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Top Leaders Sometimes Have to Get Out of the Way

Philip Betbeze, for HealthLeaders Media, September 27, 2013

Traditional top-down leadership is ill-suited to the changes required for accountable healthcare. Empowerment, also known as bottom-up leadership from frontline workers, may be the best route to organizational transformation.

Founding father Thomas Paine is widely but wrongly credited with saying, "Lead, follow, or get out of the way," to his fellow revolutionaries.

Yet despite the misattribution, the saying has staying power because it's a useful rallying cry for those who prefer action to endless deliberation and debate. It even has something to tell us about the transformation healthcare leaders are charged with engendering at their organizations these days, as they try to make a dramatic business shift from a volume-based model to a value-based one.

But in a touch of irony, CEOs might be better served not as the leaders or the followers in that maxim, but as those who get out of the way. As a leader of your hospital or health system—and for many of you, as the leader—you're used to providing the vision and asking your lieutenants to execute that vision. That's traditional top-down leadership, and there's nothing inherently wrong with it. But it's not the only way to lead, and in many instances, it's far from the best way. That's not just my opinion; more and more of you are telling me that in a new era of accountable healthcare, the CEO can't always say—to borrow from President Truman, who actually did say this—"The buck stops here."

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2 comments on "Top Leaders Sometimes Have to Get Out of the Way"


Michael Ackermann (10/15/2013 at 6:59 AM)
Philip, I agree with your article; however, these days bottom up translates very often into inertia from the top. While a team is often capable of improving tactical measures, it cannot always have the vision that leads to significant change. Usually, the senior leaders/CEO have the broader insights that leads to a vision or transformation. I totally agree with you that leadership has to occur on all levels and you can see that on every successful athletic team. Rather than having an attitude that people work "for you" leaders need to have the attitude that people work "with them". That attitude change will go a long way

bettynoyes (9/27/2013 at 12:20 PM)
I agree Philip! It is the middle managers who know what is dysfunctional and how it becomes more dysfunctional at time of stress and change. My caveat is that many have not had the opportunity to be offered some basic management skills in a safe "arena" of discussions in the classroom and with skilled mentors. Dealing with conflict, managing change using skillful communication, organizing teams and holding them accountable, rewards and recognitions that work, etc. An educational approach to these "soft" skills is essential before we can expect them to "run" with the ball.