, ultimately resulting in one winner? I do not think so and let us hope not. Leaders in the trauma practice setting must set their goal on creating a win-win-win environment, that is, an environment in which the physicians, nurses, and even patients can win.

WHAT DO FOLLOWERS WANT?

While knowledge may equal power to some, it is really the knowledgeable leader who listens to, understands, respects, and values those with whom he or she works. Leaders such as this are drawn to the ability that they see in others and they seek out these others to work for them. These leaders cultivate their team members so that they may all be successful. Their success will serve to foster professional development in the team as a whole, as well as providing for excellence in patient care.

Followers want leaders who are not worried about promoting knowledge in those whom they lead. Followers who gain knowledge do not threaten leaders, rather they promote achievement. Followers who want to succeed will choose leaders who will encourage disagreement and allow them to challenge the status quo so that change and growth can occur. It is important that leaders are open to such challenges and constructive confrontation by their staff members/followers.

Followers need to know that they are respected and valued individually and as team members. Leaders can demonstrate this for their staff by making every effort to "be there" for them. Being there for staff members means actively listening and supporting their concerns and needs at all levels of corporate involvement. To "be there" is to acknowledge and advocate for them-not just to provide lip service.

In addition, leaders believe that the efforts of their staff members should be rewarded. Achievement is of value to them, and to not reward an individual appropriately for his or her efforts would be an error in judgment on the part of the leader. Rewards can range from monetary to as simple as verbal praise or encouragement.

Unfortunately, we have all seen the results of the "negative reward" system. This occurs when a leader "rewards" an excellent worker by giving the worker more work-while the other, less competent workers get the "reward" of less work. This can be problematic in that although a leader wants to provide a challenging and positive work environment for all staff, it is sometimes easier to just delegate to a very competent worker instead of taking the time needed to nurture a less competent worker. This can have a very negative impact on the overall morale of the department.

FOLLOWERS WANT TO KNOW WHERE THEY ARE GOING

A person with vision and passion can achieve great things. Leaders must establish a common goal and a shared vision and communicate this effectively so that all team members can follow the same plan. The next step, which in fact never stops, is to constantly sell and develop the vision. This takes energy and commitment, as few people will immediately buy into a radical vision, and some will join in much more slowly than others. The most effective leader will take every opportunity and use whatever works to convince others to climb on board the bandwagon.

In order to create motivated followers, leaders have to be very careful in creating trust, and their personal integrity is a critical part of the package that they are selling. In effect, they are selling themselves as well as the vision. If there is inconsistency between leaders, it is difficult for team members to follow out a program of care or practice to a designated end.

When two individuals or groups hold the same basic principles, yet oppose each other on a given issue, it means that at least one of them is inconsistent. Because basic principles determine the ultimate goal of any long-range process of action, the person who holds a clearer, more consistent view of the end to be achieved will be more consistently right in his choice of means, and the contradictions of this other will work to his advantage and the followers will choose the leader whose plans are most consistent.1

Followers will find it difficult to follow a leader who is inconsistent because existentially, every step or measure taken to achieve the common goal will necessitate further and more crucial steps in the same direction (unless the goal is rejected and the basic principles reversed), thus strengthening the leadership of the consistent person and incapacitating the inconsistent one.1

FOLLOWERS MAY SOMEDAY BE LEADERS

Leaders must also remember that some of their followers are also leaders in their own right. An insightful leader will mentor these informal leaders so that their skills are utilized to their best advantage. A leader always plans for success and succession.

If you want to be a leader, you must first understand what those whom you would lead need and want from a leader. You must not only take your cues from your organization but also take your cues from your followers. When every member of the team is working toward the same goal, it can be achieved. Excellent patient care is a goal that can be achieved by teams led by exceptional leaders and equally outstanding followers. Leadership is not a game of "Survivor," rather it is thriving to create the ultimate win-win-win environment for all.

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