Healthcare leaders remember Martin Luther King, jr.

Today as we celebrate the legacy of Martin Luther King, jr., I invite you to take a look at reflections on his influence on some key healthcare leaders and clinicians who have strived to create better access and decrease disparities across our healthcare system.

In 2000, the late Dr. John Eisenberg, former director of the Agency for Healthcare Research on Quality, provided these remarks in observance of Dr. King’s birthday. In them he recalls the inequality he observed growing up in Memphis, where African-American patients entered Baptist Hospital through the back door. He also notes the role Medicare and Medicaid had played in facilitating hospital desegration – and also the substantial disparities that continued to this day.

In January of 2011, DMC Sinai-Grace hospital provided this fascinating video interview of Dr. William G. Anderson, who first met Dr. King in college during the 1940′s.  In the interview Dr. Anderson also describes his experiences and struggles for equal access to the medical profession.

In October of 2011, Dr. Risa Lavizzo-Maurey, CEO of the Robert Wood Johnson Foundation, provided this editorial in the Seattle Times.  In it she describes her excitement in meeting Dr. King at the age of 7, as well as the influence his perspectives had on her own work.

In her editorial she also mentions two of Dr. King’s quotes.  One of these, from a speech he gave to the Medical Committee for Human Rights, and has become familiar within healthcare circles: “Of all the forms of inequality, injustice in health is the most shocking and the most inhumane.”

The other quote is not nearly as well-known, but should be, given the persistence of health disparities:   “Whatever affects one directly, affects all indirectly. I can never be what I ought to be until you are what you ought to be.”

Remembering Luther Christman: A pioneer leader-as-teacher

Earlier today I had the good fortune to attend a tribute symposium held on behalf of distinguished nurse leader Luther Christman.

Through his remarkable career, Luther became known for the great many ways in which he furthered the role, autonomy, and professional status of the nursing profession.  He is also widely recognized for leading by example in breaking down gender and race barriers within nursing.  Less widely known is the impact of his innovations on how all health professionals are taught.

In 1967, Christman became dean of nursing at Vanderbilt.  During his tenure there, he proposed the development of a “unification model.”  In addition to its implications for nursing, the model proposed integrating the training of graduate nursing students and medical students.  He would later propose expanding the model into the clinical setting, which created the foundation for advanced practice nursing.

In 1972, Christman was recruited to the newly established Rush University, part of the Rush-Presbyterian-St.-Luke’s Medical Center.  In addition to his accomplishments on behalf of the nursing profession while there, he championed a university-wide model in which senior leaders of the medical center also took substantial roles in educating future leaders and clinicians.  Christman himself took on a dual leadership role: as vice-president for Nursing Affairs in the hospital, and as professor and dean of the College of Nursing.  This practitioner-teacher model, as it came to be called, held that teachers needed to also be competent in the profession in which they were teaching.

Although the model was foremost about ensuring the quality of the student learning experience, the benefits to the teachers themselves soon also became apparent.  Leading in the classroom not only improved their communication skills, it also pushed leaders to a level of content mastery beyond what their day-to-day work required.  The opportunity to reflect on experience had benefits as well.  Finally, to the extent that graduates would be working with the leaders who taught them, the possibilities for setting a depth of expectations by example were unparalleled.

A few years later, a soon-to-be-well-known emerging leader at General Electric named Jack Welch would recognize the power of a corporate university in changing the way work gets done.  Starting in 1981, Jack made regular trips out to Crotonville, site of GE’s corporate university, to personally get to know his company’s leaders and participate directly in their education about the GE way.  The GE model of leadership development has since been transported to other organizations, and the critical roles of leaders-as-teachers has been well documented.

Today, the value of the leaders-as-teachers role in private industry is much more widely recognized.  New accreditation guideline from CAHME will also help ensure that healthcare leaders are helping to shape the direction our graduate healthcare management programs take.

Christman was reportedly once told by an early detractor that “No one, but no one in the world, can be vice-president of nursing in a major medical center and dean of a college of nursing at the same time.”  His reply was that it was the easiest job he’d ever had.

Apple’s Quest to Outlive Steve Jobs

On August 24, Tim Cook took over the reins of Apple from its co-founder and unusually high-visibility leader, Steve Jobs.  This week, Steve’s direct mentorship of Tim and Apple’s leadership came to an end, as his years-long battle with pancreatic cancer reached its conclusion.

