Leading Through the Complexity of Health Care Change

To thrive in the complex health care environment, leaders must leverage and nurture their connections to drive a more productive organization.

Health system leaders now face numerous challenges in guiding their organizations: Reimbursement is in question as the health policy debate ebbs and flows. The market is becoming increasingly consolidated and competitive. Technology provides tremendous opportunities along with significant costs and risks.

In this ambiguous mix, decisions must be reached. Practices must evolve. And emotions come into play as hardened professionals resist change.

At the intersection of these trends, health leaders recognize that the answers are not simple. There are choices and consequences. And those consequences will be welcomed by some and despised by others. Health care leaders must be effective amidst this complexity. Success depends on grasping what is happening, what precisely is to be done about it, getting people on board, and motivating them to action.

Leading Beyond Complexity

 Seeing beyond this complexity, successful health leaders recognize, leverage and nurture the connections that will help them intentionally drive their system.

“In this topsy-turvy health care world, people can work with or against each other,” said Eric McNulty, MA, Associate Director of the Program for Health Care Negotiation and Conflict Resolution (PHCNCR) at the Harvard T.H. Chan School of Public Health and Co-Program Director of Leading in Health Systems:Activating Transformational Change. “There are a lot of changes happening and the more adept leaders are at fostering collaboration, the more productive their organizations will be.”

The meta-leadership framework and practice method – the focal theme of the Leading in Health Systems program – provides health leaders with a tool set for assessing and directing their system.

There are a lot of changes happening and the more adept leaders are at fostering collaboration, the more productive their organizations will be.

The model was developed by PHCNCR Founding Director Leonard Marcus, PhD and his colleagues. “Meta-leadership has three dimensions. It begins with the person,” Marcus said. “It is who you are as a person. The second dimension is the situation—discerning what is happening and what is to be done. The third dimension is connectivity. Meta-leaders look at problems using a wide lens, rather than just focusing on their own silo. This helps them develop solutions that speak to the organization’s opportunities and challenges more holistically” Marcus explained that meta-leadership helps leaders foster innovation, anticipate change, and improve execution by creating unity of purpose across organizational boundaries.

Meta-leaders identify and assess key stakeholders in a situation. Applying another PHCNCR methodology, the “Walk in the Woods,” they engage key parties and identify their interests. With that, they explore points of agreement and disagreement along with innovative opportunities to resolve shared problems. Through this process, they are able to generate agreements for which the stakeholders have buy-in, a critical factor in rallying support for new and significant changes. According to Marcus, “When stakeholders have been heard and accounted for, and when their opinions are incorporated in solutions, they are more willing to endorse and champion change.” The Walk in the Woods is another key theme of the Leading in Health Systems program.

“We call connectivity at it most robust ‘swarm leadership,’ said Marcus, who is also Co-Program Director of Leading in Health Systems. “When leaders swarm, they come together swiftly and in synchrony to achieve common goals. Their swarming behaviors cascade, increasing collaboration at all levels. This is important because problems in health care are systemic, requiring cooperation and coordination among multiple care providers and administrative functions inside and outside the organization.”

Extending Influence

 Meta-leaders excel at “influence beyond authority.” This is particularly important in health care: there are so many inter-twined responsibilities, inter-connected decisions, and critical outcomes. No one is really in charge of everything.

As health care becomes more integrated, the capacity to forge connectivity of effort is essential. The connectivity dimension of meta-leadership helps leaders discern and function in multiple directions:

  • Leading down to your team
  • Leading up, offering perspective and guidance to help your boss reach decisions
  • Leading across your organization to link and leverage different organizational silos
  • Leading beyond, working with stakeholders outside your organization

Key in building this connectivity of effort is recognizing and working with shared interests among all these different stakeholders. “Meta-leaders foster order beyond control by adeptly building and exerting influence,” Marcus said.

“Humans are social species,” said McNulty. “You can be intentional about increasing your influence and when you do, you’ll be more successful.”

If you say you are all about the workforce and don’t support them when it matters most, you will lose the confidence of those upon whom you depend.

