Healing Our Future

Leadership for a Changing Health System

Andy Garman

• Publisher: Berrett-Koehler Publishers
• Year: 2021
• ISBN:
  9781523090129
• Edition: 1
• Topic: Negocios y empresa
• Subtopic: Industria farmacéutica, biotecnológica y sanitaria

This practical and evidence-based guide offers the seven key domains of effective healthcare leadership and explains what it will take to develop leaders for an evolving healthcare system. Andrew Garman looks at both the major changes facing healthcare organizations and the leadership competencies required to successfully meet those challenges. He offers a glimpse into our more distant future and how our health systems—and the demands of leaders—could evolve. He also explains how people become more effective leaders over time and what the research has to say about what works best in making this happen. Garman introduces the seven primary disciplines associated with effective leadership: values, health system literacy, self-development, relations, execution, boundary-spanning, and transformation. Each discipline is rooted in research on leadership effectiveness, including studies conducted with the National Center for Healthcare Leadership. He also provides additional tools and resources to help people on their leadership journey.

APPENDIX 1

Developing Mentoring Relationships

In chapter 2 on accelerating leadership development, I describe the essential role of high-quality feedback; in the chapters on the seven disciplines, I suggest places to look for good role models and mentors. In this appendix I will give you some tips on engaging people to become mentors, and suggestions on how to make the most of these important relationships. For our purposes, I define mentor as anyone other than your boss who is willing to voluntarily provide you with some level of ongoing support, guidance, and/or advice that may help you develop your leadership capabilities.

If you have read the earlier chapters, the benefits of mentors should already be clear. But you may still be wondering why someone would volunteer their time to mentor you, particularly if they already seem quite busy. It’s true that mentoring is not for everyone. For that matter, not everyone is good at mentoring, at least not right from the start. But lots of people truly enjoy mentoring, and, as with every other leadership skill, they can get better at it over time, with practice and feedback. There are other payoffs for mentors as well: they tend to have greater job satisfaction, higher organizational commitment, and quicker career success than their colleagues who don’t mentor (Ghosh and Reio 2013). Mentors also often find this role very professionally fulfilling, especially if protégés (mentees) manage their side of the relationship well.

Approaching a Potential Mentor

Before asking someone to mentor you, first make sure you are clear about what you want out of the relationship, as well as what you are willing to put into it. For example, are you looking for guidance on career decisions, or help with a specific leadership discipline? If the latter, which one? Are you hoping for a few meetings over a short period of time, or a longer-term relationship, perhaps involving an annual check-in or two in the years to come? Sometimes informal relationships work best; however, if you are hoping for a longer-term commitment, working out a more specific agreement may make sense. A good approach can involve structuring your “ask” along the following lines: (1) stating your goals, (2) explaining why you are reaching out to them specifically, and (3) making a specific initial request. Here’s an example:

I am reaching out to you today because I am working on getting better at leading organizational changes. I was given your name by _____, who said you are the most effective change agent they have ever worked with. Would you be willing to meet with me sometime, at your convenience, so I could ask you some questions about your work?

Pause for a moment now, and consider how you might react to a request like this one. If you’re like most people, you’d be flattered, and would be enticed by the chance for more such compliments. Or, you might feel you don’t have time for this meeting, but the message itself would not have been experienced as a nuisance. If you do get a decline on your invitation, you can make a more modest follow-up request for a nomination of someone else this person thinks would be good to approach. Continuing to build your professional network in this way is almost always time well spent.

Your First Meeting

Once a potential mentor has agreed to an initial meeting, make it easy for them to participate. Ask for their guidance on the best way to schedule with them (e.g., do they have someone who manages their calendar?), and the best time of the day and week for them. Offer to come to their office or meet in another location convenient for them. If you can afford to, consider offering to take them to breakfast or lunch at a favorite restaurant.

In getting ready for this first meeting, take as much personal responsibility as you can for ensuring its success. Prepare an agenda of the topics you’d like to cover, and a good set of questions to ask. Make sure you arrive early, and stay conscious of time during the meeting itself. Bring something to do in case they are running late, and be understanding if they are. Let them know when you are running toward the end of the allotted time so that you don’t inadvertently make them late for their next appointment—but be willing to stay longer if the conversation is going well and they have additional time they’d like to share with you.

