When decisions and leadership are called for I find that a course of action usually comes to mind. However it has taken me my whole life to try to work out an answer to the question: what should I then do next? If I act, or make a suggestion, the outcome may be good. However a corollary may be that other people will not feel that they have had their views accepted or their desires met. Others, who might be less self confident or less assertive, may not have a chance to advance their views. Valuable ideas may be lost.

Time has taught me to just watch, listen and wait a little. Frequently, if given a little time, others will reach similar conclusions about which appropriate action to take. Occasionally someone will have a better idea. Sometimes, a suitable course of action will not occur to anyone else. In times past, this was the moment when I might have stepped into a leadership role and taken a direct hand in guiding events. These days, I am more likely to say “What do you all think about ….” And then make a suggestion. It is wise to then step back, wait and see what happens.
The group will often concur that the suggestion which has been made is a good one and will agree to the course of action I had in mind. The result will then be achieved (perhaps in a more leisurely manner). My role is not a disinterested ‘wait and see’. Rather it is an active involvement, with a choice to reserve speaking if possible, but with a hand guiding the outcome.

To my surprise, I have discovered that this strategy has a name. It is called ‘leading from behind’. A search has revealed that there is an extensive body of literature on this topic. There are certain necessary pre-requisites to leading from behind. Probably most important is respect for the other members of the group and a genuine desire to empower them. Also important is an attitude that it doesn’t matter who gets the credit for the initiative as long as the outcome is achieved. Another important factor is the capacity to accept that results may occur a little more slowly.

This strategy is often appropriate in my work as a GP in a rural Aboriginal Medical Service, where I work three days a week. It is also appropriate in community groups where I have a role.

However, also I work one weekend a month as an emergency department doctor in a small rural hospital. A different strategy is required: The nurses in the hospital are an excellent team. However most of their day to day activities revolve around the large, semi-permanent frail aged population of the facility, or patients admitted with non-acute medical problems (frequently pneumonia or cellulitis on iv antibiotics, or people transferred back to the small facility for convalescence after surgery). These nurses may work many shifts between seeing an emergency case.
When a seriously ill patient attends the tiny emergency department I may be called upon to be much more pro-active: I can rely only on myself to assess the situation, decide what is called for and request it politely. It is also necessary to ensure my requests are accompanied by explanations (so that not only is my request understood, but also the reason why I think the course of action is a good idea). The particular personalities in this hospital mean that my explanations must be couched very carefully. I employ phrases like “…of course you know we need to put in a intravenous line….” in order that fragile egos are not bruised by the possibility that I could believe that staff might not know what to do. Nevertheless, these nursing practitioners rarely deal with critically ill patients and do not have the requisite body of knowledge readily to hand. Gently directive leadership is essential.

I have concluded that there are certain necessary prerequisites to being a leader: capacity for observation & assessment, intelligence, decision making skills, self confidence and assertiveness. However it seems that additional personal characteristics are required to be a good leader: capacity to know when to act or speak and when to refrain, a balanced and measured approach, respect for others and a genuine desire to empower others.

It seems that ‘leading from behind’ may frequently be the optimum strategy in community groups and in organisations if the decisions and actions are non-urgent and non-critical. More directive leadership may be required where action must be taken swiftly and correct outcomes are imperative or where the right action depends on the possession of a body of knowledge (for instance in emergency situations).
However, capacity to choose the correct leadership strategy in each circumstance is clearly the mark of an expert leader. It is here that I feel I have a very great deal to learn.

Leadership Strategies – Personal Views was authored by Dr Carol Booth (NSW) in August 2008 as part of her AFMW Leadership Scholarship