Imparting wisdom to evolving leaders: new leadership program at Geisinger focuses on case-based discussions mixed with personal experience.

A significant challenge for senior leaders of health care organizations is to identify and prepare the next generation of leaders.

Traditionally, leadership development programs provide training in key management areas (such as finance, human resources, legal issues, and marketing) and exposure to leadership issues. The latter may include formal leadership skills assessment leading to programs of individualized skill building, exposure to the theory of leadership through academic presentations, or mentoring during graduated assignment of responsibilities.

Teaching the next generation of leaders by helping them develop traits such as emotional intelligence or by instructing them in skills ranging from public speaking to financial statement analysis are vitally important for basic survival as a new leader in nearly any position. But is this enough?

Leadership development also requires the acquisition of wisdom that experienced leaders gained as they moved through their careers. In most fields, world-class performers seem to possess an instinctive feel for what and how to do what is needed at precisely the correct moment.

Just as great artists, athletes, or surgeons gained their "instinctive" touch through mentoring with masters and experiential learning at an early age, so must emerging leaders be given the opportunity to learn from master leaders. This is where traditional leadership training has been lacking. There has been no mechanism for an intergenerational transfer of wisdom from today's great leaders to tomorrow's leaders.

CEO's wisdom

For the evolving leader in an organization, the most pertinent wisdom comes from the CEO. He or she is the most successful leader in the 0organization and the CEO's experience sheds light on his or her personal values and priorities that color the entire organization.

In the usual process of leadership development, the evolving leader rarely interacts with the CEO of the organization outside of the top leader's formal role in meetings and presentations.

That's not the case at Geisinger Health System in Pennsylvania, where the CEO and other leaders share unique, personal, case-based wisdom with evolving leaders.

For our purposes, we define wisdom as successful decision-making based, in part, on the experience of successful leaders. Wisdom encompasses the subtleties that traditional programs cannot adequately address. Timing, values, risk-taking and prioritization can be better learned from the stories of a master.

What cannot be accomplished through academic presentation and analysis can be accomplished through story telling. It is akin to walks in the woods with a grandparent when stories from earlier times and the lessons learned are shared.

Much as family histories and values are conveyed from grandparents to a younger generation as part of their stories, the CEO's wisdom is passed on to evolving leaders through the stories that provide the basis for the open give-and-take of case-based discussions. Just as grandparents and the future generation have a memorable shared experience after their story-telling walk, so do the younger evolving leaders develop a deeper bond with the CEO and stronger ties to the organization.

Although the CEO plays the pivotal role in this program, a neutral expert is required for the program to be successful. In Geisinger's program, the neutral expert is a professor of management from a collaborating university who had been highly successful in the for-profit world prior to entering academics.

This person plays a number of roles. In the first session, he introduced the program goals, provided a brief overview of the academic models of leadership and oriented the group to case-based learning for those who were unfamiliar with it. He then conducted the first several case discussions without the CEO present.

Since the group of evolving leaders had had little face-to-face contact with the CEO in give-and-take discussions, the goal was to set the framework for free flowing, uninhibited interchange. This opened up the group and allowed all to be comfortable with case-based discussions prior to the CEO joining the sessions.

When the CEO joined the group in later sessions there could have been a tendency among the members to regress from this forthrightness, but the CEO's initial discussion revealed a degree of personal vulnerability not seen by the group in previous, more formal, exposure to him.

The neutral expert also facilitated parts of the discussion when the CEO joined the group. Facilitating case-based discussions takes experience and skill, especially when one of the goals is to challenge the participants to come to their own conclusions when faced with a set of circumstances.

A primary objective was to help the participants develop their own decision-making skills; it was not to guide the participants to come to the same conclusions as the CEO.

Usually, one or two cases were discussed at each two-hour session. Case materials were distributed during the week prior to the meeting. That information took the case to the point of the first critical decision; additional information was provided to the group though discussion and with additional written data presented during the case discussions.

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Themes of the cases included managing versus leading, forming a vision, predefining a person's moral compass, risk-taking, and transactional leadership.

Outcome and evaluation

A confidential survey of the participants was conducted following the series. Each participant was asked to rate his or her response on the following 10 questions, using a five-point scale (five being most favorable):

1. In my experience, the leadership seminars series was a unique leadership education experience.

2. I will change how I approach the CEO and other senior leaders because of what I learned.

3. I believe I will be more successful at Geisinger because of what I learned.

4. I would recommend the seminar series to a colleague.

5. The participation of an "outside expert" was necessary for the program to work.

6. My perception of what it takes to become a successful leader at Geisinger changed because of the program.

7. My perception of the leadership characteristics valued by Geisinger senior leaders changed.

8. The program should be continued in the future.

9. The case-based format was an effective approach to learning.

10. I will change how I lead based on what I learned.

The average score of the responses for all questions was four or greater with the exception of a 3.88 rating for question six. The highest rating was in response to question eight (4.78), with responses over 4.4 for questions one, four, nine and ten.

The overwhelming willingness of the participants to recommend the program to colleagues and their desire to see it continued for other groups were the critical questions, and each of them received a superior rating.

