KCH physician authors leadership playbook from the Pentagon’s best

LEXINGTON, Ky. (Aug. 8, 2025) – When R. Thomas Collins, II, M.D., started down the path of leadership development, he wanted to learn all he could from the best leaders in the world. While earning his master’s degree in leadership from The Citadel and enrolled in a Ph.D in educational leadership from the University of Kentucky College of Education, he has read more than 350 books on the topic of leadership. But for all the wisdom and enlightenment amassed during his research, there was a void — the absence of insight from the leaders he admired most.

“The book I wanted to read was the leadership of four-star generals,” said Collins, a veteran of the Air National Guard with a lifelong interest in the military. “I imagined this book would be a Swiss army knife of leadership books that would help people survive from a leadership standpoint. That book did not exist.”

Collins knows a thing or two about leadership. As the vice chair of faculty and academic affairs in the UK College of Medicine Department of Pediatrics, he guides approximately 200 faculty members through academic and professional development. In addition to his clinical role in Kentucky Children’s Hospital as a pediatric cardiologist, he works as an executive leadership coach and hosts a podcast called “The Science of Leadership.” As an expert in the field, he’s well-suited to fill the void in leadership literature.

Collins began his research while in a clinical and leadership role at Stanford University and was able to contact several generals through the university’s Hoover Institute. The first general to agree to an interview was former Secretary of Defense and retired Marine Corps Gen. James Mattis. From there, he asked each general or admiral he interviewed to introduce him to five more. Collins’ goal of 50 interviews, which initially seemed out of reach, was quickly coming to fruition.

“There have only been something like 900 four-star generals and admirals in the history of the United States,” said Collins. “There are approximately 250 living. So, the idea that I was going to interview 20% of the living four-star generals and admirals is something nobody else has come remotely close to. And I did it in nine-and-a-half months.”

Approaching it as a research study, he asked each of his subjects the same four questions:

• What are the three most important leadership lessons you learned across your career?
• What was a leadership lesson you learned the hard way?
• How do you want to be remembered as a leader?
• What are five leadership maxims you always try to keep in mind?

The result of hundreds of hours of interviews, 385,000 words transcribed from 51 high ranking military officers with a combined 2,000 years of experience was “The Four Stars of Leadership: Scientifically-Derived Principles from the Experiences of America’s Highest-Ranking Leaders.” While the stories and experiences of each of his subjects varied greatly, Collins noted four recurring themes in each of the interviews, common principles demonstrated by truly effective leaders: character, competence, caring and communication — the four C’s.

Some of those themes presented themselves overtly in the interviews. During a conversation with Les Lyles, the retired Air Force general stated the three most important leadership lessons were to “communicate, communicate, communicate.” For Tony Zinni, retired United States Marine Corps general and a former commander-in-chief of the U.S. Central Command, competence is the most important trait; no one will follow you if don’t know what you’re doing.

But the other two traits emerged in a more subtle way, through the stories told by the generals. Charles Krulak, a retired United States Marine Corps general and former commandant of the Marine Corps, spoke of the importance of character. Every Christmas while he was commandant, he and his wife delivered homemade cookies to every Marine on duty in the Washington, D.C. area. On a stop at the control center in Quantico, Krulak asked the sergeant on duty who the officer of the day was. The sergeant replied that the officer was none other than Gen. Mattis. Thinking the sergeant misunderstood the question, Krulak asked again, and was told, again, that the officer of the day was Gen. Mattis, former Secretary of Defense. Just as Krulak, frustrated by the perceived miscommunication, asked again, Gen. Mattis appeared, dressed in his Marine Corps best with his sabre at his side. He told a baffled Krulak that he had taken the overnight shift so a young Marine captain could be home with his family. And this story showcased the other two principles of leadership: character and caring.

Collins said there are countless stories like these in his hours of recordings, demonstrations that at the end of the day, the most lauded and celebrated leaders are humans, trying their best to guide and shape those in their charge.

“The core principles are interconnected,” he said. “If you don’t care about people, people won’t care about your mission. You may be the person of the greatest character, and you may have immense competence. You may care about people, but if you can’t communicate successfully, they won’t know it and they won’t follow you. These principles all hinge on each other.”

The lessons in his book aren’t just applicable to people in the military or leadership positions. Communicating effectively and clearly, having a solid knowledge base and demonstrating compassion and respect are the core pillars necessary to build both personal and professional relationships.

“This isn’t just leadership, it’s about life,” Collins said. “There’s not a human situation where the four C’s don’t come into play.

Learn more about the Four Stars of Leadership.