Stephen Covey and medical leadership part 2: Begin with the end in mind

The_7_Habits_of_Highly_Effective_PeopleRecently we published the first of a new series looking at the lessons we can learn in medicine from Stephen Covey’s legendary book ‘The Seven Habits of Highly Effective People’.  A lot of this is relevant to our everyday lives as well as our careers, and you definitely don’t need to have an interest in medical leadership for this book to really change your outlook on life.  In Part 2, we’ll look at Stephen Covey’s second habit: ‘begin with the end in mind’. I’ll talk about what I learned from this and how it relates to Medicine.

[DDET What does it mean to ‘begin with the end in mind’?]

When you read this I guess it’s unlikely that you’re actually at the ‘beginning’ of something like a new job or taking on a new responsibility.  That doesn’t matter.  The beginning is right now.  Because, starting from right now, we should all really know what we’re trying to achieve in our careers or our lives.  How often do you really think about that?  I don’t mean making general career choices like what to specialise in; and I don’t mean general feelings like ‘I just want to be good at what I do’.  This is about asking: what do you really want to achieve in life, no matter what happens?  What do you want people to say about your career at your retirement party?  And why?

In the book, Stephen Covey gets a bit deep and asks what people might say about us when we’ve died.  What’s most important?

“One man asked another in the death of a mutual friend, ‘How much did he leave?’ His friend responded, ‘He left it all'”.
– Stephen Covey

When we’re rushing through the daily grind and competing against each other to climb up the greasy career pole, it’s worth stopping to think about things like that now and then.


[DDET How do we set about achieving the ‘end’ we have in mind?]

If we’re going to get to the ‘end’ that we have in mind, we have to ask what we’re doing right now that’s really helping us to get there, and what we’re doing that’s actually just irrelevant.  It’s very easy for us to be very busy doing lots of things that really don’t help us to get to where we really want to be.  I’m sure that most of us are pretty familiar with that.  We take on jobs and roles that seem like a good thing to do at the time.  It could be taking on extra clinical hours or accepting an extra teaching commitment.  When you relate them to what you actually want to achieve in your career, do they really help you to get to that or are they just distractions?  If the latter, are they actually taking you in a totally different direction than the one that you want to head in?

Obviously, we should be asking why we’re doing that!  Is it for money? (Is that the ‘end’?). Is it for esteem, career progression, something else?  And does any of that really matter or is there something higher that you really should be aiming for?

Here’s where this 2nd habit links with the first. To ‘begin with the end in mind’, we also have to be proactive, take difficult decisions and shape ourselves into what we want to be:

“We are either the .. creation of our own proactive design, or we are the .. creation of other people’s agendas, of circumstances, or of past habits”.
– Stephen Covey

Bird Over Sunset by Scorsagra
Bird Over Sunset by Scorsagra

Can that explain a lot of what’s in own job plans, and even our own lives?  If so, what are we going to do about it?! There’s little point in moaning about the things we can’t change (our Circle of Concern). We should be concerned with what we can change (our Circle of Influence) in order to point our lives in the right direction.  There may be many things about your current situation that you find frustrating.  (I bet you can’t name one doctor who doesn’t!)  But Stephen Covey advises us to focus on the things we can do to sort that out – not on the things that are outside our control. [/DDET]

[DDET So can you actually write down what the ‘end’ is that you have in mind?]

This is really worth thinking about. Do you know what you want to achieve in life? Are you just taking it one step at a time?  Are you making yourself a victim of circumstance? Or are you really controlling the way that your life goes?

In ‘The Seven Habits’, Stephen Covey asks readers to do something that might sound a bit warm and fluffy – to write a personal mission statement. You might not like this idea.  But why not give it a try?  I found it really hard, but that was probably because I hadn’t actually thought about what I wanted to achieve in any detail.  Are you the same?  Does that worry you?!  Perhaps it should.  If you don’t know what success looks like, how will you ever achieve it?

