New Leadership Needed to Tackle Healthcare's Adaptive Challenges

The challenges right now for healthcare are daunting. When the situation calls for adaptive change, you are helping people navigate through a period of disturbance as they sift through what is essential and what is expendable. This disequilibrium can be a catalyst for you to ask people to operate beyond the default set of responses. With too much disequilibrium you will lose people's attention. Without enough disequilibrium, nothing happens.

No one faction owns the problem—not the administrators, specialists, hospitalists, payers, patients, employers, local governments, or the policy makers. While getting people to the table is important, no one will volunteer to give up the control, authority or expertise they now have. A significant part of adaptive work is getting people to focus and put consistent attention on the difficult issues at hand.

The system will begin to adapt when there is enough disequilibrium for all the salient factions to exhume and examine the conflicting priorities. Progress and adaptive change involves asking people to confront difficult issues in their domain and give up habits and beliefs they hold dear. Successful adaptation occurs when all factions participate, collaborate, and identify what they need to leave behind.

Progress on adaptive challenges requires the kind of leadership that breaks through the impasses, unveils the competing commitments, and confronts the legacy behaviors that prevent progress. This is a different kind of leadership for a system anchored in scientific training. Resist the temptation to tackle challenges by framing them to fit within a technical insight.

The cliff is near, and you are uniquely in a position to help and prevent your system from falling over it. You can develop the skills to diagnose the challenge and orchestrate the conflict. Adaptation is more than surviving; it is about mobilizing people and creating environments that are more robust and resilient, environments for people to thrive. With the right focus, you can engage people in adaptive work and nurture the new DNA that will promote wellness and healing that brings your organization into the future.

How can you take advantage of the opportunity to create enduring change in healthcare? Where will the leadership come from?

For many, the traditional paradigm of a "great leader" conjures images of famous CEOs, great presidents, or iconic battlefield commanders. That notion is not uncommon; and it is a dangerous assumption. Exercising leadership for adaptive work is not about directing others and telling them what to do. The work of leadership is both having the courage to face reality and helping the people around you to face three realities at once:

• What values do we stand for, and are there gaps between those values and how we actually behave?
• What are the competencies we have, and are there gaps between those resources and what the patient care demands?
• What opportunity does the future hold, and are there gaps between those opportunities and our ability to capitalize on them?

You don't have to answer those questions yourself. What well-structured questions can you raise, rather than offering definitive answers? Imagine the differences in behavior if you believed the idea that leadership means influencing the organization to follow the CEO's vision or if you operated with the assumption that leadership means influencing the organization to face its problems and to live into its opportunities.