One of the most important responsibilities of any leader in any organization and any place within that organization is seeing and advocating for the larger interests. I realize that such a view might be seen by some as an outdated collectivist perspective, but I believe that every successful individual, team and organization has as a fundamental part of its make-up the ability to sacrifice for the greater good; the well being of the whole. In fact, if such sacrifices are not made and they do not lead to enhanced success, then what possible value could we derive from associative action? Over the years I have asked the same question to hundreds of teams in development workshops: What were the key elements of your most successful team experience? I hear lots of qualities, but I never fail to hear individual sacrifice as one of the efforts that is essential for teams to work.
Heath care is undoubtedly entering a period of profound change and promise. Reinventing what we do and how we do it will perforce require such sacrifices. Leaders that will be effective in this new world will be those that build an environment that can promote such efforts. These environments will have the following four core elements that leaders can develop as a part of any culture in health care.
First, and perhaps most essential is advocacy for the common ground or shared purpose. We create organizations to achieve broad purposes such as service to patients, health outcomes and effectiveness, not to have an admissions office, or post-operative recovery or a billing system. But much of our health care system has become large aggregations of independent parts that do not function to produce a seamless service experience with commensurate outcomes. The advocacy for the common ground is a continuous task for every leader. Without vigilance the parts soon spin out into their own orbit, returning to what they have known for all of the remembered past. This is the essence of all culture change and it is no wonder that it takes six plus years to really change the culture of any organization. It is galling to no end when a perfectly rational solution that has served one part of an organization is rejected by other units. The bane of the change agent is that every new innovation, in order to be successful, must start from scratch. The hope is that by sticking with a coherent change program long enough, it will produce a culture that can be as resilient as that which went before. It just takes time and a continuous and unwavering commitment from leadership to the common ground.
Just advocating for the shared purpose is necessary but not sufficient to bring about individual sacrifice. In addition, the leadership of an organization must present, support and enact a set of clear and coherent strategies that lead to the common future. Individuals will give up what they do and how they have been doing it if they have a large shared goal, and they have understandable pathways to move toward it. Just sharing the goal without offering the steps that must be taken is asking more than many individuals are likely to be able to give. The plan does not need to be perfect and everyone involved will need to understand that parts of it will need to evolve, but there must be a place to start, strategies that are complimentary, and a way to measure progress and redirect effort as needed.
In addition to a plan the leader must also focus effort. It would be terrific to have all the money we need to change, so much so that we wouldn't need to depend on the redirection of the existing budget and resource allocation. But this world rarely exists and, even if it did, it would actually keep the leader from addressing the core issues of realigning the work of the organization. So the hard leadership work here is how to take the resources that are at hand and, while still in full flight, begin to redirect of the organization. Effective leaders look for early adopters and support their efforts. They also look for opportunities for small experiments, particularly when processes or efforts are in transition. Leaders also use their own energy and attention to bring focus to the desired outcomes. They take the scarce extra efforts and bet them on the new direction. They align all of those things that must be done to keep the doors open – meetings, new hires, outreach efforts, mentoring, assignments, and communication of all types - to remind the organization about the focus.
To ask individuals to make sacrifices, the burdens of change must be equitable. Even the true believer will soon get burned out if others do not share in the responsibility for action and risk. Structuring this participation is the responsibility of the leader. Asking for volunteers at the outset of the new venture is fine, but to sustain the change the burdens must be borne justly. Every participant will have a different calculus around the benefits and costs of the change, but it will take the broad view of the leader to ensure that someone or group is not bearing too much of the weight of the change and that all are giving their due to the undertaking.
Change in health care will be as much about giving up old ways of doing our business as it will be about building new exciting ways to organize and deliver health care. Artful leaders will balance the sacrifice of the old with the challenge of the new.