Leading Ways: Influencing Up


A Big Challenge


One of the trickiest and most necessary of all tasks facing leaders is how to lead up. Many people do not even think of this as a leadership responsibility or, if it is, it’s not theirs but their boss’s. But leading up is critical in order to influence your boss and others that are “up” in the organization, and to properly position your work for organizational, team, and individual success. 


Many shy away from this work because it strikes them as something that looks like self-promotion, feels a little slimy, or because they are just not good at it. If you are trying to lead by only influencing down or out, then you are a third less effective than if you skillfully work the last dimension: influencing up. 


Here are a few keys for effectively leading up directly to the person you work with and more generally in the organization. 


1.     Be self-aware– This is a valuable place to start in any leadership endeavor, but when leading up there are some special considerations to keep in mind. First is your attitude about leading up. Yes, it probably is your boss’s job to get your input, and yes, the higher ups could be clearer about the direction of the organization and more consistent in their actions, but if you are going to influence up, blaming them for their shortcomings and being resentful is not a good place to begin. Rather, think through how to get from them what you need:  clarity, a chance for input or consistency, whatever will help you advance your leadership agenda to make the organization better. 


2.     Know their style– It is essential to be clear about how the up folks like to communicate, receive new proposals, learn bad news and brain storm. Everyone is different and the more you align how you present it with how they like to hear it, the more successful you will be. You can be too creative when you are leading up, so save that for when you have the opportunity to expand the idea.



3.     You need to push– Working well with others is an important quality for a leader in any organization. But if you are influencing up and hoping to advance an idea you need to actively push this agenda and send a strong message that you are the person who can make this change happen. There are a lot of ideas and a lot of people advancing them, why should the people up in the organization choose you? You are selling, they are buying; the onus is on you to make the case, not for them to understand.


4.     Frame it big– When you have been working on something for a period and are presenting it up in the organization most likely it will be something that you understand better than anyone else around. It has become an important part of your life and you want to share all of the details of this with others. They don’t care. They assume you know the details and they do not need to, what they want to know is what this will solve, how it fits with the bigger strategy, how it will make things better. And most of these are not in the details.  A specific reminder on this point is to not to get lost in overly technical language and acronyms. 


5.     Just the facts- Always have hard numbers around the costs and benefits of the proposal. It is fine to have a best and worst-case scenario, but do not color this in any way. Be objective.


6.     Stepping on toes- Understand the broader political context of your proposal from its impact on other parts of the company to how it will be seen by other individuals not immediately involved. Regardless of how right you are, someone will have to take a political hit when you get the go ahead.


7.     Run it up the flag pole (but not the one out front)- Before presenting or even beginning to advance an idea pressure test it with your staff, others from the outside and senior people who may not be a part of the decision process, but who have good judgment and political sensitivity. 


8.     Get gradual buy-in- Pre-sell or shop a general concept to test how those that you need to influence will receive it. This will give you intelligence about what they believe are the important issues, current pressures on them, insights into the competition and an early warning on possible objections. It also gives you a chance to enhance relationships with all of them.


9.     Welcome a conversation- During the formal presentation it is important to not over sell, over discuss from your perspective and fail to register the cues you are getting from them. The idea is to get it out in a general way, giving them the pros and cons and then allow them to have the space to explore their concerns with you. Ask for feedback. Engaged questioning is a better sign than uncritical acceptance. 


Leading Ways: Feedback

Most of us want to improve the quality and efficiency of our work. Central to this improvement is receiving feedback. If you are a manager or leader you are in the crucial position of providing this feedback. You have to have some help in this. The person you are working with needs the basic skills and ambitions needed to advance in the organization. And the organization itself needs to value this improvement and provide the structures advance the individual’s effort, such as annual reviews, promotion opportunities and appreciation of effort. 


The role of the supervisor however is crucial and is often needed to make up for shortcomings in the individual or the organization. Creating a positive feedback environment is critical to this management role. 


