leading adaptive change: a framework to transform healthcare
TRANSCRIPT
© 2014 Health Catalystwww.healthcatalyst.comProprietary and Confidential
© 2014 Health Catalystwww.healthcatalyst.comProprietary and Confidential
Val Ulstad MD, MPH, MPA
Leading Adaptive Change
© 2014 Health Catalystwww.healthcatalyst.comProprietary and Confidential
Why Adaptive Leadership?
• Describes what people do• Describes what people exercising
leadership can do if they see differently• A way of developing a shared language
to describe group dynamics• Describes a way to be an active
engaged organizational citizen• Really resonates with professionals in
health care
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Adaptive LeadershipWork of Ron Heifetz, M.D.
People adapt more successfully to their environments by facing painful circumstances and developing new
attitudes and behaviors.
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Productive Range
Threshold of learning
Limit of tolerance
Time
Tens
ion
of c
hang
eCONCEPT #1
Productive Range of Tension
Based on R. Heifetz. and M. Linsky. Leadership on the Line, Harvard Business School Press, Boston, MA, 2002, pg 108.
© 2014 Health Catalystwww.healthcatalyst.comProprietary and Confidential
Productive Range
Threshold of learning
Limit of tolerance
Time
Ten
sio
n o
f c
ha
ng
eHuman Systems
Based on R. Heifetz. and M. Linsky. Leadership on the Line, Harvard Business School Press, Boston, MA,2002, pg. 108.
I understand the reality of my condition.I am looking to you for guidance and honesty.I understand what I need to do.
I don’t want to hear any more bad news.I can’t make sense of any of this.I am so terrified I don’t understand a word you are saying.
I came for a pill or gadget to fix this.
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Productive Range
Threshold of learning
Limit of tolerance
Time
Ten
sio
n o
f c
ha
ng
eHuman Systems
Based on R. Heifetz. and M. Linsky. Leadership on the Line, Harvard Business School Press, Boston, MA,2002, pg. 108.
© 2014 Health Catalystwww.healthcatalyst.comProprietary and Confidential
CONCEPT #2Types of Situations Requiring Leadership
Technical - Apply abilities that already exist in the system’s capabilities
Adaptive - People deeply and broadly within the organization need to learn new capabilities
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Address the Gap Between
The Way Things are
and Achieving the Triple AIM
Improved Health of the Population
Enhanced Patient Experience of Care (not forgetting the experience of the people who provide it)
Reduce (or at least control) Total Cost of Care
The Challenge
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Properties of an Adaptive ChallengesWicked Problems
•Gap between way things are and desired state
•Varied points of view
•Requires difficult learning
•Involves facing loss
•New competencies must be developed
•People with problems have problem solving responsibility
•Takes longer than technical work
•Requires trying things
•Generates disequilibrium, distress and work avoidance
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The most common cause of leadership failure is treating an adaptive challenge
with a technical fix.
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Question #1What is the work?
Gap = difference between the way things are and the desired state
Start somewhere meaningful and manageable
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Adaptive WorkDiminishes the gap between the way things are and the way things need to
be to create a better future
Adaptive leadership is the activity that mobilizes people to perform needed
adaptive work
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Adaptive Work
You
Question #2 Who Cares About the Work?
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Organizations are illusions; they are just groups of relationships
- Parker Palmer
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When you consider Lincoln, did he embody -
Authority?
Leadership?
Both?
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Authority Leadership
• Leadership is an activity• Authority, power and influence are tools
but do not guarantee leadership- necessary but insufficient
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CONCEPT #3There is a difference between the role of authority and the exercise of
leadership.
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Authority (whether formal or informal)
is necessarybut insufficient for the exercise of leadership.
Ability to constructivelyinfluence
is acritical resource for leadership
even when/if you have a big title.
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Developing Influence
• Assess their capability
• Help them see what’s in it for them
• Earn trust
• Speak to their perception of cost
• Acknowledge their perception of risk Adapted from C. Dwyer, The Shifting Sources of Power and Influence,
Amer Coll of Phys Executives, 1992
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Your Success at Influencing Another
•Their capability to do what you ask
•Plus +• (Their Perception of Potential Benefit X Their Perception
of the Probability of the Benefit Really Happening)•Minus -
• (Their Perception of Cost -Their Perception of Risk)
It’s all about perception.
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Developing InfluencePerception Matters
You will tend to over focus on
● Potential gain to other
● Extent to which you are trusted
Other will tend to over focus on
● Potential personal risk
● Potential personal cost
Adapted from The Shifting Sources of power and Influence – Dr. Charles E. Dwyer
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Emotional Bank Account
Adapted from S. Covey Sr., Seven Habits of Highly Effective People, Simon and Schuster, 1999
EsteemAcceptanceRespect
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Emotional Bank Account Balance Sheet
Courtesy
Kindness
Honesty
Keep commitments
Discourtesy
Disrespect
Interrupting
Overreacting
Causing another to feel ignored
Becoming arbitrary
Betraying trust
Threatening
Adapted from S. Covey Sr., Seven Habits of Highly Effective People, Simon and Schuster, 1999
Esteem
Acceptance
Respect
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Build Up The Emotional Bank Account• Understand the individual
● seek to understand the way you want to be understood
• Attend to the little things ● be kind and courteous
• Keep commitments
• Clarify expectations
• Personal integrity● Walk your talk
● Be loyal to those not present
• Sincerely apologize when you make a “withdrawal”
Adapted from S. Covey Sr., Seven Habits of Highly Effective People, Simon and Schuster, 1999
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People will trust you when you fulfill their expectations (their wants and needs).
