From nuclear submarines to graduate medical education: applying David Marquet’s intent-based leadership model

Abstract

L. David Marquet, a decorated Navy Captain, transformed an underperforming submarine crew by empowering his subordinates to be leaders and reach their full potential. He called this intent-based leadership (IBL). What would happen if Marquet's model were implemented in Graduate Medical Education (GME)? In this letter to the editor, we summarize the potential of the IBL model in graduate medical education as opposed to the traditional leader-follower method. IBL harnesses human productivity toward the shared goals of GME, which are patient care and trainee learning. This shift in mindset could lead both teachers and trainees to focus more on the real reason that we undertake GME and change behaviors for the better. We suggest that IBL can and should be adopted in GME and propose that both patients and providers will benefit from this action.Keywords: David Marquet, Leadership, Graduate medical education, Intent-based leadership Dear editors:L. David Marquet was a man on the rise. He was a top graduate of the Naval Academy class of 1981 and was poised to assume command of the nuclear-powered attack submarine, the USS Olympia. He had been preparing diligently for this role for more than a year when plans changed at the last minute. Instead, Marquet would unexpectedly become Captain of the USS Santa Fe, a different type of submarine, which had the worst performance record in the fleet.A few weeks later, Captain Marquet would discover how rough the waters around him really were. He gave an order during a drill, "ahead two-thirds." This order was passed down the line, but when it reached the helmsman who was supposed to execute the order, nothing happened. Although this was a valid order on other ships, this was not one that could be executed on the USS Santa Fe. When questioned, the officer on deck said that he had repeated the order, knowing that it was wrong. Marquet knew something had to change.Marquet recognized the danger of the classic leaderfollower model that was commonly practiced in the military and elsewhere. His crew would blindly follow his commands even if they knew that these orders were unsound. He boldly turned his back on the conventional leader-follower paradigm and employed a novel model in which each crewmember engaged and contributed to his full intellectual capacity. He empowered his subordinates to be leaders, allowing each person to feel valued and to reach his full potential. He called this IBL [1].The results were astounding. "Santa Fe went from 'worst to first, ' achieving the highest retention and operational standings in the Navy." Even after Marquet left the Santa Fe, it continued to thrive, winning awards and promoting "more officers and enlisted men with increased responsibility than any other submarine".Can GME similarly benefit from IBL? We believe that the answer is yes. A search in the database, including PubMed and Google Scholar from February 1, 2015 through May 19, 2017 did not uncover values to measure the outcomes of IBL in GME. To our knowledge, this is the first let...

Developing a maritime cyber safety culture: Improving safety of operations

“…The concept involves passing decision-making to those closest to the information, rather than those with the highest rank or authority. In this way, all personnel feel involved within the decision-making process, and are able to contribute their ideas based on their own experiences and practices, as illustrated in Fernandez-Salvador et al (2017). This example, along with the highlighted elements of an effective safety culture, reiterates the importance of developing a safety culture.…”