Relevant Reading

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Managing in the Health Care Workplace —
Lessons From Paul Bracken’s “Futurizing Business Education”
Appeared In The Futurist – July/August 2008

Summary
Good communication and teamwork are critical leadership skills.  In a stable world, they are often enough to bring success.  But, in the turbulent world of today’s health care system, they are not there.  They need to be complemented by a new set of leadership abilities.  Turbulence is usually thought of as something bad, but it can be a positive for those with foresight and the agility to act on what they see.  Turbulence means more big problems and opportunities.  The ability to take advantage of these is a crucial leadership skill for the twenty-first century.

Our environment is becoming more turbulent.  Individual health care professionals and organizations are facing complex situations for which there is little or no experience.  It isn’t difficult to identify the drivers behind this.  Although their importance varies by industry, several major developments characterize our current environment.

First, technology is transforming one industry after another. For example, in health care the electronic medical record is changing medical practices and often impact the way patients are treated.

Second, industry boundaries are blurring with interlopers attacking new sectors outside their traditional domain. A good example is Walmart adding health clinics and ophthalmology shops to their traditional services.

Finally, new competitors are appearing with different strategic personalities than traditional companies.  As noted above, Walmart is now in the health care business.  And U.S. health systems are establishing “beach heads” in countries outside the U.S.

This turbulent world requires new kinds of leadership abilities.  At one time, sticking to your “craft” and making modest improvements guaranteed success.  No longer.  Increasingly, foresight and agility are needed to stay ahead of the game. 

Foresight and agility require a broader assessment of problems.  Leaders have a critical need to be able to rapidly leverage resources, ideas, and people; even those not under one’s control.  In a turbulent environment, there often isn’t time available to assemble the resources needed for success by developing them inside the organization.

It’s one thing to identify the leadership skills needed in a turbulent world – foresight, agility, a broader perspective, and leveraging resources that are not under one’s control – but it’s another to teach them.  However, they can be learned.  It can be done the hard way – on the job.  Companies can wait until a disaster happens or a historic opportunity is missed.  Or they can speed up their learning, seeing how others have seized opportunities and avoided calamities, and promoted people with foresight and agility to senior positions.

Scenarios are an ideal learning tool for this process.  They are about “the next bounce of the ball” – i.e., where things are headed.  Scenario thinking helps frame problems in a broader way.  It enlarges perspectives on opportunities – for example, by looking at problems from different viewpoints, such as those of clients, payers, or purchasers.

There is a subtle but important point about opportunities.  They usually don’t spring out of nowhere to land at your front door proclaiming “I am an opportunity.”  Rather, opportunities come when you actively look for them, with a framework that doesn’t kill them off.  Opportunities can be killed off in a number of ways, but there is an exercise that can teach leaders how to avoid it: the Compass Exercise.

The Compass Exercise extends a framework developed by Richard N. Haass, former director of policy planning for the State Department and author of The Opportunity (2005) and The Power to Persuade (1995).  It consists of putting the leader at the center of a compass and asking him or her to plot a course to achieve some specified goal.

The compass points are the four directions of the journey (See Figure 1).  North represents the boss and those higher in the organization.  East comprises your colleague associates with whom you collaborate inside the organization.  South includes those who work below you.  West consists of those outside the organization with the potential to affect matters that affect you.  This could mean customers or others with important resources, like suppliers, consultants, or regulators.  The compass explicitly broadens perspectives by showing the many possible sources of ideas, capital, and authority that exist.

With a blank sheet of paper with the compass drawn on it, leaders are instructed to map out a scenario for advancing some opportunity.  The scenario is described on the diagram. 

Discussions about the scenarios are usually quite revealing.  Some leaders use a rule: “Take the idea to my boss.  See if he likes it.  Continue the exploration.  If not, stop, because I don’t have the authority or resources to go any farther.”  A variation is, “If my boss doesn’t like it, then neither do I.”  This is a North-South scenario on the diagram.  This approach usually kills potential opportunities.

Other leaders approach the scenario with an opportunity-seeking response that takes an indirect route - i.e., trying to persuade their bosses of the value of the idea (see Figure 2).  If she doesn’t buy it, but her approval is critical, i.e., she has the needed authority and resources to implement the idea, a counter strategy would be to (West) ask for it by having them call on your colleagues (East) to tell them of their interest in the idea.  Then, have your colleagues tell senior management (North), reporting what the patients said.  In other words, to go North, first go West, then East, and then back to North.   If this sounds tortuous and inefficient, the lesson is that the shortest distance between two points in an organization is rarely a straight line.

The Compass Exercise is a great way to crystallize what it means to “lead from the middle.”  This is defined as opportunity seeking without the authority or resources needed to exploit it.  In the old way of thinking, it was senior managers who led and middle managers who followed.  The idea was that only those at the top had the breadth of experience to put the big picture together.  In a turbulent world, however, it’s often those in closest contact with the world who see clearest what’s going on.  Middle managers can be far ahead of senior leaders when it comes to spotting opportunities, but only if they are encouraged to do so.  The Compass Exercise sends the signal to middle managers that they are expected to take the lead when it comes to opportunities, and not to passively await direction from their bosses. Give it a try!