We need leaders: The 48th Annual Rovenstine Lecture.

IT is an extraordinary honor to be here today to deliver the 48th Annual Rovenstine Lecture. I am reminded of the tremendous journey that anesthesiologists have traveled over the last half century: a journey that started when anesthesia was in its infancy, and patients died needlessly; a journey that required great vision and determination, that reduced preventable harm, and that made patient safety in anesthesiology a model for all of medicine. Today, this journey continues. The healthcare industry faces daunting challenges. Physicians must play a significant role in evolving health care to ensure that all patients receive the best and safest care possible, while at the same time controlling healthcare costs. This is a heavyweight responsibility on anesthesiologists, whose job has traditionally been to keep patients safe in the operating room (OR) and whose concerns with healthcare costs ended at those doors. In the days to come, our responsibilities will only intensify. Dr. Rovenstine started this journey of vision and excellence with his scholarly work and great leadership. Today, there is an even greater need for leadership. We use the word leadership slackly, often without clearly defining its meaning. Some describe leadership as being in charge or providing protection. Others describe leadership as a position of power. Yet, neither description is accurate. Leadership is helping people address problems that will make the world better. It means focusing on a goal and inviting everyone to help achieve it. It means serving others more than ourselves. It is inherent in each of us; something anesthesiology, health care, and the world need desperately. You do not have to be the smartest or the strongest or the most powerful or the most influential. You also do not need to be the department chair to show leadership. You simply need to have courage to think of what could be, clarity about the task at hand, and commitment to convert these thoughts into a reality. I remember being on a camping trip. I was in one of the three groups of eight campers; each group had a lead counselor. We set out early in the morning to hike a local mountain, but we had to choose, from among a number of peaks, which one to climb. One counselor took an autocratic approach. He decided which peak to climb and provided excruciating detail about what we would do every step of the way. Needless to say, there was little enthusiasm from the group. The second counselor took a noncommittal approach. He said, “There are a lot of great hills. I do not care where we go. Which one do you want to climb?” This vague directive also garnered little enthusiasm. The third counselor took a collaborative approach. He said, “You see that peak over there, I think that is the one we should climb; it has an amazing view from the top. I am not sure we will make it. It is going to be difficult, and I will need your help. However, if we all work together I am pretty confident we can reach the summit.” As expected, everyone wanted to be a part of his group. You do not need to have all the answers to be a great leader. You will never, but you must actively lead. You must take a stand, set a course, and inspire people to lift themselves and others to new heights and make the world a better place. It is not about individualism; it is about teamwork. It is not about judging and blaming. It is about accepting responsibility for what can be accomplished. For every great achievement, there is an army of leaders helping to make it happen. Leaders must see beyond the barriers, and they must focus on the goal and inspire others to do the same. It is the power of that collective vision—when the team and the leader see the same future—the one that enables the group to make the world a better place. Anesthesiology has had many visionary leaders. Beecher and Todd first unveiled the problems of patient safety and preventable harm with their groundbreaking work on anesthesia-related deaths in 1954. Never before had anyone questioned our methods, encouraged us to study ourselves, and * Professor, School of Medicine, Departments of Anesthesiology and Critical Care Medicine and of Surgery, Bloomberg School of Public Health, Department of Health Policy and Management, School of Nursing, The Johns Hopkins University, Baltimore, Maryland.