Leading Humbly in a Hierarchical World
“We have had three other foreigners in this position to help us improve quality, but what has been lacking is leadership. We think you can help us. Can you start tomorrow?”
I was honored to be offered a high nursing leadership position in an up-and-coming hospital in Nouakchott. The hospital owners aspire to provide the highest quality of care in Mauritania. Yet despite internationally trained doctors and capable nurse managers, the nursing care remains mediocre at best. The hospital, still less than three years old, faces cultural challenges that are deeply ingrained within the nursing staff. Like many organizations, their solution has been to bring in outside leaders. If I accept this challenge, I would be the fourth person in this role in just a few years. The difficulties my predecessors faced, entrenched habits, team dysfunction, and cultural barriers, are still very present. How does one disrupt such a cycle?
In Humble Leadership: The Power of Relationships, Openness, and Trust, Edgar and Peter Schein propose a different path. They suggest that what is needed is not another leadership theory, but a foundational approach that undergirds all others. [1] Humble Leadership is a relational process of cultivating transformation and new direction through deep, trusting relationships. [2]
This concept immediately resonated with my own long-standing struggle. In my twelve years in Mauritania, I have continually wrestled with a fundamental question: how can one be a humble leader in a culture where humility is perceived as weakness, vulnerability is seen as a handicap, and trust is virtually nonexistent?
Reading Schein and Schein’s work reminded me of this tension once again. They argue that “leadership is always a relationship, and truly successful leadership thrives in a substrate of high openness and high trust.”[3] I agree. Management prioritizes results; leadership is relational. Relationships, however, cannot exist without trust. Patrick Lencioni, in The Five Dysfunctions of a Team: A Leadership Fable, identifies the absence of trust as the ultimate foundation of team demise. [4] Trust is essential to individual relationships, effective teams, and organizational innovation.
Over the past three weeks, I have been writing a counterproposal for the hospital. Building trust with both the hospital leadership and the nursing staff has been central to this process. Rather than accepting a traditional managerial position, I am proposing to serve as a coach—guiding the staff through leadership development and quality improvement. My greatest question, however, remains whether I can build trust and inspire change without defaulting to the traditional Mauritanian model of transactional, hierarchical leadership.
The book Humble Leadership came at a pivotal time in my leadership journey. Chapter 4 resonated with me in its account of the navy captain who embodied humble leadership within a highly hierarchical framework. His example demonstrates that even in settings defined by position and authority, leadership practiced through humility can thrive. The captain’s approach directly addresses the five dysfunctions of teams. Lencioni identifies these as: absence of trust, fear of conflict, lack of commitment, avoidance of accountability, and inattention to results.[5] In reflections that follow, I pair these two frameworks together as specific practices I intend to adopt in my new role.
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- Build trust through asking questions.[6] Questioning rather than directing fosters vulnerability, values individual perspectives, and dismantles distrust between leader and follower.
- Invite staff to identify needed changes.[7]Encouraging input motivates the team to speak up and address conflict directly, rather than avoiding it.
- Encourage staff to propose solutions.[8] Contributing solutions demonstrates trust, reduces unhealthy conflict, and strengthens ownership and commitment.
- Empower implementation.[9] When staff feel empowered to act, they assume responsibility and accountability for change.
- Sustain effort with patience and resolve.[10] Lasting results are not immediate, but they are possible even within hierarchical systems when pursued with persistence and steadfast resolve.
Humble Leadership has encouraged me that meaningful change is possible even within a hierarchical system such as the Mauritanian medical context. Returning to my guiding question—how one can be a humble leader in a culture where humility is perceived as weakness, vulnerability as a handicap, and trust as virtually nonexistent—I recognize that some of the answers lie in the practices outlined above. Yet the journey begins not with strategy alone, but with trust and obedience, as I submit my own pride and rest in God’s will and plan.
This new leadership role stirs both anticipation and fear. The call to build deep, vulnerable relationships ultimately points beyond human technique to the deeper relationship the hospital staff most needs: a relationship with the Humble Servant Leader, Jesus. As I walk this journey, I want to remember this truth:
“Jesus’ humanity restores our humanity. Jesus’ humility restores our humility.”[11]
[1]Edgar H. Schein and Peter A. Schein, Humble Leadership: The Power of Relationships, Openness, and Trust, 2nd ed. (Berrett-Koehler Publishers, 2023), 4.
[2] Schein and Schein, Humble Leadership, 156.
[3] Schein and Schein, Humble Leadership, ix.
[4] Patrick Lencioni, The Five Dysfunctions of a Team: Leadership Fable (Jossey-Bass, 2002) 188.
[5] Lencioni, The Five Dysfunctions of a Team, 188.
[6] Schein and Schein, Humble Leadership, 55.
[7] Schein and Schein, Humble Leadership, 56.
[8] Schein and Schein, Humble Leadership, 57.
[9] Schein and Schein, Humble Leadership, 58.
[10] Schein and Schein, Humble Leadership, 58.
[11] Hannah Anderson, Humble Roots: How Humility Grounds and Nourishes Your Soul (Moody Publishers, 2016), 75.