For years Steve’s leadership style has been studied by practitioners and scholars alike, in part due to the enormous success of the companies he ran, and in part because, like Apple, his style was so very unique.   Books and  trade articles regularly attempt to distill his approach into teachable principles that can help other organizations achieve Apple’s success.  Memorable presentations at the Society of Industrial/Organizational Psychologists offered Steve’s style as the thorny exception to allegedly universal leadership truths.

While memorials and celebrations of Steve’s leadership continue, the press is now turning some of its attention to the inevitable comparisons between Steve and his immediate successor.   But at least so far, little attention has been paid to the broader story of the leadership development system Steve put into place over the past three years.

As Jessica Guynn noted her recent L.A. Times story, Steve invested considerable time re-invigorating Apple’s corporate university, and in 2009 hired Joel Podolny, one of higher education’s most innovative business leaders to head it up.  Recruited from the deanship at Yale School of Management, Joel not only led a highly successful curricular overhaul at the school as the youngest dean in its history, he had also been a devoted Apple computer user since the days of the Apple II.

With a world-class university like Stanford so close by, why would Apple invest so much in building its own university – one that offers no products for sale outside of its own walls?   Clearly, Apple’s executive team recognized that leadership development needed to be one of its core competencies.  The swift and decisive hand-off between Steve and Tim also suggests a clear recognition of the value of succession planning – not just identifying replacements, but preparing them for the roles they will need to take.

NCHL was founded on the principle that leadership development needs to be a core competency of healthcare organizations.  The demands on healthcare leaders continue to grow and evolve rapidly, roles take longer to master, and on-the-job mastery continues to demand center stage.

Over the past ten years, many healthcare organizations have made great strides in adopting leadership development practices, shifting the dialog over time from “why” to “how.”   Leading corporate healthcare universities, such as NSLIJ’s Center for Learning and Innovation, now easily hold their own against leadership develpment in other sectors.

What might healthcare learn from Apple?  As expected, the new Apple U. is as shrouded as the rest of Apple’s trade secrets.  What little has been revealed by former executives and other investigative efforts suggests a leaders-as-teachers approach, perhaps not so different from what Becton, Dickinson, & Company’s Ed Betof  has already shared with the world.  If successful, Apple’s case study may prove the strongest yet for the contribution of leadership development to continued organizational vitality.

As both an analyst of leadership excellence, and someone who first learned to program (in all-caps) on an Apple II+, I am rooting for their continued success.

Linking leadership practices to healthcare outcomes

Earlier this summer, NCHL published the results of a national study of hospitals’ leadership practices.  Based on a subset of items on the NCHL Leadership Index, the study was designed to assess how we are doing as a field in preparing our next generation of healthcare leaders.

The study also provided a first look at how these leadership practices may relate to organizational outcomes such as quality and efficiency.   This topic has not yet received much research attention in healthcare, mainly due to the trouble involved with collecting cross-organizational data.  Research conducted in places where large-scale comparative data have been available, such as the VA System and the NHS, these relationships have been established, and become clearer once confounding factors such as organization size and context are controlled for.

In the coming months, we will be refining our own results to take these organizational factors into consideration, and providing preliminary findings in forums such as the annual UHC meeting in September.  Of particular interest to us is the relationship between leadership practices and the organizational outcomes associated with value-based purchasing.   We will have more to report in the coming months.

High-performance work systems in healthcare: Toward an evidence-informed approach

Management research often focuses on individual practices without considering the contexts in which they operate.  This bias makes it difficult to weigh the relative value of programs against each other, and also contributes to the misperception that when it comes to management programs, “more is better.”

Our recent research attempts to address this limitation by reviewing what is known about work systems.  (We have been presenting preliminary versions of the model in venues like ACHE Congress and AcademyHealth, but this its debut in a peer-reviewed publication.)

As the featured article in the latest issue of Health Care Management Review, it is available online for free as a PDF or EPUB.

Is the model useful to you?  Do you have questions about it?  Suggestions to improve it?  Comments are welcome.

“Timeless Truths”

NCHL to promote leadership development that works whatever future  holds
By Andrew Garman and Christy Harris Lemak

This article was originally published May 2, 2011 MODERN HEALTHCARE.   It is reprinted here with permission.

