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Lead, Follow, or Get Out of the Way: Leadership vs. Management in O&P
By Judith Philipps Otto 
Consult any Internet search engine: Enter the word
Leadership and prepare to be overwhelmed. You'll quickly discover
that there is no shortage of self-proclaimed experts willing to
share their concept of leadership, and--for a nominal fee, of
course--wave their wand and turn even the unlikeliest of candidates
into a leader.
Is it really that easy?
More Important, is it really
necessary?
Bruce P. "Mac" McClellan, CPO, president,
Prosthetic-Orthotic Associates, hints that leadership is not always
all it's cracked up to be. "Some people really truly have a desire
to be out front, to be at the head of this and the top of that--I
think a lot of it is just egotistical, quite frankly. From my
perspective, it's more useful to have people standing shoulder to
shoulder with me with a common goal and a common interest and a
common work ethic. I don't need to stand out in front of the crowd.
" I tell people I'm just a foot soldier who's full of ideas--and
I'm not afraid to implement them or share them."
And yet, McClellan is an acknowledged industry leader who also
heads his own business--how did that come about? "I started it," he
shrugs modestly. "You can become a leader by default. You really
can."
How does one recognize a leader, as differentiated from a
manager?
Denise Altman of the Altman Initiative Group Inc.,
Matthews, North Carolina ( www.altmaninitiative.com), has
presented seminars and written books on developing personnel skills
and addressing "people" issues in order to achieve business
success. Her topics include a definition of management and
leadership.
 "Leadership is more the managing of ideas than the
managing of tasks," she explained. "The ideas have to be
forward-looking, where tasks are current-based. Thus management, in
my view, is very much 'the here and now.' Leadership is concerned
with where we want to be and how we're going to get there.
"She recalled a favorite Wayne Gretzky quote: "He claimed that
the reason he was so good at hockey was that he didn't go where the
puck was, he went where he felt the puck was going to be.
"To take that parallel a step further, possibly we could
identify Gretzky as both a leader and a manager: Leadership guided
him to anticipate and plan his strategy; management of his skates
and the stick carried him to the puck and enabled him to follow
through successfully.
Several O&P industry leaders aired their views on management
and leadership, among other topics, in an O&P Management Forum
conducted as part of the PrimeFare Seminar presented in June by the
PrimeCare O&P Network.
Thoughtful comments and insights emerged from the
discussion.
Motivation and Vision
Leaders have motivation and vision. Said Dale Beckham, CPA,
director of operations, Prosthetic-Orthotic Associates, Tyler and
Lewisville, Texas, "Motivation is important. Before we can lead
others, we need to ask the question: 'Why are we doing what we're
doing?'" He asked, "Do your employees know what your vision is?
What is your dream?" He pointed out, "If you want to build a team
and have leadership within that organization, you need to let
employees know what your vision is.
" Do your employees know why you're in your business? "I know my
boss' answer," Beckham continued. "Mac [Bruce "Mac" McClellan],
CPO, has reiterated it often to us, so I know why we're there:
Number one--for patient care. And we're going to do it right. We
want to get paid for what we do, but we want to serve the patient
and do what's best for the patient, even if it means cutting into
the dollars and doing work over if that's what's required." Beckham
added that McClellan has captured that vision and conveyed it to
his employees.
"Part of leadership is& being able to define the corporate
mission and goal of the company," said Keith Senn,
COO, Center for Orthotic & Prosthetic Care, based in
Louisville, Kentucky.
John Reynolds, CPO, Reynolds Prosthetics &
Orthotics, Maryville, Tennessee, sees his role as leadership and
patient care. Both managers and leaders have their place. "I think
most of the P&O field basically enjoys patient care--it allows
us to put people's lives back together. [And] if I'm not providing
care for the patients, there's really no revenue stream coming, so
it doesn't matter how good my manager is. That's been my spin on
the issue. If you're credentialed, you see the patients. You don't
need to work on facility accreditation and other clerical chores.
Let somebody else do it--pay them to do the managing while you
provide the leadership."
Wearing Two Hats
Sometimes, however, in an O&P business, the owner must wear
both hats. "You may begin in a leadership position, but you still
have to manage every day if you want to be profitable and keep a
patient population satisfied," said M. Kale Hinnant, CP, FAAOP,
president, W.T. Hinnant Artificial Limb Co.Inc., Charlotte, North
Carolina. He cites the example of keeping tabs on billing. "If you
don't check periodically on your billing specialist to see if she's
doing it right, you could be in big trouble. It doesn't take but
one degree of inaccuracy per day. That leads to 30 degrees in 30
days. And in six months, you're 180 degrees off center! It doesn't
take long.