A final question was also posed, and rated from worst to best: Compared to other leadership training and education programs you have taken, how would you rate this series?

The average rating of the responses to this addition question was 4.63. This taken with an average response of 4.67 to question one indicate that the participants felt that they had experienced a unique learning opportunity that was superior to other leadership training and education activities in which they had participated.

The participants expressed enthusiasm for the case-based method, especially among the physician group, many of whom had not had prior experience with this teaching method.

The group describes a sense of a deeper insight into the decision-making process and values of successful leaders, and a better first-hand understanding of our CEO, with whom they feel a more personal bond.

During the case discussions they had the opportunity to test their own decision-making skills in the light of the experience of successful leaders. In addition to the experiential learning opportunities provided in the case discussions, several of the participants reported experimenting in their current leadership assignments with concepts discussed during a session.

One participant has even used one of the cases to heighten the leadership awareness of some of his own subordinates. The survey also showed that the participants rated the seminar series as their best leadership education experience when compared to other programs.

The CEO reported a deeper appreciation for the caliber of future leaders and an unexpected understanding of the need for risk-taking among them. The opportunity to engage evolving leaders in open discussion gave him first-hand appreciation of the leadership potential of each participant. The CEO noted an appreciation for these individuals who aspire to leadership positions, their values, their willingness to take appropriate risks, and, to a degree, the potential of each to become a successful leader.

William Gruver is director of the Geisinger Health System Foundation Board of Directors and a professor at Bucknell University in Lewisburg, Pa. He can be reached at [e-mail]

Robert C. Spahr, MD, is senior vice president of service quality at Geisinger Health System in Danville, Pa. He can be reached at [e-mail]

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By William Gruver and Robert C. Spahr, MD

RELATED ARTICLE: Test: Which Job Would You Take?

Example of Geisinger's storytelling leadership program forces potential leaders to ponder difficult decisions.

In 1975, "Dr. B" finally--after many years of academic and clinical residency training--faced the challenge of choosing a first job.

At age 32, Dr. B's preparation for a "real job" included college, medical school, and basic science training at the PhD level. His clinical trade skills were honed through five additional years of surgical training after graduation from medical school. His plan was to initiate a clinical surgical practice in a setting centered on an academic medical center and, in parallel, build a research career in a new field designated as "translational research" (tying basic biology discovery to patient benefit).

The last part of a three-part career plan was to use his clinical/research reputation to land an administrative/business leadership post, hopefully heading a major academic department by the age of 40, moving to a more senior deanship by the age of 50 and finally, landing either a non-profit or for-profit CEO job as a last leadership position between the ages of 55-60. Obviously, the timeline was flexible but the career strategy was relatively firm.

An important predicate was Dr. B's choice of clinical and scientific specialization. He obtained excellent training pedigrees in cancer and transplantation surgery, plus doctoral training in microbiology, with particular expertise in immunology. Both were presumed "launching pads" for upward career movement in rapidly expanding fields that were quickly linking basic biology discovery to real clinical advances.

Three exceptionally successful academic venues were on Dr. B's finalist list for first job choice. All had excellent reputations in clinical care giving, as well as variable (but significant) scientific acclaim in the fields of transplantation and cancer treatment/cancer biology.

Before making a choice, he needed to define the strengths and weaknesses of each of the potential choices. He received offers from all three institutions. Which would be the best job for him?

Choice # 1

First perhaps, the most logical choice of entry job was the university academic medical center where he had trained in clinical surgery. The chief of surgery at that center was widely acknowledged as a leading organ transplant surgeon. He had been rightfully credited with extending the concept of kidney transplantation to application in many other organ systems, including what was then the burgeoning, but still experimental field of liver transplants.

This leader's technical brilliance was equaled by his interest and accomplishment in setting the standards for modern day immunosuppression, allowing transplanted organs from unrelated donors to be accepted long-term without the ill consequences of immediate or chronic rejection. There was no question that this individual, who would be Dr. B's boss, was one of the most brilliant, creative and productive leaders in the rapidly expanding field of clinical and experimental human transplantation.

There were other factors to consider. First, the chief had a "unique personality." Even in dealing with medical students, this world renowned, revered leader tended to routinely dismiss critical analysis of his pronouncements or discussions that might question current dogma.

When Dr. B discussed the possibility of using his basic biology training in immunology to link not only to clinical transplantation, but also possibly to cancer surgery (a conceptually sound basic science underpinning for both clinical specialties), the chief simply said the combination was not practical. He told Dr. B that he would need to pick one or the other clinical field but not attempt both. There was no further discussion.

Obviously, if Dr. B were to stay at his home training ground for his first "real" professional/academic position, he would need to conform completely to what the chief wanted him to do. One additional fact--neither the chief nor the home institution had a substantial track record of spawning leaders for other clinical or basic science venues elsewhere.

Choice # 2

A second career choice was represented by a nationally renowned academic medical center located in the upper Midwest that, like Dr. B's training ground, also had established a reputation as one of the strongest venues in clinical transplantation, particularly pancreas transplants.

