Reviews of lessons from the field and relevant literature reinforce that integrated leadership actions exist. However, understanding the integrated behaviors is often clouded by different language for similar behaviors. The leadership practices can meld with any philosophy you choose and offer a clear approach to healthcare leadership. In brief, the practices are founded on Personal Mastery – knowledge of self that contributes to credibility and authenticity in how we engage in our daily lives. The practices include: Purpose, Partnerships, Systems, and Mastery. We have heard from many of you that the practices make sense and resonate with leaders in a range of roles and settings.
In the previous blog we committed to delving into each practice in more detail. Purpose is the first practice – an important initial step in the sequence for the other practices to follow. Without clarity of Purpose, the other practices can result in random acts of goodness.
Purpose: Eye on the Prize
Purpose describes leaders who make meaning of our collective work – they clarify the reason and make sense of ‘why’ we are doing what we do and make it come alive. Purpose is a basis for finding joy in highly demanding healthcare roles. Eye on the Prize is a phrase used to evoke constancy in the face of struggles. The ability to engage others in conversations about purpose and meaning provides a sense of direction in the noise of daily activities. It exemplifies Deming’s constancy of purpose (1) – what is our work, why this work is meaningful, who we are as team members, and where we are heading.
Extensive literature and lessons from the field find that effective leaders demonstrate three behaviors to achieve Purpose. They are –
- Model the Way (2)
- Build on Strengths
- Engage Others to Aim High.
Model the Way
Model the Way is where leaders show the behavior expected of others, demonstrate the values in action, and live the credibility and authenticity described in Personal Mastery. Kouzes and Posner note, “People first follow the person, then the plan” (2).
The leaders’ behaviors show consistent focus on Purpose – what they say; how they spend their time and with whom; what leaders pay attention to, measure, and recognize; how they learn about daily organizational activities.
Leaders who Model the Way do one behavior very well – they label (actions) and link (to purpose). Through consistently modeling label and link behavior, leaders offer an urgent and relentless commitment to a clear purpose based on the mission that is shared with everyone at every opportunity. They do not assume everyone understands why strategies exist. Through conversations – not just telling – they help team members see how their role and daily actions contribute to the mission. They offer a clear picture to colleagues that they are part of something larger than themselves and how each contributes to the outcomes no matter what their role. These leaders intentionally use their words and actions to model high aspirations and to let others know what is important.
Steps that leaders find useful to assess actions that Model the Way include a variety of individual and team reflections. Asking specific questions about “what does this look like for us” is a healthy step for leaders to consistently improve in Model the Way. Sample assessments include:
- Our Purpose or “Why” is . . .
- Can you clearly communicate it in a 20-foot walk down the hall with a colleague?
- A current example of how I was able to label and link is: . . .
- Tie what an individual or team is doing today to the Purpose.
- Here’s a story I recently used to tell about our Purpose in action . . .
- How do we as the executive team demonstrate alignment?
- I can clearly state “what the purpose means for me”.
- Executive actions show consistent focus on purpose; examples include: how we spend our time and on what content; who we consider experts and consult with; the partners we have identified as essential; what we pay attention to and measure, and recognize.
- How do I role model the purpose? Give two examples from the last week.
- How do I help others see they are part of something larger than self – that they contribute to a worthy aspiration:
- E.g. Team members can say what they do to achieve the Purpose and know where they fit.
- How we teach new colleagues about the Purpose is . . .
- In our change or improvement efforts, do we routinely link changes in behaviors or process to purpose?
Build on Strengths
Understanding and building on strengths – what is working or bright spots (3) – achieves far more acceleration than solely focusing on problems. Healthcare issues can seem intractable, however in most settings (organizations or communities) there is often work underway that shows improvement. Making those actions visible helps others to see how progress towards the Purpose is possible. Emphasizing bright spots taps into positive energy for change.
Examples of strengths help to make the actions tangible, not an abstract concept. Even when others challenge: “that won’t work here”, it offers a chance to ask: “what would work here?”; “what can we do today?”
Leaders who regularly seek out strengths and share those stories throughout the organization make improvement towards the Purpose come alive. Identifying strengths requires curiosity and humility to learn from others – inside and outside the organization (4). It means being close to where work happens to discover strengths. The bright spot examples do not magically appear in a leader’s office.
