American Association for Physician Leadership

Peer-Reviewed

Three Things a Physician Leader Must Know About Followers

Jonathan Bolton, MD, MA, MPhil, MMM


Jan 1, 2023


Volume 10, Issue 1, Pages 27-29


https://doi.org/10.55834/plj.7741672989


Abstract

Much has been written about leadership styles, attitudes, and practices. Much less is known or taught about followership. This article introduces three aspects of followership that should be appreciated by physician leaders and emphasizes characteristics of individual followers rather than the social interactions of followers on teams or in groups motivation, variety, and insights.




It is a common mistake for new leaders to stop listening to followers, or even trying to understand them. If the leader does this out of hubris, not a lot can be done about that. But if it is done out of ignorance or misunderstanding, that can be remedied by learning about the psychology of followership. This article is for the leader who wants to understand followers better: their motivations, their varieties, and their insights.

What Motivates Followers?

Followers are motivated by the same things that motivate anyone: commitment, self-interest, and avoidance of pain. The expert leader knows this and is adept at activating all three to motivate followers to work toward the identified goals and to stay on the team.

Commitment refers to emotional and intellectual buy-in. If a follower believes in a cause or can accept the reason for a demand, they are more likely to do what is asked and to do it willingly. The follower is more likely to have a sense of commitment when the mission and means to achieving it are respectfully presented and even discussed. If followers do not believe in the leader’s objective or the leader’s legitimacy, it is unlikely that they will be committed to the leader or the leader’s plans. As important as this motivation is, the leader should not assume that it is always sufficient. It can be strengthened by attending to the other motivations.

Self-interest refers to what the follower wants personally. It might be money, opportunity, recognition, status. The leader can satisfy this motivation by providing material and symbolic benefits in the form of praise, rewards, opportunities, higher pay, etc.

The avoidance of something unwanted is the negative version of self-interest. The follower can be motivated to do something to avoid being punished in some way, such as being shamed, fined, or reassigned. It requires the leader to be willing and able to apply coercive power.

Leaders vary in how much faith they have in each motivation and their willingness to bear the costs of each. Followers who are committed to the leader and to the mission are self-propelled. They willingly accept responsibilities and work to the identified goal.

The cost associated with this motivation is the effort that the leader must make to encourage, or not discourage, commitment. These efforts include being clear in what the leader stands for and in conveying respect for the follower as a moral agent. Followers who are more motivated by self-interest require the leader to provide them with the money, status, opportunities, etc., to sustain their engagement. These are direct costs that the leader must be able to afford. Leaders should be aware that followers whose primary motivation is self-interest are susceptible to better offers made by other leaders.

Motivation under coercion is the costliest, at least in terms of supervisory effort. Followers must be under surveillance and violations must be met with punishment, which risks unintended consequences of resentment and retaliation. The wise leader puts more effort into motivating followers through commitment first, self-interest second, and coercion last.

Types of Followers

Curphy and Hogan(1) and Kelley(2) use two dimensions — critical thinking and engagement — to distinguish four types of followers. Most groups will include all four types and the leader must be able to manage each type.

The Yes-Person (Kelley) or Brown-Noser (Curphy) is highly engaged and works hard, but does not offer independent ideas or criticize bad ideas. They play it safe and ingratiate themselves with their leader. They are more motivated by self-interest and coercion than by commitment. They seek permission rather than forgiveness.

Many leaders prefer this type of follower, as they reap the benefits of patronage without upsetting their superiors. This may explain their concentration at the upper levels of organizations.

The Self-Starter is also highly engaged but is more open to saying what he or she thinks and sees. They buy into the mission and want to do things better. They are the innovators, disruptors, progressives. They prefer to seek forgiveness if they seek it at all. These followers can be useful to the leader in accelerating progress, but it requires the leader to be willing to tolerate them. Many leaders are threatened by Self-Starters and try to rein them in, preferring the politeness and pliability of Yes-Persons.

The third type of follower is the Regular Follower (called a Slacker by Curphy and Hogan and Survivor by Kelley). This type is disengaged and non-critical, at least in a contributory way. They are not motivated by commitment, only by self-interest and avoidance of trouble. They show up (mostly) and do their assigned work. They invest their interests and energies in other parts of their lives. They adopt new ideas slowly and reluctantly.

Lastly is the Criticizer. This type is disengaged but critically active. They are sensitized to the shortcomings of the leader and to failures in the group. They make their observations known to anyone who will listen. These followers can be a bane to leaders. They take up emotions and time that the leader would prefer to spend on other things.

It takes a secure leader to resist the impulse to silence or banish the Criticizers, and to accept their observations as potentially valuable. Most leaders are not this secure. The risks Criticizers pose to team functioning and the emotional climate are usually more compelling than their potential benefits.

There are implications of this typology.

Any group is likely to contain followers of each types. It is an empirical question of which types tend to be more common in groups/teams of physicians. It has been suggested that many groups function best when they include each type of member. If one type is not represented in a group, one or more followers may become that type.(3) The leader might wish that the group were filled with the type of follower that they prefer, but most leaders learn that instead of the group of their dreams, they have a motley crew through which they must achieve objectives.

There are risks to trying to have one type of follower— usually Yes-People or Regular Followers. While they might be easy to lead or manage, neither will challenge the leader or provide feedback necessary to reduce the leader’s blind spots.

