Health Care - From Good to Great?

I started writing this particular blog entry while waiting in the Denver International Airport for my flight home to Edmonton.  I had just completed class work for my LEAN certification with BMGI.  The time away from home allowed me to gain valuable training to complement my experience with LEAN implementation.  It also afforded me the opportunity to attend to other matters and interests - like re-reading books and synthesizing the learning into something relevant for myself and my consulting practice.

One author, researcher and speaker that I have thoroughly enjoyed and whose work has really resonated with me over the years is Jim Collins. It's amazing to think that Built to Last was first published in 1994 - almost 20 years ago.  Since then Collins has gone on to release well-researched and thoughtful studies on organizations and published those findings in Good to Great, Good to Great and the Social Sectors, How the Mighty Fall, and Great by Choice.  There are many results and lessons worthy of comment, but given the nature of my blog I want to focus on Collins' concept of Level 5 Leadership.  Collins started to build the base for this concept in Built to Last but articulated it more coherently and forcefully in Good to Great.

As Collins attests to in Good to Great he was initially highly resistant to recognizing and identifying leadership as a distinguishing factor between good and great companies.  He believed that the perspective put forth by his research team in the initial phases of their research leading to a conclusion that leadership distinguished good from great companies was too easy an answer.  He was concerned that he and his team not fall into a trap of just crediting the leader or blaming the leader with company success or failure.  He wanted his team to dig deeper to achieve a better understanding of key differences between the comparison companies.  Eventually, however, he was persuaded by the data his research team collected.  There was a difference in the style of leadership between the good-to-great and the comparison companies. 

Ultimately Collins and his team established a hierarchy of leadership which is represented here in simplified graphical form.  As you view this hierarchy, consider where you as a leader fit in and/or where those around you fit in.  In addition, start to consider what we hope for in leadership for our health care system today and what style of leadership we believe will truly transform our system to better meet the challenges we face.

Collins and his team were surprised to discover that the leaders of the good-to-great companies were not anything at all like what one would have expected from popular portrayal.  These leaders were not larger-than-life, bombastic, or constantly in search of the spotlight.  Rather, Collins and his team found the good-to-great leaders to be "...self-effacing individuals who displayed the fierce resolve to do whatever needed to be done to make the company great." (italics represent my emphasis).  The research team observed that the Level 5 Leaders possessed a blend of extreme personal humility and intense professional will.  Collins was at pains to assure us that it wasn't that Level 5 Leaders didn't have egos or self-interest.  They were incredibly ambitious leaders but channeled that ambition towards the creation of a great - and sustained - company, and not towards personal gain.

Collins and his team identified some extraordinary examples of Level 5 Leaders in action - one CEO giving up $5 million of a $20 million retirement package that he was contractually entitled to (and not due to any organizational or public pressure to do so); CEO's unwilling to take credit for organizational success and deferring to team accomplishment instead; CEO's determined and focused on developing the next generation of leaders and their personal successor(s) so that they could step aside and ensure the success of the company beyond their tenure.  In contrast, comparison company CEO's were identified as being very much larger than life, possessed of tremendous drive tied to personal success or gain, able to achieve great success for the company in the short-term, but not able to sustain those gains or successes past their particular tenure. Nor were such leaders particularly interested in developing their successors - they needed to be the unquestioned "big dog". 

Equally interesting, Collins' team found no support for the idea that a company had to recruit from the outside in order to move it from good to great status.  In fact, the evidence collected pointed in the opposite direction - there was a negative correlation in any sustained transformation from good to great.  Those leaders who were "raised" from inside the organization were more committed to the long-term values of the organization and were ultimately the most passionate about the long-term success of the organization even at the expense of their own personal gain or recognition.  In both Built to Last and Good to Great there was strong empirical support for growing leaders from within the company and ensuring continuity of quality leadership. Contrast that recommendation with the reality of constant turnover in too many of our organizations.