One key practice embedded in meta-leadership practice is noticing. Often information, clues and important data are missed or ignored. This information could be critical in building situational awareness and assembling balanced decisions. Practice improves performance. “Take time to notice those around you – everyone around you – and have real conversations with them,” McNulty said. “By practicing this skill – inside or outside the workplace – you’ll train yourself to be more emotionally intelligent.”

“Our brains are always unconsciously recording everything and looking for risks and rewards,” said McNulty. “When you engage people who usually get ignored, it’s almost always a positive experience. Your brain will recognize it as good and want to do it more often. By slowing yourself down and intentionally looking for these positive reactions, you’ll learn how to gain trust and build influence.”

Developing Your Crisis and Change Leadership Skills

Leaders today must be ready to meet a crisis head on any day of the week. It could be a personnel crisis, a fiscal crisis or at its worst, an active shooter in a hospital. It will be the day that will test any leader. And it will be a day always remembered.

For this reason, Marcus and McNulty teach meta-leadership as a guide for everyday leadership as much as a preparation for that moment when crisis hits. “We teach leaders to pivot at the moment when their brain alerts them to trouble,” Marcus noted. “You apply the same concepts and practices in that moment that you have been using every day. We intentionally design the curriculum to have dual purpose.” Reflecting on the recent Winter Olympics, McNulty noted that none of those athletes started practicing on the day of their big event. “They had been working at it for years. Day to day meta-leadership practices prepare leaders to be ready for crisis.”

Among the practices and perspectives recommended by Marcus and McNulty are:

  • Create clear operating principles: Articulate the values that guide your organization. Ensure that you and your organization live by those principles in your decision-making, actions and statements. If you say you are all about the workforce and don’t support them when it matters most, you will lose the confidence of those upon whom you depend.
  • Create islands of certainty: Consistency of process and transparency of data create “islands of certainty” even amidst great uncertainty and turbulence. “People need to be able to trust the organization as well as each other,’ McNulty said.
  • Get out of “the basement”: When a crisis arises, people “go to the basement,” according to Marcus. “This is the instinctual freeze-flight-fight survival response that obstructs logic and complex thinking.” Marcus suggested having a “trigger script” to reset the brain and rise out of the basement. “Something as simple as taking three deep breaths or following a practiced protocol gets you back on track. Going through this script restores your self-confidence and your team’s confidence. You simply can’t lead well from the basement,” Marcus said. Effective leaders, recognize when they are in the basement, quickly climb out, and then help others out as well.
  • Learn to pivot: As a leader, when faced with new information or a novel challenge you must pivot – that is, seamlessly shift your strategy and tactics and help your organization do the same. Agility and flexibility are core competencies of the meta-leader.
  • Have a high tolerance for low-consequence mistakes: There are different kinds of mistakes. Obviously, clinical mistakes that have consequences for the quality of care cannot be tolerated. However, there are low consequence mistakes – including trying on a new program or procedure to test its effectiveness – that when taken in an intentional manner can encourage the sort of creativity and innovation that are critical for health care today.
  • Look outside of health care: It is often helpful for health care leaders to peer outside the system to gather new perspectives and solutions. Marcus noted, “The patient care movement learned a great deal by looking at aviation safety and how pilots and regulators used errors and mistakes to ensure they were not repeated.” “Nothing happens in a bubble,” said McNulty. “For example, if you want to know what patients expect of you in terms of customer experience, you should look at places like Amazon and Starbucks. Nowadays, you won’t just be compared to other providers. Looking at the standard-setters in other industries with which your stakeholders interact will help you foster innovation in your own sphere.”
  • Make leadership development a career-long investment: “Forward-looking health care leaders are constantly learning,” said Marcus. “They know the status quo will not last long. The concepts and tools of meta-leadership are a pragmatic guide as they constantly work to pro-actively adapt and evolve”

Few settings are more complex, challenging, or potentially rewarding as leading in a health care system. Those who intentionally equip themselves will be poised to thrive in this dynamic environment.

Harvard T.H. Chan School of Public Health offers Leading in Health Systems: Activating Transformational Change, a high-impact health care leadership development program, which focuses on meta-leadership. To learn more about this opportunity, click here.