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Organizing for Success—What is the Key Requirement?
I have pointed out previously the need for successful healthcare organizations to have effective dual (clinical and non-clinical) leadership at all levels and to balance the clinical, financial, and human drivers of outcomes in a comprehensive fashion. Val Jones, a locum tenens physician made some interesting observations about what makes for a great (or a toxic) hospital to work at.[1] “Hospital culture is largely influenced by the relationship between administrative and clinical staff leaders. In the “old days” the clinical staff (and physicians in particular) held most of the sway over patient care. Nowadays, the approach to patient care is significantly constricted by administrative rules, largely created by non-clinicians.” He goes on to note that in a few hospitals, the old order still holds, but that is no guarantee of success. “This can lead to its own problems, including unchecked verbal abuse of staff, inability to terminate bad actors, and diverting patients to certain facilities where they receive volume incentive remuneration...And so, when physicians are empowered, they can be as corrupt as the administrations they so commonly despise.” Titrating the balance of power seems to him to be a necessary, but not sufficient condition for creating a great hospital. It is also necessary to pay attention to the personalities of the leaders, as that determines the culture. “Leaders must be carefully curated and maintain their own balance of business savvy and emotional IQ. Too often I find that leaders lack the finesse required for a caring profession, which then inspires others to follow suit with bad behavior. Unfortunately, the tender hearts required to lead with grace are often put off by the harsh realities of business, and so those who rise to lead may be the ones least capable of creating the kind of work environment that fosters collaboration and kindness.” Emotional intelligence is the new term for the more old-fashioned notion of temperament. Oliver Wendell Holmes famously said of Franklin D. Roosevelt that he had a second-class mind but a first-class temperament.[2] What he was getting at was the idea that Roosevelt was not a scholar. He did not write books like his cousin Theodore Roosevelt, but he had the emotional temperament that made him an effective leader. Evaluating temperament is difficult, and inherently subjective, which makes people uncomfortable. We tend to want to rely on “facts” not “intuition” when searching for a candidate for a leadership position, yet success is going to rely more on the latter. My hospital is starting through a leadership search process. I have not participated in the discussions, but as they think about what skill sets they want in the successful candidate, there will be a tendency to rely on credentials. Has this individual done this or that in the past. Sometimes that can be helpful, of course, but as they say on financial prospectuses, “past performance is not a guarantee of future results.” I wonder, though, how they will judge temperament. After all, the challenge is not necessarily to find the most experienced person, but the one who can communicate effectively and get an emotional commitment from all those people who are already here to lead the organization in the desired direction. The other challenge, of course, is that leadership in large organizations is inherently bureaucratic. Pope Francis has made some pungent observations about the challenges of leadership facing those who work in a bureaucracy, (and certainly the Curia has the reputation of being the epitome of one.) Some of the points he made were summarized by Gary Hamel in an article last year in the Harvard Business Review.[3] Three of his points relate to the subject here. “Then there is the disease of mental and [emotional] “petrification.” It is found in leaders who have a heart of stone, the “stiff-necked;” in those who in the course of time lose their interior serenity, alertness and daring, and hide under a pile of papers, turning into paper pushers and not men and women of compassion. It is dangerous to lose the human sensitivity that enables us to weep with those who weep and to rejoice with those who rejoice! Because as time goes on, our hearts grow hard and become incapable of loving all those around us. Being a humane leader means having the sentiments of humility and unselfishness, of detachment and generosity.” “The disease of excessive planning and of functionalism. When a leader plans everything down to the last detail and believes that with perfect planning things will fall into place, he or she becomes an accountant or an office manager. Things need to be prepared well, but without ever falling into the temptation of trying to eliminate spontaneity and serendipity, which is always more flexible than any human planning. We contract this disease because it is easy and comfortable to settle in our own sedentary and unchanging ways.” “The disease of poor coordination. Once leaders lose a sense of community among themselves, the body loses its harmonious functioning and its equilibrium; it then becomes an orchestra that produces noise: its members do not work together and lose the spirit of camaraderie and teamwork. When the foot says to the arm: ‘I don’t need you,’ or the hand says to the head, ‘I’m in charge,’ they create discomfort and parochialism.” Temperament is difficult to define, but usually evident when meeting people and spending some time with them. There in no one temperament that predicts who will be a successful leader, either. The challenge is to find the person with the right temperament to take your organization where you want it to go. It is difficult to do, but those that get it right function more efficiently and are better places to work and receive medical care than those that don’t. 19 July 2016 [1] Jones V. What Creates a Toxic Hospital Culture? 28 October 2015. Accessed 12 March 2016 at http://www.kevinmd.com/blog/2015/10/what-creates-a-toxic-hospital-culture. [2] President Bill Clinton included the quote in his discussion about presidential leadership. Clinton WJ. Getting It Right. TIME, 24 June 2009. Accessed 19 July 2016 at http://content.time.com/time/specials/packages/article/0,28804,1906802_1906838_1906981,00.html. [3] Hamel G. The 15 Disease of Leadership According to Pope Francis. HBR 14 April 2015. Accessed 30 May 2016 at https://hbr.org/2015/04/the-15-diseases-of-leadership-according-to-pope-francis?utm_campaign=HBR&utm_source=facebook&utm_medium=social. |
Further Reading
Clinical Microsystems Clinical microsystems are composed of front-line clinicians engaged in direct patient care. Despite a lack of formal authority, they are the key to successful healthcare reform. Engaging Burned Out Physicians Healthcare organizations are told to engage their physicians, many of whom are "burned out." is this squaring the circle? On Resilience Resilience is a concept that assumes bad things will happen, but it is necessary for success in medical organizations. Organizing for Success - Lessons from Keystone The Keystone Cooperative ICU Project obtained major improvements in safety. The "soft science" lessons need to be applied more widely. Putting Patients At The Center Of Healthcare Putting patients at the center is crucial for healthcare organizations, but how can it be done? |