Leadership development in healthcare has progressed considerably since 2001, when the National Center for Healthcare Leadership was first established. From the classroom to the C-suite, healthcare has increased its uptake of evidence-based practices. Leadership development that is clearly tied to strategic objectives, such as higher-validity hiring and promotion systems,
performance calibration and the implementation of leadership academies, are now providing great results for many hospitals and systems. And the NCHL, through the support of foundations, corporate sponsors, our volunteer board of directors, members of our Leadership Excellence Networks, graduate demonstration projects and our many other stakeholders, has been proud to play
a role in helping raise awareness of these practices across the field.

As we celebrate our 10th anniversary, the journey continues. Despite the efforts and achievements to date, the burning question remains: Are our leaders today being adequately prepared for the challenges they will face in the coming years?

Recent realities challenge the industry’s forward progress on two fronts. Many organizations are struggling to find the resources to invest in our leaders’ development. And even when those resources can be secured, how do we develop leaders for the future when we don’t know what that future is going to look like?

The NCHL focuses on leadership as the key driver of transformational change in healthcare. But from our perspective, leadership
development is not a transaction (i.e., a service that is delivered by a developer to someone being developed), but rather a process that involves learners developing their skills so they will be more effective—no matter what the future holds. Think of leadership development like water: Our task is less to “turn on the spigot” and more to guide the water that’s already flowing in the directions that will be most effective.

Where do we look for resources to invest in leadership development? If resources are a barrier, turn the question on its head: “How would I develop leaders if I had no resources to invest?” The answer is to find out where leadership development is already taking place in your organization and seek ways to make that development more effective.

For example, many organizations want to improve the business literacy skills of their clinical leaders. An organization can begin by identifying clinical leaders with the strongest business skills and find out how they developed these skills. Who are the natural mentors already at work in your organization?  How could you give these individuals a broader audience? Can leadership development be integrated with solving current clinical and strategic issues through case studies or other activities that bring together experienced and new leaders in a structured way? Pursue these questions, and you can be on your way to fortifying leadership development within your organization without even asking the resource question.

As we move forward, NCHL will expand our efforts to identify and share best practices—including ways of keeping the leadership development flowing despite resource limitations.

How do we develop leaders for the future when we don’t know what that future is going to look like? This question brings to mind another helpful philosophy: “Embrace the mystery.” There are some things about the future we simply cannot know. So, if planning is a barrier, try removing that altogether and ask, “How would I develop leaders if I didn’t know what the future looked like?” Under such conditions, your best approach is to identify some timeless truths and develop leaders against those truths.

What do we know about leadership that can be applied regardless of what the future holds? Using an evidence-based approach, we can identify many truths. For one, we know we will be challenged to deliver better care with fewer resources. So a focus on performance metrics and continuous improvement is here to stay. We also know that improving population health will require
many disciplines working in close harmony. Thus, interdisciplinary collaboration and teamwork will be key competencies. And certain leadership skills are not bound to specific environmental conditions. For example, how can your organization support skill development so leaders at all levels effectively listen, respond, reassure, train and reward others?

Lastly, and perhaps most importantly, we know the coming years are going to have more than their share of challenge and stress. Research is very clear about the greatest sources of job stress: role conflict, role uncertainty and role overload. We also know that the most potent buffers to stress are supportive relationships, a deeply felt sense of personal accomplishment and a sense of optimism about the future. The most effective leadership development efforts, then, will cultivate all of our leaders’ abilities to provide these remedies.

As the NCHL begins the second decade of its work, we will continue our focus on helping organizations make their own journeys toward leadership excellence, by focusing on building the leadership development evidence base and disseminating high-value resources and success stories. Regardless of what the next few years hold, we see a bright future for healthcare in the U.S., and we look forward to continuing this journey with you.

NCHL – the next chapter

Greetings,

Over the past several months, the NCHL has been migrating its offices to its new home at 1700 W. Van Buren in Chicago, on the Rush University Medical Center campus.  As expected, the move involved working through the at-times overhwhelming number of details involved in bringing organizations together:  telephones, computer networks, space reconfigurations, and office protocols to name just a few.   And of course there are only so many changes we can identify and plan for in advance; the rest end up on the ‘leap-of-faith’ list: the many unknowns we know we‘ll need to face, and need to trust in our colleagues and ourselves to get us through them.  

Throughout this process, we kept focused on the NCHL vision:  optimizing the health of the public by supporting excellence in healthcare leadership.   To the extent that our roles and activities evolve in the coming months and years, it will reflect our efforts to continuously improve our pursuit of that vision.

