Adaptive Leadership
Beliefs Behind Dr. Ron Heifetz’ work
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Problems are embedded within complicated
and interactive systems.
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Much of human behavior reflects an
adaptation to circumstances.
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People adapt more successfully to their
environments by facing painful
circumstances (aka FEAR) and developing
new attitudes and behaviors.
Why Apply Adaptive
Leadership in Health Care?
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Describes what people do
Describes what people exercising leadership
can do if they see differently
A way of developing a shared language to
describe group dynamics
Describes a way to be an active engaged
organizational citizen
Really resonates with clinicians
Opportunities
Enhance capacity to exercise leadership
Build a framework to help others make
progress on tough problems
Create resiliency to withstand the work of
leadership
Limit of tolerance
Productive
Range
Threshold of learning
Time
Based on Heifetz, Ronald A. and Marty Linsky. Leadership on the Line, Harvard Business School Press,
Boston, MA,2002, pg. 108.
Type of Situations Requiring
Leadership
Technical -- Apply abilities that already
exist in the system’s capabilities
Adaptive -- People deeply and broadly
within the organization need to learn
new capabilities
Technical vs. Adaptive Work
Disequilibrium
Adaptive challenge
Limit of tolerance
PRODUCTIVE RANGE
OF DISTRESS
Tension
of
change
Technical
problem
Time
Threshold
of learning
Heifetz, Ronald A. and Marty Linsky. Leadership on the Line, Harvard Business School Press, Boston, MA,2002, pg. 108.
Adaptive Work
Adaptive work diminishes the gap between
the way things are and the way things
need to be to create a better future
The most common cause of
leadership failure is treating
an adaptive problem with a
technical fix.
What is hard about leading
others in improving care?
Properties of Adaptive Work
Gap between aspirations and reality
Tension between between points of view
Difficult learning required
Involves tolerating loss
Perspective needs shifting
New competencies must be developed
People with the problem have problem solving
responsibility
Takes longer than technical work
Requires experimentation
Generates disequilibrium, distress and work
avoidance
Adaptive Work
Adaptive work diminishes the gap between
the way things are and the way things
need to be to create a better future
Adaptive leadership is the activity that
mobilizes people to perform needed
adaptive work
Technical and Adaptive

Fishbone diagram
 Affinity diagram
 Decision analysis tools
 Measurement tools
What is the work?
Gap = difference between the way things are
and the desired state
Technical or adaptive?
Hearts and minds need to change?
Process of exclusion
Persistence of conflict
Crisis
Where do we begin?
Meaningful and Manageable
AIM Statement

The work you are doing together
 Addresses
a gap
 A big enough improvement target to be
meaningful
 A contained enough project to be
manageable

Has key components
 Clearly
articulated statement of intended
improvement
 Aligned to organizational strategic focus
 Supports system quality or operations goals
Who Cares About the Work?
Delivering high quality care
with optimal stewardship of
resources
You
Patient
Other team
members
Family
Who cares about the work?
Important stakeholders
 Team
members
 Those affected by the change
 Those
who support it
 Those who do not want to see it happen
 Project
sponsor
 You
 Who
else?
Delivering high quality care with optimal
stewardship of resources
Tension of change
Limit of tolerance
Productive Range
Threshold of learning
Time
Based on Heifetz, Ronald A. and Marty Linsky. Leadership on the Line, Harvard Business
School Press, Boston, MA, 2002, pg 108.
Are you reading the signals others are sending?
Work avoidance is triggered when the heat is too high or too low
Adaptive Challenge
Work Avoidance
Tension of change
Limit of tolerance
Productive Range
Holding Environment
Threshold of learning
Work Avoidance
Technical Challenge
Time
Heifetz, Ronald A. and Marty Linsky. Leadership on the Line, Harvard Business School
Press, Boston, MA, 2002, pg. 108.