In addition, it had attracted a superb group of laboratory investigators who were producing dramatic new biologic knowledge in cancer and in transplant immunology. This was important since many of the biologic mechanisms involved in transplantation rejection and in helping the body recognize and fight off cancers are the same.

The linkage between these two areas of basic science fit nicely into one of Dr. B's career design goals, which was to combine immunology investigation with clinical cancer and transplantation surgery.

The "proximate" boss at this second possible venue was an eminent surgeon whose reputation rested almost solely on his research credentials. This individual had created one of the largest accumulations of federal grant dollars in the country and primarily investigated the immune response to cancer and to organs transplanted from unrelated members of the same species or from other species. Dr. B's ability to establish his own independent research credibility by becoming involved in this major research effort was a given.

Unfortunately, a few other considerations are important. Upon visiting this venue, Dr. B found out that his potential boss was completely divorced from the clinically active members of this highly respected academic department of surgery.

In addition, the chief of the entire department, an eminent leader in clinical transplantation and cancer surgery himself, questioned Dr. B's potential boss's clinical surgical and administrative skills. So the two compartments of this particular venue (one involving superb clinical productivity and the other involving superb basic science contribution) were totally distracted from each other.

Choice # 3

The third choice of initial professional setting was a premier private hospital associated with one of the country's oldest and most renowned medical schools. This Eastern establishment included a hospital culture and a surgical department culture that were distinctly hierarchical.

The medical school staff was extremely proud of their school's heritage as one of the most productive clinical research departments in the country. They were rightly proud of the fact that the school had spawned numerous leaders in both surgical practice and basic research over many years. This institution was, in fact, one of perhaps the top three most successful "factories" of modern day academic medicine during the past 100 years anywhere in the world.

More importantly, the accomplishment of basic science investigation where clinically involved surgeons could combine basic biology discovery with active clinical practice was more than promissory note--it was being done and had been done for many years, exemplified by the soon to be retiring chief of surgery who had been doing what Dr. B wanted to do for 30 years.

In addition, a new federally funded regional cancer center has opened up new opportunities in both basic study of cancer/transplantation immunology and an unlimited potential for developing a robust clinical practice in cancer surgery.

As usual, several additional considerations were important. First, leadership in this most eminent department of surgery was changing. The new chief was not the individual with whom Dr. B interviewed. The new leader's clinical interest was in a surgical subspecialty focused on diseases of the blood vessels--an area that was not part of Dr. B's career plan or interest.

Second, if Dr. B were to take this job, it would be the first time anyone from outside this Eastern establishment had ever joined the staff who had not attended the associated medical school and clinically trained as a resident and fellow at this same institution. Inbreeding was part of the religion!

Finally, there was unlimited new laboratory space at the recently federally designated regional cancer center and unlimited patient care needs as the cancer center developed its clinical reputation. But, the culture was straightforward. You were expected to develop your basic science as well as clinical career on your own. No one was going to extend a helping hand. In fact, there would be head-to-head competition at every step along the way and the expectation was that no outsider could possibly ever make it in this extraordinarily competitive venue.

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What job did Dr. B take?

Dr. B's final decision was choice #3. His key consideration was which venue would provide him with the experience, opportunities and atmosphere necessary to be successful and provide a launching point for the next phase of his career.

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With choice #1, it was convenient and logical to work in the same venue that he trained in. In addition, Dr. B's potential boss was extraordinarily brilliant in the field of transplantation (which matched Dr. B's interests) and in immunosuppression. His surgical brilliance was virtually unparalleled.

However, the boss's personality was the deciding factor for choice #1's rejection. Dr. B knew what field he wanted to work in, and he knew where he wanted his career to take him. The leader of choice #1 told Dr. B he could not carry out his plan. A first job working for someone as insecure as he was would not be the best atmosphere.

Choice #2 also seemed like an attractive choice at first. The specialty of the venue, clinical transplantation, matched superbly with Dr. B's interest. Additionally, there was an outstanding group of laboratory investigators developing new knowledge in cancer and transplant immunology that also fit in with Dr. B's interest.

Dr. B rejected choice #2 because of the gap between the research and clinical venues. Dr. B was intent on combining both research and clinical activity; the atmosphere of choice #2 would not have fostered such a combination.

The research end, under which Dr. B would be working, was unparalleled. Unfortunately, the leader of the entire department did not think highly of Dr. B's potential new boss, thus causing a large rift between the clinical and research components of the department.

Choice #3, which by no means was the safest choice, was Dr. B's final decision. The culture was extremely competitive and Dr. B knew he would have to work hard to establish himself there; nevertheless, the culture was also exactly what Dr. B was looking for.

The combination of surgical practice and basic biology research was the standard, rather than something that was discouraged. Also, the opportunities available to him were abundant. With the opening of the new cancer center, Dr. B would have huge amounts of laboratory space and a virtually untapped client base.

With his long-term goals in mind, Dr. B was able to eliminate choices that he knew were not conducive to achieving his long-term ambitions.