How to Create a Positive Feedback Environment


Long before specific feedback is given it is helpful for managers and leaders to work toward the creation of a positive feedback environment. Such an environment creates the shared expectation that everyone involved is on the team and the team has a shared goal, values, culture and expectations. The leader is the principal coach in establishing such an environment, but when it is successful, everyone is coaching everyone else, offering supportive and appreciative comments and, when needed helping think through how to improve the situation or address a problem.


Creating such an environment requires continuous action by the leader until the team can make the culture belong to them. Here are five elements that are important to such a culture:



Clear sense of purpose and common ground– All teams and work groups need this as the first step. Without both elements, they can’t answer basic questions such as “Where are we going?”  and “What is in this for me?” or “How will success be measured?” It is the leader’s job to facilitate this conversation and keep it going forward as new things arise and situations change. 


Acceptance of every individual– Most people come to new ventures with some anxiety about acceptance and performance. Some of this is constructive and produces effort, but it is important for the team leader to create an environment of acceptance and trust. Otherwise it will difficult to coach in a situation without it seeming judgmental at the personal level. This leads to defensiveness, cover-ups, and emotional outbursts, as the feedback seems more personal than professional. The ideal place to be is, “We are in this together and it is in all of our interests to address the problem.” 


Two-Way nature of most situations- Almost every situation and dynamic in an organization that is problematic and requires feedback has two sides. Unfortunately, most of the two sides discussions we have are focused on fixing the blame on one side or the other. The famous he said – she said dynamic. There are situations where one person or group has acted in a unilateral and conscious manner to be dishonest or harm another or subvert a process, and these should be dealt with accordingly. However, for the vast majority of problems the two-sides perspective points to the reality that each side has contributed something to the situation and these elements need to be teased out and addressed.


Expectation of improvement– Every person on the team, including the leader must go into the situation with the expectation that a better job can always be done and that is possible if everyone is helping everyone else improve. This means feedback goes in all directions.


Sanctions on individuals who remain outside the culture - Nothing will kill a feedback culture faster than a rogue individual who is left to create discord. This does not mean everyone has to agree, far from it. It does mean that individual behaviors that are inconsistent with a constructive feedback culture- unwillingness to share in feedback, vindictiveness when feedback is given, using feedback to make personal attacks-are addressed immediately. Without such attention from the leader all of the other efforts to create a culture will be for naught, worse they will seem hypocritical and bring out cynicism in others.






Giving Feedback


Remember, a constructive feedback culture goes both ways. So, learning how to both give and receive feedback is essential. Here are some general rules to keep in mind when giving feedback:


Giving It


Be Confidential – Feedback is always given in private and it is a conversation between you and the person receiving the feedback. Do not bring a lot of other people into this conversation by representing their feelings or attitudes. 



Be Supportive – The point of the feedback is improvement so that the person receiving it can improve and be successful in a work setting. Being non-judgmental is a major part of this. Be encouraging and non-threatening. Attacking in anyway will just make the person you want to influence defensive, resentful and likely to not hear any of the things you want to say. 


Be Clear– If it is important to offer feedback, then it is important to be clear about what you want to say. Here are some steps to clarity:


·      Think about it before hand

·      Share it with another person, someone totally outside of the work setting

·      Question your own motivations in giving the feedback

·      Imagine what the outcome is you would like


Be Timely– Nothing is worse than waiting until the annual review to give feedback on something that was important but happened six months ago. While it is important to be timely, it is also wise to remember to give yourself some time to cool off if the item of feedback you want to share has brought out an emotional response in you. 


Be able to speak from a non-emotional, but caring space – This may be the most challenging element in giving feedback, but it is essential. If you are still “steaming” about something, you have to regain your composure before you engage in feedback, nothing constructive will be gained and there is the real potential for damage, wasted time and even bigger problems. Step away, wait a day, cool down, think about it and what you want to achieve, but then have the courage to re-engage. 


Be Focused on a Specific Behavior or Situation– General feedback is generally a fuzz ball when the feedback giver is uncomfortable with what needs to be said. Just say it, a clear, short non-judgmental message opens the door for a conversation to solve the problem. Anything else opens the door to lack of clarity, emotional response and inappropriate escalation of the significance of the problem. 


