Leadership Principles

I am not afraid of an army of lions led by a sheep; I am afraid of an army of sheep led by a lion. Leadership is practiced not so much in words as in attitude and in actions. The art of communication is the language of leadership. Leadership is not about a title or a designation.

Alexander the Great


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Leadership is defined as the art of motivating and guiding people toward a shared objective. This art includes the capacity of the individual to engage with others and inspire. Competent leadership depends heavily on effective communication skills and emotional intelligence. In essence, leadership is about influence.

The effective leader cultivates an environment that motivates and unifies the team. The priorities and values of the leader are imparted on the team, thereby implicating the importance of self-awareness and emotional intelligence in the actions of the leader.

However, just because an individual possesses a position of leadership does not imply that he or she is a leader—this distinction is reserved for individuals who demonstrate the following distinctions:

  1. The main difference between leaders and managers is that people follow leaders but work for managers.
  2. Leaders establish new standards; managers imitate others’ standards.
  3. Leaders create visions; managers create goals.
  4. Leaders are agents of change; managers maintain the status quo.
  5. Leaders are risk takers; managers are risk averse.
  6. Leaders have a vision for the long term; managers have a goal for the short term.
  7. Leaders grow their team’s talents; managers rely on their team’s existing talents.
  8. Leaders build collaborations and a culture of innovation; managers support processes and micromanage.
  9. Most importantly, leaders create fans; managers create employees.

In this chapter, we briefly review leadership principles relevant to the neurosurgeon.


The fundamental principles of leadership (integrity, inspiration, decisiveness, vision, and political skill) are relevant to all successful leaders.


Integrity is a critical quality of the virtuous and successful leader. The leader will provide the stark truth and take ownership of responsibilities, even when facing failure. Admission of guilt or mistakes is challenging for anyone, but leaders with integrity do not conceal their mistakes. Instead, they use these opportunities for growth and development of the team. A true leader does not misrepresent facts to encourage personal gain but instead relies on the truth to guide progress and prestige.


The leader must cultivate a motivational environment for inspiring the best attributes of team members. A true leader must empower others. No matter how small the task, the leader should impart the importance of the vision. Most dissatisfied team members do not leave their job but leave their manager/leader.


A successful leader must infuse confidence in the decision-making process. The leader demonstrates wisdom and exercises restraint. Successful leaders routinely use executive coaching and reach out to their trusted counsels or mentors before making critical decisions.

Complex decisions often challenge the leader because such decisions may have broad and irreversible implications. The successful leader does not get frustrated by the complexity of decisions and focuses on the opportunity for advancing organizations goals. When practiced judiciously, decisive leadership is often sought out by colleagues.


The visionary leader is one who pushes the organization or team to advance beyond the status quo in pursuit of excellence. This pursuit of excellence is cultivated as a shared goal with an appropriate level of optimism. The visionary leader transforms skeptics and opponents/blockers into believers. With a unified pursuit of the vision, the leader serves as a pillar for progress within the organization.

Political Skill

Positions of leadership impart multiple complex political situations, which the leader must navigate successfully and eloquently. To do this, the leader must remain diplomatic. Diplomacy for a successful leader involves conflict resolution and the ability to maintain good relationships with the conceding parties.

This culmination of skills permits the social finesse necessary for the leader to possess political savviness. This is a challenging quality to cultivate and often is an innate talent of successful leaders.


The personality of a leader often deeply affects his or her leadership style. Certain leadership styles are more effective in favorable situations, and this phenomenon highlights the importance of an adaptable leader. A list of leadership styles is shown in Table 1. Practically speaking, most leadership practices are a combination of these styles.

Table 1: Leadership Styles

The affiliative leader focuses on the happiness of the group’s members over the organization’s goals. This style often creates a harmonious environment but may not promote a collective vision. This style may be temporarily effective in organizations with low morale. The leader focuses on growing a strong emotional connection with the group members with the hope that the team members will be highly committed. Unfortunately, hope is not a persuasion strategy.

The authentic leader uses his or her personal experiences to empower members of the organization. This style requires that the leader be highly introspective and capable of behaving in a genuine manner.

The authoritarian leader maintains governance through dominance and coercive tactics. This leader relies on intimidating constituents to attain goals. This style adheres strongly to a hierarchical workflow. Authoritarian leaders may be effective in scenarios in which drastic change is necessary or when dramatic events have occurred and strong, resolute leadership is immediately required to avoid or control untoward events.