As you are wrapping up the meeting, mentally ask yourself how things went. If you thought they went well and you’d like to continue the working relationship, then after you thank them for their time, ask if they might be willing to meet up again periodically in the future. If they say yes, you have found yourself a mentor.

Managing Your Mentoring Relationship

The best mindset to have about mentors is that they are a valuable resource in short supply, and you are fortunate to have found one. It is a good idea to reinforce this perspective each time you meet with your mentor. In addition, it never hurts to convey that you want to be as helpful to them as they are being to you—if not now, then at some point in the future. Another way to reinforce this mindset is indirectly, through how wisely you use the working relationship and your time together.

Managing Mentoring Meetings

However many demands you may have on your time, your mentor’s schedule may be even tighter, so do your best to set meetings for times when there is no risk that you will have to reschedule. As a meeting draws near, make sure you prepare carefully so that your time together is used most wisely. No matter how informal your conversations may be, it is always a good idea to have an agenda in your own mind.

If you have set development goals for yourself, now is a good time to review them, making note of any successes, lessons learned, and questions they may suggest for discussion. If you implemented any of your mentor’s advice from your last meeting, be sure to note that as well. Next, consider any upcoming events or activities where your mentor’s input could be helpful. Finally, try to identify any topics or areas that provide you with an opportunity to give back. For example, if you have run across any articles or videos on topics of interest to your mentor, you can offer to send them along if she confirms they are of interest. For all of the above, I recommend making notes along the way so that you remember everything you’d like to discuss.

Using Time in between Meetings

Before you end a meeting, try to identify at least one specific “homework assignment” you can make progress on before your next meeting. Doing so will help you stay accountable to making the most of the learning relationship. The “assignment” can be as simple as applying a specific piece of advice you received from your mentor, and keeping track of how things went. This will help you mark progress, and also tee up your next conversation. You may even find your mentor starts to look forward to hearing the outcome of your next “chapter,” making for an even more engaging mentoring relationship.

Build in Periodic Reviews

Although your mentor may be willing to set up a relationship that is open ended, setting a specific time frame has many advantages, particularly in terms of keeping a clear focus. Along the same lines, agreeing to periodic reflections about how the working relationship is going can help you take stock of progress and also decide when to end the formal part of the relationship. For example, if you asked your mentor to work with you because of her strengths in a particular discipline, the two of you may evaluate your progress and decide if you have made the progress you had hoped to. You may then make an intentional decision to either wrap up the meetings or perhaps continue them with a different focus. Without this type of structure, the mentoring relationship may simply taper off over time, which is usually a less satisfying way to leave things.

End the Formal Relationship Well

If you have followed the time frame suggestions above, I recommend scheduling a wrap-up conversation that you both understand will be your final formal meeting. At this meeting, you can express your gratitude for the progress your mentor helped you make. Even after the mentoring relationship has formally ended, plan to check in periodically to keep the relationship going. For example, you could set a calendar reminder to send an e-mail a year or so after your final meeting. In it you can give an update on your work and career, mentioning any ways that their work with you has been especially helpful, and also ask about how their work has been going.

APPENDIX 2

Developing a Longer-Term Mindset

Foresight Resources and Strategies

The most important question we must ask ourselves is, “Are we being good ancestors?”

—Jonas Salk

When you think about what the future may hold, how far into the future do you imagine? If you are like most people, your time horizon does not extend very far. Recent research suggests that more than a quarter of U.S. adults rarely or never think about their lives even five years ahead, and more than half never consider life 30 or more years from now (Institute for the Future 2017). This short-term bias, which was critical to survival throughout most of human history, has become more of a collective liability than an asset. In recent decades especially, many of the biggest threats needing our attention—in society and in our environment—move too slowly to be noticed in the present; they can only be seen and fully understood at the timescale of human generations. Successfully addressing these challenges will require us to sustain much longer-term courses of action, something our societies are not yet well designed for. Even among the leaders of large enterprises, attention tends to be bound within financial reporting cycles—a coming month, quarter, or fiscal year. When longer-term planning does get discussed, it is often defined on a time horizon of just three to five years. Rarely are an organization’s activities or impacts considered in the context of decades, let alone generations.

