Live From MGMA: Leadership Complications

Elyas Bahktiari, for HealthLeaders Media, October 21, 2008

Every leader has different comfort zones—types of problems they are better at dealing with than others. Effective leaders are able to respond to context and varying levels of complexity in medical practices, said Alan Winkler, vice president of clinic operations for St. Vincent Health System during an MGMA breakout session.

Winkler took principles from "complexity theory," a leadership approach used by other industries and government agencies, and applied it to medical groups and the healthcare industry.

Most groups encounter four types of problems, each of which requires a different leadership approach:

Simple. Problems with a straightforward cause and effect relationship fit into this category. Answers are often straightforward, and leaders whose comfort zone is day-to-day operations often excel at this type of leadership. However, there's a danger that problems can be oversimplified and larger issues may be overlooked.

Complicated. These problems may have multiple right answers, and "good practice" may be preferable to "best practice" to capture the benefits of flexibility, Winkler said. Complicated leaders tend to be analytical and are able to listen to conflicting advice.

Complex. Complex problems often don't have clear-cut solutions, and responding requires greater levels of interaction and communication with multiple people. Winkler offered the example of a group whose compensation plan was ineffective and needed to be revamped—it doesn't have to happen right away and may require a big-picture approach. "As the context gets more complicated, you have to talk more, you have to solicit feedback more. You may have to call the whole staff together," he said.

Chaotic. Chaotic situations are essentially emergencies. Decision-making must be quick and clear, and analysis is often done after the fact. Leaders have to look for what works at the moment, rather than for a right answer.

Although most leaders excel at managing one or more of these types of problems, the best are able to adapt to all situations. "The problem is we get comfortable with our preferred mode of thinking and when context changes we try to deal the same way," Winkler says.

It's also important to recognize employees' skills. An employee might excel at simple problems, for example, but then struggle after a promotion that leads to more complex problem-solving.

Elyas Bakhtiari is a managing editor with HealthLeaders Media. He can be reached at

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