Menu
Home
Log in / Register
 
Home arrow Management arrow Leadership Learning for the Future

CASE STUDY: FOR-PROFIT COMMUNITY HOSPITAL IN THE WESTERN UNITED STATES

Background

The author was retained to support the senior leadership team of a West coast, not-for-profit hospital in the United States in its objective to develop its individual and collective leadership capacities. This hospital was a stand-alone, 300-bed for-profit hospital with 1,800 employees including nurses from the nursing registry. Its census typically ran between 85-95% as this hospital served a population primarily dependent on it for emergency, medical-surgical, and ICU services. The hospital had a recently renovated heliport allowing it to serve as a triage center particularly well poised to serve those individuals in vehicle or recreational accidents given its location outside the Los Angeles metropolitan area.

The senior leadership team was comprised of Robert, the CEO, who assessed at an early Strategist action logic; the CFO was Michael who assessed at a late Expert action logic; CIO Catherine assessed at an Achiever action logic; Luke the CNO (chief nursing officer) assessed as an Individualist action logic; John, the COO (chief operations office) scored as a late Achiever; and Patrick, VP of Development assessed at the early Individualist stage. (Pseudonyms have been used for the individuals' names). See Table 13.2 for the executive names, titles, action logics and the key concern of each executive. Figure 13.2 shows a developmental fields.

Table 13.2. Case Study Executives, Titles, Action Logics and Key Concerns

Executive

Title

Action Logic

Key Concern to Consider

Robert

CEO

Early Strategist

Execute 3 year strategy

Michael

CFO

Late Expert

Meet financial plan

Catherine

CIO

Achiever

Implement digital record

Luke

CNO

Individualist

Maintain quality of care

John

COO

Late Achiever

Meet goals of health care reform

Patrick

VP Development

Early Individualist

Build medical tower

Representative development strands of a hospital's senior leader¬ship team for illustration purposes.

Figure 13.2. Representative development strands of a hospital's senior leadership team for illustration purposes.

LEARNING FROM OPPORTUNITIES IN THE OVERLAPPING HORIZONTAL DEVELOPMENTAL FIELDS

Each executive leader's key concerns (see Figure 13.2) reflected the responsibility assigned to them from the 3-year strategic plan that carried the most risk. There was contention between the leaders due to this general performance pressure, other systems dynamics including resource contention, and interpersonal relationship histories. Some had known each other at previous hospitals, and each had a unique relationship with CEO Robert. Robert was an extremely effective senior executive, his Strategist action logic made visible in his integration of core hospital values with operating plans, his first-rate systems thinking, and his uncanny ability to consistently reframe conflict among his senior leaders and their staffs as opportunities for the whole hospital system to become stronger. Robert often raised the external and internal uncertainty as a key feature of their environment and a driving reason for his team's need to get better at dialoguing and working together on the toughest problems they shared. Robert seemed to have a sixth sense in how he influenced the development of his executives including encouraging them to work together to find areas of consensus and compromise in their key areas of responsibility.

Catherine, Luke, and John, (CIO, CNO, and COO respectively) collectively shared the hospital goals stemming from three mission critical initiatives: (1) implementing the digital (paperless) patient record and the related information system conversions and upgrades associated with this; (2) maintaining the quality of patient care during these systems upgrades; and (3) meeting the U.S. health care reform-driven goals for increased accountability by institutional providers, physicians, and payers such as insurance companies. These three strategic initiatives required these individuals to work collaboratively and effectively but there were tensions between them given their different personalities, approaches to working across hospital departments and other boundaries, and even arising from their different relationships with Robert.

The developmental opportunities for this trio included Catherine consolidating her Achiever action logic by becoming increasingly aware of her preferred learning style and using different ones in her relationships with Luke and John. She benefitted from moving from a directing style of leadership to a more facilitative style, particularly considering these were her peers. She was encouraged to use a more strategic approach to managing the information systems projects and to build more reflective capacity into her meetings by how she led others in understanding and learning from the occasional errors that were made. She attempted to seek feedback more often so she could adjust her approach in response to other executives' reaction to her. Her efforts to consolidate her Achiever action logic capacities was challenged by the others' distrust of her, a dynamic that arose from the catalytic action of her private conversations with Robert. Because of their prior working relationship at a previous institution, her close and effective working relationship with Robert was a frequent perturbation in the larger senior team set of relationships.

