To build leaders, give them 'permission to throw rocks'

By Michael Canady, M.D. | September 6, 2018


No one is born with all the skills necessary to manage and lead, and healthcare leadership is no exception.

All physicians are leaders. However, sometimes physicians find themselves in positions of formal leadership without necessarily planning to be there. They need to be supported and nurtured to grow as leaders. They need to be given the opportunity to develop skills, and the trust and latitude to apply those skills.

As CEO of Holzer Health System, a 160-provider organization in Southeastern Ohio, one of my goals is to create a culture that enables the next generation of leaders to develop the skills that they need in order to lead better than they have been led.

Here are a few strategies I've deployed along the way that have helped us develop that culture. Feel free to add your contributions to the comments section below or tweet your views @athenahealth.

Develop leadership skills with intention

In addition to standard management training, we hold quarterly, all-day off-site leadership sessions for all of our managers, medical directors and members of the leadership team. We bring in outside professional experts to lead these sessions, each one delving into a different leadership topic like change management, effective presentations, or communication strategies.

Each month we also have a one- to two-hour manager's meeting. One of my favorite things to do in this particular forum is what I refer to as "Larry King Live." This is a technique that I learned from Kevin O'Connor, a faculty member of the American Association for Physician Leadership. I bring one executive onstage and with no preparation on either side, do a 30-minute in-depth interview about who they are and what led to their current career choice. We always talk about what led them to Holzer; other than that, I take the conversation wherever it goes.

In the end, 150 people know the executive better and feel that they have a relationship with that individual. You cannot be a great leader without building great relationships.

Additionally, all of our senior executives work with an executive coach, both one-on-one and as a group. The goal is to build teamwork, but also to build real relationships and trust.

Give people permission to do the right thing

When I was in the Navy 25 years ago, I had a commanding officer who came on board and observed for a couple of weeks. He called the team together and said, “I've walked around and watched you guys, and it seems like you know what you're doing and how to do it. Proceed until apprehended."

It was a phrase I have never forgotten, and I used it when I met with our team for the first time as CEO. In fact, I've used this approach my whole career. My expectation is that people have the skill set to make the right decision at the point of contact – where it needs to be made – and they don't need to ask for permission to do the right thing. We can tolerate honest mistakes.

I also employ an "eyes-on, hands-off" philosophy of leadership. Leaders and managers need to know what's going on, and they need to set direction, but they should not be involved in the weeds of getting a job done. They need to trust their people to take responsibility and then hold them accountable.

Often, we think we need to receive trust before giving it. It's just the opposite. You can't gain trust unless you give it first. That gives people the freedom to do their best work.

Encourage constructive conflict

A friend of mine told me a story about his son and a summer internship at a local bank. He noticed that one individual who always questioned everything – every idea, every proposal, every comment. Eventually, he said, “What's the deal with that guy? He throws a monkey wrench into every idea." The leader said, “That's his job, he's my 'No Man.' If we can't defend our decisions internally, we can't defend them to the outside world."

At Holzer, I have made a couple of people on my executive team my "No People." One of their responsibilities is to question everything, throw rocks at every idea, and every other leader in the room knows it. This often creates “constructive conflict," but the end result is that we make better decisions with more individual involvement. This type of constructive conflict can help avoid groupthink.

Our leadership team models the kind of culture we desire. People must feel free to express their opinions, even when they know they might not be popular. I want to give everyone permission to speak freely. I encourage people to challenge each other candidly, but always with respect. Ironically, it is this constructive conflict that leads to a culture of openness and trust.

Two years ago, we were not doing very well financially, and our physician engagement scores were very low. Today we are far more secure financially, and our scores for physician engagement and alignment rose from single digits to the 26th and 49th percentile, respectively. We haven't changed our core management team at all – we've made a significant turnaround, not by bringing in new people, but by intentionally nurturing a culture where our own employees can do the right thing.

Change the tone in the room

You can feel the difference. One of the most dramatic examples is the manager's meeting. Two years ago there was almost silence when I walked into the room. Now, the atmosphere is very animated. Everyone is talking to each other and networking, which is healthy and productive.

I recently read an article and the leader said, “I'll know I'm successful if I go on vacation and nobody knows I'm gone." That could be a great goal for all leaders.

Michael R. Canady, M.D., MBA, CPE, FACS, is CEO of Holzer Health System in Gallipolis, Ohio.

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