New leadership challenges for healthcare

When it comes to leadership, hospitals resemble organizations like universities in terms of their diverse, decentralized power centers. It is no surprise that the traditional "command and control" model of leadership does not suit these institutions' proud professionals (nor can it keep pace with the constant triaging necessary in a hospital setting).

But the current form of decentralized power does not, in fact, meet the newest challenges in healthcare leadership. In higher education as in healthcare, these power centers are often siloed and over time develop as professional or specialty-based "fiefdoms." To work effectively and change nimbly, organizations must break down the rigid boundaries between these siloes while also fostering (and accepting) leadership from its individual employees.

These imperatives are front and center for healthcare organizations thanks to news about the Millennial generation: according to the Pew Research Center, Millennials became the largest generation in the U.S. workforce in early 2015.1 The growing power of Millennials in the workplace has the potential to recreate silos on a micro-scale, with each individual "leader" the ruler in his or her own (tiny) fiefdom. Right now, however, it appears that the bigger problem is the underutilization of these potential leaders. In a survey of over 7500 Millennials worldwide, Deloitte found that 63% say their own "leadership skills are not being developed." Respondents who felt this way were significantly more likely to be planning an exit from their existing company within two years. Ultimately, "Millennials believe businesses are not doing enough to bridge the gap to ensure a new generation of business leaders is created."2

Deloitte's findings pose a challenge for employers, but they may also point the way forward. Instead of replicating an outdated top-down model in each departmental silo, healthcare leadership needs to adapt to the leadership practice that meets the needs and values of Millennials, namely developing their capacity to lead and be led simultaneously.

Familiar problems
HR departments know all too well the litany of traditional challenges in organizational culture. Some of these perennial problems include employees' lack of engagement, attrition, and distrust, particularly around performance feedback and team dynamics. For company leaders, the problems that crop up around decision-making are typically more pressing. Executives must constantly walk the line between poor choices due to a lack of deliberation and missed opportunities because of too much deliberation.

The new employee mix complicates both employee satisfaction and team decision-making. With Millennials occupying a greater share of the positions in all industries, inter-generational demands on and for leadership require new responses from the company's formal leaders.

An unfamiliar solution: Leading and following at the same time
New leadership practices have been developed around the recognition that authority and responsibility become less concentrated as information circulates more freely. These practices equip leaders to harness Millennial preferences to adjust organization culture toward genuine engagement, flow, accountability, and better outcomes. These skills can be understood as a kind of simultaneous leadership.

The most basic form of leading and following simultaneously is when a team's leaders are genuinely present in the same moment, bringing with them conviction and a curiosity that remains open to different points of view. This presence and curiosity encourage contributions from all team members, and conveys the expectation that everyone can and will contribute genuinely to the conversation, project, or decision at hand. Also when the situation warrants, leaders can learn to make more authoritative decisions in a manner that accentuates trust.

The model of leading and following at the same time is already emerging in corporate America, driven largely by Millennials demanding new styles of leadership. For instance, Millennials do not appreciate meetings for meetings' sake—but they also lack the deference to traditional ways of doing things that keep most workers from balking at poorly run or unnecessary meetings. A responsible way to address this is to indicate for all attendees the form and goal of each meeting. Is this an exploratory discussion about a potential change, or is it the way to communicate a change that's already been made? Stating this outright is a vital piece of a leadership strategy that builds trust and increases accountability. (Indeed, this stark example also shows how mismatched expectations might actually put team members at cross-purposes, degrading trust by seeming like a bait-and-switch.) Appreciating the possibility of divergent expectations—and working to communicate openly across those distances—is a hallmark of a leader who is also open to following.

When properly applied, this model of leadership can establish a culture of listening and trust, which in turn unlocks talent, ideas, and creativity—the keys both to productivity gains and to employee satisfaction. Without structure and training, however, and without clear communication, this model can seem haphazard or inconsistent. Healthcare organizations may have unconsciously backed into the leading and following model at the structural level, but they can harness this structural diffusion to more productive, less aggravating, and more positive ends by treating the resulting leadership as a critical competency.

Some of the skills that demonstrate training in Simultaneous Leadership™ include:
• Reframing conflict as an opportunity for creativity;
• Bringing curious convictions to decision-making and group meetings, not tepid interest or strident proclamations; and
• Foregoing the urge to convince or the perceived requirement to compromise—instead, recognizing that each individual stance is merely one part of a bigger, emerging conversational puzzle.
Ultimately, these skills can foster and transmit a culture of trust and effective, flexible decision-making and agile, effective execution throughout a large health system or major hospital. More broadly, this model also better leverages human capital, making employees understand, and be accountable for, the genuine value of their contributions.

Part 2 of this two-part series will explore the impact Millennials are having on healthcare organizations and how healthcare organizations can adjust traditional practices to meet these new expectations.

1 http://www.pewresearch.org/fact-tank/2015/05/11/millennials-surpass-gen-xers-as-the-largest-generation-in-u-s-labor-force/.
2 https://www2.deloitte.com/global/en/pages/about-deloitte/articles/gx-millennials-one-foot-out-the-door.html.

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