The chairman finally arrived and sat down after flashing smiles at members of the
medical staff in attendance. It was obvious he subscribed to the notion that leaders
should never apologize for being late to a meeting with subordinates. My first meeting
as an attending physician at an academic medical department was about to start. Agenda
items had been distributed in a one-page written memo the day before (email was not
widely available yet). The list was long, but I remember being impressed by how fast
we sailed through it. Only later did I discover the secret of efficient meetings,
that is, the 90/10 rule, which states that 90% of agenda items—especially thorny issues—are
already discussed and decided prior to the meeting, and the remaining 10% revolves
around polishing these decisions and getting a seal of approval.
Discussions appeared smooth, civil, and professional, but I quickly discovered another
90/10 rule of meetings: 90% or more of the conversation was between the person running
the meeting and 10% or less of the attendees (the remainder tend to take a vow of
silence or settle for nonverbal cues).
As time dragged on, discussions narrowed further to a dialogue between the chairman
and one resilient—or long-winded—staff member. I later learned that he was more of
an intellectual sidekick who achieved a special status partially for his skills as
a mediator: he reported to the chairman on the pulse (and other vital signs) of the
crowd, and when needed, distributed the chairman's trial balloons to gauge the mood
toward controversial decisions.
The last item on the agenda finally arrived: a proposal to allocate some resources
to a colleague to help her achieve what was painted as a lofty goal. This seemed to
ignite a lightning bolt and a burst of energy from a hitherto dormant staff member,
who apparently had been waiting for too long, for a similar chance, to start his own
project and achieve what he considered a more worthy goal. The newly energetic staff
member demanded more discussion, and the conversation became heated. It was obvious
that we had veered suddenly off script. The chairman, being in the position he was
in for the exact skills needed in such moments, listened attentively, and remained
calm and composed. Then, with a big smile, he tried to invoke humor, saying, “As you
all know, when I accepted this role, I was given a large desk with two big drawers:
one is filled with money, and the other is filled with titles.” He continued, “Well,
I have to tell you, at this point: I am fresh out of both!”
For the rest of the meeting, a sense of quiet and surrender quickly returned.
For years that followed, I remembered this meeting and believed the chairman's two-drawer
theory explained much about management and leadership in academic medicine.
However, the more experience I gained, the more gaps I started to see in this theory.
I watched attentively as leaders with abundant resources, and free hands to grant
positions and titles, still failed, failing to lead, and falling short of inspiring
confidence in their teams. Meanwhile, other leaders with less resources—sometimes
much less—achieved a lot more and helped their teams flourish. Furthermore, the greater
the responsibilities I myself carried, the more clearly, I could see that great leaders
have a third drawer. Unlike the other two, this drawer is filled with less tangible
items: social skills—sincere and open communication, courtesy, and respect for others,
and eagerness to lead by example—as well as strong values, such as fairness, empathy,
and equality. Without a splendid third drawer, I noted, the other two drawers can
be drained or even squandered quickly. The more time passes by, the larger that third
drawer has grown!
Very soon, some of you will be completing another academic year. Others will finish
training, join the work force, and perhaps eventually serve as leaders. I hope that
those who have the privilege to serve in leadership positions remember and keep in
mind this three-drawer theory.
Congratulations and best wishes to all on completing another successful academic year!
