Hospitals' ivory tower problem

Most leaders spent time in the trenches at some point in their career. When they gradually move into ivory towers shielded from the pain points, dynamics and ideas pulsing throughout their organization, they rarely realize it — and that's what makes it dangerous. 

Leadership presence is often linked to command of a room, polished presentation or confidence. These traits are nice to have, but mean little if leaders simply aren't showing up. The state of existing in a place or thing is the literal definition of presence. 

As healthcare workers continue to weather COVID-19's ups and downs, there is a determinant of job satisfaction unrelated to pay, benefits or time off: "Have my leaders shown up in a real, meaningful way?" 

Doing so in spring 2020 was a given. Doing so now differentiates strong servant leaders from their average white-collar counterparts, the latter of which are aplenty in every field and industry. 

"Even though most business schools, executive training courses and leadership programs espouse servant leadership, few bosses manage to fully commit to it," a director and senior partner wrote for McKinsey Quarterly. "Perhaps that's no surprise."

One of the most common methods through which hospital executives aim to make their presence known is scheduled leadership rounding, in which they walk the halls and speak with and help staff and patients. In 2019, Gallup devoted an entire article to the ways rounding can go wrong and become a check-the-box task leaders rush through. The article shared tips to avoid sounding robotic and strategies to recognize employees that go beyond "a flurry of thank you cards." 

Droning, thoughtless leadership rounding was one thing pre-pandemic — expectedly disappointing, maybe pesty to people on the front line. But the discontent, turnover, exhaustion and frustration consuming hospitals and their workforces today makes the idea of this ornamental exercise unbearable. 

Megan Ranney, MD, a practicing emergency medicine physician and associate dean for strategy and innovation with Brown University School of Public Health in Providence, R.I., told me last month that the health systems she's seen best weather COVID-19 are those where leaders are in the trenches with the front lines. Systems that have had the toughest time have leaders who don't understand the real pain points people experience.  

When pressed to differentiate between these two leadership personas (because who would admit to the latter?), Dr. Ranney immediately pointed to an executive at Providence-based Lifespan Health System, where she practices. Hers is insight into leadership sans ivory tower, an executive who has made a point to be on the floor late at night (versus 10 a.m. on Tuesday) when her presence was needed.

"She is someone who has literally shown up on the floor and in the ED to help manage crises," Dr. Ranney said. "Not in a 'let me be here and show my face' way, but in a way of 'let me help the team, brainstorm and get the solution they need and not let off until we've gotten through the other side of it.' As a leader, you can't create a solution to every problem brought to you, but she supports us and champions finding a solution. There is a difference between the lip service of 'let me take a tour' versus 'I'm hearing from the ground what the issues are, and I'm committed to being present and empowering teams to create solutions that work for them.'" 

She pointed to other non-physician leaders in healthcare who have excellent reputations for standing behind — not in front of — their teams, and upholding staff concerns and well-being as critical to providing good patient care. "Versus C-suite folks who really are only focused on the bottom line," Dr. Ranney distinguished. "They see the complaints from workers as distractions."

Thoughtful presence through thick and thin, and without fanfare, is one thing. But ivory tower syndrome involves a physical element (being there or not), as well as a social element. People in positions of power are too often told what they want to hear, living in comfortable cocoons. A leader may be in the trenches, yet still thinking, listening and problem-solving within their C-level bubble. Nobody will penetrate this bubble but the executive themselves. It takes commitment to recognize the dynamics of power and overcome it in daily interactions. 

"In the course of conducting more than 200 research interviews with senior business executives over the past few years, I've come across hardly anyone who did not identify with this problem," Hal Gregersen, PhD, former executive director of the MIT Leadership Center, wrote for Harvard Business Review. "But more tellingly, I've also seen that at firms that are highly successful innovators, leaders are especially attuned to it and committed to overcoming it. Those executives work hard to break down the walls surrounding them." 

To move out from the ivory tower, leaders need to reframe questions so they are more likely to get at "unknown unknowns" within their organization — information they haven't sought because they don't know to ask for it. ("Every answer has a question that retrieves it," as the late innovation expert Clayton Christensen put it.) 

Leaders need to assume they are wrong, and do so more often. As one leader told Dr. Gregersen: "Every day I ask myself, 'How many things am I dead wrong about?'" Successful leaders recognize poor decisions and adjust, whereas lagging leaders double down and uphold the case that they were correct. 

Leaders can also make a point to embrace silence. "This is not typical behavior for CEOs, who are generally expected to be in broadcast mode, delivering words of inspiration, explanation, and unambiguous direction," Dr. Gregersen wrote. To receive messages and information, stop sending them. Let people expand on their thoughts. Abandon preconceived notions. Ask more questions versus telling the answers. 

Beating ivory tower syndrome takes commitment, habit and real intention. It involves being wrong, uncomfortable and quiet when there is always a temptation or excuse to stay insulated and comfy. Healthcare leaders who continue to dwell higher up and further away from their people will only let the realistic, genuine servant leaders shine. Keep a look out for them, and let's hope emerging and growing leaders learn from them. 

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