The New Year is traditionally a time to take a good hard look at the future and commit to new or renewed efforts to make important changes. Leadership, too, is about the future – about seeing the future, marshaling supporters, and helping enact new possibilities for organizations or communities. This year, many potential futures stretch out ahead of us in the health care industry. Too many, alas, look dire: out of control spending, overworked providers, Medicare cuts, an obesity epidemic, and a lack of true health information exchange are just a sample of the challenges that 2013 will bring.
Health care presents countless challenges, but it’s also an industry built on the premise that intervention to change the natural course of a disease or accident is possible. It is, in other words, an industry built on the hope that challenges can be overcome. Yet despite health care’s basic tenet to change the natural course of events, it is an industry that is often change-averse. As health care providers struggle to conform, by 2014, to the requirements of the Affordable Care Act, it’s a good time to ask, “What role will I play in creating positive change?”
Given the many deeply entrenched stakeholders involved in any change in health care, and the multitude of intertwined problems the industry faces, it’s natural to feel overwhelmed by the enormity of this question and to ask yourself, “Where do I even start?” Before you lose all hope however, consider three essential leadership tools that you can use to create positive change in your organization:
Envision a compelling future possibility;
Enroll people to help create that future; and
Engage them in the work of making change.
Envision: Creating the future starts with articulating a compelling vision. Inventor and futurist Buckminster Fuller (1895-1983), with whom I worked as an engineer in the early 80s, argued that the best way to get people to embrace change is to develop “a new model that makes the existing model obsolete.” In other words, don’t try to talk people into behaving in a new way; use design (of new processes or products) to make people want to change. For instance, few people had to be convinced to change their habits to use the many appealing features of the iPhone. Concern America, a California-based non-profit founded in 1972, developed an integrated health care model called “Health Promoter Practitioners” that trains community members to be the primary health care providers in their own villages in poor and war-torn countries around the world, places with inadequate or non-existent health care infrastructures.
Concern America’s vision was fairly straight-forward: the solution to a lack of primary care providers was to train more providers. But many problems require entirely new modes of thought. In 1979 Antonio Mendez, chief of the CIA’s worldwide disguise operations in the Office of Technical Services, was asked to come up with a solution for rescuing the six American hostages who had escaped from the militant-overrun U.S. embassy in Tehran. To rescue the hostages he had to abandon the past. “Normally, cover stories were designed to be mundane,” Mendez wrote in the memoir that George Clooney and Ben Affleck made into the hit movie, “Argo.” But this wasn’t a normal situation. “So instead of boring, what if we went in the opposite direction? What if we designed a cover story so fantastic that nobody would believe it was being used for operational purposes?” When past solutions won’t work, it’s just an opportunity to think completely outside the box.
Enroll: Visions go nowhere without followers. To attract people willing to create change, you have to show that you care about them. Communicating that someone is being specifically selected for a project builds intellectual and emotional commitment to the work. In my study of cardiac surgery teams implementing a new technology, a major difference between successful and unsuccessful teams was the belief by non-surgeon team members that they were picked for the effort for a reason—that their skills and interests mattered to the surgeon leading the change. In a recent blog entitled, “To get a commitment, make a commitment,” Jim Dougherty, veteran software CEO and senior lecturer at the MIT Sloan School of Management reminded readers that leadership works by valuing people as individuals more than valuing their accomplishments:
“The highest motivation for team members is to get that kind of emotional connection to the team leader…If you want to get an emotional commitment from the people who work for you, or with you…you need to be willing to commit to them too…. You can think strategically about how to do this, so you’re ready when opportunity presents itself … But you can’t force it, or fake it. If you do something purely for [selfish reasons], it will show and you will likely fail.”
Mendez, similarly, realized that he needed the six hostages to trust him and to participate wholeheartedly in the scheme he devised to get them home, in which they would stage a Hollywood movie complete with script, publicity and “actors.” Mendez (the leader) brought to the hostages (his de facto team) “a cover [story]… to engage them, get them to believe… and to become willing participants. Pretending to be someone you are not isn’t as easy as it sounds,” he wrote, “especially if your life depends on it” (Mendez (2012) Argo, p. 157,). Although the hostages ranged from skeptical to downright dismissive at first, Mendez’s straightforward honesty and competence earned their trust and soon became fully engaged in making the outlandish idea work.
Engage: A major barrier to engaging in the work of change is people’s natural reluctance to take action without a solid plan. Yet, implementing change in today’s complex organizations increasingly requires what I call execution-as-learning – making progress by learning as you go—and accepting that everything won’t work perfectly the first time. When Chief Operating Officer Julie Morath wanted to create major change at Children’s Hospital of Minnesota, she engaged people by inviting them to figure out how to make things safer in the units in which they worked. Her vision of 100% patient safety could not be achieved through a uniform roll-out approach, but rather by inviting people at the front lines of patient care to solve problems and improve processes themselves, across very different service lines.
What do Tony Mendez, Kenneth C. Frazier, and Julie Morath, have in common? Courage, inventiveness, and skillful use of the three E’s discussed here. It may indeed seem, these days, as if our lives depended on leadership to bring about visionary change, the kind of change that can make small molehills out of apparently large fiscal cliffs; rescue six hostages in plain sight, or find revolutionary approaches to transforming an over stressed health care system. It’s a tall order, and it’s getting taller. Every day, there’s fresh proof that we are up to the challenge. “We are called to be architects of the future,” Fuller once said, “not its victims.” Make a resolution that in 2013 you will be an architect of positive change, that you will envision, enroll and engage a solution to even the smallest of health care problems.
The Gauntlet Before Health Care Leaders is to Eliminate Unnecessary Care
By William Chin, MD
Who better to achieve higher quality outcomes and reduce the waste in care than the physicians leading this process? If we are the best people to do this, then let's start. Or, we need to stand aside and stop lamenting the change happening around us. Read more
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