Manchester EMERGING (Emergency & Intensive Care Research Group)

I learned something really important here.  (You have to read the book to really get it).  Writing down what you really want to achieve helps you to focus on what’s actually important.  So, when I started leading our research group (EMERGING), we wrote a mission statement together.  Here it is…

“Our mission is to continuously strive to improve standards of emergency and intensive care. We aim to produce world-leading, patient-centred research that will promote effective and efficient clinical decision making and optimise the wellbeing of service users, and to provide outstanding training for future generations of clinicians and researchers”.

We have this pinned to the front door of our office and on every newsletter.  It’s pretty simple and some people might say it’s obvious, but I hope it helps to shape the culture within our team and to let everyone know what it is we’re really trying to achieve.  The idea is that we should go back to it every time a new opportunity or new study comes along.  Before we can decide whether to take on a new study we have to ask: does this help us to achieve what set out to? And if not, then why are we doing it?

Lots of people dismiss the idea of a mission statement and can’t see what it really changes. Why not give it a try? Don’t just write it for the sake of it. Write it because you mean it – and involve everyone in the process. What’s to lose? It may just help you to achieve the ‘end’ you’re striving for.


[DDET What should the ‘end’ be?]

Lastly, this book made me think about what’s really at the centre of my list of priorities, and what really ought to be there.  In this book Stephen Covey points out (in a very clever way – again, you have to read the book to really get it) how stupid it is to put things like money, possessions, pleasure, work or even family at the centre of your life.  If any of these (by themselves) is what you put first before anything else (yes, even family) then you can end up having difficulties.  It’s true – what if someone in your family does something that’s not right, that hurts you or someone else?  As an alternative, how about putting principles at the centre?

Principles are timeless. They tell you what’s right and what’s wrong. They don’t change with time, circumstances, moods. And putting principles at the centre of your life will always help you to strike the right balance between the conflicting demands on your time and the tricky decisions that we have in life.

If you’re working in the ED at 18:45 and you finished duty at 18:00 but another patient is brought to Resus on a particularly busy day, do you stay? What if your other half has organised a night out? Your son or daughter has a school play? There are loads of considerations.  If your centre is work or family you’ll give a predictable answer.  But if your life is centred on principles, won’t you make an even better, more reasoned decision about what’s the best thing to do?  And nobody can argue with your decisions if you can show that they’re based on a good set of principles.

If you’re a leader at work, it’s equally important to make your team, your department or your organisation principle-centred and to live up to that yourself.  Everyone wants to work for a boss with principles. It’s motivating. We would all hate to work for a boss who lacks them. How can you even trust them? What’s more, if a leader is principle-centred, her/his staff are likely to be so too. If she/he isn’t, what kind of message does that send to the staff about how to behave?

“Integrity is not a state, it’s a destination”

– Joe Lex (@joelex5)

Joe Lex visits Virchester
Joe Lex visits Virchester


[DDET So what’s the bottom line here?]

I hope that you’ll take three important things away from reading this blog post:

First, I hope it makes you think about where you’re going in life and what you might do to make sure that you achieve what you really want to.

Second, I hope it makes you reflect on the importance of being principle-centred and causes you to ask whether you already are principle-centred or if you could do more to be so.

And third, I hope it makes you go out and buy Stephen Covey’s ‘7 Habits’! I have no shares in it – no vested interest. But reading the book will give you so much more than just reading my rambling reflections!


If you liked this you might also like:

Leadership pearls from Stephen Covey part 1: Be proactive

Am I intimidating?  Sarah Payne guest blogs at St. Emlyn’s

Are you a good trauma team leader?

Sir Alex Ferguson and Emergency Medicine

Teamwork in Resus – just like football?


Cite this article as: Rick Body, "Stephen Covey and medical leadership part 2: Begin with the end in mind," in St.Emlyn's, June 12, 2014,

2 thoughts on “Stephen Covey and medical leadership part 2: Begin with the end in mind”

  1. Pingback: Be a Better Learner - Part One at #TTCNYC15 - St.Emlyn's

  2. Pingback: The seven habits of highly effective people: Eigenschap #2: Begin met het einde voor ogen | fan of EM

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