Luke attempted to enhance this trio's cohesion by being aware of what was trying to emerge, or watching for opportunities to "start over" with a new set of agreements between the three of them. The disagreements among them typically had to do with budget and resource contention, or information system priorities, and John (late Achiever) often accused Catherine (Achiever) of trying to control the entire enterprise. In her role she was tasked with developing timelines and project plans for the large-scale computer conversion projects and this necessarily drove other priorities. The developmental challenge was for Catherine and John to develop a mutual understanding of their priorities and to identify how their objectives were necessarily interindependent. This meant John overcoming his distrust of her, something that is still a developmental goal. Luke's influence was most effective when he could use feedback loops effectively to understand how the staff's of each of these three vice presidents understood and misunderstood agreements and disagreements between their departments. Luke, as an Individualist, often acted as mediator between Catherine and John. Finally, the pervasive uncertainty in the external environment due to health care reform requirements passed by the U.S. Congress and the shaky economy, actually worked to encourage a developmental perspective by this senior team in that Robert continuously pointed out the benefits of using the unexpected changes as vectors to bring the senior team together and to expect the same of their departments.

Another good example of the developmental potential in overlapping action logics was the field created between Michael, the CFO Expert, and the rest of the senior leadership team. Michael had a long career as an accountant, tax expert, and hospital vice president of finance and had a solid track record of keeping the hospital profitable each year that he was CFO. The challenges arose in Michael's solid Expert action logic and how it showed up in senior leadership meetings, particularly when he adopted a quite static, black-and-white approach to the complex challenges the senior team had to resolve. The senior team was at its best when it was successful in uncovering the limits of the Expert approach to their complex issues such as the need to trim millions of dollars from the budget, or to finance a start-up neonatal intensive care unit that wasn't estimated to make a profit until its third year in operation. The senior team discovered how to present a more complex approach to financial challenges by allowing Michael to be the expert and let him know they all carried the responsibility for the hospital's financial success with him, and that it was not only on his shoulders. This enabled them to show Michael the limitations of the Expert action logic and that they were encountering problems that required a broader and more complex understanding of possible alternatives. This interindependent spirit provided a supportive context in which Michael gradually assumed a more reflective, collaborative approach to identifying, framing, and proposing alternative solutions to the most challenging budget issues.

Table 13.3 shows the transforming (vertical) and consolidation (horizontal) development opportunities by executive, and how they contributed to collective team development given the organizational issues facing this executive team.

Table 13.3. Executive Team Member Developmental Opportunities: Transforming and Consolidating

Executive Team Member Developmental Opportunities: Transforming and Consolidating

The interindependent dynamics of executive functioning within this senior leadership team can be informed and aided by combining successful individual executive development per the potential learning objectives as shown in Table 13.3. For example, Catherine could relieve some of the tension between herself, Luke and John by experimenting with a role on a specific part of a larger initiative where her positional power was reduced and she had to rely more on accomplishing goals by relying on others, that is, Luke or John. As she learned to hone her influential skills, Luke's deepening spiritual practice could allow him to receive Catherine's change from heavy reliance on positional power to a more subtle use of influential power with grace and renewed camaraderie. Further, if John were to recognize some of his own biases particularly where Catherine was concerned, and acknowledge some of that stemmed from his shadow side and had little to do with the demands of the work, then perhaps he too could acknowledge and allow Catherine's new approach to using influential power as positive for the three of their working relationships.

Another example of overlapping individual developmental arcs, and therefore collective team development can be seen at the intersection of Robert and his CFO, Michael. Robert is perplexed at Michael's inability to see the budget and overall financial strategy of the hospital in as broad of terms as he does. Robert could lean into better understanding Michael's perspective and integrate it into his own framework, thereby making it more likely he could understand and then help Michael see a larger perspective. If he could understand how Michael's relatively narrower view served him, Robert could mentor him into a more strategic role as CFO.

