As we all develop as leaders, it is worth noting that several of our leadership skills tie back to a subject many of us did not like as kids – mathematics!


Maulik Joshi, DrPH – President and CEO, Meritus Health

Adjunct Faculty, University of Michigan School of Public Health Department of Health Management and Policy

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The Mathematics Behind Successful Leadership

As we all develop as leaders, it is worth noting that several of our leadership skills tie back to a subject many of us did not like as kids – mathematics! An article about math and leadership may lead many of you to move on to something more exciting, but for those who are ready to entertain the idea, you might find this interesting; even though it is the opinion of someone who didn’t do much with their college math degree.

These observations are not based on any hard-core research that may have included quantitative analysis and hundreds of interviews of leaders and findings grouped or correlated with organizational performance. I can’t demonstrate that leaders with great division skills were associated with organizations that had superior results, let alone could show a change from before and after performance. This does not include that level of science as a foundation for this thought. That said, not many leadership frameworks or models do have that level of rigor. Which is not to say they are not useful – rather it shows how hard it is to gather solid, conclusive evidence in the real world.

A final bit of context before I begin – these are not to be considered the only or most important skills of leadership. There are hundreds of better articles that articulate leaders with a focus on purpose and people, and many other talents as a more comprehensive leadership skillset. I propose this as another rubric to consider as we all strive for improvement and another opportunity to identify specific leadership attributes to develop.


Adders are leaders who excel in adding to existing programs and services. They can take a program and service and easily expand it. If an adder is running a physician practice operating one location, they can figure out how to add another physician to the practice in terms of space and workflow. If they need to see five more patients into a full scheduled day, they will find the means to do so. If you need to provide a service that you haven’t provided before (like vaccinations for COVID-19 or monoclonal antibody therapy for newly diagnosed COVID-19 patients), adders will mobilize the team to add to the current service offerings. Adders are gifted with the ability to manage increased need within a relatively fixed resource.


Subtractors are leaders who can reduce resources to meet changing demands. In instances where scheduled surgery cases in the operating room are 30% less on a Friday before the holiday, subtractors reduce staffing to match demand. If fewer home health patients are scheduled, subtractors call off staff for that day. It is not an easy task to reduce resources since most resources are people, but subtractors are able to reduce resources appropriately to stay efficient without impacting quality. In doing so, they also minimize financial losses associated with wasteful spending.


Multipliers are proficient in scaling and growing programs and services – they are the go-to leaders when you need to multiply your offerings. If the lab needs to grow and needs to provide three more lab draw sites for patients in the community, multipliers will identify the needed resources and efficiently expand resources. Multipliers possess a level of entrepreneurial dexterity to not just add to exiting resources, but to identify and implement additional resources for multiple sites. Multipliers identify and implement the inputs to go from one (site, location or program) to many.


Division is perhaps the most dreaded math function; and for leadership, it is a more challenging expertise. Dividers are constantly focused on efficiency and productivity. They are the best at managing budgets and resources across a portfolio of services, products and programs. Dividers analyze ratios and productivity to see how many people can be seen well across the whole scope with the fewest resources. For a multi-site, multi-modality radiology practice, dividers are best able to identify the best hours for each site and each modality based on demand and resources. Dividers will increase all the supply to meet changing demand, while staying efficient. If you over see multiple patient care units, dividers will ensure the appropriate staffing ratios for all patients across all units, based on patient needs and specialized skill sets. Dividers will also objectively analyze programs and services that may need to be stopped. In all organizations, it is a difficult task to close, shut down or stop a program or service and admit it did not work. Dividers can be honest and harvest the learnings from failure to improve in other ways and areas.

Great Leaders are Adders, Subtractors, Multipliers and Dividers

These skills are purposeful in their order I believe there are fewer leaders with the specific proficiency as you move from adders to subtractors to multipliers to dividers. There are specific leadership skills that are most evident in each of these math functions. The table below identifies the focus and the specific skills each leader needs for each math function.

joshi leadership skills white background

The reality is that great leaders work continuously to get better all the time across multiple attributes. However, I would suggest that those who continue to get better as adders, subtractors, multipliers and dividers will be better managers and leaders.    

One can suggest that these are more management skills than leadership skills. While that is a fair point, I would propose you cannot be a great leader without strong management capability and these math related skills are essential to that point.  

The pandemic has perhaps heightened the need to develop our evolving math-like leadership skills. Healthcare is grossly inefficient, and we must better manage our resources for the people we serve. Improving our leadership abilities to be better adders, subtractors, multipliers and dividers will be important in this journey for leaders to be mathematicians. 

Maulik Joshi, DrPH

President and CEO, Meritus Health
Adjunct Faculty, University of Michigan School of Public Health Department of Health Management and Policy

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