Dilbert on Leadership


The image here is the final panel of a Dilbert strip from 2010.

I use the last panel because it's an all-purpose punchline to many different scenarios.

I asked Paul O'Neill what's preventing us from improving patient safety… he said “leadership.”

To become a Lean organization…. leadership. To engage people in continuous improvement…. leadership.


Does leadership have to be so hard? Why are we always asking for it? Why is it so often lacking?

Dr. W. Edwards Deming used to prescribe for the woes facing most organizations, “Substitute leadership.

Lack of leadership is often a real problem… is it an excuse or something we can address, even if having to “manage up?”

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  1. Mike Lozano, MD says

    Assessing your site leadership should be a sub plot to your lean transformation. You need know if they are in current state due to lack of ability or mis-focused self interest on the part of the leadership. You might be able to overcome the former with education and support. If you can get past selfishness on the part of site leadership, you are on the path to failure.

    1. Mark Graban says

      Understanding the current state of leadership should arguably be a main plot point and story line, not just a sub plot.

      I’ve found that management will usually blame everything else other than themselves for an organization’s poor performance. It’s always the fault of workers, unions, governments, competition, regulatory groups, unfair magazine reviews, etc. etc.

      I had a plant manager at GM who I really respected because he told the employees that the problem was the management system. Additionally, he would admit that HE used to be the problem until he learned to lead differently at the NUMMI (GM/Toyota) plant.

      ThedaCare and John Toussaint, MD have said that the problem was the leadership style and management system (collectively and individually). Arguably, the only reason ThedaCare has been willing to change is that John was, himself, willing to look in the mirror to change.

      I try to do the same, personally.

  2. Bob Emiliani says

    “Purpose” or “Corporate Purpose” is often cited as a factor more important than leadership. However, we must recognize that the top leader (or senior leadership team) defines purpose. Example: The CEO states the purpose of the business is to “maximize shareholder value” versus a CEO who states that the purpose of the business is “to satisfy our customers.” Unfortunately, purpose is not constant; it usually changes when the top leader changes, and can oscillate between purpose that employees ignore, tolerate, or embrace. This causes a lot of confusion. So, leadership matters, and corporate purpose must resonate with everyone in the organization (“to satisfy our customers”) rather than just top leaders (“maximize shareholder value”). The hierarchy is: leadership, purpose, strategy, etc.

    1. Mark Graban says

      For purpose to truly be accepted by the organization, I think it can’t just be dictated from the top… it’s got to be more collectively developed (or at least done using a catchball-type process)?

  3. Ajoy Kumar, MD says

    In disaster management, failure of operations is directly attributable to failure of leadership (ie. Lack of situational awareness, management, etc). Healthcare is a disaster, and quite frankly we need leaders who are situationally aware of what exactly is happening on the ground such that their policies and processes address those issues at all levels, especially the ground level, rather than having a detrimental long-term impact.

    1. Mark Graban says


      Part of leadership is accurately depicting reality to folks and that includes inspiring change… I commented earlier that I rarely meet a senior healthcare leader who gets ANGRY that hospitals hurt and kill so many patients through preventable errors.

      I’m not saying getting angry helps, but there needs to be some dissatisfaction with the current condition rather than being resigned to this being “the way it has to be.”

      Some occasional human emotion (“we have to stop hurting people!!!”) would probably resonate with staff and physicians, I bet — as long as the leader isn’t blaming folks.

  4. Dave Kippen says

    Are there tools or other techniques out there for those of us who are “working in the middle” to assess the current state of our leaders? How can i tell if our woes stem from inability or mis focused self interest? What are the tell-tale signs of either case?

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