Seeking bright spots can add joy to leaders’ work. Finding strengths can energize leaders and those they learn from. Sample assessment activities can include:
- “Who is doing this well here?”; “who do we need to learn from?
- “What are you most proud of?”
- “What has gone well here in the past week?”
- “What improvement have you made in the past week that I should know about?”
- “What do patients or community members think we do well? What can we learn from them that builds on our strengths?”
- Do all leaders spend extensive time each week close to the work understanding strengths and gaps?
- Are all leaders skilled storytellers and able to share strengths effectively?
Engage Others to Aim High
Joy in work comes from finding meaning in what you do every day and being part of something greater than self. Meaningful lives are where people say they have purpose, coherence, and worth. Coherence means you are able to make sense of experiences and they fit into a whole picture. Worth means you feel significant and valued. (5, 6)
In developing Purpose, leaders engage others to aim high for aspirations that make a difference – not simply to lead in a market but to make a difference in the lives of community members.
This is accomplished in several ways. First, by partnering with others to create the Purpose. Crafting what the Purpose is and what it means to the organization is not solely the work of senior leaders. It is built and strengthened through conversations with team members, patients, families, and community members. For example, one executive team was ready to launch a new mission and vision developed by a small group of board members and executives. Fortunately, a few executives advocated for a more engaged approach. Despite a push by the drafting group to get it done quickly, the process of conversations over several months, involving hundreds of organizational members, reaped huge rewards. By asking small groups of team members “what is important to you?”; “what are you most proud of in this organization?”; “what is our promise to the community?”, a deep understanding of what matters emerged. As a result there was widespread engagement in the organization’s direction not just another communication from leaders handed out to team members. There was a collective ownership of the Purpose.
Engagement on behalf of the Purpose offers a sense that all team members are involved in collective, meaningful work. Engaging in partnerships with others – patients, families, community members, and healthcare team members – also assures that we aim high in our aspirations. Conversations about the direction and why we need to take actions prompts a different level of action – that what we are currently doing is not enough.
While we all would like to claim we work well in partnerships for engagement, the dominant culture in healthcare often limits our actions to a more parental approach. Assessments are intended to take an honest look at how we really act in partnerships – or not.
Assessments can include:
- One of the most useful tools we use is asking: Are we Doing To – For – or With others? This activity often illustrates the levels of engagement and partnership in the current organizational culture. We provide examples of each stage in the journey and ask participants to identify behaviors in their own setting that may illustrate the stages. The question can be focused on how we relate to patients/families or to team members. It inevitably leads to robust conversations.
- Doing To is the equivalent of “I say and you do”. This stage shows little engagement of others and assumes leaders know what others think and need. Examples include lack of family presence in hospitals or lack of team member involvement in changes that affect them.
- Doing For is “I’ll think about you while I do it for you”. Whether designing programs or processes for patients or employees, it reflects a culture that, while the intent is good, lacks true engagement.
- Doing With exemplifies: “nothing about me without me”; “full transparency”; and “at the table, every time”.
- Other questions to assess levels of engagement include:
- What partners are involved in developing the Purpose?
- What team members and patients do we have involved improving daily work?
- How we developed a shared purpose with all team members:
- E.g. how do we listen, appreciate others’ values, build consensus, and resolve conflicts?
Clarity of Purpose requires far more than simply stating what the leaders believe but actively demonstrating the commitment every day and in every encounter. This does not require extra work – it requires different work to engage all in dedicating their efforts to meaningful outcomes and joy in work.
1. Dr. Deming's 14 Points for Management. https://deming.org/management-system/fourteenpoints; accessed 1/4/2017.
2. Kouzes, J. Posner, B. (2012). The Leadership Challenge. San Francisco: Jossey-Bass. Page 15.
3. Heath, C. Heath, D. (2010). Switch: How to change when change is hard. NY: Random House.
4. Balik, B. Gilbert, J. (2010). The Heart of Leadership: Inspiration and Practical Guidance for Transforming Your Health Care Organization. Chicago: AHA Press.
5. Smith, S. Acker, J. In 2017, Pursue Meaning Instead of Happiness.
http://nymag.com/scienceofus/2016/12/in-2017-pursue-meaning-instead-of-happiness.html?mid=fb-share-scienceofus; accessed 1/4/2017.
6. Achor, S. (2011). The Happiness Advantage. NY: Virgin Books.