The new rules of leadership and organizational politics. (In the Trenches).

Periodically we look at how organizational politics evolve as organizations rethink themselves. No industry has experienced more change than health care in the past few years with the result that, as we speak, major changes are underway in the rules of engagement--how management and workers behave on the job. Here are important changes to note.

Practice leadership, not management

Old style management is out. Younger workers, especially, don't want to be managed. They want to follow someone who knows where he or she is going. They want to be taught, not directed. Labor shortages intensify when physician executives don't adapt their styles. For example, many of the best and brightest young physicians are never going to make the same time commitment to practicing medicine that physicians did 25 years ago. You can lament this or accept it and move on.

Never forget that your direct reports are your most important audience. They can, and will, punish a physician executive who is arbitrary, underskilled, capricious, or judgmental. They don't care that a boss could retaliate by giving a bad reference later, and they will quit--or underproduce just enough to make the point without getting fired--if they're not happy with the leadership provided. More fearsome, they do not suffer silently. They let everyone know, including top management (usually via a message in the secretarial grapevine), when they believe they are mismanaged.

Here is the difference in relationships between physician executives and younger workers and physician executives and older workers: Younger workers care nothing about the physician executive's reputation within the organization (if they even know what it is). They're not impressed if the physician executive is highly valued by his or her boss. They make independent judgments based solely on their personal relationship with their bosses. Since good workers are nigh unto irreplaceable, take it personally when younger workers leave. Figure you failed them. Wait a few months, track them down, and get honest feedback. You need to know why they weren't satisfied. Even if your organization has no worker shortages this minute, as Alan Greenspan continues to point out, the law of supply and demand has not been repealed.

Practice inclusion with a vengeance

We watch physician executives shrug and say, "The young ones won't attend meetings, and if they do, won't participate. What can I do?" The answer is "Experiment!" This is especially important when younger workers disdain team participation and practice indifference. If you let them withhold ideas and information, no team will function. Cajoling everyone into verbal contributions is a late-90s leadership skill that's often overlooked. Try different questions, different settings--one-on-one versus group--to get participation. Most retention studies indicate that even employees who actively dislike teamwork tolerate it when a boss relentlessly includes them.

Practice modesty and consideration and demand both

Arrogance can undermine your effectiveness. False humility is better than none. Hypocrisy is vastly underrated as a means of gluing people together long enough to get the desired outcome. In some of the more spectacular organizational firings in the past two years, arrogance obviously played a part. (We see many of the vanquished and their hindsight is acute.) For example, the boss who kept publicly complaining about the quality of his recruits was drop kicked into outplacement when turnover rose. Worker tolerance for the divine right of kings and queens is nonexistent in today's workplace.

Watch your expense account. Have you any idea how much younger workers resent physician executives who spend heavily on travel and entertainment? They aren't like the 40-somethings who consider lavish lifestyles a perk of office. They don't envy or want to emulate the profligate. Younger workers believe those wasted dollars come from their salaries, and they never let it pass unnoticed. A characteristic shared by many failed physician executives is too many perks, too publicly displayed. Wasteful bosses are equally disliked. The temp who isn't kept busy, meetings that linger, and opportunities that wither because of procrastination enrage them.

Act on rumor, don't await confirmation

In today's unstable workplace, the first time a rumor of discontent circulates may be the only signal before the aggrieved takes action--usually by leaving or filing a complaint. The physician executive who leaps into the fray before either occurs has the best chance of resolving the problem. For example, a rumor arises that the workers want compensatory time for Involuntary overtime. If you ignore it on the theory that it's just a rumor and they can't have It anyway, watch some of your best people blow Out. They probably won't confront you on the issue because it's so easy to move on.

Aggressively collect allies

Everyone has potential as an ally, including your enemies. Relationships are the only form of job security that begin to equal a written contract specifying handsome severance. It's far more likely that 20-somethings, trolling the organizational waters as they do, would recommend a former boss for an interview than the other way around. The young are not aggressive networkers but they don't hesitate to give good references for bosses they've judged competent.

Understand the politics of voice mail

Voice mail Is a political tool. One of the unspoken rules of business etiquette used to be, "Return all calls within 24 hours." With voice mail, calls must be returned the same day, because the efficiency of technology makes it a slap in the face if a call is not returned. So what if the person you're calling isn't there? It doesn't matter--talk to voice mail and you're on record as having responded. We hear people from top management to the newest hire say. "It's obvious he doesn't want to talk to me; he knows I have voice mail."

Position power isn't personal power

Power in organizations has never been more ephemeral. Workers no longer share a common definition of who is powerful and why. Many physician executives aren't personally powerful; they only wield power in their narrow roles. Employees may deride the CEO and label him or her hopelessly weak. Fortunately, most CEOs are remote enough not to hear the boos. Middle physician executives are closer to the troops and can see and hear signs that they are only conditionally respected.

Not everyone who suspects he or she is not universally admired can be effective in a leadership role. Sometimes younger workers take a "poor you, why did you let them promote you?" attitude when a physician moves up. This dents the egos of Baby Boomers who were brought up to expect envy and praise. Promotions are no longer win or lose--I got promoted because I was smarter (a harder worker, better liked, etc.) than you." Leadership roles have become service opportunities that may lead to personal power. There has to be some satisfaction in knowing you make a difference, that, literally, they couldn't do it without you. As prestige and power seem more situational than real, expect money--especially bonuses--to replace them.

Marilyn Moats Kennedy is Managing Partner. Career Strategies, Inc., Wilmette, Illinois, and a long-time member of the ACPE faculty She can be reached at 1150 Wilmette Avenue, Wilmette, Illinois 60091, 847/251-1661, or via fax at 847/251-5191.