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Top Leaders Sometimes Have to Get Out of the Way

Philip Betbeze, for HealthLeaders Media, September 27, 2013

In recent conversations with healthcare leaders, I'm hearing a word that nicely describes this leadership philosophy: empowerment. In this sense, empowerment is 180 degrees away from the top-down model, but it's still leadership. In fact, you might call it bottom-up leadership.

What these leaders mean when they talk about empowerment is that they're enabling others to lead, and they're getting out of their way. When I talk to CEOs about such things as removing waste from processes, they almost always reference their use of Lean, which relies on frontline workers to identify wasteful steps in providing care and which also relies on them to design better, more efficient processes. This is just one example of empowerment, or getting out of the way.

There are many ways to lead, but bottom-up leadership is counterintuitive because many don't consider it leadership at all. On the contrary, it takes a special leader to know that he or she doesn't have all the answers, and that those on the front lines of care—whether they're nurses or business analysts or registrars—might be best equipped to get your health system focused on driving out inefficiency.

It's amazing sometimes what it takes to see decisions get made in healthcare, which is one reason why so many agree that healthcare is so far behind other industries. In general, healthcare is so afraid to be bold—to make mistakes—that it defaults to the "way we've always done it."

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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.