Describe, don’t judge- Your job is to raise the issue and broaden the understanding. If you have already decided what caused the problem and what needs to be done, then you are not giving feedback you are passing judgment. This is where the famous “I” statements can help. You don’t give up your opinion or what you have observed, but you are signaling that it is only one perspective and you are inviting them in to share their view. Remember to not generalize or make absolutist statements such as “You always do that.” Don’t make a simple situation worse by overreacting. 


Direct the feedback to changeable behavior- Observing that someone might be smarter about something is not really helpful feedback. Observing that they were quick in making a judgment and reacting and that others and you seemed to be offended by this action is an observation they can consider and perhaps do something about. 


Don’t lead with advice– Feedback is not advice giving. It is sharing observations about a situation. After that is understood and valued, then it is possible to guardedly offer advice. In a constructive feedback culture the advice is generally asked for right away. A helpful question for the feedback giver at the outset of feedback is, “Are you getting the results you want from this approach?” Let the other person answer and then quiet naturally ask if there are alternatives. 


Check it, briefly–It is quite all right to check to see if the feedback is understood but do so briefly. After two checks the questioning becomes abusive as in “What part of this don’t you understand.”


Remember that constructive feedback is always given to help the individual who is receiving it. The more the feedback comes across as supportive and helpful, then the more successful it will be. This does not mean that continued inattention does not require more specific requests for change from the manager, leader or co-worker. But such a response should always be reserved until needed. 



A Word on Different Types of Reviews


Annual reviews are an important opportunity to look at the big picture from the past year and to do some planning for the coming year. They should stay at this level, except when specific goals for past year are assessed mutually and those for the coming year are set. The annual review is not a good time for feedback. If it was important in June, it should have been given at the time, not in March when the annual reviews are held. A development plan has some of the annual review and goal setting of an annual review but is more focused on personal professional growth and should become a way for activity and reinforcement to be shaped throughout the year. 

Leading Ways: Mediating Conflicts

Invariably the best of managers and leaders find themselves in a position of having to mediate issues between two direct reports that have gotten sideways. It is important not to get in a series of separate conversations with the parties. You will wind up in the middle of the conflict. This is a no-win situation.


It is always best to avoid these situations by making sure that goals, roles and key processes – communication, decision making and accountabilities- are clear, consistent and continually reinforced. My experience is that while leaders believe that all of these matters are clear, they often are not and touchy concerns like roles, decision authority, and accommodation of other’s needs are often glossed over or ignored.


But even with these preventative matters well in place, things can go off track.


It will be inevitable that the conflict will come to your attention in a one-on-one conversation with one of the parties. Do your best to listen, ask questions for clarification, pass no judgment and indicate that you would like to discuss the situation one-on-one with the other person involved. Again, in this second conversation you are there to ask, listen and learn.


Then it is time to convene the two parties. This will be a challenging meeting, but here are some things that can help. 


First send out a set of rules prior to the meeting. Here are some that I like to go out ahead of time as a way of setting the stage for a productive discussion:


·     I want us to have a chance for and open and honest exchange that is safefor all of us. 


·     This means listening to each other, focusing on the problems and issues not each other, withholding judgment and maintaining civility.


·     I would like us to be able to identify, agree and focus on one problem at a time, if multiple problems are related, we can identify them and still focus one particular problem or issue at a time. It may help to think through issues that are important to you beforehand and write them down.


·     I will go in to our meeting assuming that all of us are motivated by good intentions and invite you to do the same.


·     My goal at the meeting will be for us to have a shared understanding of the problem or issue and for us to come up with ideas of how we can address these as we go forward. If it is possible, I would like to leave the meeting with a better appreciation of each other’s positions and understandings. As well, my aim will be to help us get to some specific, positive next steps that we can all take and support of improving this situation. 


·     I hope we can all come to the meeting with some genuine curiosity and seek to improve your understanding of the dynamics that have gotten us to where we are.






At the meeting try to maintain complete neutrality and to model the kind of curiosity that you have suggested they bring to the meeting. You will need to actively moderate the discussion. Do not allow personal attacks and be sure to call out all judgments for what they are. Try to keep them focused to facts, not how they interpret the facts. 