"The number one thing is to take care of your patients. Number
two is to make sure that you survive and have some degree of
profitability," Hinnant continued. To succeed, you must combine
leadership and management, he pointed out.
Holding people accountable is an aspect of management, said
Beckham, since policies and procedures have been established that
employees are expected to follow.
Terry Shaw, CP, BOPO, FAAOP, Shaw's Prosthetics
Plus Inc., Owensboro, Kentucky, agreed. "That's right. You're
seeing that the implementation is being carried out, while
leadership is establishing goals and principles."
Lead by Example
Leading by example and letting people know they are respected
and are a valued part of your organization are hallmarks of
excellence in leadership. Being willing yourself to do what you ask
of others can be very effective. Said Beckham, "Sometimes you need
to lead by example. Sometimes picking up a broom and sweeping makes
a significant impression on the person that's at the bottom of the
rung, who thinks, 'Look, if he does it, I guess I can do it--it's
not a big deal.'"
This comment led into other definitions of leadership versus
management. "Management pushes people, and leaders pull people,"
said Joel Mitchum, manager, Alabama Artificial
Limb & Orthopedic Service, a multifacility company based in
Montgomery.
Beckham mentioned a book on leadership that he recommends:
The Way of the Shepherd by Kevin Leman, PhD, and William
Pentak, MBA. "The Way of the Shepherd suggests that in
order to lead people and get them to go where you want them to go,
do it by persuasion rather than coercion. I think that's the
difference between leadership and management." He adds, "You
persuade people by showing them, demonstrating with your own
life that you're willing to get down there and do even the
unpleasant jobs yourself."
Betty Hamil Lolley, vice president, Dothan
Brace Shop, Dothan, Alabama, agreed. "That's exactly right. If you
treat people with respect, you'll earn their respect in turn. But
you have to be willing to set the example for them." McClellan
tells each of his employees when he hires him that there is no one
in his practice or on this earth that is any more important or less
important than he is. "This is an attitude that I believe is vital
to good leadership at every level," he added.
McClellan likens his practice to a three-legged stool: "We have
front office staff, technical staff, and professional staff. If any
one of those three legs isn't working, that stool isn't balanced,
and your business isn't right." For instance, he tells his
telephone receptionist, "I could be the greatest orthotist and
prosthetist in the world, but if you don't come across well to
someone on the phone, they may never come to see me."
Beckham agreed, "I think we need to let our people know that
every one of their positions and everything they do is
important."
Mike Russell, Lexington Prosthetics &
Orthotics, West Columbia, South Carolina, added, "And we need to
say 'thank you' for what they do. 'Thank you' is a simple thing,
but often people won't say it."
Senn also pointed out the importance of leading by example and
letting people know how important they are to the company. He adds,
"But if you don't demonstrate that by your actions, they're not
going to believe what you say to them. When you take care of your
patients, and you treat other people the way you want to be
treated, and they see you delivering good quality care, you're
leading by example and you're demonstrating the very best in
leadership--and it will show: Good companies need good
leaders."
 Mitchum noted that his company spends thousands of
dollars on marketing to referral sources, such as doctors, case
managers, and physical therapists. "We try to explain to our people
that all those thousands of dollars and all the time we spend on
marketing are useless unless that patient 1) feels comfortable
walking into our facility, and 2) also feels comfortable when he or
she walks out. Our receptionist is probably one of the most
important people in our office because she's the first person
patients are going to see." Everyone has a part in ensuring that
the patient has a positive experience, he added.
Hinnant nips another problem in the bud: "I've had certified
prosthetists come in saying, 'Where's my tech?' And I say, 'We
don't have techs. These are your associates--they're not techs."
Otherwise, a class system begins, Hinnant said, "and once you start
it, you don't have any communication, because it's this class
against the other class."
Tackling the Hard Stuff
Leaders aren't afraid to tackle controversial issues. "In his
book Winning, Jack Welch talks about candor and points out
that people often do not want to talk about important issues,"
pointed out Robert Leaber, CPO, Adaptive
Prosthetics & Orthotics, Gulfport Mississippi. "You might not
want to offend people by letting them know how you feel, what you
want for your company, and all those other things that really need
to be verbalized. And I think that's leadership--addressing those
issues in a candid, straightforward manner.
"Part of leadership involves finding solutions for those
difficult subjects that come up--for example, the Region C audit,"
Leaber continued. "How is your company going to attack that
problem?" Just letting problems happen and trying to bumble through
them doesn't leave much hope: companies need someone to lead them
through difficult times and decide future directions. Managing is
sort of a secondary aspect of leadership, I think. Leadership is
finding solutions and managing is deciding how to accomplish
them."
On the lighter side, a comment that brought forth general
laughter from the forum was, "The impulse that compels you to take
over when others in your group are doing it wrong is--
frustration!"