Work Avoidance Signals Being Out of a Productive
Range of Tension
•
Displacing responsibility• Distracting attention
•
Attack authority
•
Kill the messenger
•
•
•
•
Scapegoat
•
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Make the problem too big
Make the problem too small
Meetings with only information
exchange when engagement and
deep conversation is needed
Ask more consultants
Denial
•
Collude in magical thinking
Can you imagine some
work avoidance examples
you might see?
How are the people who care
about the work reacting to it?
Interpret Factional Stances:
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Is the faction above the limit of
tolerance?
Over the top
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Is the faction engaged in the work?
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Is the faction below the level of learning?
Not my concern
How are you and others reacting to the work?
You
Delivering high quality
care
with optimal stewardship
of resources
Begin to Plot a Strategy
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What do you need to do to make progress?
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What can you do to lower the distress on the
factions that are above the limit of tolerance?
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How can you maintain engagement of factions
that are currently engaged in trying to make
progress?
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What can you do to raise the distress to a
productive level for the factions below the level
of learning?
Help People Make Progress on Adaptive
Work
 Use
yourself differently
 Create productive tension
 Keep people engaged who are making
progress and figure out what you need
to do to reengage others.
Authority ≠ Leadership
Informal Authority = Influence
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Power to influence beyond job description
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General credibility and professional reputation
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Implicit expectations
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Critical source of leverage for formal
authorities too
Think of a time when you told people
what they needed to hear rather than
what they wanted to hear.
What happened?
Exercising leadership to do
adaptive work
means
disappointing people’s
expectations
at a rate they can tolerate.
Exercising leadership to do
adaptive work
means
disappointing people’s
expectations
(that things will stay the same)
at a rate they can tolerate.
(and not muzzle you)
Leadership is an activity
There can be leadership from multiple
positions within a social structure
Get on the Balcony
Fundamental Skill in Adaptive Leadership
Reflect in action
Keep the pattern of the dance in mind
while dancing
Move back and forth
Use Yourself Differently
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Exercise leadership and use your informal
authority as a resource
Reflect in action – get on the balcony
Set a great example
Celebrate and learn from what is going well
Talk about why you think this is important
Ask questions
Listen
Pay attention
Behaviors That Build Trust
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Talk straight
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Demonstrate respect
 Create transparency
 Right wrongs
 Show loyalty
 Deliver results
 Get better
 Confront reality
 Clarify expectations
 Practice accountability
 Listen first
 Keep commitments
 Extend trust
Adapted from The Speed of Trust, Stephen M.R. Covey, 2006.
Create Productive Tension
Make it safe to disagree and debate but not OK to opt out
and disengage.
Talk honestly to one another about the challenge
Listen with genuine interest to the various points of view
Build trust
Have difficult conversations
Difficult conversations are inevitable
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Safety is critical for them to be productive
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shared purpose
mutual respect
Be willing to be influenced
Be curious rather than judgmental
100% candid
100% respectful
Lead with questions not answers
Engage in dialogue and debate not coercion
Create an Environment to Hold Attention on
the Work
Tension of change
Limit of tolerance
People need to feel safe enough
to do adaptive work but not so safe
that they will do nothing.
Productive Range
Threshold of learning
Time
Based on Heifetz, Ronald A. and Marty Linsky. Leadership on the Line,
Harvard Business School Press, Boston, MA, 2002, pg 108.
Distressed System
No Trust, Little Adaptive Capacity
Limit of tolerance
Productive Range
Threshold of learning
Time
Based on Heifetz, Ronald A. and Marty Linsky. Leadership on the Line,
Harvard Business School Press, Boston, MA,2002.
What is a difficult conversation?
• Any conversation that you dread and perhaps
seek to avoid, if possible
• Three inherent challenges present the source
of difficulty
• There are inevitably more ways to understand
the situation than any one participant is aware of
or agrees with
• The situation is emotionally charged with strong
feelings
• The situation is psychologically threatening to
one or both parties
Which Condition of Safety is at Risk?