Finally, Collins identified Level 5 Leaders as having a markedly different perspective on success and failure - personally and organizationally.  He described this as the window and the mirror.  Collins and his team consistently saw Level 5 Leaders attribute success of the organization to factors other than themselves and in particular often credited their teams with achievements of the company.  By contrast, they were quick to take responsibility for the lack of success and identify learning opportunities to guide future efforts.  They did not blame others or circumstances for that failure.  Comparison company leaders displayed mirror opposite behaviours - quick to take personal credit and apportion blame away as required to maintain personal standing. 

As readers of my blog will likely already know from my entries, I am quite biased in favour of the conclusions reached by Collins and his research team.  I aspire to be a Level 5 Leader and most certainly hope to work with Level 5 Leaders as part of any team.  One of the conundrums that Collins leaves his readers with is why we see so few Level 5 Leaders at the head of companies.  Collins' take on this reality in the business world is that personal ambition often drives people to positions of power but it is this same ambition that stands at odds with the humility required for Level 5 Leadership and long-term success (and transformation) of an organization.  He further suggests that boards of directors compound this situation by looking for, recruiting and rewarding larger-than-life leaders to move their organizations from good to great.  Long-term success and a movement from good to great requires a change in the processes by which leaders are recruited, selected and sustained - and there has to be a commitment to a long-term agenda with stability for the leadership group.

I am interested in hearing your thoughts on Level 5 Leadership and its application to health care or in general.  I want to learn from you and I hope a conversation will help all of us advance our organizations to greater success and each of us to greater personal satisfaction.  Thanks again for reading.
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Greg Hadubiak, MHSA, FACHE, CEC, PCC
TEC Canada Chair/Executive Coach/Senior Consultant
hadubiak@wmc.ca

Helping leaders realize their strengths and enabling organizations to achieve their potential through the application of my leadership experience and coaching skills. I act as a point of leverage for my clients. I AM their Force Multiplier.

Leaders need...Leaders!

Initially, my thought was to title this blog entry as "Good Leaders Need Good Followers", but my view and experience is that the most valuable people you can ever have working for you are the ones that demonstrate the highest levels of competence and motivation, the ones that are constantly solving problems, the ones that are always multi-tasking, and that are setting the example for others in the work environment.  In short, they are leaders and fulfill that role both formally and informally in an organization.  Their impact goes well beyond their immediate areas of accountability.  In military terms they are a force multiplier!!  You wish you could clone them!  In contrast, follower just seemed to be too passive a term for the type of relationship and work environment I believe best serves an organization and its clients.  We need more "leaders" and less "followers".  Unfortunately, not everyone sees it the same way I do.

A reader of my blog recently reinforced the reality of a contrary perspective on the quality of leadership we experience, or hope for, by noting that "...there is no shortage of self-centred, narcissistic, aggressively driven people in leadership positions..." and we often times go to extraordinary lengths and efforts to work around them and get the job done.  A pretty harsh assessment on the current state of leadership!  In a similar vein, another former colleague of mine once gave an aspiring manager this bit of back-handed career advice - "Surround yourself with good people".  The manager on the receiving end of this advice may or may not have understood the underlying meaning of this statement and the commentary on their leadership it was intended to convey... 

So why does a cartoon like Dilbert have such resonance for so many of us?  Well, clearly we've all been there at one point or another in our careers.  And often the reality of the pointy-headed boss has been too much the norm of our career rather than the exception.  In the times when we've had the experience of a truly inspirational and inspiring leader its been like a breath of fresh air!  In many ways, our organizational cultures and systems foster a style of leadership that is counterproductive to truly getting the best out of our organizations.  Large, bureaucratic organizations often value (consciously or unconsciously) conformity, caution, adherence to rules, and a deference to authority and the chain of command.  Taken to extreme, leaders who "succeed" in these environments are often politically skilled, controlling, effectively manage upward, and are too often focused on achieving their personal goals whether that be a performance bonus or, in some cases, mere survival.  They are certainly not the most effective leaders particularly as defined by their followers.

I don't believe it has to be this way.  We can do better. Clearly, however, we need governing boards and leaders at all levels of our organizations to buy into a different philosophy of leadership, a philosophy that is engaging and empowering, one that does foster teamwork and team achievements, and one that taps the full potential of all staff.  And there are real life examples of leaders who work in this fashion.  Most of us, including myself, have had some experience of them.  To make my point on this, however, I'm going to revert to a fictional leader to illustrate some of the key characteristics of what a Leader can be and how they also develop, and need, other Leaders to achieve success.