So in many ways, NCHL’s move into a university consortium symbolizes the broader changes taking place in the U.S. healthcare system.   Health reform legislation brings with it unprecedented opportunities to build partnerships throughout our system, to improve coordination, increase reliability, expand the evidence base, and reap the greater efficiencies these efforts can provide.  But getting there will involve at-times overwhelming changes, and a great many unknowns we will together need to work through. 

We look forward to updating you on our progress in the coming months, and finding new ways for the NCHL support the mission of your organization in the longer term.

– Andrew Garman, CEO, NCHL

Decade as a Catalyst for Leadership Innovation

It has been a decade since a group of forward-looking healthcare leaders gathered to consider the challenge of how to better prepare the next generation of leaders to meet an increasingly complex world that would demand a higher level of performance from healthcare organizations. Their strategy to create competency-based models using global best practices that could be implemented, tested, evaluated, and then widely disseminated became the foundation for the National Center for Healthcare Leadership (NCHL).

As NCHL enters into its tenth year, we do so with innovations that healthcare organizations and universities around the country are adopting to help transform cultures, improve competencies, and drive higher levels of performance. For example, NCHL’s Health Leadership Competency Model is a gold standard in the field. It is referenced in multiple graduate level textbooks and in the curriculum of leading universities. NCHL has led major changes in graduate health management education with over one third of the accredited graduate programs using the NCHL Competency Model to introduce competency-based education and outcomes assessment, better preparing graduates to enter their roles as new members of healthcare management teams. Additionally, it has been adopted by hospitals and health systems nationwide.

NCHL’s innovative Nurse-Executive Team Leadership Demonstration Project has identified key elements that can enhance organizational performance with improved senior leadership team effectiveness in quality and patient safety performance initiatives. And the NCHL Diversity Leadership Demonstration Project will provide insights on the impact of improved diversity and culturally competent leadership on patient safety—so critical with our nation’s changing demographics.

By focusing on industry-wide collaboration, C-suite peer-to-peer learning, and Leadership Excellence Networks (LENS), new paths have been forged in the quest for organizational excellence. Additionally, NCHL’s annual symposium and leadership award dinner remains one of the industry’s seminal events for convening thought leaders and honoring those leaders who role model and espouse the mission and vision of NCHL.

On this tenth anniversary of NCHL, as many of you know, I am retiring as President and CEO. It has been a extraordinary privilege to work with some of healthcare’s greatest visionaries and esteemed professionals in pursuing NCHL’s vision. As I move into the next transition of my life I will be spending more time with my family, pursuing personal interests, as well as continuing to mentor and teach the next generation of health leaders. NCHL will now be lead by two long-time colleagues and friends, Andrew Garman, PsyD, who will serve the chief executive officer, and Christy Harris Lemak, PhD, as chief academic officer. Joyce Anne Wainio will continue in her role as vice president responsible for operations and NCHL’s national demonstration projects.

The management structure reflects a new partnership between Rush University Medical Center and the University of Michigan and ownership of NCHL will continue to engage the diverse constituencies of our field: providers, suppliers, payers, policy makers, and academia, and across administration, medicine, and nursing. NCHL’s research programs and evidence-based management tools will continue to advance healthcare leadership and respond to the growing demand for more research-based best practices for healthcare leaders as part of the mandate for comparative effectiveness and improved performance. Additionally, in working with these two world class institutions, we see the opportunity for growth, synergies, and the benefits of deeper focus on our research.

When Gail Warden and I co-founded NCHL in 2001, we knew there was a need, but the response over the past decade has been overwhelming and I am personally grateful to The Robert Wood Johnson Foundation, W.K. Kellogg Foundation, our corporate sponsors, our Leadership Excellence Networks participants, demonstration sites, academic partners, executive coaches, and other friends and stakeholders for your outstanding contributions to the success of NCHL. I have been humbled by our work, creating best practice tools that have the ability to transform healthcare, improve performance, and create better environments for the delivery of healthcare services to the nation’s entire population.

As we look ahead, NCHL will continue to seek out innovation and innovators in its role as an industry-wide catalyst. Your continued, unwavering support to our vision to optimize the health of the public through leadership and organizational excellence is more important than ever. This is a remarkable time to be in healthcare as our nation pursues seismic change. Let us know what you think about your own experiences in leading these important changes at your organization and in the field.

