Extreme Ownership: How US Navy Seals Lead and Win
Jocko Willink and Leif Babin
St. Martin’s Press, 2015
Reviewed by Laura Calhoun, MD, and Rowland Nichol, MD
Although I am not a fan of using war metaphors for health care operations, Extreme Ownership has some useful advice for leaders in our world of caring for others.
Jocko Willink and Leif Babin (even their names evoke images of Vikings and war) are Navy Seal officers who served together in Ar Ramadi, Iraq. They took the lessons they learned during their training and in the battlefield, reflected on them, and then created, evaluated, and incorporated a comprehensive paradigm into their personal approach to leadership and named it “extreme ownership.”
An operational leader centred within concentric rings of activity and influence could visually represent this paradigm. The concentric circles contain elements relevant to the mission/leadership activity and are assumed to be within the leader’s field of influence. Because a book has to be read linearly, the chapters necessarily detail parts of the concentric circles; however, the whole of the extreme ownership paradigm is more than the sum of the chapters.
Each chapter starts with a recounting of some part of the war, where a particular principle is used or should have been used. Each chapter also illustrates how the authors have since used the principle in the businesses with which they now work. Top
Although war is about fighting and winning, it also demands teamwork, communication, clear roles and responsibilities, and data analysis before, during, and after battle. The team must trust that everyone is working toward the same goal and that every team member has every one else’s back. The leader must own the outcome, learn from it, communicate about it with the rest of the team and ensure understanding from each team member. There is volatility, uncertainty, ambiguity, and chaos in every battle and the executive leadership is nowhere to be found when the guns are blasting, even though they attempt to set everyone up for success and bear the ultimate responsibility for the outcomes. Except for the mission, then, much of the book’s ideas generalize nicely to health care.
The book has three parts and each part has four principles. Part 1, “Winning the war within” shares stories and principles described as the foundational building blocks and mindset necessary to lead and win. The principles include
This section is the most relevant for health care leaders, as it lays out the importance of leaders owning outcomes and holding themselves accountable. The authors make clear that they are talking about distributed leadership, where the leaders at each level align, communicate about who is accountable for what, and ensure everyone on their team has the same understanding of what success looks like.
Part 2, “The laws of combat,” details four concepts that allow teams to be successful in battle. One principle, in particular, stood out for us as useful: the authors call it “decentralized command,” meaning that each designated leader at whatever level has five or six people who report to them. That size of an ideal team echoes other relevant literature. For a leader to be successful, she cannot be responsible for more than a half dozen workers. This ratio of leaders to workers — called span of control — is not something we talk much about in medicine. Top
Part 3, “Sustaining victory,” covers some of the more difficult aspects of leadership, such as the importance of leading up, not just down, understanding that you will never have all the information or know the exact right answer and making a decision anyway, and many of the paradoxes confronted by leaders every day. Leaders walk a fine line between being ready to lead, but also to follow when following will improve the chance of success. This section also describes the balance between knowing enough detail without micromanaging and having good relations with direct reports, but not favouring one over the other. The biggest seeming contradiction is owning the outcome, while distributing leadership and ownership throughout the organization.
A war mission is well defined and success is easily measured and understood; therefore, war is in the realm of the complicated, not the complex. In a complex social system, such as health care, there are innumerable “right ways” to define success that vary depending on your viewpoint, and herein lies the book’s weakness.
Absent from the book is any discussion about the importance of communication and collaboration between and among leaders at each level so that the organization avoids the multiple silo effect.
The book deals exclusively with the hierarchical network, the command and control leadership style, and leaves out completely the flat networks that must exist at each level of leadership in any complex social system. There is no discussion of the quality improvement or innovation that are as necessary to health care as looking after patients, and that require work in horizontal networks as well as hierarchical ones. As well, there is no comparison between “citizen-centred” health care and “citizen avoidance” needed in war.
Despite the knowledge that health care is a complex social system, we often rely on command and control leadership. We seem to like our hierarchies and silos just fine.
Some of the leadership principles in Extreme Ownership resonate with the way we currently do things. If every leader at every level of health care took ownership of the success or failure of predetermined metrics, I suspect we would learn a lot more from our mistakes. Top
Laura L. Calhoun MD, FRCPC, MAL(H), CEC, practises psychiatry and has a role as a physician leader in Alberta Health Services.
Rowland Nichol, MD, CCPE, is a family physician in Calgary and a member of the Board of Directors of the CSPL.