•
Mutual purpose or mutual respect
•
Conditions make the conversation
difficult
•
much more than content
Adapted from Crucial Conversations
Shared Vision
Delivering high quality care
with optimal stewardship of resources
Limit of tolerance
Productive Range
Threshold of learning
Time
Based on Heifetz, Ronald A. and Marty Linsky. Leadership on
the Line, Harvard Business School Press, Boston, MA,2002, pg.
108.
How Do We Hold the Tension?
Delivering high quality care
with optimal stewardship of resources –
respectfully?
Limit of tolerance
Productive Range
Threshold of learning
Time
Based on Heifetz, Ronald A. and Marty Linsky. Leadership on
the Line, Harvard Business School Press, Boston, MA,2002, pg.
108. and adaptationfrom Crucial Conversations
Widening the Productive Range
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Conditions of safety
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Mutual purpose
•
•
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Do others believe you care about their
goals in the conversation?
Do they trust your motives?
Mutual respect
•
Do others believe you respect them?
Adapted from Crucial
Conversations
Increased Trust, Increase Capacity for Adaptive Work
Limit of
tolerance
Productive Range
Threshold of learning
Time
Based on Heifetz, Ronald A. and Marty Linsky. Leadership on the Line,
Harvard Business School Press, Boston, MA,2002, pg. 108.
Keep people engaged who are making
progress and figure out what you need
to do to reengage others.
Work avoidance signals being out of a productive
zone relative to the work
Adaptive Challenge
Work Avoidance
Tension of change
Limit of tolerance
Productive Range
Holding Environment
Threshold of learning
Work Avoidance
Technical Challenge
Time
Heifetz, Ronald A. and Marty Linsky. Leadership on the Line, Harvard Business School
Press, Boston, MA, 2002, pg. 108.
Think about a time when the heat was
too high.
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How did you know?
 What did you do to bring things to a
productive level of tension so progress could
be made?
Lowering the Heat
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Validate feelings, acknowledge loss
•
Simplify and clarify
• Address the technical aspects
• Break problem into parts
•
Restore, add, or reallocate resources
• Temporarily reclaim responsibility for tough
issues
• Give your attention
• Take stock of what is available
• Allot more time, enrich knowledge and skills
Think about a time when the heat was too
low.
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How did you know?
 What did you do to bring
things to a productive level
of tension so progress could
be made?
Raising the Heat
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•
•
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Raise the standards
Increase accountability
Change the task to something more
motivating
Refocus on higher, more widely
shared and yet compelling purpose
Exercising leadership to do
adaptive work
means
disappointing people’s
expectations that things will stay the same but
at
a rate they can tolerate.
Give Work Back to People
at a Rate They can Tolerate
Adaptive Challenge
Limit of tolerance
Tension of change
Work avoidance
PRODUCTIVE RANGE
HOLDING
ENVIRONMENT
Work avoidance
Threshold of learning
Technical
challenge
Time
Heifetz, Ronald A. and Marty Linsky. Leadership on the Line, Harvard Business School Press, Boston, MA,2002, pg. 108.
Exercising leadership requires
keeping an experimental mindset
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Work avoidance looks the same when the
heat is too high or when the heat is too
low.
 If what you try makes things worse try
the opposite.
 What looks like laziness may be
exhaustion.
 Keep rechecking your assumptions.
Keep an experimental mindset
When you try something and things get worse try the
opposite!
Adaptive Challenge
Limit of tolerance
Tension of change
Work avoidance
PRODUCTIVE RANGE
HOLDING
ENVIRONMENT
Work avoidance
Threshold of learning
Technical
challenge
Time
Heifetz, Ronald A. and Marty Linsky. Leadership on the Line, Harvard Business School Press, Boston, MA,2002, pg. 108.
Building Your Practice of Leadership
Adaptive leadership helps people to make progress
on difficult problems
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Develop a new capacity to see what is
happening
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Learn to effectively analyze what you see
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Learn to strategically intervene to make
progress on difficult problems