– Marie Sinioris, past president & CEO

A Call for Evidence-based Leadership

Transcript of April 30, 2010 Presentation by Marie Sinioris to National Association for Healthcare Quality (NAHQ)

Evidence-based leadership will drive U.S. healthcare organizations’ performance in coming years, said Marie Sinioris, president and CEO of the National Center for Healthcare Leadership (NCHL), in her recent address to NAHQ state leaders at the State Leadership Summit in Chicago.

“Ten years ago, the Institute of Medicine (IOM) made a challenge to have 80 percent of all healthcare evidence-based. We need to do the same in management,” she said. “Is our approach to changing leadership behaviors grounded in science? Does it actually change organizational climates and individual behaviors?”

NCHL is a not-for-profit organization whose mission is to be a catalyst for high-quality healthcare management leadership for the 21st century. The organization conducts research in areas such as defining what competencies are necessary to transform the healthcare industry.

Health Reform and Leadership
Sinioris, who is also a professor of health systems management at Rush University in Chicago, says that with health reform, success will go to leaders who develop cultures that span boundaries.

“The electronic health record is absolutely essential. It goes beyond just implementing it,” she said. “Interconnectivity is essential.” To achieve community-based care and wellness, interconnectivity among healthcare records, school health records, and pharmacy networks is imperative, she said.

Sinioris called for new levels of transparency and accountability in reporting. ‘High-leveraged changes’ to our healthcare system, including nursing indicators and outpatient metrics, will lead to more informed decisions.

“This is going to be at levels that are unprecedented in our problem solving. It’s not just a fishbone analysis; it is really thinking outside the box,” Sinioris said. “We’re talking about systemic, sustainable quality at the highest levels of our organizations. [We need to] reduce disparity gaps and advance innovation to create new care models and relationships.”

Competency-based Learning
Sinioris points to a 2009 IOM report, Redesigning Continuing Education in Health Professions, which calls for a close link between professional education and quality and patient safety. “It moves away from CME and CNE credits. It’s not about getting credit, but demonstrating competence,” she said. “We’re moving from knowledge-based classroom learning to experiential learning … If leaders aren’t attending to their own professional development, how are they going to do the job and create high-performing environments for change?”

Healthcare quality leaders must possess good collaboration and communication skills, as well as an ability to partner with and be accountable for each other. Moreover, with the retirement rate of healthcare executives expected to soar in coming years, more attention must be paid to succession planning—an area far more developed in business than in healthcare.

In addition to possessing technical knowledge, quality leaders must become well versed in change management, transformation, and innovation. They must focus on and learn techniques to improve their innovative leadership capabilities to create new concepts, Sinioris said.

“[Cultivate] an ability to energize stakeholders and sustain their commitment to change focus, processes, and strategies. The role that I envision for [healthcare] quality leaders is that of ‘change coaches’. You need to understand the science of improvement and be armed with change-management skills. How do you get people to change behavior and embrace change?”

Sinioris called for quality leaders to:
• Improve their peer-coaching skills in order to provide effective feedback immediately.
• Develop human capital dashboards. “This is about educating the board and trying to get them to be mindful that it’s about capital—human capital, not just financial indicators. We’re a service industry—and a high-risk one. Why would you not be monitoring your human capital with the same metrics you use for anything else that’s critical?”
• Rethink your job description and understand what competencies you’ll need to do your job effectively.

From Marie Sinioris, President and CEO of NCHL

NCHL’s perspective is that much of what needs to be done is already known to the field and to health policy makers. A greater challenge is putting this knowledge into action and broadly assimilating best practices that may have been developed in other industries or among thought-leader healthcare providers.

This is especially true at a time of dramatic change. As the U.S. makes significant investments in healthcare systems, processes, and technologies, the capability to assimilate these massive changes must also be built. Fortune 500 businesses have understood that these huge investments have the best chance of delivering their expected return when they attend to the human side of the equation: ensuring that the skills, rewards, talent management, and overall organizational culture are aligned with the intended change. This is achieved when leadership best practices are adopted, cultivating the necessary competencies to inspire and manage in a challenging and changing environment. Frighteningly, at least 66 to 75 percent of large-scale changes have historically failed to deliver on their initial return on investment (ROI) promise (Kotter, 1995). Without adequately and pervasively preparing healthcare leadership to effectively implement new capabilities, many transformational components of health reform will have a lower probability of succeeding or meeting the public’s expectations.

Healthcare leadership needs to be prepared for its biggest challenges, never more than in this environment, with its intensifying demands for excellent outcomes and better value.