Jean-Luc Picard.  Captain of the Enterprise.  A strong, confident and imposing leader.  An individual trained to command.  Probably not a character that we would immediately connect with terms like "engaging" or "empowering".  But consider the organization that he leads - a crew of over 1,000 highly trained professionals - very much like a health care organization of today.  And this crew is also a highly diverse group.  The most visible example of this diversity is represented by characters such as the Klingon security officer, Worf, and the android second officer, Data.  But there is an even greater diversity within the command structure and strength of personality when we take full account of all of the main characters - Riker, Counsellor Troi, Dr. Crusher, Geordi LaForge, etc.  All of them are very accomplished professionals, highly trained, passionate, committed, and strong-willed.  They are all Leaders. 

There is no doubt as to who is in charge - Picard.  But Picard does not simply exert that authority and enforce his will to achieve mission success.  He relies heavily on his team of Leaders.  He frequently consults with one or more of them, appreciating that the diversity of their training and experience will result in better decisions and outcomes.  This seeking out of input is not mere formality.  Picard uses this input to formulate a strategy or make a decision and is open to changing his perspective based on the information provided to him by his team of Leaders. 

The process by which input and feedback is gained can often see Picard's senior commanders at odds with each other, presenting contrary points of view in a very "vigorous fashion".  They are Leaders after all.  Picard does not stifle this exchange of ideas and perspectives.  Other less confident leaders might easily see this "debate" as a conflict to be managed, de-escalated, diffused and taken off line.  Picard may moderate some of the discussion, making sure it does not become too personal, but he sees the value in strong discussion of a situation and the value of looking for solutions from all possible angles.  Ultimately, his approach builds and enhances trust between and with his senior officers.  They do not question their commitment to each other and their mission.  And they feel heard and respected for their skills and abilities.

Picard is also very engaging with his senior officers.  He is quick to praise the achievements of his personnel, both publicly and in private.  Whatever form it takes, the recognition is individualized and in a form that has real meaning to the officer receiving the praise.  In addition, the recognition is not done according to some pre-established schedule; it is done as and when something of significance has been achieved.  Picard doesn't set a reminder in his calendar like "Say something nice about Riker today".  Rather, the recognition is relevant, specific, timely and - because it is genuine and comes only when truly earned - is highly valued by the recipient.

In a previous blog I focused on mentoring.  Despite Picard's rather imposing persona, professional demeanour, and perceived detachment or coolness, he is quite invested in supporting and developing his team.  He is actively engaged in developing and enhancing the skills of his team, he continuously challenges them to grow and develop their skill set and their leadership potential - even when, or particularly when, they may not even know it is a skill they need to develop.  There is no doubt that there is benefit to Picard and his command if his senior officers become more skilled - it makes his job easier and gains him recognition from his superiors.  However, Picard takes a more altruistic and unselfish view in this regard.  He sees the opportunity not from the perspective of how their development can benefit his success.  Rather, he sees the opportunities for his subordinates and actively supports their growth even if he runs the risk of losing them to another opportunity outside of the Enterprise. 

Finally, keeping to the theme of Leaders Need Leaders, Picard himself possesses the humility to accept mentorship from his subordinates.  He accepts guidance, support and even a healthy dose of chastisement from various members of his senior leadership team without resentment.  He may not like being reminded of his weaknesses or foibles, but he also understands the sentiment behind his team's efforts.  More importantly he recognizes the need for continuous improvement in his skill set and relishes the journey of learning and self-discovery.  And sometimes we need that extra help from outside of us to identify and work on our flaws.  So rather than silence our "critics" we should embrace and thank them for their support.  Because Leaders need Leaders too.
  ______________________________

Greg Hadubiak, MHSA, FACHE, CEC, PCC
TEC Canada Chair/Executive Coach/Senior Consultant
hadubiak@wmc.ca

Helping leaders realize their strengths and enabling organizations to achieve their potential through the application of my leadership experience and coaching skills. I act as a point of leverage for my clients. I AM their Force Multiplier.