Episode 4, Knowing Who You Are as a Leader. One of the primary motivations for those of us in healthcare, is that we want to add something positive to the world by helping others. I know that my image of myself as a physician, was that I would be taking care of individuals. And my learning was all about that, learning about diseases, their treatment and how to assess a patient and how to learn to deliver both good and bad news. What I had not thought about is how to be a leader, and yet I was frequently cast in a role of a leader in both large and small ways. What I learned since through both formal course work in my own life experiences is the most important element of leadership is to truly know yourself. Leaders have been described in many ways having many different attributes. Among these attributes are having a vision, communicating the vision, caring about people, honesty, delegating effectively, having confidence, commitment, a positive attitude, and a kitchen sink full of other characteristics. However, at the deepest level, leaders, and especially leaders of change, must understand themselves and how they function in their role as a leader. Another key attribute of effective leaders is their ability to listen. And to recognize ideas and critical skills of others at all levels of the organization. I've seen many situations where ideas to improve care generated by hands on staff have been ignored to the peril of patients. This frequently manifests itself as nursing and medical staff during work arounds within a broken system because they can't get the attention of the leaders of the organization to fix a systemic problem. Many organization groups feel that there's far too much focus put into the leader, the President, or the CEO and far too little attention given to the importance of other levels of both formal and informal leaders within an organization. Healthcare organizations that are too hierarchical tend to stamp out the ability of people to be curious and to engage in systems thinking. In addition, often little attention is paid to the teams that are the real unit of work in the organization. People are sort of thrown together whit the expectation that they'll be productive. But with little support for knowing how those teams should function and having a limited idea of how the work of the team fits into the whole of the organization. Kegan and Lahey have done a lot of work around mental complexity and the fit between the complexity of an organization and the capacity for the complexity of leaders. This fit depends on the leader. While organizational complexity can change, it's the leader who needs to adjust. Kegan and Lahey identified three plateaus for adult mental complexity. The first plateau is the socialized mind, where the person is a team player and a faithful follower and seeks direction and is reliant. The second plateau is the self-authoring mind, with the individual driving an agenda, learning to lead and being a problem solver with a great deal of independence. The self-transforming mind is the third plateau. At this level the leader leads to learn and can reflect on the limits of their own authority or ideology and can live with those contradictions. This type of leader can be effectively messaging that all communication is welcomed, both formal and informal. In this model of mental complexity and performance, each level builds on the previous level, with a self-transforming mind being the highest level of mental complexity and therefore performance. Work done by Eigel supports, higher level of mental complexity is related to a more effective leader and a more effective organization. So, what do Kegan and Lahey suggest that can help leaders move to this higher plateau? The challenge is to have leaders learn how to step outside their values and beliefs and to look at issues and themselves through a new lens. Only by stepping outside their usual way looking at things can the potential for change happen. Based on much research of the decades, as well as on their own work, Kegan and Lahey suggest what they call optimal conflict, that helps move to a higher plateau. Optimal conflict includes the persistent experience of some frustration, dilemma, life puzzle, quandary, or personal problem that is perfectly designed to cause us to feel the limits of our current way of knowing. In some sphere of our living that we care about and with sufficient supports, so that we are neither overwhelmed by the conflict nor able to escape and diffuse it. Knowing where you are at as a leader is critically important. Having greater mental complexity will help in leading change. Establishing a culture of quality and safety in today's healthcare environment means doing this within very complicated situations. Think about the changes in the health systems that you work in. In a few short years, the US has been through health maintenance organizations that kind of a procure organizations integrating technology for patient care, integrating electronic health records. And in addition, we've had to deal with new diseases that have emerged, including HIV/AIDS, Ebola and the Zika virus. The challenge to leaders is not just to create the quality culture but to do this as the business of healthcare changes. Argyris and Schon propose that organizations engage in single-loop or double-loop learning to solve problems and describe these processes as follows. When an error is detected and can be corrected in a way that allows the organization to just carry on its present policies or achieve its current objectives, this error in correction process is single-loop learning. Double-loop learning occurs when the error is detected and the correction requires changes and modifications of an organization's underlying norms, policies and objectives. While single-loop problem solving is efficient and usually sufficient, healthcare organizations that stay within single-loop thinking often fail to recognize situations that require double-loop learning and will fall behind those who can seize on those opportunities to change their underlying norms, policies and beliefs. Thus building a deep culture of quality and safety. It takes double-loop learning to challenge assumptions and ways of doing business to build a true culture of safety. One example of single-loop learning, for example, would be recruiting a new director of quality insurance when the department of quality insurance is not improving some key measures that are important. Double-loop thinking would look deeper and might include an analysis of what staff believes about quality. And how quality improvement is supported or not throughout the organization. Developing leadership capacity is not easy work. However, there are ways of continuing to develop leadership capacity including working with a coach, using leadership assessment instruments for feedback and recognizing that leadership is not only about knowledge but also about heart. To seek knowledge without the passion to apply that knowledge is useless, it does not improve anything. Self reflection is an important aspect of leadership, of leadership at every level.