About the Author
Kari
Kari is a passionate follower of Jesus. Her journey with Him currently has her living in the Sahara in North Africa. With over a decade of experience as a family nurse practitioner and living cross-culturally, she enjoys being a champion for others. She combines her cross-cultural experience, her health care profession, and her skills in coaching to encourage holistic health and growth. She desires to see each person she encounters walk in fullness of joy, fulfilling their God-designed purpose. “Rejoice in hope, be patient in tribulation, be constant in prayer.” Romans 12:12 ESV14 responses to “Leading Humbly in a Hierarchical World”
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Hi Kari, hope you had an enjoyable birthday week.
Thank you for sharing such a rich and vulnerable reflection. Your post reflected leadership theory, cultural discovery, and spiritual conviction.
How can humble leadership practices—such as asking questions, inviting input, and empowering implementation—be adapted to cultures where vulnerability is misunderstood and hierarchical norms dominate?
Thank you, Shela. I had a great week and have a final birthday celebration on Saturday morning!
That’s a great question, and I would love to hear your answer to it, too! Being consistent in implementing humble leadership, even in the midst of challenges in these cultures, is vital. It will probably mean counting the small victories and continuing to aim for the ultimate goal. These are things I’ve learned to do: Keep asking questions. Start small when modeling vulnerability; share one small thing at a time. Let them know they are seen and valued as a person.
Wow Kari way to go! I appreciate your post so much and the hospital would be lucky to have you!
What would be some questions you would ask if you were to take on the role? How do those reflect then principles of Humble Leadership?
Thank you, Ryan. I have had the opportunity to shadow various departments at the hospital since my interview. From day one, I started asking questions: What do you love about your job, what do you do well, what would you change if you could, what do you wish was different, etc. That staff was very receptive to these questions. I think they felt like they were part of the solution and perhaps even something new.
Kari,
I just want to commend you for not simply taking the position right away but instead offering a counter proposal, which shows care and discernment, making you the person needed for the role (or a role.)
What criteria might you be setting in place for accepting or not accepting a position?
Thanks, Adam. These are some things I’m still wrestling with. A major criterion is whether they will consider my request for additional staff on the hospital floors. The current staffing is so tight that there is no margin whatsoever for change or improvement because they are stretched too thin. Another one is if I can help direct changes on staff input and not just what leadership thinks must happen. Lastly, I believe communication is key to building level 2 relationships and I want to have the freedom and support to have regular meetings with teams and individuals.
Kari, I can’t believe you’ve been in Mauritania for so long! Amazing!
I love your idea, your counter proposal. I’m wondering, how do you plan to measure the success of your coaching-based approach compared to the previous transactional leadership models?
Hi Debbie, First of all, if they accept my counterproposal, that is a win! It is very counter-cultural, but I think it is deeply needed. I also plan to measure success based on the five bullet points above: do they share when asked questions, are needs being addressed, what solutions are being offered, are solution initiatives happening within the team, and what micro-results are we seeing along the way.
Kari, you will be a great influence in that place for however long God has you there.
I do wonder how power-distance norms in that culture would adapt to a coach model. What strategies will you employ to address these if or when people resist a different approach?
Thanks, Graham. The power-distance norms are one of the biggest challenges I have faced when using a coaching approach here. One strategy will be to be flexible and adjust as needed. Another approach will be to find a middle ground between a hierarchical approach and a coaching approach, gradually moving closer to the coaching side as the relationship grows. I also plan to address and name the power dynamics upfront and when they seem to be causing a divide.
Kari,
Twelve Years? You must have started there when you were 16. What an honor to be asked to serve in that position, yet so much responsibility. You are definitely approaching this with an appropriate mindset. I really like your counter proposal, the idea of coming alongside as a coach in that culture seems appropriate.
Obviously within that organization there is the existing Mauritanian culture where you, even after twelve years, can probably still be seen as an outsider. I am wondering what other cultures exist within the hospital setting that might hinder your role. For example, how do others view your education/position as a nurse? Will there be people who won’t take you seriously because you are “just a nurse” or because you are female?
Jeff, you are too kind! I just had a birthday that was harder than I expected, so thank you.
You are very astute to recognize the various cultures I face. There are probably more that I am not even aware of, but here are a few. Doctor/Nurse, Male/Female, Young/Old, Mauritanian/Foreigner. As an educated, foreign female, I face both barriers and exceptions to cultural norms that can be to my advantage as well. My biggest challenge that I foresee is working with the two male head nurses. There are multiple things at play with those dynamics. Hopefully, with time, trust can be built to overcome those challenges.
Hi Kari, as I read your post, the first thing that stood out to me was that you are personally looking at things from a different perspective. It indicates that you are willing to do what you will be asking the nursing staff to do. I also appreciate that you are already exploring tangible ways to support the hospital by requesting additional staff. Again, the staff could see you going to bat for them. How do you think the staff might respond to being empowered (Lencioni)when it could be a foreign concept to them?
Kari – I love your post, and you are wrestling with some of the same questions I have been wrestling with!
I think humble leadership, as defined in the book, can work really well in western contexts, but there are additional challenges in cultures where humility is interpreted as weakness or incompetence. I love the counterproposal you’re making. I am praying for you to be able to find a good way forward that improves the medical care while also raising up a generation of national leaders. Please keep us posted on this!