The Importance of Followership

I was recently at—“at”—the British Society of Interventional Radiology. It was, as many are these days, a hybrid meeting. The lecture I presented was on creating a positive culture in IR. A “soft” topic, and one I profess to knowing little about—or, at least, not knowing the social science behind positive culture building. I enjoyed learning about that more than I thought I would, and writing the lecture turned out to be quite eye-opening for me. And I realized I have a long way to go in creating a positive culture for our IR division and, more broadly, the radiology department at my institution as a whole. Not that I think we have a negative culture, quite the opposite, actually, but that is more a reflection on our extraordinary faculty who accomplish this sometimes in spite of my efforts rather than because of them. I, as a leader, will always have more to learn.

It's that last thought—“as a leader”—that got me thinking about writing this editorial. At a different meeting recently, Laura Findeiss delivered a lecture on being a good mentee. It was one of the first times that I heard of a topic like that, and recognized that there are innumerable resources for being a mentor and leader but that there are few to none on being a good follower. I have many faculty who rightly want to develop themselves as leaders and who want formal training on that topic. It is good to see them want to develop themselves, and I am hopeful that they will continue to progress through the college and hospital ranks. At my institution we are also required to have a formal departmental mentoring program which, to be honest, I disagree with for many reasons. The primary reason I believe these formal programs often fail is because of the power differential between the mentor and the mentee, which precludes a splitting of the relationship from either individual. Neither individual wants to ask for the divorce. For our faculty, there is no formal education given on being a good mentor, and there most certainly isn't one on being a good mentee.

So what makes a good mentee, or a good follower? Laura's lecture pointed out three characteristics—the relationship is the mentee's responsibility, be reliable, and respect the gift of time from the mentor. The larger issue isn't how, but it is why—why bother learning to be a good follower when what we really want is to be a good leader. Where is the value in learning those skills, and how do those skills allow people to progress?

When cogitating on leadership/followership, one can't help but think about the military structure. Many of you readers (well, if there are “many” which I doubt) just shuddered at the term “military.” We live in a society now where those in the military may be respected, but the institution itself is not. And certainly the hierarchical nature of the military is neither respected nor considered desirable. I'm not sure, however, that this tiered structure is all that bad. One of the five commonly quoted characteristics of a highly reliable organization is just that—a hierarchical structure or, as sometimes stated, a deference to expertise. In the most highly functioning organizations, this requirement to seek out those more knowledgeable than oneself results in a closed loop, with feedback to those who are asking for help and guidance which allows them to learn and grow. But the first step in this entire process is that the individual who is lower on the food chain must acknowledge the deficit and know when to ask for guidance. And to me, this is where my own followership comes in. There needs to be recognition that there are those in the organization who are better suited to a specific task than I am, and who in certain circumstances know far more about a topic than I do. There is, after all, only one dean and one CEO at my institution, and I'm not either of them. It requires an understanding of my own deficiencies and the ability to swallow my pride and ask for help—both are difficult for me and, I would think, for many others as well.

This acknowledgment of one's own deficits allows not just the best path to solving a problem but also a tremendous learning experience. Followers learn from leaders. That is how we all progress, whether in the military or education or health care. But it is only by recognizing our own holes in our skill set that we will be open enough to learning these lessons—hence the need to be good followers before we can be good leaders. Rarely, by the way, can one be categorized as either a follower or a leader. Almost invariably, we are required to be both. A staff sergeant commands a squad but answers to the lieutenant who commands the platoon who answers to the captain…. Nearly everyone in a health care organization falls into both categories of follower and leader, and I'm of the opinion that those who are the best followers make the best leaders.

At some point in time, I am of the opinion that we will have far too many leaders and far too few followers. The American Revolution gave us lessons in this. George Washington, when asked what his haphazard militia needed, wasn't more officers, it was more sergeants. In a more contemporary setting, highly respected restaurants are closing everywhere not because of a paucity of chefs, but of servers and dishwashers. At some point in time, we will recognize that sous chefs, teachers' assistants, grips, and scrub techs are as instrumental to success as the “leaders” in the kitchens, classrooms, movie sets, and IR suites. So the next time you run into one of these individuals who may be successful in their own way, take notice on what makes them good at what they do, and what lessons on followership we can all learn from them. And, if you remember, you might want to consider thanking them for their efforts and contributions.

Publication History

Article published online:
18 February 2022