Advancing Leadership Skills for Today’s Needs
A Framework for Tomorrow
Gary Oftedahl,
MD
Transforming Health Care Through Collaboration
Copyright © 2010 by ICSI
Objectives
• Background
• Adaptive Framework overview
– Leadership/Authority
• Breaking it down—what do I do?
• Moving ahead
– Discussion and questions
Copyright © 2010 by ICSI
Yesterday….
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Today..
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The Way It Is
• We no longer live in a world where we
have the right to expect authorities to know
the answers
• The challenges our organizations face are
complex
– Require MORE THAN application of expertise
– Require changes in the habits, attitudes and values of
people high and low in the organization
Copyright © 2010 by ICSI
Copyright © 2010 by ICSI
Recognizing the Challenges of Leadership
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Framing the issues
Adaptive Challenges
• Situation is complex, solution not obvious
• Can’t be done within present system
• Need to change/address deeply held beliefs and
values
• Loss is inherent part of process
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Framing the Issues
Technical Challenges
• Problem well defined
• Answer can be found within present structure
• Implementation is clear
• Value of “expert” to provide answer
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Adaptive Challenges
• We look for the wrong kind of leadership
• Human behavior and Uncertainty
• Leadership and authority
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Copyright © 2010 by ICSI
Copyright © 2010 by ICSI
Authority
• Power entrusted to perform a service
– Meeting expectations  “good” leader
– Power and position decrease if expectations
are not met
• Important in driving technical change
– BUT—what if it’s not technical?
• Leadership = authority but used differently
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Authority in the Adaptive Work
Using Authority with a New Focus
• Frame and provide tough questions
– Rather than fulfilling the expectation for answers
• Let people feel the pinch of reality
– Rather than protect people from an outside threat
• Disorient people so that new role relationships develop
– Rather than orient people to their current roles
• Draw issues out
– Rather than quell conflict
• Challenge the way to do business, distinguishing those
values and norms that must endure from those that should go
– Rather than maintain norms
Copyright © 2010 by ICSI
Six Principles of Leadership for
Addressing Adaptive Challenges
• Get on the Balcony
• Identify the Adaptive Challenge
• Regulate Distress
– “Productive level of distress”
• Maintain Disciplined Attention
• Give the Work Back to the People
• Protect Leadership from Below
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Getting on the balcony
•
•
•
•
See patterns instead of isolated events
Understand structure, culture, norms
Identify struggles over value/power
Watch for reactions to change/loss
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Identify the adaptive
challenge(s)
• Need to understand whether you’re dealing
with adaptive or technical work.
• Open to gathering/hearing other
perspectives
• History of unresolved conflict
• Festering issue, regardless of efforts
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Regulating Distress--Holding
Environment
• Need to provide environment
which creates “productive
level of distress”
• Safe but not too safe
• Fosters necessary
discussions
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Distress and Adaptive Work
Disequilibrium
Adaptive challenge
Limit of tolerance
PRODUCTIVE
RANGE OF
DISTRESS
Work avoidance
Technical
problem
Time
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Threshold
of learning
Raising the Heat….
• Draw attention to tough questions
• Give people more responsibility than they
are comfortable with
• Bring conflict to surface
– Not in the “parking lot”
• Listen to the gadflies, “peons”
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Lower the Heat….
• Address technical aspect of issue first
• Address problem solving by breaking an
issue into parts
• Take responsibility back—carry the load
• Use “work avoidance” wisely for short time
• Slow down process of changing norms
and expectations
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Maintaining the Focus
• Keep attention on the task at hand
• Ensure topic has time to mature
• Watch for “work avoidance”
– Shifting focus to another topic
– Laying blame
– Creating “ad hoc” committees
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Give the Work Back to the
People
•
•
•
•
Resist the temptation to resolve the issue
Get people engaged
Place the work with the relevant parties
Ensures “fair process”
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Protecting Voices of Leadership
Without Authority
• Protect the voices you want to silence
• Annoyance is a signal of opportunity
• Is there potential value in addressing the
provocative questions being raised?
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“The key to successful
adaptive leadership is
disappointing people’s
expectations at a rate they will
tolerate.”
--Ron Heifetz, MD
Copyright © 2010 by ICSI
Leadership Actions for Adaptive
Challenges
• Listen
– Concerns, fears expressed
– Create environment to foster dialogue
• Reflect
– Feed back from your “balcony” position
– Assess reaction to see if you are “on mark”
• Intervene
– PDSA—”experiment”
– New discovery to introduce
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The most common cause of
leadership failure is treating
an adaptive problem with a
technical fix.
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Your Commitment
• Get on the balcony
• Identify the adaptive challenge
• Keep the level of distress within a tolerable
range for addressing adaptive challenges
• Focus attention on ripening issues and not on
stress-reducing distractions
• Give the work back to the people -- at a rate
they can tolerate
• Protect voices of leadership without authority
Copyright © 2010 by ICSI
Thank you.
Questions??
Transforming Health Care Through Collaboration
Copyright © 2010 by ICSI