In this appendix, I offer some strategies for expanding the time horizons of your own thinking, and of the people you work with. I will also provide examples of methods that foresight practitioners (sometimes called “futurists”) use to help people envision potential future states, to inspire more meaningful dialogue about these longer time horizons. In doing so, I hope to heighten your interest in long-term thinking and equip you to help others understand what their own short-term actions look like through the lens of long-term impact.

Starting with You: Personalizing a Time Horizon

One of the most compelling ways to think about a distant point in the future is to create a vision of yourself at that mile marker. To get an even clearer sense of how things evolve over longer periods, mentally travel backward in time by that same amount. For example, if you are interested in what some aspect of the world may look like in 10 years, consider first what you think your own life will look like. How old will you be? Where do you imagine you will be working? How might your age have affected your day-to-day life, and those of your loved ones? If you do the same exercise in reverse, you can ask similar questions: How old were you 10 years ago? Where were you then, and what were you doing? How were you physically different? And how was the world different?

If you are trying to help others develop a longer-term perspective, a decade can be a useful time frame to work with on an exercise like this one. Even younger adults can typically remember what life was like when they were in their early teens, and will also be able to identify specific ways in which the world has changed since then. However, in the context of our contemporary challenges—equity and ecological sustainability, in particular—a decade may still not be long enough to reveal the shape of these trends, and a timescale that spans generations may be needed. Let’s say we want to think about the world 50 years from now. Or 100. Looking backward, constructing a longer-term perspective may require a review of written histories or documentaries, and getting perspectives from the generations before you if you can. Looking forward, developing this longer-term perspective may require looking through the lens of an extended family. For example, if you don’t think you will still be here 50 years from now, you could apply the questions above to your current or future children, nieces and nephews, or those of your friends or neighbors.

Projecting Forward from Long-Term Trends

Organized systems of all kinds tend to operate according to inertia: trends toward growth tend to continue growing, trends of decline tend to continue declining, and systems in equilibrium tend to stay that way. However, some systems are more robust to outside influence than others. The futurist Daniel Burrus (2017) refers to more robust trends as hard trends. Like freight trains, hard trends tend to speed along in their current direction until they crash into something bigger than they are, at which point the inertia meets resistance and the trend begins to slow down.

Human population is a good example of a hard trend. We can make a darn good guess about how many 18-year-olds there will be in the world 17 years from now, given that they were all already born. Even beyond this rather obvious example, demographers have found they can make pretty accurate assessments of the population growth we are likely to see in the future, even over very long periods of time (National Research Council 2000). As with other species, when human subpopulations have crashed in the past, it was usually because the population began depleting local resources—arable soil, animals, and water, in particular—at a faster pace than they could be replenished. By measuring the upper limits of resources (also called carrying capacity), the end point of local population growth can also be forecast pretty accurately. Once that limit is reached, either new resources must be found or the population must level off or decline. Biology dictates it.

Similar principles hold true for organizations. Left to their own devices, they take on the characteristics of the economic systems within which they operate, such that survival demands continued expansion over time. The rate of this growth almost inevitably exceeds growth in the underlying market (the organization’s resource base), leading first to competition between organizations, then to consolidation among them (Grullon, Larkin, and Michaely 2019). Surviving organizations then extend the growth pattern for a time by continuing to evolve their goods and services beyond what customers have asked for and continuing to demand higher prices for them. That strategy meets its end when new organizations learn to give customers what they actually wanted in the first place at inevitably lower costs—a process that has been called disruptive innovation (Christensen 2003). If the dominant organizations are powerful enough, they may choose to prevent these new organizations’ success (e.g., by funding the creation of new regulatory barriers), or they may simply buy the new organizations as they spring up. But if these new organizations are successful enough fast enough, they will continue to chip away at the old organizations’ markets until these newcomers prevail, and the cycle will start all over again.

While hard trends can help you understand the likely range of potential future states, combining them into a coherent whole can quickly become a mind-numbingly complex task. Intersections between the trends often don’t point in one definitive direct...