The unprecedented worldwide crisis spawned by the novel coronavirus disease (COVID-19) makes leading in health care more challenging than ever. Executives face the stress and consequences of a pandemic on top of the tumult of an unsettled marketplace. The concepts and tools of meta-leadership help those leaders reframe adversity. It is an opportunity for building enduring transformational change.
Since early 2020, the world has been grappling with the health and economic consequences of COVID-19. There are two distinct pictures of the response in health care: One is the heroism of health care workers fighting to save lives. The other is health systems pushed to the brink as the surge of COVID-19 patients necessitates the cessation of operations critical to their institutions’ financial viability. There are no easy choices. Yet critical decisions must be made.
“We have offered the Leading in Health Systems executive leadership program for several years. Never has this topic been more important,” said program co-director Leonard Marcus, Ph.D. “This year, we have revamped the program to focus on leading through crisis and change, with specific focus on the unique challenges and requirements of COVID-19.”
The meta-leadership framework and practice method at the center of the program has evolved over decades of engagement with leaders in high consequence situations. Each concept is paired with pragmatic tools and techniques for putting the ideas to work.
“Our field research and teaching has given us insights into how leaders can best guide their organizations through turbulent times,” said program co-director, Eric McNulty. “The most effective leaders are self-aware and emotionally grounded. They ‘drive to the knowns’ to understand the contingencies they face. And they forge unity of effort across the larger enterprise.”
The most effective leaders are self-aware and emotionally grounded. They ‘drive to the knowns’ to understand the contingencies they face. And they forge unity of effort across the larger enterprise.
Meta-leadership has been used to craft high-performance work groups in a wide range of health systems, government agencies, businesses, and non-profit organizations. It provides as common vocabulary for leaders and followers as well as the tools and techniques to achieve mission-critical objectives.
“For us, it has been gratifying to get word from executives and clinicians on the front lines of the fight against COVID-19 who are finding meta-leadership useful,” said Marcus. “Nothing in our lifetimes has challenged the world like this coronavirus. We measure our success through the impact of meta-leaders wrestling with real-world problems like this.”
What is a Meta-Leader?
The career tracks of many health care executives have taken them through promotion up the clinical ranks. They have deep technical medical expertise yet have not developed the aptitude for the human factors of leadership. This includes motivating diverse teams, engaging stakeholders, and delivering coordinated care—all while operating a productive business.
Meta-leaders take a broad view, grasping the connections and interdependencies between these varied aspects of success. They lead institutions that achieve highly rated patient and workforce experiences. These institutions are integrated into their communities, providing important contributions while garnering the necessary support. The “meta-” view of opportunities, problems and solutions provides a wide palette for engagement.
In a crisis, people panic. It is critical to recognize that automatic response and then take action.
Key Meta-Leadership Principles and Practices
The three dimensions of meta-leadership provide a roadmap to building one’s leadership internal capacity and external capability, applicable to both routine operations as well as crisis and change.
1. The Person of the Meta-Leader
Meta-leaders understand their strengths and weaknesses. They realize that great leaders are not superheroes. According to McNulty, they are people keenly aware of both who they are and what their followers need them to be. “People don’t follow you because of your title or because you tell them to,” he said. “They follow when they see that you are as invested in their success as you are in your own. Meta-leaders attract followers through their commitment to something larger than themselves.”
In the Leading in Health Systems program, participants explore emotional intelligence, an awareness that helps people get “smarter than their brain.” Often in a crisis, people panic. It is critical to recognize that automatic response and then take action – as described in the meta-leadership curriculum – to get “out of the basement,” a reference to the reptilian brain that obscures rational decision-making.
2. The Situation
In order to make meaningful decisions and take appropriate actions, a leader builds rapid “situational awareness.” In a crisis scenario, with its many unknowns, the parameters of the situation are not immediately evident. The ever-evolving coronavirus pandemic provides ample support for the need to adapt continuously to situations as they evolve.
