Defining a Leader’s Reality: Ordered or Unordered?

Below is a short reflection of multiple interactions I’ve recently had with several clients. Let’s imagine a healthcare CEO and leader of a large regional delivery system in the Midwest. The conversation is one you could very well have with me or one of my coaching colleagues at MEDI Leadership if you engage our services.

Read on and see if any of these challenges sound familiar.

During one of our coaching sessions, Susan was reflecting on her organization. She said, “It’s not as it ought to be.”

“How ought it be, Susan?” I asked.

“Better,” she responded quickly, and then added, “more like a system.”

I was curious to see how she would more descriptively define the situation she was experiencing, and I asked her to tell me more.

“We still don’t behave as one system. There’s a resistance to the changes we’re striving for. Even after five years of work, every hospital can act as if they are a special case and fight for exceptions to the plans we create,” Susan described. “Things go sideways very quickly – unpredictably – especially as we apply more pressure to follow the plan.”

(Is this already resonating with you?)

Curious about what this meant to their expected results, I asked her to describe their current tangible outcomes.

“We aren’t performing as well as I had hoped. We continue to struggle to meet or goals for quality, our costs continue to climb causing our margins shrink, and our employee engagement scores have really taken a hit as we’ve tried to navigate the changes,” she paused. “It seems like the harder we press to standardize our processes to gain the efficiencies that we have to realize, the more resistance we see – the morale of our associates is sinking, and I’m concerned.”

I could tell Susan was lost in thought. So, I let her think. As is often is the case, when we allow for silence, it does amazing work.

After a bit, she continued. “I hadn’t expected it to be this difficult, to create some order, some ‘systemness,’ out of these hospitals.” She sighed, “I don’t think I’m being as effective as I had hoped.”

From my perspective, and by many measures, she was a very effective leader.

But things had changed.

What was once a two-hospital entity in a single market, was now a 17-hospital system in five states – and growing rapidly. In addition to hospital expansion, the organization had acquired many physician practices, several long-term care facilities, and had established joint-ventures with several physician-owned surgery centers.

Susan was experiencing self-doubt, she was in a tough spot and she was uncomfortable. She wondered whether she would be able lead this organization to where she knew it needed to go.

The silver lining for Susan, and for all of us, is that often the most effective change comes from being in a place of discomfort. The key when we are in that state is the choices we make; the thoughts, feelings, and behaviors we exhibit once we have consciousness around that discomfort.

Curiosity: A Good Beginning

Making the decision to look at a given situation from a place of curiosity is always a good beginning. Intentionally be curious about yourself, your organization, and even others.

No judgments. Just notice and be curious. When we are wedded to a belief about a ‘right’ or a ‘best’ way, our minds are closed to other possibilities.

Two questions come to mind for Susan, and other leaders in a similar situation:

  1. What kind of system is the organization you lead?
  2. What kind of system ought it be?
Defining Reality

The first question gets to the issue of reality. This is where curiosity starts to help. Reality needs to be understood and accepted for what it is.

We do, as leaders, need to make sure we have a solid grasp on our reality. Susan’s reality, as is the case for most leaders today, is complex. It is not obvious to her that her situation has grown beyond complicated. She doesn’t fully appreciate the shift that has occurred.

Each of us hold to various mental maps about how things work, ought to work, or don’t. We derive those maps from our myriad experiences as well as insights we’ve gained along the path of our leadership journey. When our context changes, however, as has happened in most healthcare systems over the past many years, our mental maps can become outdated and begin to fail us.

Understand the Mental Map

The second question gets to the deeper thinking that helps to define the mental map held about how systems ought to behave – what they should be like.

Again, curiosity is a helpful attribute for leaders on this journey. Susan, and those like her, have the opportunity to be more curious about the mental map she held about what organizations ought to be like. Where does that idea come from? Why?

If this seems too difficult to process, even being open to the idea that there are different kinds of systems and different ways to approach systemness, is a start.

A Framework to Understand Reality

I have found that leaders can foster curiosity by leveraging a model to examine an environment or situation without allowing emotions or bias to cloud thinking.

One such model, a framework for decision-making from David Snowden, applies broadly to helping leaders make better sense of their situations – like Susan’s. The framework is called ‘Cynefin’ (pronounced: kuh-NEV-in).

With Cynefin, we begin by noticing two general archetypes – for our purposes, two worlds: the ordered and the unordered.

As I’ve discussed in a previous writing, we make many (usually untested) assumptions about our world. And the assumptions of the ordered world do not work well in the unordered world.

The ordered world is most familiar to us, especially those of us who were trained, educated, and developed our leadership in the 20th century, or within the framework of 20th-century management thinking, like Susan.

As her organization grew, it became a more complex system. It no longer behaves, nor will it, as if it were obvious or even merely ‘complicated.’

If she reaches for what is most familiar, leadership tools and assumptions of an ordered world, it’s less likely that the organization she leads will achieve the vision and mission to which it aspires.

Now that Susan is coming from a place of curiosity, and we have a framework to help her identify her reality, our goal together is to explore other ways of understanding her organization and to consider other leadership tools she may leverage in order for the organization to thrive.

While she hasn’t yet defined the path she will walk, to her credit she is curious and eager to learn more about this mysterious (to her) unordered world, and what it may mean for her leadership.

A very good beginning.

Michael Hein
About the author

Michael Hein, MD has over 20 years of healthcare leadership experience in multi-specialty practice, large integrated health systems, academic medicine, and start-up companies. He has extensive clinical leadership experience and deep knowledge in transformational change.
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