Are great leaders born, or are they made?

THE QUESTION IN THE TITLE to this commentary has been debated for centuries and continues to dominate the study of leadership development, yet evidence is insufficient to support either answer. The feature article authors in this issue of Frontiers do not attempt to answer this question, but they do offer two different perspectives of leadership: one as a personal journey, and the other as a process for accomplishing an organizational goal. In her article, Debra Sukin outlines her own leadership successes, highlighting such qualities as passion, vision, quality outcomes, strong knowledge of the industry, the ability to think critically, perspective, adaptability, and ongoing learning. She describes each of these elements from an intense and personal perspective. This perspective contrasts with the article by Stephanie McCutcheon, in which she deliberately outlines her process for leading the Hospital Sisters Health System through the transformation into a care integration model. Ms. McCutcheon carefully outlines the elements and specific steps needed for an organizational transformation of this magnitude. After reading these articles and noting the contrasts between leadership as a personal journey and leadership as a process for change, one might conclude that leadership must be one or the other. However, my personal experience - one I am sure many of our readers share - is that leadership is often both. MISTRUST AT BAY AREA MEDICAL CENTER My recent journey at Bay Area Medical Center (BAMC) clearly showed me that both elements of leadership come into play in transforming an organization. In February 1999, BAMCs medical staff had voted "no confidence" in hospital administration. The mistrust was palpable. The construction of a competing ambulatory surgery center was on the horizon, and BAMC faced an inability to meet space needs for outpatient surgeries and diagnostics, resulting in medical staff and patient dissatisfaction. This opened a door for the competing center. A not-forprofit organization with an approximately 48 percent Medicare population, BAMC could have been devastated by the competition. The future was uncertain, the anxiety level of BAMCs board of directors and employees was high, and the atmosphere was one of non-support. Mistrust of the hospital was also high among the community and county government. Publicity in the local newspapers was consistently negative, and the Board of Supervisors from Marinette County, which leased the Marinette hospital's fixed assets to BAMC, felt that the county was being shut out of hospital planning. The county board was asking for a renegotiation of the lease with the intent of gaining more operational control of the hospital. The county had engaged consultants to perform a community health needs assessment that painted BAMC in a poor light, insinuating that the hospital was not meeting the community's needs and that the strategic direction was misplaced. BAMC would not be able to garner the necessary support for a building project that would allow it to successfully compete with a freestanding ambulatory surgery center unless relationships were mended and trust reinstated. Financial gains that BAMC had made in recent years were in serious jeopardy. BRIDGING THE COMMUNICATION GAPS In May 1999, as the newly appointed president and CEO of BAMC, I knew I needed to begin my turnaround quest immediately. I started with exhaustive efforts to bridge communication gaps with the medical staff, community, and county boards. I worked to develop open relationships with honest communication. Because BAMC had facilities in Marinette, Wisconsin, and Menominee, Michigan, this was a double effort. Soon I was providing monthly reports to update both county boards on the hospital's successes and challenges. I developed communication strategies with local news reporters so they would feel free to participate in hospital discussions or call with questions at any time. …