If things do get too emotional, and they can, you may need to suggest that the discussion stop for the day and reconvene, but make sure you summarize what progress they have made and also offer some thoughts about next steps.


If you do get some progress on having them understand each other and the problems better, make sure you reserve 15 minutes or so at the close of the meeting to focus on practical action steps that all parties, including you, can take to make sure this works well as we go forward. A commitment to a small test of changed behavior is much better than a promise to “change everything.” I would suggest that you offer to draft a summary of the conclusion, share this in an email and ask them for their input. This should then be the basis for the next meeting.


The next steps are rinse and repeat until there are clear and accepted rules for behavior, hopefully some acceptance and understanding and a lowering of tensions


Also, after this first meeting, all future discussions of these issues need to involve all of the concerned individuals or you will be back in the middle. 


You can use the same approach if you find yourself mediating between two peers on a team. It just requires that you alter your role a bit to be more collegial

Are We There Yet?

Like petulant children in the backseat, we keep asking the familiar interrogatory question from the family vacations of our youth, but now it is about health care reform. Admittedly the changes were sold to us as a wonderful trip to a better place for the nation and for every individual. It has not helped that we have had a serious misstep of a detour right as we began the trip with the failure of healthcare.gov to deliver the promise of buying insurance with the same ease with which we purchase lace-ups from Zappos. This was sort of the vacation equivalent of running over the family cocker spaniel while leaving for the summer excursion to the lake. But before we give up entirely on this trip, we should ask and understand some basic questions.

Read More


The faithful reader of this space will note a modest change from issues past. This month column has a dual byline pointing to an upcoming change in the leadership of the Center for the Health Professions at UCSF. Ed O’Neil, who established the Center and for the past 20 years has directed its effort to frame policy issues around health workforce, will retire from the university in June 2012. Assuming the role of Interim Director will be Sunita Mutha, a long-time member of the senior faculty at the Center and a Professor of Medicine at UCSF. This transition will be an opportunity for the Center to take stock of its accomplishments and position itself to continue to play a vital role in pursuing its mission to transform health care through workforce research and leadership development. 

Read More

Remaking the Value Proposition Where the Work is Difficult

Last month I gave a quick sketch of what I see as the key elements of producing value in a reconfigured health system. This aim is the very best way for health care leaders to ensure that their institutions remain viable and driven toward a future state that can improve the health of those they serve and not damage the overall economy of our nation. Nowhere will this value pursuit be more challenging than in the nation’s hospitals. In large measure, the difficulty that hospital leaders face is a function of the niche in the health care ecology that they occupy. Because they have housed many of the highly specialized, technologically driven and expensive services, they have come to represent the excesses of the system and are targets for change from every quarter. The addiction of hospital finance to the revenue stream that flows from the emergency room through the ICU to the step down unit means that quitting the habit developed during the era of cost plus reimbursements will be hard, if for no other reason than that there is little, if any, experience at running hospitals in other types of business models. 

Read More

Health Care's Value Proposition

After we get everyone enrolled in a health home. And the silos of the old provider world are merged into organizations that can account for care. And budgets that are global emerge, heralding the return of capitated care. Then we will finally get around to the real work of providing health care services that are valuable to those that purchase them. And then, and only then, will we do something that is really new.

Read More

Is Primary Care Necessary?

No, it is essential.

At the most macro level it has always been interesting to me that those nations that seem to take better care of their citizens for less money have the exact reverse proportions of providers--greater numbers of primary care providers than specialists; whereas the U.S. has more specialists than primary care. When you make a statement like this you can be attacked for wanting to dumb down the system of care. I know I have been attacked on this for many years.

Read More

A Reframing of the Stream

In a recent Wall Street Journal article, David Gelernter was interviewed and in effect asked what was on his mind.(1) Gelernter, as the IT intelligentsia will know, is the Yale Professor of Computer Science, Unabomber victim and the individual some credit with coining the term “cloud” for that amorphous aggregation of the data of our lives. The whole article is worth a read for its value in helping provide a different framework as to how we think about information and its manipulation and use in the future. Gelernter sees an expanding future in which almost boundless information is readily and inexpensively available on a ubiquity of devices of increasingly smaller size and elegance of design.

Read More