Can Physicians Become Tribal Leaders?


Companies and thus hospitals are essentially tribes – or tribes of tribes. Tribes are groups between 20 and 150 people. What’s going on in these tribes from a social perspective is very comparable between different tribal settings, be it companies, villages, the boy scouts or medschool cohorts. In their book “Tribal Leadership”, Dave Logan et al. nicely elaborate how knowing about these social dynamics can improve corporate culture. Specifically they describe the five different stages that can be found in a tribal culture:

  • Stage 1: A person in stage one is characterized by an attitude that “life sucks”. It’s the tribal stage of most gangs and mob-type groups. When these people cluster together, their behavior is of despairing hostility. These individuals cannot possibly imagine that there are people who think that life is good.
  • Stage 2: The victims. An individual in stage two has an attitude of “my life sucks”. He sees that there are people around him who seem to do all right. Many of these other people are in stage three. When stage two individuals form a group, they develop a collective feeling of being apathetic victims who have no influence. Convincing them of new ways of doing things is usually very hard.
  • Stage 3: The lone warriors. People in this stage exhibit a language of “I am great”, which often implies that “you are not”. They usually develop dyadic (two-person) relationships. Stage two and three are very closely related and often cause each other. When stage three individuals form a group, they try to outperform each other. The authors describe how these individuals can typically be found in academic environments (i.e. the super performing professor who does not care much about the rest of his organization).
  • Stage 4: This stage is characterized by a “we are great” language. People in stage four report an epiphany that occurred in stage three where they realized that they could not achieve the goals they set out to achieve. Moreover, they realize that victories in stage three are a zero sum game: for every winner there is a looser. This is different in stage four. Stage four crowds, however, still need an external group or company (i.e. a “them”) to define their own identity. People in this stage form triadic relationships (i.e., with three people involved) where each individual is responsible for the relationship of the other two.
  • Stage 5: Having a higher cause. Stage five cultures are characterized by a “life is great” language. There are some small but important differences between stage four and five: stage five crowds are aligned by a higher purpose, they thus need no “them” for finding their own identity. Their cause is their purpose. The authors often refer to Amgen being one of the typical stage five companies. When you ask someone from a stage four company “who is your competition?”, they will answer “company xyz”. If you ask someone from Amgen, they will answer you “cancer”. The authors claim that companies and groups in stage five always achieve greatness.

The tribal leader can take her people all the way to stage 5, the ultimate leadership goal. The authors describe how all stages have to be run through in consecutive order (e.g., tribes and individuals cannot go from stage 2 to 4 without traversing stage 3).

It strikes us that most hospitals seem to be stuck in a stage 2&3 type situation with some egocentric stage 3 high-performers and a crowd of frustrated stage 2 individuals. This is puzzling in so far as doctors have THE higher purpose to aspire to, namely life and health. We don’t know why so many hospitals get their culture wrong. Maybe it’s the physicians’ characters, maybe it’s the long hours, maybe it’s the hospital environment? Or maybe we just don’t have enough tribal leaders amongst our peers? We would love to hear your opinion in the comments section.

PS: There is one hospital in the book that was praised for their mastery of tribal culture: Griffin Hospital in Derby Connecticut. We will try to follow up with an interview of their management to share with you some of their tribal wisdom. Should you have liaisons with their staff, we would be more than happy if you could connect us. Just shoot us an e-mail at

PPS: Check out the shoes in the image – rubber tires. That’s innovation as we like it 🙂

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Franz is an internist with a specialization in cardiology. He co-founded the e-learning company 123sonography and MedCrunch. Franz is Associate Professor for internal medicine at the Medical University of Vienna. In 2001 he did his MPH at Johns Hopkins University as a Fulbright scholar. Follow Franz at @franzwiesbauer.


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