The authoritative leader, not to be confused with an authoritarian leader, is a compelling leadership type that uses motivational techniques to inspire members. This leadership style maintains the leader as an authority figure while permitting followers to define their specific personal contributions to the organization. This style is effective when it is necessary for an organization to redefine its future goals and vision.

The coaching leader authentically promotes the personal development and prosperity of the followers. This technique uses constructive feedback to enable team members to address weaknesses and develop positive attributes.

The democratic leader involves the team members in practically every decision, which spurs a collaborative spirit and even work distribution within the organization. The group effort allows inclusion of the unique talents of each member. The leader serves as a facilitator for the group.

The pacesetting leader serves as a role model for work ethic, motivation, and performance standards. If an individual does not meet the expectations set forth by the leader, the leader steps in to facilitate meeting the goals. This style is effective primarily for organizations with highly skilled and motivated employees. This technique can be effective when the organization requires quick results.

The transactional leader focuses on balancing the organization’s returns with that of the members. A reward system promotes the performance of tasks aligned with the organization’s goals. This style may be effective for a brief time but not in the long term because it does not value the critically important intangible factors such as personal growth and development of the members.

The transformational leader focuses on transforming followers through serving as a charismatic role model. The leader takes the humble role of a servant, with the goal of guiding members to achieve a collective identity. The leader must have the following hierarchical priorities in mind: organization goals, team members’ goals, and only lastly, the leader’s interests. This style requires a selfless ideal to be embraced by the leader.


Leadership requires an intricate implication of interpersonal communication, and emotional intelligence is the centerpiece. Emotional intelligence is a person’s ability to interpret and use emotions appropriately in a social setting. Within the leadership framework, emotional intelligence is the most effective predictor of successful leadership.

The major facets of emotional intelligence are personal and social. The personal component can be subdivided into self-awareness and self-management. The social component can be subdivided into social awareness and relationship management. Self-awareness is the most important ability of a desirable leader.

Self-awareness involves recognition of one’s own emotional state and this state’s impact on one’s behaviors. The leader must recognize emotional trends that are imparted by specific social and environmental situations. Recognition of these trends facilitates anticipation and refinement of behavior.

Self-management is an indispensable skill for leaders, particularly for surgeons, who must control their emotions in all situations. Successful management of one’s emotions permits the minimization of internal emotional wrestling and allows the leader to focus on the task at hand with mindfulness.

Social awareness is a critical component of emotional intelligence that is relevant to the public’s impression. Social awareness depends on one’s capacity for empathy, both with individuals and in the communal setting. This awareness permits the leader to judge the social situation and determine the most effective method of communication.

Relationship management is another critical skill for successful leaders who need to maintain collegial and productive exchanges with all team members. The cornerstone to relationship management is effective communication. For the effective leader, conflict resolution and promotion of a motivational atmosphere are keys to success. Maximizing the creative potential of others leads to a productive environment.


The organizational structure of the operating room provides the necessary environment for adoption of the leadership principles described above. The successful function of the operating room requires a collegial environment with a broad hierarchical leadership structure.

Effective navigation of the operating room culture requires an intimate knowledge of presumptions, values, preferences, and behaviors. To manage this complex environment, the leader must evolve in response to dynamic changes in this culture.


  • Leadership is defined by the influence of a leader on others.
  • Self-awareness is the most important ingredient for success as a leader.
  • Neurosurgical leadership has historically been power-based. To achieve the ultimate potential of neurosurgical faculty, transformational and democratic leadership styles are needed.
  • Tactics that differentiate between thriving and struggling leaders include the following:
    • Convey a clear direction and vision that align with those of team members
    • Listen and support empathy and trust
    • Communicate effectively
    • Resolve conflict

Contributor: Benjamin K. Hendricks, MD

DOI: https://doi.org/10.18791/nsatlas.v0.5.01


Egger C, Macario A. Leadership principles. In Kaye AD, Fox CJ, Urman RD, Operating Room Leadership and Management. Cambridge University Press, Cambridge, England: 2012:1–16. doi.org/10.1017/9781108178402.004.

Musumeci R, Kaye AD, Fox CJ, Urman RD. The path to a successful operating room environment. In Kaye AD, Fox CJ, Urman RD, Operating Room Leadership and Management. Cambridge University Press, Cambridge, England: 2012: 17–25. doi.org/10.1017/9781108178402.005.

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