Your balance increases in their emotional bank account
People will distrust you when you fail to fulfill their expectations (their wants and needs).
Your balance decreases in their emotional bank account
Constraints of Authority
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Exercising leadership to do adaptive work
means disappointing people’s
expectations at a rate they can tolerate.
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Exercising leadership to do adaptive work
means disappointing people’s
expectations (that things will stay the same)
at a rate they can tolerate.
(and not ignore you or try to silence you or resist in infinitely creative ways)
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Resistance (passive or active)
• A signal that you are losing influence and are exceeding the amount of loss and uncertainty they can tolerate.
• Clarify your intentions
• Refine your approach to the tensions between perspectives (conflicts) inherent in the issue
• Try again to help the group make progress
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Productive Range
Threshold of learning
Limit of tolerance
Technical challenge
Time
Making Progress on Work
Adaptive Challenge
Ten
sio
n o
f ch
ang
e
Based on R. Heifetz and M. Linsky. Leadership on the Line, Harvard Business School Press, Boston, MA,2002, pg. 108.
© 2014 Health Catalystwww.healthcatalyst.comProprietary and Confidential
Productive Range
Threshold of learning
Limit of tolerance
Technical challenge
Time
Making Progress on Work
Adaptive Challenge
Ten
sio
n o
f ch
ang
e
Based on R. Heifetz and M. Linsky. Leadership on the Line, Harvard Business School Press, Boston, MA,2002, pg. 108.
© 2014 Health Catalystwww.healthcatalyst.comProprietary and Confidential
Productive Range
Threshold of learning
Limit of tolerance
Time
Tens
ion
of c
hang
eThe Work
Distress
Distress
Based on R. Heifetz and M. Linsky. Leadership on the Line, Harvard Business School Press, Boston, MA,2002, pg. 108.
© 2014 Health Catalystwww.healthcatalyst.comProprietary and Confidential
Productive Range
Threshold of learning
Limit of tolerance
Time
Tens
ion
of c
hang
e
The WorkWhat People Will Not Tell You, Their Behavior Will Reveal
Blame others, distract attention, denial
Blame others, distract attention, denial
Distress
Distress
Based on R. Heifetz and M. Linsky. Leadership on the Line, Harvard Business School Press, Boston, MA,2002, pg. 108.
© 2014 Health Catalystwww.healthcatalyst.comProprietary and Confidential
CONCEPT #4Work Avoidance as a Signal of Being Outside
the Productive Range of Tension
37
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Work Avoidance (Resistance)
• Displacing responsibility
• Attack authority
• Kill the messenger
• Scapegoat
• Distracting attention• Pretend to be busy• Define problem to fit your
competence• Make the problem too big• Restructure/reorganize• Meetings with only information
exchange when engagement is needed
• Pick a fight
• Denial• Flavor of month?
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Work Avoidance (Resistance)
• Displacing responsibility
• “The rest of my team is incompetent”
• “Our coach is not doing their part.”
• “This is a passing fad – the leaders don’t really want this”
• Distracting attention• “This cookbook medicine!”• “This all about money not
care.”• “I am too busy – I have a day
job”• “I can’t ask my colleagues to
do that!”• Excuses for missed meetings• “I am losing income to do this
work”
• Denial• “This work will not change
anything”• Not showing up
39
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PRODUCTIVE RANGE
HOLDING ENVIRONMENT
Work avoidanceThreshold of learning
Limit of tolerance
Technical challenge
Time
Adaptive Challenge
Based on R. Heifetz and M. Linsky. Leadership on the Line, Harvard Business School Press, Boston, MA,2002, pg. 108.
Work avoidance
Ten
sio
n o
f ch
ang
eAre You Reading the Signals People are Sending You?
Work Avoidance Signals Being Out of Productive Zone
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Resistance/Work Avoidance
When people resist the change you are helping them face and avoid the work – which of the following is true?
a. It can mean they just don’t think the issue requires their involvement
b. The rate of change is too much for them to tolerate
c. It can mean they are overwhelmed and don’t know what to do next
d. It means you need to try a new “test of change”
e. All of the above
41
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Productive Range
Threshold of learning
Limit of tolerance
Time
Tens
ion
of c
hang
eThe Work
Distress
Distress
Based on R. Heifetz and M. Linsky. Leadership on the Line, Harvard Business School Press, Boston, MA,2002, pg. 108.
© 2014 Health Catalystwww.healthcatalyst.comProprietary and Confidential
What Does Work Avoidance/Resistance Tell You?
Interpreting stakeholder behavior when they are engaged about the work
Which ones are above the limit of tolerance?
