Resilient leadership for challenging times.

IN THIS ARTICLE ...

Examine six different leadership styles and consider how each one could be used in different circumstances to achieve favorable outcomes. Most physicians only use two of the styles and they may not always be appropriate.

**********

Resilience may be the attribute most needed today by health care leaders and organizations.

The good news is that increasingly physicians are moving into leadership and executive roles. This will certainly help to mitigate the real and perceived loss of control physicians have experienced over recent years.

However, we are now in a time when all physicians must re-think their leadership roles if we are to be influencers and shapers of the health care delivery system.

In my travels as a physician executive coach and organizational consultant, I am amazed to see how few physicians outside of formal leadership roles actually see themselves as leaders. Too often, they also do not realize the impact they have on others.

Admittedly, the system is broken and the conflicting demands can be stressful and disorienting. Yet, physicians are typically granted leadership status by virtue of their knowledge and expertise. Others see them as leaders and look to them for leadership. However, the technical and cognitive competencies that define scientific excellence are not the same as those that define leadership excellence.

The heroic model of medicine has been the predominant archetype informing physician leadership styles until recently. In this framework, physicians are expected to always have the answer and to be right.

Yet we have enough feedback from the environment--other health care professionals, administrators, third-party payers and patients/customers--to know that this is an overused style and is frequently regarded as ineffective.

The heroic model is inappropriate in many situations and does not provide the resilience and adaptability we need as physician leaders to be attuned and responsive to current life and business conditions.

Physicians have a more significant opportunity to influence than they may realize in the midst of this period of change, flux and chaos, for this is the time when systems and organizations unfreeze, become unstuck and are able to reorganize.

However, in order for physicians to assume and exercise the kind of resilient leadership for which health care systems are crying out, we need to understand the available range of leadership styles and be open to learning and exercising new skills and behaviors.

The business case

If we are to be effective change agents, it is incumbent on all of us to become conversant and fluent with the different leadership styles that different environmental and situational circumstances require. Not only will this enhance our abilities to step up to the challenges facing us personally and professionally; it will promote the well-being of the system at large.

There is a strong business case to be made for promoting systemic well-being and resilience by supporting physicians to develop a broader and more diverse range of leadership styles based on what they frequently model and how they are perceived in their interactions with colleagues, other health care employees and patients.

The employee-customer profit chain model developed by Sears in the early 1990s demonstrated that how people feel about working at an organization (organizational climate) affects employees' predisposition to satisfy customers which then drives organizational and business results.

Organizational climate can account for 20-30 percent of business performance. Furthermore, 50-70 percent of how employees perceive their organization's climate can be traced to the actions of the leaders.

You only need to spend a little time perusing the medical literature to find multiple studies documenting the negative effects of physician behavior on employee and patient satisfaction. Common sense alone would tell us that such behaviors are counterproductive to promoting resilient and adaptive organizations.

However, they turn out to be a significant source of liability for physicians, personally and for their organizations, as they have been found to contribute to increased conflict, decreased employee and customer satisfaction, increased employee turnover and increased malpractice liability. Negative characteristics include:

* Lack of flexibility

* Under-appreciation and/or devaluing of multiple perspectives

* Failure to consistently demonstrate respect for individuals

* Failure to seek win-win solutions

* Valuing professional autonomy rather than other professional cultural attributes like trusting others

* Being the solo player vs. being a team player

* Under-developed interpersonal & communication skills

* Insularity and lack of openness

Research done by the consulting firm Hay/McBer found six distinct leadership styles in their study of thousands of executives. Yet, as physicians we have learned and often rely predominantly on two styles of leadership, the commanding and pacesetting styles, both of which are congruent with the heroic model.

When people are experiencing fear, threat, worry, or embarrassment, they move into the withdrawal (fight or flight) sides of their brains and disengage, waiting to react rather than moving into the approach side of their brains and greater engagement.

Negative physician behaviors can translate into employee disengagement and interpersonal conflict which is much more costly to organizations than we typically realize. Consider the cost to your organization of wasted time, decreased productivity and motivation, decreased decision quality, absenteeism and stress-related health costs and the costs of employee turnover.

Expanding your leadership styles

How can physicians become more resilient leaders?

At its core, resilience is built on a foundation of emotional competence. Emotional competence represents our brain's ability to integrate cognition and emotion, and is the application of a set of emotional intelligences that encompass self-awareness, self-management, social awareness and relationship management skills. It is what gives outstanding leaders their edge and what differentiates them from average or typical leaders.

Over two decades of research done by Daniel Goleman, Richard Boyatzis and others in the field of emotional intelligence demonstrated that emotional intelligence is twice as important as technical competence and IQ combined in differentiating outstanding performance from average performance.

The six leadership styles discovered by Hay/Mcber draw on the full range of emotional competencies and the resilient leader is able to use each style as needed. Goleman likens the six styles to a set of golf clubs in a golf pro's bag. Different shots demand different clubs, and the pro has proficiency with all of them, although he may need to think about his selection.

Abraham Maslow said. "He who has only a hammer sees everything as a nail." If we are comfortable with only one or two styles, then we'll approach every situation with our most familiar but not necessarily the most appropriate style.

