“True genius resides in the capacity for evaluation of uncertain, hazardous, and conflicting information.” When Winston Churchill shared this wisdom, I doubt he was thinking of healthcare leadership in the twenty-first century.
Doctors, nurses, and other providers understand the Churchill quote viscerally. It’s a description of every minute of their workday. Danielle Ofri even created a point-by-point accounting of her “mental high-wire act” — the 550 complex evaluations she made in a day.
What we aren’t very good at acknowledging is that healthcare leaders live in that same vortex of information, and their evaluations often affect more than one patient, more than one physician, more than one practice — which is why we desperately need more true genius. But as leaders, physicians or not, we can’t always get there.
What’s holding us back? Well, let’s start with the constant flow of sometimes indecipherable legislation and regulation. The seismic shifts in science and technology. The pressure to provide the highest quality care at the lowest possible cost. It can feel like trying to cross a battlefield, barraged by demands, disruptions, dire predictions, and pleas. Around the strongholds, we can just make out the hordes of real people wanting to heal or be healed.
Sometimes when I’m listening to a leader talk about how overwhelmed she is by a new challenge, my brain goes to The Princess Bride. I envision her as the man (or woman) in black confronting Fezzik — a stand-in for payers, regulators, vendors, even members of staff. She says to the behemoth, “You mean, you’ll put down your rock and I’ll put down my sword, and we’ll try to kill each other like civilized people?”
Seriously, though, I’m using the war metaphor to mirror the battle mentality common in our industry — because that is what’s really keeping us from true genius. If we hold on to the belief that the art, the science, and the business of medicine are factions in a healthcare civil war, we’ll never find the powerful solutions we need. Our evaluations will be faulty because our perspective will be limited.
Healthcare leadership for battle will never help us level the field for the art, science, and business of medicine. Instead, we have to strive for balanced leadership. Test your leadership approach for signs of true, balance-creating genius with these three questions.
1. Are you asking the right questions?
One of the great books of the last couple of years, in my humble opinion, was Warren Berger’s A More Beautiful Question. In it, he asks, “Why is questioning underappreciated in business, undertaught in schools, and underutilized in everyday life?” And yet, the influential thinkers in our lives — from Socrates to Einstein to Jobs — have told us over and over how important it is.
Each of us can change that trend, and by changing it, bring more of our true genius to our work. To get to the most valuable information, we should ask more powerful and beautiful questions. Hal Gregersen, executive director of the MIT Leadership Center, has written a great piece on finding those questions. In the short term, though, we have to start somewhere. These three are where I almost always begin.
First, are we achieving our stated goals?
If you are, great. If not, and this is true for most of us in healthcare on some level, it’s a sign you may need to be asking different questions. The best one to start with is …
What are the outcomes we actually want?
Sometimes our stated goals are not a very good reflection of the answer. We focus on the process, or the financials, or what seems like the shortest route to the easiest win. We especially let other people or entities inflict goals upon us. That needs to stop, because the greatest innovation in healthcare is happening and will continue to happen on the frontlines, by people pursuing outcomes they know matter most. Getting clear about what you and your organization really want, because it’s what inspires your daily work, puts you exactly where you need to be to ask the next question.
How do we get there — together?
This is the question great leaders dig at until they find the best answer — which is almost always one that balances the art, science, and business of medicine. In fact, they never stop asking this question, even when it seems like they’re on the right track. To get to good answers, we have to fight the battle mentality within our own thinking. If we don’t we’ll discard or discount critical information. We’ll assume others want to keep us from that goal or will fight us as we try to achieve it.
Sachin Jain, CEO of CareMore Health, recently wrote: “More than ever before we need to end the cycle of blame in U.S. healthcare. Every healthcare sector has something to contribute to a better future state.” Blame is how we talk our way out of asking difficult but valuable questions about how to achieve what we really want.
2. Do you know who the true leaders are in your organization?
In healthcare we make a lot of assumptions about who is a leader. We base those assumptions on traditional roles of doctors and administrators. I’m going to let you in on a secret, based on years of anecdotal research:
Not all doctors are the amazing leaders we expect them to be.
In fact, they often don’t even want to be because they don’t have the capacity.
And it certainly doesn’t help that they usually aren’t trained to be. According to this interesting HBR read from Jennifer Perry, Foster Mobley, and Matt Brubaker, they aren’t even given essential management skills: “They receive little on-the-job training to develop skills such as how to allocate short- and long-term resources, how to provide developmental feedback, or how to effectively handle conflict — leadership skills needed to run a vibrant business.”
True leaders are the people in your organization who are actually getting things done. Therefore, there is no better place to find and empower them than at the frontline. Use the following questions to spot those with the greatest influence.
Who is everyone following — or, whose opinion matters?
I’ve been known to say, “Look behind you. If nobody is following, you’re not a leader.” (John Maxwell has a similar saying.) In a natural state, leaders are those who other people follow, and who are valued for their opinions. But in healthcare, we tend to ignore this basic truth and create an artificial leadership paradigm. We force people to follow “leaders” who aren’t actually leading them anywhere. Of course that’s going to create frustration, burnout, and poor progress or innovation.
Instead, let’s ask:
Who is pushing ideas forward successfully?
How do people on the frontlines frequently fill in this blank: “We should talk to __________ about that.”
Who is building relationships that help them accomplish goals faster?
One of the important signs of a leader is a concept we emphasized in Tribal Leadership: triads. In healthcare leadership we talk about dyads — partnerships of a clinical and an administrative leader. It’s a good start in breaking down siloes, but it’s not enough. And it assumes those in the dyad are true leaders.
True leaders create three-legged relationships based on common values that help each of the people achieve their goals. They do it organically, and they do it a lot. The more triads in that person’s network, the more likely it is that they and their “tribe” will be successful. Better, the more triads, the more likely it is that they have a balanced rather than battle mindset.
Find these true leaders as fast as possible and start learning from them. They are the ones you can and should turn to for insights that help you evaluate all of that uncertain, hazardous, and conflicting information.
3. Are you giving the right people control of the right things?
This is a question I ask a lot (I recently asked it about healthtech), and I ask it because, frankly, we’re so very bad at it right now in healthcare. Lack of power or control is the biggest contributor to a battle mentality, to disengagement, and to feeling disheartened. As an industry, we make people accountable for goals or results but give them little authority to make the work happen, and then we’re surprised when we don’t accomplish the goals. Or we identify problems affecting our organizations, but don’t give people enough control or autonomy to really contribute to solutions.
And that’s why it’s one of the most important questions you should ask yourself. As a leader, you have the ability to give people control, to spread out the evaluation of information and leverage all of that true genius for something great and powerful (not to make you sound like the Wizard of Oz). I’ll continue to explore how we can all get better at it over the coming months. (In the meantime, this free resource tackles how to address the question in practices.)
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How can we effectively evaluate important information if we keep falling back on blame and mistrust and entrenched silos. If we let the zero-sum, I-win-you-lose culture reign in healthcare leadership, we won’t challenge ourselves or others to push for understanding or collaboration. But the more we work at balance in our decisions and actions, the more we’ll build cultures that support that balance. Those cultures will then influence our decisions and actions, building a more satisfying, more effective healthcare future. This is what the true genius that Churchill described can produce in our industry.
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