Marcus explained that meta-leaders are relentlessly curious. They ask probing questions to consistently expand their understanding and then apply that knowledge to accomplish critical objectives. “We call this ‘driving to the knowns,’” he said. “We share a series of tools for discovering and integrating different perspectives, mapping the many aspects of a situation, and moving through a disciplined cycle of thinking and action.” Marcus noted that this process is similar in many ways to how clinicians diagnose a patient. The process, however, is far more complex in a large institution.
Health care systems incorporate a breadth of discreet functions and values, from patient care to the bottom line. There are trade-offs, difficult decisions, and a multitude of stakeholders. Amidst that complexity, it is up to the health care leader to generate coherence of effort. There are many different “silos” of activity that must be integrated. Only when these “silos” are intelligently linked can the best possible outcomes be achieved.
“Health care is not a machine,” McNulty said. “It involves people and therefore is a complex, dynamic system. The challenge for leaders is to deploy influence, often beyond their formal authority, to foster unity of purpose and effort. The secrets to success are communication, coordination, and collaboration.”
Marcus, McNulty, and their colleagues originated the concept of “swarm leadership” based on the highly collaborative leadership of the Boston Marathon bombing response. They identified three foundational conditions and five behaviors that stimulate human “swarming” instincts. McNulty explained that leaders who create the right conditions and model swarm behaviors increase collaborative interactions and deemphasize competitive ones.
Marcus commented that when participants in their programs are asked about the “great” and “lousy” leaders they have experienced, clear patterns emerge, often linked to the appreciation for the human factors of leading. “There are rarely surprises,” he said. “The interesting ah-ha for us is that although ‘good’ and ‘lousy’ are obvious, we still see people trying to lead by ignoring important relationships and making bad choices.”
McNulty explained that he and Marcus are committed to help executives recognize their range of options and then to make choices most in line with their leadership objectives. “Rarely have we encountered someone who wants to be the ‘not so great’ leader,” he said. “They micro-manage out of fear. Or they are seen as disengaged because they aren’t self-aware enough to perceive the needs of followers for their presence. It is much more often lack of knowledge than malign intent.” The dimensions of meta-leadership framework help define pathways to better choices. The meta-leadership tool kit makes it possible to systematically develop proficiency and with that, to put best practices into place.
The challenge for leaders is to deploy influence, often beyond their formal authority, to foster unity of purpose and effort. The secrets to success are communication, coordination, and collaboration.
Surviving the Coronavirus Crisis
One ingredient for successfully traversing the current COVID-19 crisis is sheer capacity: enough people, resources, and equipment to meet the surge of cases. Another ingredient, equally important, is leadership performance. The tone leaders set and the guidance they provide will shape the trajectory of their organization. Leaders will determine the morale of their workforce, the financial viability of their departments, and ultimately, the resilience of their institution.
Marcus noted that every crisis has a beginning, middle, and end. Through its course, the crisis traverses “arcs of time” marked by what was, what is, and what will be. While the present, what is, can be all-consuming, it is the job of leaders to look forward to what will be. They discern what will be needed in the future, whether that is tomorrow, in two weeks, or in a year. Only by anticipating next steps will leaders best prepare their organizations for the adaptation required to remain viable and prepared for what lies way ahead.
“The middle of a crisis may seem an odd time to participate in a training program,” McNulty said. “It may actually be the best time given the extended duration of this event. Everyone perceives the urgency and the early stages of the crisis have revealed systemic challenges across health systems. There is still time for leaders to shape the outcome. We have moved the program online to make it easier to participate and apply the lessons immediately.”
Marcus added, “We want people to look back on this period and be proud of what they did in the face of adversity and tremendous loss. This may be the ultimate example of ‘just-in-time’ executive education.”
Harvard T.H. Chan School of Public Health offers Leading in Health Systems: Navigating Crisis and Change, a high-impact health care leadership development program, which focuses on meta-leadership.