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!
