THERE IS A lot of “noise” in the CME world. If you don't have to worry about your finances or declining enrollment, then there is the specter of implementing the new ACCME Standards for Commercial Support, or the need to practice evidence-based CME, or moving your programming closer to supporting maintenance of competence. And if that's not enough, you need to do a better job of measuring outcomes. Maybe all this noise is why there seems to be a significant turnover in CME offices.

Of course, there are ways to address the challenges of leading a CME office. We have discussed many of them in this series based on Harvard Professor John Kotters' 8 Steps in Leading Change. Instead of reviewing those models, we'd like to conclude this series by reflecting briefly on what Harvard Business School Professor Joseph Badaracco Jr. calls “leading quietly.”

To Lead Change, Shhhh!

This notion of quiet leadership — characterized by modesty and restraint — really fits our noisy CME world. Badaracco talks about this kind of leader as one who “moves patiently, carefully, and incrementally.” The quiet leader is discerning and is often acting on faith — the faith that small and obscure deeds add up to big changes.

In the end, three quiet virtues — restraint, modesty, and tenacity — characterize an effective leader. While it may seem that these virtues are in conflict with one another, the creative tensions that result from the conflict are the kind that quiet leaders can effectively balance to accomplish lasting change.

Badaracco's book Leading Quietly: An Unorthodox Guide to Doing the Right Thing describes how this quiet, deliberate approach has been employed in various settings. Badaracco gives us another look at the ingredients for successful organizational change. His perspective is rooted in the desire “to provide a set of useful, practical ideas for people who want to live by their values, take on hard, serious problems, and do so without risking their careers and reputations.”

Leading change is what we've been talking about in this series. Our columns have examined some of the ways that change can be driven, and we've provided some useful guides to accomplish that. This notion of quiet leadership is a fitting perspective to conclude the series because it brings us back to face our own realities without lists, schemes, sensational processes, or simple-minded equations. It brings us back to the heart of the leader and to the matter of faith.

Badaracco quoted Albert Schweitzer, who said, “Of all the will toward the ideal in mankind only a small part can manifest itself in public action. All the rest of this force must be content with small and obscure deeds. The sum of these, however, is a thousand times stronger than the acts of those who receive wide public recognition. The latter, compared to the former, are like the foam on the waves of a deep ocean.”

Robert E. Kristofco, MSW, is director, Division of CME, University of Alabama School of Medicine, Birmingham, Ala.; Joseph S. Green, PhD, is president, Professional Resource Network Inc., Durham, N.C.; James C. Leist, EdD, is interim director, Alliance Center for Learning and Change.

Lessons learned:

1. Lead change systematically, with restraint, modesty, and tenacity.

2. Be realistic, spend the time to assess and understand complex problems, and find practical methods that may stretch the rules.

3. Focus on the big picture to shape the future as you deal with day-to-day reality.

4. It's not easy to lead change, but you must do so in order to be an effective leader.