Two intra-group processes that are more common when followers are predominantly Yes-People or Regulars and which the leader should be alert to so they can reduce their impact on decision making are GroupThink(4) and the Abilene Paradox.(5)

GroupThink occurs under certain circumstances: homogenous followership, shared ideology, high cohesion, threats from outside the group, insulation from experts, and directive leadership. These antecedent conditions can result in the group feeling that its decisions are unanimous expressions of shared collective beliefs. Individual members all publicly and privately believe that the right decision is being made for the right reasons, even though to outsiders it may seem wrong or even absurd. Insiders are prone to self-censorship; outsiders are stereotyped; external criticism makes no impact.

The Abilene Paradox is different in the sense that group members privately think that a decision is wrong, but they do not raise their objections because they believe they are the only ones who think so or because they fear being marginalized for their view.

Both group dynamics undermine the decision-making process and can lead to disastrous decisions. The wise leader will look for signs of each: e.g., groups that are too homogeneous in outlooks, a paranoid stance to outsiders, an absence of opposing arguments. Once they are detected, the leader can devise ways to undermine the dynamic, such as by asking individuals to privately write their decision and advice, to play devil’s advocate, to diversify the group, to introduce team-development exercises that focus on the dynamic, to reward critical thinking.

It is important to know that followers are not fixed in their type. Followers can and do change from one type to another, depending on desires, assessment of risks and benefits, and the actions of the leader. Criticizers usually start off as another type, become disillusioned, often with the leader, and change into a Criticizer. The Self-Starter is especially prone to become a Criticizer. If the Self-Starter is thwarted or if the leader fails in their role (in the eyes of the Self-Starter), the follower may stop trying and start criticizing.

A Yes-Person might feel pushed aside by the leader despite all of the displays of subordination, or believe that sucking-up is no longer an effective strategy to reach their goals. They might make the transition to become a Regular Follower or a Criticizer. Even the Regular Follower can become resentful of being taken for granted or simply gets tired of trying; these followers remain disengaged but become more critical.

Wisdom of Followers

It is common for leaders to believe that they have all the answers and that their job is to convince everyone else of it. Some systems are better than others at schooling the hubris out of a leader. The second lieutenant might be the leader of the platoon, but they learn that it is perilous to ignore the wisdom of the sergeant. As a leader ascends a system, the less influence others have on the leader, even in the form of relevant information.

Leaders ought to know what sort of intelligence they need from their followers. Unless the leaders make the effort to get this information and advice, they will be left to their own beliefs, impressions, and biases.

A simple way of getting this information is to talk less and listen more. When people feel listened to they usually talk more freely. Of course, the leader has to believe that the followers do have wisdom, or at least information, that is worth listening to. It is most useful when the wisdom comes from a different vantage point than that of the leader. Others can see things that the leader cannot.

Of course, the leader does not have to agree with what others see and say. The important thing is to know what they see and say, and for it to be included in the leader’s calculations. Not knowing makes the calculation simpler but riskier.

Conclusion

Wise leaders are empirically rare. Being a wise leader does not require superior intelligence or unrivaled experiences. It mostly requires understanding how to motivate followers to be their best selves and to make full use of what they bring to their work.

Certainly, leaders can conspicuously fail to achieve the basic tasks of their position, i.e., to get followers to work toward an objective, to prevent unwanted defections, and to make wise decisions, and still remain in their position. This probably says more about the system that they survive in than their political acumen. However, if a leader wants to be successful beyond mere survival, their decisions and actions will be better to the degree that the leader takes seriously their followers’ subjectivity, motivation, and wisdom.

References

  1. Curphy G, Hogan R. The Rocket Model. Practical Advice for Building High Performing Teams. Tulsa OK: Hogan Press;2012.

  2. Kelley RE. In Praise of Followers. Harvard Business Review. 1988;66(6):142–148.

  3. Beck AP. Developmental Characteristics of the System Forming Process. In Living Groups: Group Psychotherapy and General Systems Theory, J.E. Durkin, Editor. New York: Brunner/Mazel;1981:45-54.

  4. Janis IL, Mann L. Decision Making. New York: Free Press;1977.

  5. Harvey JB. The Abilene Paradox: The Management of Agreement. Organizational Dynamics. 1974;3(1):63-80.

Jonathan Bolton, MD, MA, MPhil, MMM

Jonathan Bolton, MD, MA, MPhil, MMM, is the director of the Institute of Ethics and a professor of psychiatry at the University of New Mexico Health Sciences Center, where he is the former director of the Office of Professionalism and an associate vice chancellor of academic affairs. Prior to moving to New Mexico he worked and taught at Harvard Medical School/Cambridge Health Alliance and Brown University.

Interested in sharing leadership insights? Contribute


This article is available to AAPL Members.

Log in to view.

For over 45 years.

The American Association for Physician Leadership has helped physicians develop their leadership skills through education, career development, thought leadership and community building.

The American Association for Physician Leadership (AAPL) changed its name from the American College of Physician Executives (ACPE) in 2014. We may have changed our name, but we are the same organization that has been serving physician leaders since 1975.

CONTACT US

Mail Processing Address
PO Box 96503 I BMB 97493
Washington, DC 20090-6503

Payment Remittance Address
PO Box 745725
Atlanta, GA 30374-5725
(800) 562-8088
(813) 287-8993 Fax
customerservice@physicianleaders.org

CONNECT WITH US

LOOKING TO ENGAGE YOUR STAFF?

AAPL providers leadership development programs designed to retain valuable team members and improve patient outcomes.

American Association for Physician Leadership®

formerly known as the American College of Physician Executives (ACPE)