All the leadership styles can have either a resonant or dissonant effect depending on the situation, which is why we must be attuned to the impact we're having on others and be able to adjust our style to get the best results. Of the six leadership styles identified by Hay/McBer, it is the commanding and pacesetting styles that have a predominantly dissonant impact on organizational climate.

These styles are useful and indeed essential in certain circumscribed situations, such as clinically in the operating room or the emergency department, and administratively in managing a crisis, kick-starting a turnaround or raising the bar on lagging performance.

However, when overused, the behaviors characteristic of these styles contribute to a dissonant environment, driving down morale, motivation and performance.

To be a resilient leader who creates resonance, you must have the ability to employ the four styles that have a consistently positive impact on organizational climate.

* Visionary style. The hallmark of this style is vibrant enthusiasm and a clear vision that motivates people by making clear how their work fits into the larger vision for the organization.

* Coaching style. The coaching leader helps employees identify their unique strengths and weaknesses and tie them to personal and career aspirations. A coaching approach guarantees that people know what is expected of them, and is a mutual commitment to improve performance.

* Democratic style. This style works best when leaders need guidance, input and buy-in from employees and stakeholders. It can drive up flexibility and responsibility in the process of building trust, respect and commitment.

* Affiliative style. This style is particularly useful when leaders need to increase team harmony, improve morale and communication, and repair broken trust.

Although we each have a natural preference for one or two of the six styles, we can learn the skills and behaviors of other styles, and which are optimal for what types of situations.

In the same way that the golf pro may choose a different club for each shot, the resilient leader moves seamlessly between different styles from one situation to the next. Being able to move beyond personal preferences to respond to the needs of the system promotes organizational resilience.

Don't forget your golf clubs

Much of what is taught in management and business education expands a leader's technical knowledge base. However, it is the emotional intelligences of self-awareness, self-management, social awareness and interpersonal effectiveness that allow us to be cognizant of the impact we're having on our environment and to flex our styles to promote resilience, resonance and wellbeing in those we influence.

Emotional competence is built on the cornerstones of self-awareness and accurate self-assessment. However, it is competence in social awareness and relationship management skills that funds the interpersonal and social connectedness necessary for any organization to learn and to thrive as a living system: empathy, organizational awareness, service orientation, influence, inspirational leadership, conflict management, teamwork and collaboration, developing others and being an effective change catalyst.

Many studies have shown that the more styles a leader exhibits, the better. Those who have mastered four or more have the best climate and business results. Thus, resilient leaders are fluid. Having access to the full range of styles is what promotes resilient leadership and consequently, resilient organizations.

With a commitment to personal leadership development, physicians will regain their influence in a way that renews people's trust, improves their relationships with other health care providers and administrators, improves patient relationships and care, and as a result of all this, improves the bottom line business results.

With an expanded repertoire of leadership styles, physicians can become even more effective leaders and maximize the influence they have and the contribution we can make as professionals at the hub of the health care system. When we do this, not only will our personal sense of well-being and resilience increase; so will our patients well being and satisfaction.

The Six Leadership Styles at a Glance

                Commanding    Visionary     Affiliative

Alias           Do what       Do what       Let's do
                I tell you    will help us  what's best
                              reach our     for everyone
                              goals
Underlying      Achievement,  Self-         Empathy,
emotional       Initiative,   confidence,   Building
competencies    Self-control  Empathy,      relationships,
                              Change        Communication
                              catalyst
Overall impact  Negative      Strongly      Positive
on climate                    Positive

                Democratic     Pacesetting   Coaching

Alias           Let's decide   Do what       How can
                what to        I do          I help
                do together                  you do
                                             it better?
Underlying      Collaboration  Conscien-     Developing
emotional       Team           tiousness,    others,
competencies    leadership,    Achievement,  Empathy,
                Communication  Initiative    Self-
                                             Awareness
Overall impact  Positive       Negative      Strongly
on climate                                   Positive

Adapted from "Leadership That Gets Results," Goleman, D, HBR OnPoint
Reprint from the Harvard Business Review. March/April 2000, Product No.
4487.

Recommended Reading:

* Rucci AJ, Kirn SP, and Quinn RT. "The Employee-Customer-Profit Chain at Sears," Harvard Business Review January--February 1998, Product No. 98109.

* Goleman D, Boyatzis R, and McKee A. Primal Leadership: Realizing the Power of Emotional Intelligence, Boston Harvard Business School Press, 2002.

* Goleman D. "Leadership That Gets Results," HBR OnPoint Reprint from the Harvard Business Review, March/April 2000, Product No. 4487.

* Loehr J and Schwartz T. The Power of Full Engagement, New York: Free Press, 2003.

By Manya Around-Thomas, MD

Manya Arond-Thomas, MD, is the co-founder of Encompass Health, a coaching and consulting firm that supports health care leaders and organizations in transformative change through developing emotional intelligence, resilient leadership, and high-performing teams. She can be reached at 734-480-1932 or [e-mail]

[ILLUSTRATION OMITTED]