Legacy leadership: stewardship and courage. Five attributes characterize genuine healthcare leaders

In organizations with the power to persist through turbulent eras, one finds leaders who live as if they were stewards of a legacy-the culture, mission, and founding spirit of the organization. These legacy leaders may be physicians, administrators, chief executives, or board members, but they all have the ability to weave a thread of constancy through times of peril. Five attributes characterize legacy leaders: Their work is a vocation, they possess a moral code, they are committed to stewardship, they have a bias for building, and they instill hope. Legacy leaders stay with one organization a very long time, patiently removing obstacles to worthy accomplishments. Because the profession of healthcare is at heart a vocation, not a business, we must pay attention to the kinds of leaders we place in our healthcare institutions. To carry out their responsibility of transforming healthcare delivery, boards of directors must hire legacy leaders, manage their business focus, carefully evaluate executives, enhance mechanisms for board evaluation, and raise the bar for decision making.