Heat too high
Which ones are engaged in the work?
Heat is in the zone to keep things cooking
Which ones are below the level of learning?
Heat too low
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Productive Range
Threshold of learning
Limit of tolerance
Time
Tens
ion
of c
hang
e
The WorkWhat People Will Not Tell You, Their Behavior Will Reveal
Blame others, distract attention, denial
Blame others, distract attention, denial
Distress
Distress
Based on R. Heifetz and M. Linsky. Leadership on the Line, Harvard Business School Press, Boston, MA,2002, pg. 108.
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Adaptive Work
You
Question #3 How are the people who care about the work reacting to the work?
What does the work avoidance suggest?
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Which statement best represents how you are feeling? Choose one
1. I feel like I’m taking a drink from a fire hose; I’m overwhelmed
2. Seems like good common sense to me; I’m with you, keep going
3. This really doesn’t apply to me ; I’m not in charge, so I’m not sure I need this
46
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Productive Range
Threshold of learning
Limit of tolerance
Time
Ten
sio
n o
f c
ha
ng
eWhere We are Right Now
Based on R. Heifetz. and M. Linsky. Leadership on the Line, Harvard Business School Press, Boston, MA, 2002, pg 108.
Taking a drink from a fire hoseOverwhelmed
Seems like good common sense to meI‘m with you, keep going
This doesn’t really apply to meI’m not in charge, I don’t need this
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Question #4 What Do I Do Next?
• Use yourself differently
• Keep people who are making progress engaged and figure out what you need to do to reengage others.
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Use Yourself Differently
• Pay attention
• Set a great example
• Celebrate and learn from what is going well
• Talk about why you think this is important
• Ask questions
• Listen
• Reflect in action
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CONCEPT #5Reflect in Action
Get on the Balcony and Dance
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Balcony AND Dance Floor
Over focus on Balcony Over focus on Dance floor
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Question #4 What Do I Do Next?
• Use yourself differently
• Keep people who are making progress engaged and figure out what you need to do to reengage others.
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What do you need to do to make progress?
What can you do to lower the distress on the factions that are above the limit of tolerance?
How can you maintain engagement of factions that are currently engaged in trying to make progress?
What can you do to raise the distress to a
productive level for the factions below the level of learning?
Begin to Plot a Strategy
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Think about a time when the heat was too high.
What did you do to bring things to a productive level of tension so progress
could be made?
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Lower the Heat
• Validate feelings; acknowledge loss
• Simplify and clarify
• Restore, add or reallocate resources
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Think about a time when the heat was too low.
What did you do to bring things to a productive level of tension so
progress could be made?
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Raising the Heat
• Raise the standards
• Increase accountability
• Change the task to something more motivating
• Refocus on higher, more widely shared and yet compelling purpose
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PRODUCTIVE RANGE
HOLDING ENVIRONMENT
Work avoidanceThreshold of learning
Limit of tolerance
Technical challenge
Time
Adaptive Challenge
Based on R. Heifetz and M. Linsky. Leadership on the Line, Harvard Business School Press, Boston, MA,2002, pg. 108.
Work avoidance
Ten
sio
n o
f ch
ang
eAre You Reading the Signals People are Sending You?
Work Avoidance Signals Being Out of Productive Zone
© 2014 Health Catalystwww.healthcatalyst.comProprietary and Confidential
Resistance (passive or active)
• A signal that you are losing influence and are exceeding the amount of loss and uncertainty they can tolerate.
• Clarify your intentions
• Refine your approach to the tensions between perspectives (conflicts) inherent in the issue
• Try again to help the group make progress
© 2014 Health Catalystwww.healthcatalyst.comProprietary and Confidential
Exercising leadership requires keeping an experimental mindset
• Work avoidance looks the same when the heat is too high or when the heat is too low.
• Keep rechecking your assumptions.
• What looks like laziness may be exhaustion.
• If what you try makes things worse try the opposite.
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Nobody misbehaves from a place of strengthStart with CompassionWhen you don’t know what to try first,
lower the heat
• Validate feelings; acknowledge loss
• Simplify and clarifyo Address the technical aspects
o Break the problem into parts
• Restore, add or reallocate resourceso Temporarily reclaim responsibility for tough issues
o Give your attention
o Take stock of what is available
o Allot more time, enrich knowledge and skills
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CONCEPTS• Productive range of tension• Difference between technical and
adaptive work• Difference between role of authority
and the exercise of leadership• Work avoidance as a signal of being
outside the productive zone• Reflect in action
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Leading Adaptive ChangeFour Questions
What is the work?
Who cares about the work?
How are people who care about the work reacting to it?
What do I do next?- Use your self differently
- Regulate the heat
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Technical vs. Adaptive workClear answers, minimal uncertainty
Straightforward, few big choices
Execute via precise instructions
Requires hands, feet, mouths
Focus on task
Linear, demands precision
Runs smoothly
No clear answers, often high
uncertainty
Time-consuming, difficult choices
( losses)
Demands lots of conversations
Requires hearts, eyes and ears
Focus on people connected to
task
Spiral with feedback loops,
demands creativity
Conflict and distress
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