Finally, CEO Robert was aware that his team needed support to be able to continue to take a developmental perspective in managing its complex and challenging strategic objectives. The current uncertainty both within the hospital itself and within the health care industry in the larger national environment contributed a never-ending source of disorienting conflict as it learned each week of something a competitor hospital was doing, or some unexpected reaction of a patient posting something on social media; it seemed there was a never-ending supply of surprise and change that required the leadership team look at itself and how it was working together at the same time it did its "real work." Robert encouraged this blending of attention on "process and content" by the way he ran the senior leadership meetings, by how he handled conflict between his vice presidents, and the ways in which he informally sought and offered feedback to his senior leaders.

SUMMARY

This discussion of how intersecting individual and collective leadership development domains was but a brief start to exploring the potential of leading with a developmental perspective. The benefits of interweaving a developmental approach with leading an organization include building a deeper capacity to resolve problems in sustainable ways, and, uncovering the underlying assumptions in those challenges such that they are less likely to continue to reemerge. To the extent a company "builds its bench" while it meets its operating goals, it is increasingly capable of setting and achieving more difficult goals each subsequent year. Such an approach is more likely to develop leadership capacity throughout the organization, and support individual horizontal and vertical development. This is what is needed to position organizations to contribute and compete more effectively in the emerging global economy of the 21st century.

REFERENCES

Adler, A. (1938). Social interest. London, England: Faber & Faber.

Cook-Greuter, S. R. (1999). Postautonomous ego development: A study of its

nature and measurement. Dissertation Abstracts International, 60, 06B. (UMI

No. 993312).

Cook-Greuter, S. R. (2004). Making the case for a developmental perspective. Industrial and Commercial Training, 36(7), 275-281.

Fisher, D., Rooke, D., & Torbert, W. (2003). Personal and organizational transformations through action inquiry. London, England: Cromwell Press.

Freud, A. (1937). The ego and the mechanisms of defense. London, England: Hogarth.

Jung, C., & Campbell, J. (Eds.). (1991). The stages of life (R. F. C. Hull, Trans). In The portable Jung. Westminster, London: Penguin Books.

Kegan, R. (1982). The evolving self: Problem and process in human development. Cambridge, MA: Harvard University Press.

Kegan, R. (1994). In over our heads: The mental demands of modern life. Cambridge, MA: Harvard University Press.

Kohlberg, L. (1969). Stage and sequence: the cognitive developmental approach to socialization. In D. A. Goslin (Ed.), Handbook of Socialization Theory and Research. New York, NY: Rand-McNally.

Loevinger, J. (1976). Ego development. San Francisco, CA: Jossey-Bass.

Loevinger, J., & Wessler, R. (1970). Measuring ego development: Construction of a sentence completion test (Vol 1). San Francisco, CA: Jossey-Bass.

McCauley, C., Drath, W., Palus, C., O'Connor, P., & Baker, B. (2006). The use of constructive-developmental theory to advance the understanding of leadership. The Leadership Quarterly, 17, 634-653.

Piaget, J. (1954). The construction of reality in the child. New York, NY: Basic Books.

Rooke, D., & Mulligan, J. (2004). Supporting development (LDP Certification workshop materials). London, England: Harthill Consulting.

Rooke, D., & Torbert, W. R. (2005). Seven transformations of leadership. Harvard Business Review, 83(4), 67-76.

Torbert, W. (1987). Managing the corporate dream: Restructuring for long-term success. Homewood, IL: Dow Jones Irwin.

Torbert, W. (1991). The power of balance: Transforming self, society and scientific inquiry. Thousand Oaks, CA: SAGE.

Torbert, W. R., & Associates. (2004). Action inquiry: The secret of timely and transforming leadership. San Francisco, CA: Berrett-Koehler.

Uhl-Bien, M., & Marion, R. (Eds.). (2008). Complexity leadership: Conceptual foundations (Part I). Charlotte, NC: Information Age Publishing.

 
Found a mistake? Please highlight the word and press Shift + Enter  
< Prev   CONTENTS   Next >
 
Subjects
Accounting
Business & Finance
Communication
Computer Science
Economics
Education
Engineering
Environment
Geography
Health
History
Language & Literature
Law
Management
Marketing
Mathematics
Political science
Philosophy
Psychology
Religion
Sociology
Travel