The 2019 John Monash Oration and Dinner

Speech by Dr Martin Seneviratne

I begin by acknowledging the traditional owners of the land and paying my respect to elders past and present.

For the last few months, I have been percolating on this topic of leadership beyond confidence and charisma. 

I was reminded of a moment in my interview for the John Monash Scholarship. The first round panel asked me what my leadership style was.

I paused. And I said - this is a true story: “I try to lead like a hippo”. The hippopotamus, you see, spends a lot of its day resting just beneath the water - only its eyes and snout above surface - surveying the watering hole. What I was trying to say (I think) was that I try not to interfere in a team’s work, be as invisible as possible, not micro-manage. The panel’s eyebrows raised. They were probably thinking, quite rightly, that this is an extremely creepy image of leadership to be lurking in a muddy watering hole. Or perhaps they knew that the hippo is the second most dangerous animal in Africa (after the mosquito) - known to come hurtling out of its mudbath to devour a passing instagrammer.

I remember leaving the interview and thinking: ‘What on earth did you just say?’

By some stroke of luck, I made it through the interviews in the end. And in the years since, the John Monash Scholarship has genuinely expanded my view on leadership, by transporting me through some very different leadership cultures - cultures where confidence and charisma loom large: from the hallowed halls of the Royal Prince Alfred Hospital to the palm-lined avenues of Silicon Valley and out the other side.

Before the scholarship, I was working as a doctor here in Sydney. It is no surprise that some of the greatest leaders I’ve ever met have been doctors - moulded by the intensity and human suffering of their day-to-day. But on the whole, medicine still has a very traditional language of leadership - a leadership of credentials and confidence, built around a strict ladder of seniority, specialties, titles.

In many clinical situations - this hierarchy is precisely what you want. At a resus in the emergency room - you need a clear chain of command. As a patient in a time of vulnerability, you want a confident decision-maker by the bedside.

But this confidence can also be a flaw. We talk a lot about evidence-based medicine, but we often see “eminence-based medicine” instead - when status and seniority become the primary languages of leadership. I remember when I first arrived on the wards as a medical student, being puzzled by this strange caste system where you, the student, could only speak to the intern, and the intern to the registrar, and the registrar to the fellow and the fellow to the consultant - and then back down the chain it would go. Over the years, I saw fellow trainees getting shouted at, experienced it myself - for not knowing some arcane fact on cue, being too slow, not holding the retractor quite right during surgery, calling too late at night with an unwelcome referral. And then I started to mirror that behaviour myself when I took on more responsibility - tired and stressed and overworked as I was - because leadership languages are contagious. The recent media articles about bullying and junior doctor burnout is shedding light on this leadership culture.

The power imbalance sometimes extended to patients too. Often without realising it, we are liable to paternalism as medics: I know what’s wrong. I will diagnose you. Treat you. Manage you. My patient. Be patient. 2000 years of accumulated medical knowledge is worth something, I know, but this knowledge imbalance can create a very doctor-centric model of leadership where the physician’s word is absolute and unquestionable.

The John Monash Scholarship transplanted me out of that medical establishment and into a very different one. I went to Stanford University - in the heart of Silicon Valley. This is where Google was founded by two crazy PhD students with a vision to organise the world’s information, where Snapchat was dreamed up in a dorm room, where the buildings are called Gates and Hewlett and Packard and NVIDIA Hall.

Here, I found a leadership culture that was pointedly anti-establishment - where twenty-somethings in hoodies could be CEOs and the ultimate qualification was to drop out of school because your startup had raised capital. I actually kept a list of crazy startup ideas I saw - one of my favourites was an AI powered internet of things device that would detect when a baby’s nappy was soiled and alert the parents - poop-tech - founded by two guys who’d probably never held a baby in their lives.

On the surface, this was the polar opposite of the starched white-coat world of medicine. One that wanted to approach leadership in the same way as it approached its business problems - disrupt the status quo.

But scratch the surface and you find a very peculiar culture of leadership there too. Where medicine is about status, here was a leadership of unbridled charisma. Riddled, by the way, with tech bro culture and machismo. And most of all - obsessed with the cult of the founder. I have built this world-changing app. My valuation is X million dollars. I am going to disrupt the entire industry of Y. Invest in me. Follow my vision.

