Health care leaders now face a perplexing mix of puzzles. With a political push to repeal and possibly replace Obamacare – more accurately the Patient Protection and Affordable Care Act or ACA – the financial, service delivery, and workforce foundations of the health system are in question. It is true that managing the current operations of hospitals, clinics, and health systems looks much like it did a few months ago. But what lies ahead? Answers to this question guide leadership planning, strategy, and investment.
Those who know and understand the ACA recognize it is a complex web of provisions, protections, and financing that is intimately interconnected to one another. As with any complex system, change one piece and others morph as well, generating a difficult to predict cascade of consequences that are distasteful to politicians: insurers fleeing the marketplace, patients without coverage, and health workers unemployed. Hence, the fate of the legislation, and all that comes with it, are in flux. The most accurate description of the current state of health care is that it is “predictably unpredictable.”
The health care system is consistently in “change mode,” however, for the most part, the adjustments are incremental and foreseeable. Reimbursements, patient flows, and technology evolve in stages over time and in response to known trends. Health care leaders are accustomed to incremental change. Success depends upon being at or ahead of that fluctuating curve.
However, what we see now is fundamentally different. In part, looming legislative changes affects providers, insurers, patients, and others very differently. A fragile system is being misaligned, shaken by strong emotions, political will, and the business stakes that go with it.
So how do health leaders now chart the course for their organizations? The distinction between leadership and management has never been more important. Management is about keeping day to day operations effectively and efficiently moving forward. Leadership, by contrast, is about shaping those organizations to be adaptive, flexible, and open to new ideas and innovation. Effective leadership – especially in these predictably unpredictable times – requires a mindset that embraces complexity. Less important than standing on a solid foundation, health care leaders must fortify their ship for stormy seas.
Embrace complexity: this is a way of thinking not universally familiar or comfortable for health leaders. Today, it is an essential component of a health care leader’s survival kit. Working with complexity requires challenging long held assumptions. It questions past truisms as not necessarily relevant to the future. It demands that core principles are known and respected, recognizing the market forces can tempt compromise. Not easy. But when embraced: challenging and exciting. And if you can make it work, leading in these complicated times can be downright thrilling!
Complexity and Meta-Leadership
The theme of the Leading in Health Systems: Integrating Effort, Improving Outcomes program is “Meta-Leadership.”
The meta-leadership framework was developed by faculty at the Harvard T.H. Chan School of Public Health in their research and work with leaders facing complex change, problem solving, and crisis. Faculty observed leaders coping with difficult scenarios and traced the patterns of their thinking, problem solving strategies, and interactions with other critical stakeholders. What they found is that the more successful of these leaders adopted a “meta-” view of the situations they faced. This wide view of problems and solutions focused attention on the panoply of involved stakeholders along with the different ways in which related problems affected them. Applying this wide perspective, these leaders built an inclusive laboratory for problem solving. The connectivity of effort they forged guided the testing and adoption of new and effective strategies and operations.
These meta-leaders were remarkable for their acceptance of the complexity they faced. Curious, they sought to understand existing connections, potential linkages, and ways by which those affected could collaborate in innovative ways. A question they inserted into the mix was “How can I make you a success?” This is a powerful premise when facing uncertainty. With that frame of mind, options developed that would have been obscured by more competitive or adversarial interactions.
The solutions these meta-leaders discovered emerged from the thinking they inspired among others. Perceiving the system as a whole – as opposed to a collection of competitive parts – actions and interactions could be intentionally directed toward hoped for outcomes. With better connectivity, the cause and effect interactions of a complex system were more deliberately recognized, understood, and adjusted. By fashioning their system rather than passively accommodating to external ebbs and flows, these leaders become calculated architects of its direction and with that, more compelling for their followers.
How does meta-leadership work? There are three key dimensions to its practice:
- The Person of the Meta-Leader – understanding who you are and how to leverage your personal capabilities for the complex tasks at hand. This includes understanding the neuro-dynamics of leadership and its limiting factors, all with the intent of making you “smarter than your brain.”
- The Situation – grasping the breadth of what is going on about your organization and then rallying the right mix of strategy, operations, and logistics to meet the challenges. It is an iterative process and incorporated into its practice are tools to guide you and to help you guide others. The intent is to help you turn quick system learning into intentional system changing. “If you know where you are going, your chances of getting there are greatly enhanced.”
- Connectivity of Effort – Building integrated systems requires leaders to first understand and then to shape the motivations of those involved. This includes not only people within your system, but also people and organizations beyond your base of operations. Widely conceived solutions require active involvement of the many stakeholders whose aligned efforts achieve intended results. This includes people down and up your organizational chain of command, as well as across to others within your organization and out to those beyond your institutional walls. This connectivity of effort is essential to the big picture, the “meta-” in meta-leadership. Success on this score is “no accident – it is designed.”
The course is not about specific solutions to specific problems. Rather, it is about the process and practice of leadership. The intent is to provide you a field-tested methodology that fits the challenges now facing health care leaders.
You may not be able to fix Washington. However, being a far-sighted, pro-active and adaptive leader is now more important than ever. Given the turbulent waters, health care leaders must invent ways to forge solutions that work for their organization and the wider ecosystem in which they operate. The question is how to strategically arrange the pieces of the perplexing puzzle to nurture the strength and viability of your health care system. With it, you embrace complexity and find ways to harness its powers.
For health care organizations, the definition of “success” that prevailed in the past will be different in the future. Metrics will change, systems for providing services will transform, and institutions could look very different from what they are today. Nevertheless, for those who effectively lead and adapt, the simple question and the direction that comes with it are still relevant: “How can I make you a success?” With answers in hand, you will be more likely to succeed as a health leader and to help others do the same.
Harvard T.H. Chan School of Public Health offers Leading in Health Systems: Integrating Effort, Improving Outcomes, a high-impact health care leadership development program, which focuses on meta-leadership. To learn more about this opportunity, click here.
This article was written by:
Leonard J. Marcus, Ph.D.
Barry C. Dorn, M.D., M.H.C.M.
Eric J. McNulty, M.A.
Co-Program Directors, Leading in Health Systems: Integrating Effort, Improving Outcomes
Harvard T.H. Chan School of Public Health
They are co-authors of Renegotiating Health Care: Resolving Conflict to Build Collaboration, (San Francisco: Jossey-Bass Publishers, 2011)