Helping Others Grow
Effective leaders are willing to turn loose and let others
spread their wings. Said Reynolds, "We've got very young
practitioners, and they're very well educated. They have a much
higher education than I had when I got into the field. The younger
practitioners really want to know what their future is within the
company." If the owner can help plan their future within the
company, these young practitioners see that there may be some
positive results from their education and passing their exams,
Reynolds pointed out. He added, "What you do with it after that is
up to you, of course, but I think that including them in the
decision-tree and making them a part of it also improves
productivity. You'll see the little violations, like coming in five
minutes late, improving once they feel they have some impact on how
things are run in the business.
"That's been kind of tough for me to do," Reynolds admitted. "I
always feel like I have to have my hand in everything that's being
done. But letting these younger guys and gals get involved has been
a big help for us."
The need to set our boundaries was a point in The Way of the
Shepherd, said Beckham. "We need to establish those fence
lines, but don't confuse those boundaries with bridles--let the
people run free within those boundaries to do what they do
best.
"I started up a CPA practice, and my partner and I were doing
everything: bookkeeping, tax returns, etc.," Beckham continued.
"When it came to that point where we had to hire somebody, it was
so hard to relinquish that to somebody and let them go with it and
just review their work."
Sometimes a management team is effective, Hinnant noted. "Choose
a group of people who can get a consensus of where you're going to
try to go. You might have one leader, but you might have several
people at the management level, helping guide you through what
you're going to do. Each has a separate area of control, and you
use those people independently. I find that I do better if I have
people manage for me, but I manage with a group. One does a check
and balance on the other--and then you provide them with
direction."
Hinnant added a word of caution: "Sometimes, the worst thing you
could ever do is tell someone he's a manager. The next thing you
know, he's telling everybody in the world what to do--and he quits
working because he thinks, 'Wow, I'm a manager, now!'"
"I think there's a greater responsibility in leadership than in
management," said Beckham. "You call somebody a manager, and
there's that little pride issue; but if you call them a leader,
they react, 'Oh, I'm responsible!"'
Leaders: Born or Made?
"The problem is that five percent of the world are leaders and
95 percent of the world are followers," Hinnant pointed out. "Maybe
they'll be a leader in that one thing you assign them to handle.
But leadership is not just something that's given to you and,
presto!--you're a leader, now."
"You EARN leadership," the forum participants agreed. Shaw
added, "You can't assign leadership. People either follow you or
they don't. They either buy into your plan or they don't. You can
assign someone to manage--and they'll see that the job gets done.
It's different from leadership.
"So leaders are born, not made?
That question brought forth a variety of responses.
"I agree," said Mitchum.
"I think to a point that's true," said McClellan.
Hinnant commented, "I think 75 percent of them are born, but I
think the ability has to be nurtured. You can have a leader--like
you can have somebody with an IQ of 180 and they still can't tie
their shoes--[but] that doesn't make them effective."
"I think the circumstance determines the leadership," Shaw
said.
Mike Russell, Lexington O&P, observed, "I think you can
determine whether that person will take that mantle and carry
it--teaching them, if necessary."
"I don't know if they're born, but leaders will step up," said
Senn. "You're not going to know who is a leader in a group, but all
of a sudden, if you give the group a project, a leader is going to
step up."
"The leader is the one out there doing things when the rest of
them are talking about what they do," noted Tom DiBello,
CO, FAAOP, Dynamic Orthotics and Prosthetics, Houston,
Texas. Beckham expressed it another way: "I think everyone
throughout your whole organization can be a leader in their own
way." For instance, he recommended The Way of the Shepherd
to the company's front office receptionist. "I described it to her
and explained that it was about a shepherd leading the flock and
how he protects them, and what you do with the sheep, and she said,
'but I don't have a flock!'
"I said, 'Sure you do--your husband, your children!' If you
teach people that there's someone they are leading in everything
they do, suddenly the desire and the responsibility to perform like
a leader starts emerging."
Leadership Hallmarks
Thus, hallmarks of leadership emerging from the forum included
1) Having motivation and a vision;
2) communicating the vision to employees and
getting them to buy into it; 3) being a good
example; 4) treating employees with respect and
appreciation; 5) leading by persuasion rather than
coercion; 6) letting them grow and reach their
potential, rather than micromanaging everything;
7) setting goals and providing direction; and
8) not being afraid to tackle the hard issues and
make tough decisions.
A graduate of the University of Missouri School of
Journalism, Judith Philipps Otto has been a newspaper writer and
editor and has won national and international awards as a broadcast
writer-producer. She also has assisted with marketing and public
relations for various clients in the O&P industry.
Table Of Contents - October 2005
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