Of course, this often leads to genuinely world-changing ideas. But it is also the Valley’s greatest flaw.

Some of you may be familiar with the story of Theranos. Theranos was a company claiming to do a full panel of blood tests with only a few drops from a fingerprick, founded by a Stanford dropout - Elizabeth Holmes - a successor to Steve Jobs who dressed in black turtlenecks and was touted as a visionary entrepreneur. She was the most charismatic of leaders - able to convince Henry Kissinger to join her board - to raise the company’s valuation to $9b. She was famously pictured on the cover of Fortune as the youngest self-made female billionaire. It would have changed the world, but it was all a house of cards. Her technology didn’t work. Never worked. The blood was being siphoned out of their devices and secretly tested on commercial machines not designed to deal with such small volumes. In the process, patients were endangered with wildly inaccurate pathology results. A fake-it-till-you-make-it philosophy taken to the criminal extreme.

Clearly confidence and charisma are good things in leaders. The direct opposite - timidity and blandness I suppose - are hardly very desirable. And yet these languages of leadership can so easily turn toxic, become a vehicle for ego if the balance is not right. The Achilles heel of medical leadership is when traditional hierarchy gets in the way of care. Silicon Valley’s Achilles heel is when the cult of foundership gets in the way of real impact. While the two worlds seem like polar opposites - they actually turn out to suffer from the same affliction: one dimensional leadership, which leans on the veneer of confidence or charisma (or credentials), is flimsy. Solid leaders, of substance and depth, need to be multi-dimensional.

In fact, what I’m coming to appreciate is this idea of leadership languages - leadership as a vocabulary that you add to and refine over time. Good leaders have a wide vocabulary. Which resonates with what Julia has said tonight. Part of the reason behind this diversity problem we still see in the ranks of leadership - across gender and ethnicity and many other facets - is that we as a community still expect a very narrow leadership language and are deaf to many others. To echo Julia’s point, if we can start to appreciate more diverse models of leadership, we will elevate the quality of leadership across the board. 

So after spending the first half of this speech talking about where leadership goes wrong, I want to highlight a few leadership languages that I’ve been impressed by during my time as a John Monash scholar and more recently - languages we can learn from.

Three stories here.

First, to reference Julia herself.  While preparing for this address I have been reading Julia’s memoir - My Story. Actually I’ve been listening to it on Audible. It’s been a change from my usual routine of gory true crime podcasts (although there is some political bloodshed in there...).

The aspect of Julia’s leadership that most struck me - it echoed through the book and through her speech tonight - is the notion of being a principled and consistent leader. When she entered politics, one of her own mentors had advised her to write a leadership “manifesto” - a one page summary of what you stand for. Just to keep for yourself, for those times when you naturally doubt yourself. Julia was apparently the only person who actually took the advice and wrote that 1-pager. And it shows. Improving access to education, for example, has been a constant driver of hers from the very beginning - from her days as a student politician through Teach for Australia, through her work with Hugh Evans, a John Monash Scholar, building educational programs in Africa, and her presence here tonight supporting Australian education. Consistency is a powerful leadership language.

Secondly - on a personal note. One of the highlights of my time at Stanford was working with an organisation called Medicine X. Medicine X started as a health tech innovation conference in Silicon Valley with TED style keynotes and design jams on the future of medicine. But it had one big difference. Unlike every other medical conference I’d ever been to - there were patients in the room. Patients on stage. Patients as equal colleagues and partners in innovation. Dana Lewis was one such e-patient - a term that’s come to mean equipped, enabled, empowered and engaged patient. Dana has Type 1 Diabetes and wanted to have better control over her sugars and her life. As a citizen scientist in her garage over many years, she developed this amazing closed loop insulin system called openAPS (Artificial Pancreas System) - before commercial devices like this were available. Dana was on stage and running workshops attended by diabetes specialists. Or Liz Salmi, diagnosed with brain cancer at 29 - who went through the journey of cancer therapy feeling disempowered, and who now, through an organisation called OpenNotes, advocates for clinical notes to be made visible to patients so they have more agency in their care.

