Fundamentals of Adaptive Leadership Val Ulstad MD MPH

Fundamentals of Adaptive Leadership Val Ulstad MD, MPH, MPA

Adaptive Leadership Beliefs Behind Dr. Ron Heifetz’ work l Problems are embedded within complicated and interactive systems. l Much of human behavior reflects an adaptation to circumstances. l People adapt more successfully to their environments by facing painful circumstances (aka FEAR) and developing new attitudes and behaviors.

Why Apply Adaptive Leadership in Health Care? l l l 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 clinicians

Opportunities Enhance capacity to exercise leadership Build a framework to help others make progress on tough problems Create resiliency to withstand the work of leadership

Tension of change Human Systems Limit of tolerance Productive Range Threshold of learning Time Based on Heifetz, Ronald A. and Marty Linsky. Leadership on the Line, Harvard Business School Press, Boston, MA, 2002, pg. 108.

Type 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

Technical vs. Adaptive Work Disequilibrium Adaptive challenge Limit of tolerance PRODUCTIVE RANGE OF DISTRESS Tension of change Technical problem Time Threshold of learning Heifetz, Ronald A. and Marty Linsky. Leadership on the Line, Harvard Business School Press, Boston, MA, 2002, pg. 108.

Adaptive Work Adaptive work diminishes the gap between the way things are and the way things need to be to create a better future

The most common cause of leadership failure is treating an adaptive problem with a technical fix.

What is hard about leading others in improving care?

Properties of Adaptive Work Gap between aspirations and reality Tension between points of view Difficult learning required Involves tolerating loss Perspective needs shifting New competencies must be developed People with the problem have problem solving responsibility Takes longer than technical work Requires experimentation Generates disequilibrium, distress and work avoidance

Adaptive Work Adaptive work diminishes 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

Technical and Adaptive l Fishbone diagram l Affinity diagram l Decision analysis tools l Measurement tools Technical pieces are necessary and insufficient for adaptive work

What is the work? Gap = difference between the way things are and the desired state Technical or adaptive? Hearts and minds need to change? Process of exclusion Persistence of conflict Crisis Where do we begin? Meaningful and Manageable

AIM Statement l The work you are doing together n Addresses a gap n A big enough improvement target to be meaningful n A contained enough project to be manageable l Has key components n Clearly articulated statement of intended improvement n Aligned to organizational strategic focus n Supports system quality or operations goals

Who Cares About the Work? Delivering high quality care with optimal stewardship of resources You Patient Other team members Family

Who cares about the work? Important stakeholders n Team members n Those affected by the change l Those who support it l Those who do not want to see it happen n Project sponsor n You n Who else?

Delivering high quality care with optimal stewardship of resources Tension of change Limit of tolerance Productive Range Threshold of learning Time Based on Heifetz, Ronald A. and Marty Linsky. Leadership on the Line, Harvard Business School Press, Boston, MA, 2002, pg 108.

Are you reading the signals others are sending? Work avoidance is triggered when the heat is too high or too low Adaptive Challenge Work Avoidance Tension of change Limit of tolerance Productive Range Holding Environment Work Avoidance Technical Challenge Time Heifetz, Ronald A. and Marty Linsky. Leadership on the Line, Harvard Business School Press, Boston, MA, 2002, pg. 108. Threshold of learning

Work Avoidance Signals Being Out of a Productive Range of Tension • Displacing responsibility • Distracting attention • Attack authority • Kill the messenger • Scapegoat Make the problem too big • Make the problem too small • Meetings with only information exchange when engagement and deep conversation is needed • Ask more consultants • • Denial • Collude in magical thinking

Can you imagine some work avoidance examples you might see?

How are the people who care about the work reacting to it? Interpret Factional Stances: l Is the faction above the limit of tolerance? Over the top l Is the faction engaged in the work? l Is the faction below the level of learning? Not my concern

How are you and others reacting to the work? What does the work avoidance suggest? You Delivering high quality care with optimal stewardship of resources

Begin to Plot a Strategy l What do you need to do to make progress? l What can you do to lower the distress on the factions that are above the limit of tolerance? l How can you maintain engagement of factions that are currently engaged in trying to make progress? l What can you do to raise the distress to a productive level for the factions below the level of learning?

Help People Make Progress on Adaptive Work l Use yourself differently l Create productive tension l Keep people engaged who are making progress and figure out what you need to do to reengage others.

Authority ≠ Leadership

Authority • Power in exchange for service • A contract for service – Direction – Protection – Order • Formal and informal • A resource and a constraint on leadership

Informal Authority = Influence l Power to influence beyond job description l General credibility and professional reputation l Implicit expectations l Critical source of leverage formal authorities too

Think of a time when you told people what they needed to hear rather than what they wanted to hear. What happened?

Exercising leadership to do adaptive work means disappointing people’s expectations at a rate they can tolerate.

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 muzzle you)

Leadership is an activity There can be leadership from multiple positions within a social structure

Get on the Balcony Fundamental Skill in Adaptive Leadership Reflect in action Keep the pattern of the dance in mind while dancing Move back and forth

Use Yourself Differently l l l l Exercise leadership and use your informal authority as a resource Reflect in action – get on the balcony Set a great example Celebrate and learn from what is going well Talk about why you think this is important Ask questions Listen Pay attention

Behaviors That Build Trust l Talk straight l Demonstrate respect Create transparency Right wrongs Show loyalty Deliver results Get better Confront reality Clarify expectations Practice accountability Listen first Keep commitments Extend trust l l l Adapted from The Speed of Trust, Stephen M. R. Covey, 2006.

