Post Recession Alerts for Health Care Leaders

The July-August issue of Harvard Business Review is far from light holiday reading. Through a wide range of lenses, it aims squarely at business strategy and leadership challenges to be faced in the post-2009 recession world. Leadership in a (Permanent) Crisis by Ronald Heifetz and his colleagues at Cambridge Leadership Associates, reflecting the volume as a whole, is all about national and global post recession trends in the broader business environment that will shape industries over the next several years. As physician and other executive health care leaders we owe it to ourselves, our patients, and our organizations to examine how these will impact us.

Tools for Permanent Crisis Management

The article by Heifetz et al is rooted in the perspective that "nothing will ever be the same" in the years to follow the 2008-2009 economic meltdown. To them, this implies that current and future leadership styles must accommodate anticipated long term environmental instability rather than a return to "business as usual" as the recession appears to ease. In order to be successful, they recommend leadership styles that foster adaptation, embrace disequilibrium, and generate deep leadership pipelines within organizations.

Fostering Adaptation

To the authors, this means actively transcending conventional industry wisdom and some of the successful business techniques (not principles) that worked in the last decade rather than returning to them with the expectation of success going forward. They even go as far as to encourage wide scale experimentation, anticipating pockets of failure, to identify adaptations for wider use. They cite, as one example, the electronics retailer Best Buy which recently made fundamental changes in both consumer marketing and leadership strategies to adapt to an increasingly female consumer market - thereby repositioning itself for success going forward. The authors counsel that the courage and foresight to do things differently, rather than retreat into comfort zones that worked in previous years, will differentiate organizations that emerge from 08-09 in a health fashion.

Embracing Disequilibrium

Heifetz cited Paul Levy's success as the "turnaround leader" at Beth Israel Deaconess (BID) Hospital in Boston as an example of leadership that carefully leveraged uncertainty and instability as a potent lever for engaging an organization to change its culture and sustainably pull itself out of crisis:

"...a successful turnaround was no guarantee of long term success in an environment clouded by uncertainty....Keeping an organization in a productive zone of disequilibrium is a delicate task...if [the heat] is consistently too low, people won't feel the need to ask uncomfortable questions or make difficult decisions. If it's consistently too high, the organization risks a meltdown..."

The authors go on to cite Levy's successful use of potentially unstable devices (publication of error rates) and public cultural confrontation (of unproductive cross professional squabbles) to expose the implications of an unacceptable status quo and drive the changes essential to BID's survival.

Generating Leadership

While the need to generate deep organizational leadership pipelines may seem like a "no brainer" in theory, in my experience it's not often practice intentionally. Heifetz wrote about an organizational culture at the executive recruiting firm Egon Zehnder International which harnessed its core values of independence, shared ownership, and shared decision making as an intentional strategy to leverage internal leaders at all levels to resist and, ultimately, transcend recession in its industry. The firm's absolute reliance on the sense of shared destiny among its empowered owner-consultants:

"Zehnder's collaborative and distributed leadership model informed a strategic review ... The firm took a bottom-up approach to sketching out its future, involving every partner, from junior to senior, in the process...

led to a successful recession business strategy that did not involve downsizing staff or services or compromising its model of growing the firm while continuously distributing leadership.

Heal Thy Self?

The authors close this piece with a valuable section on leadership self care. No, not early to bed, exercise regularly, eat well, and take a deep cleansing breath 5 times a day. Rather, being attentive to the techniques business leaders should consider using to ensure clarity, objectivity, and perspective. These include balancing optimism with reality, using reflection, reaching out to trusted advisors and confidants, being attentive and responsive to the emotions of self and others, and maintaining boundaries between self and work. It's less than a page but very high value reading.

There's a tendency in crisis to simply do the familiar as well as possible or to take calculated risks and, if successful, retreat to the familiar as soon as possible. Health care leaders are loathe to rock the cultural or operational boat - much less embrace instability. Physician leaders and other executive health care leaders push themselves to extraordinary levels of personal performance and responsibility often to the exclusion of valuable self preservation techniques and support systems.

This article examines several industries (including our own) to suggest that going forward health care leaders may need to intentionally and permanently do it differently. While attending to some critical self care issues. Talk about cultural change!