Talk about disrupting the traditional power hierarchies of medicine. Here - patients were seen as leaders. And what a different language of leadership they spoke - one of vulnerability and empathy. Doctors - all leaders really - have a lot to learn from this participatory approach - what MedX calls the Everyone Included philosophy.

Thirdly. Finally. There’s no better community to learn about different leadership languages than the John Monash scholar group itself.

Over the last few weeks, I’ve reached out to a handful of scholars around the world and asked them to share some leadership lessons. Tonight I want to end by highlighting two of these scholars.

We start in Dubbo, in western NSW. Dubbo’s old clock tower and telephone exchange had been abandoned for years. Until last year, when Jilian Kilby - a John Monash scholar who also studied at Stanford - came and restored it, and is now turning it into a startup community called The Exchange. In the walls of the telephone exchange, new businesses will be grown to support young people from rural Australia to innovate and open doors beyond farm careers. Jilian brought Silicon Valley to Dubbo. And when we talked about her leadership lessons she shared this mantra:

If not you, then who

If not now, then when

You can’t be what you can’t see

A world away, messaging me after night duty at a paediatric hospital in Laos, Kat Franklin shared some of her recent leadership wisdom. Kat is a paediatrician who has done a lot of global health work with MSF and others. She spent her John Monash scholarship studying public health at Magdalen College, Oxford, but she’s more at home in the trenches of frontline clinical work - from Laos to South Sudan.

This particular lesson came from her time in a hospital in Kabul, Afghanistan. She was dealing with the toughest and most gut-wrenching of leadership challenges - palliative care for sick kids. In Afghanistan, there wasn’t an understanding of palliative care (by families or even by doctors - it’s not part of medical training) - meaning children in the direst of situations were strung on to life by a thread of medical support - with parents sometimes selling all they had to fund this futile care. Kat tried to reason with her patients, but there were big cultural and religious boulders that needed to shift. In the end what really moved the needle was finding a local champion - a man called Dr Fahim - who understood the issues. Kat hired him as the national staff supervisor, supported him. Years later - she would watch as that same Dr Fahim presented in Sweden about the palliative care program he’d set up in the district. “Being a real leader” - and this is a quote from Kat - “is about providing the platform for others to lead.” Providing the platform for others to lead.

There were many others who responded to me. Special thanks to Garang Dut (a surgeon in training who is wrapping up his time at Oxford), whom you should ask about the ‘North Star’ model of leadership - finding your inner calling that might not neatly fit into a box of professional identity. And Michael Grebla - now a composer based on the east coast of the US who described his role as an artistic leader - where his leadership is about advocating for his craft - the need for music in people’s lives - and inspiring something in people when they listen.

I return then to the beginning - leading like a hippo. Maybe there is actually some truth here. There is often a lot more to a hippo than you can see from the banks. It has a lot of weight beneath the surface. So too, there are many leadership languages beyond the veneer of confidence and charisma. Many ways to be a leader. Appreciating this a bit more will help us diversify the people we see in leadership roles - help tackle the issues of gender imbalance and political pedigree that Julia described. Remember - leadership languages are contagious - speak a language and you’ll see it spread. So - I encourage the room - try to learn a new leadership language over the next year - and look for it in others around you, beneath the surface of this muddy watering hole.

Thank you very much.

2017 Roden Cutler NSW John Monash Scholar
Dr Martin Seneviratne

Martin received a John Monash Scholarship in 2017 to pursue a Masters at Stanford University, focusing on machine learning with medical records. He currently works as a research scientist at Google DeepMind in London.

Previously, Martin trained as a junior doctor at the Royal Prince Alfred Hospital and was deeply involved in the digital health community in Australia. He served on the board of the Health Informatics Society of Australia (HISA), as a clinical reference lead for the Australian Digital Health Agency, and worked on the digital health startup CancerAid.

Martin holds a BSc(Hons) and MBBS(Hons) from the University of Sydney and an MS(Biomedical Informatics) from Stanford.