Create Productive Tension Make it safe to disagree and debate but not OK to opt out and disengage. Talk honestly to one another about the challenge Listen with genuine interest to the various points of view Build trust Have difficult conversations

Difficult conversations are inevitable l Safety is critical for them to be productive shared purpose n mutual respect n l l l Be willing to be influenced Be curious rather than judgmental 100% candid 100% respectful Lead with questions not answers Engage in dialogue and debate not coercion

Create an Environment to Hold Attention on the Work Tension of change Limit of tolerance People need to feel safe enough to do adaptive work but not so safe that they will do nothing. Productive Range Threshold of learning Time Based on Heifetz, Ronald A. and Marty Linsky. Leadership on the Line, Harvard Business School Press, Boston, MA, 2002, pg 108.

Tension of change Distressed System No Trust, Little Adaptive Capacity Limit of tolerance Productive Range Threshold of learning Time Based on Heifetz, Ronald A. and Marty Linsky. Leadership on the Line, Harvard Business School Press, Boston, MA, 2002.

What is a difficult conversation? • Any conversation that you dread and perhaps seek to avoid, if possible • Three inherent challenges present the source of difficulty • There are inevitably more ways to understand the situation than any one participant is aware of or agrees with • The situation is emotionally charged with strong feelings • The situation is psychologically threatening to one or both parties

Which Condition of Safety is at Risk? • Mutual purpose or mutual respect • Conditions make the conversation difficult • much more than content Adapted from Crucial Conversations

Tension of change Shared Vision Delivering high quality care with optimal stewardship of resources Limit of tolerance Productive Range Threshold of learning Time Based on Heifetz, Ronald A. and Marty Linsky. Leadership on the Line, Harvard Business School Press, Boston, MA, 2002, pg. 108.

Tension of change How Do We Hold the Tension? Delivering high quality care with optimal stewardship of resources – respectfully? Limit of tolerance Productive Range Threshold of learning Time Based on Heifetz, Ronald A. and Marty Linsky. Leadership on the Line, Harvard Business School Press, Boston, MA, 2002, pg. 108. and adaptationfrom Crucial Conversations

Widening the Productive Range • Conditions of safety • Mutual purpose Do others believe you care about their goals in the conversation? • Do they trust your motives? • • Mutual respect • Do others believe you respect them? Adapted from Crucial Conversations

Increased Trust, Increase Capacity for Adaptive Work Tension of change Limit of tolerance Productive Range Threshold of learning Time Based on Heifetz, Ronald A. and Marty Linsky. Leadership on the Line, Harvard Business School Press, Boston, MA, 2002, pg. 108.

Keep people engaged who are making progress and figure out what you need to do to reengage others.

Work avoidance signals being out of a productive zone relative to the work Work avoidance is triggered when the heat is too high or too low Adaptive Challenge Work Avoidance Tension of change Limit of tolerance Productive Range Holding Environment Work Avoidance Threshold of learning Technical Challenge Time Heifetz, Ronald A. and Marty Linsky. Leadership on the Line, Harvard Business School Press, Boston, MA, 2002, pg. 108.

Think about a time when the heat was too high. l How did you know? l What did you do to bring things to a productive level of tension so progress could be made?

Lowering the Heat • Validate feelings, acknowledge loss • Simplify and clarify • Address the technical aspects • Break problem into parts • Restore, add, or reallocate resources • Temporarily reclaim responsibility for tough issues • Give your attention • Take stock of what is available • Allot more time, enrich knowledge and skills

Think about a time when the heat was too low. l How did you know? l What did you do to bring things to a productive level of tension so progress could be made?

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

Exercising leadership to do adaptive work means disappointing people’s expectations that things will stay the same but at a rate they can tolerate.

Give Work Back to People at a Rate They can Tolerate Adaptive Challenge Limit of tolerance Tension of change Work avoidance PRODUCTIVE RANGE HOLDING ENVIRONMENT Work avoidance Technical challenge Threshold of learning Time Heifetz, Ronald A. and Marty Linsky. Leadership on the Line, Harvard Business School Press, Boston, MA, 2002, pg. 108.

Exercising leadership requires keeping an experimental mindset l Work avoidance looks the same when the heat is too high or when the heat is too low. l If what you try makes things worse try the opposite. l What looks like laziness may be exhaustion. l Keep rechecking your assumptions.

Keep an experimental mindset When you try something and things get worse try the opposite! Adaptive Challenge Limit of tolerance Tension of change Work avoidance PRODUCTIVE RANGE HOLDING ENVIRONMENT Work avoidance Technical challenge Threshold of learning Time Heifetz, Ronald A. and Marty Linsky. Leadership on the Line, Harvard Business School Press, Boston, MA, 2002, pg. 108.

Building Your Practice of Leadership Adaptive leadership helps people to make progress on difficult problems l Develop a new capacity to see what is happening l Learn to effectively analyze what you see to strategically intervene to make progress on difficult problems