Consultant, do no harm!

As a Consulting Psychologist, my goal is to help people.  As a matter of fact, my practice is heavily influenced by Edgar Schein's "Process Consultation" approach, in which the first of 10 principles is:  "Always try to be helpful".  So in my work in organizations, my goal is to be helpful: To help the individual I am working with, his or her coworkers, and other key stakeholders in the company.  Despite the Showtime series "House of Lies",  I imagine most consultants have this goal--to help our clients.

However, there is the law of unintended consequences.  And there are sometimes conflicts of interest. So how do we ensure that we are always helpful....or, at minimum, do no harm?  I suggest we be careful; very, very careful.

A good example of potential harm that is sometimes overlooked is with the introduction of 360s as a management tool.  I have discussed 360s in an earlier blog posting .  So what is the potential harm?  There is growing consensus on the benefits of 360 assessments, but there is also some research that suggests caution. For example, a 360 report containing a high percentage of very negative feedback can be overwhelming to someone with a fragile personality, particularly if it is not delivered sensitively and appropriately. Implementing a 360 assessment considered confidential, when in reality it is not, can also cause harm if, for example,  the leader retaliates against someone for honest but not-so-flattering comments.  Using 360s for performance appraisal rather than development can be risky;  one should be cognizant of the potential risks in this situation and ensure the implementation process is well-designed to mitigate any potential harm.

Companies need great leaders and this is especially challenging today given the rapid changes and complexities of our global economy. Assessments that help leaders better understand themselves and others can provide significant value to companies. As consultants we can really help; but we must understand the risks as well as the benefits of this sensitive work, and companies need to understand this as well. Sometimes providing this information is uncomfortable; sometimes we must make the difficult decision to walk away from a situation we know is not right. We can provide great value, but first, and most importantly, we must  DO NO HARM!

A Physician (and Psychologist) share personal perspectives

  More on healthcare, leadership and culture...

Today  there was an interview in the Boston Globe with a Physician whose mother died. He felt there were errors made and wanted to speak out to help prevent these things from occurring.  http://bostonglobe.com/lifestyle/health-wellness/2013/02/04/jonathan-welch/YDxG225lt80x7i4UG0MJbL/story.html  

His answer to this question stuck out for me:

Q. Do you think smaller hospitals, like the one in Wisconsin that treated your mother, make more errors than big, teaching hospitals?

A. I don’t know if size necessarily has a lot to do with it. What I think really matters at the end of the day is culture. I think you need [hospital] leadership to say: “This is important to us. We’re not going to have people die unnecessarily on our watch, and we’re going to listen to patients and families.” 

So, my thoughts....What will it take to ensure every hospital creates a culture that emphasizes listening to patients and families? What leadership is required?

This resonated with a personal experience I had many years ago.  My first husband died of metastatic melanoma as a young man. He received excellent care, by many providers and more than one hospital over many years; but the disease did eventually take his life. 

Despite this good quality care, he had one experience that almost led to a preventable early death. As his wife, by his side constantly, I could see things that were going wrong. He was misdiagnosed. He was being "observed" and not receiving active treatment in part because it was the weekend, the hospital was understaffed and they were waiting for the full array of hospital staff ("experts") to arrive on Monday morning. 

But that may have been too late. 

I was forced to  confront a resident who was over her head and not willing to get the help needed. I became pushy, persevered; no longer concerned with politeness, I raised my voice. I demanded a specialist. I demanded a CT scan. I insisted they get someone in who could deal with the situation. [At that point, I am pretty sure she was offended, but I no longer cared...we were talking life or death here].

Later in the day, when it was confirmed that he had been misdiagnosed, (he had a brain tumor that was causing swelling, delirium and eventually a seizure) and the situation was stabilized, I was commended by the medical staff for "catching" the problem before it was too late.

The point is not that I know more about medicine, I don't. The point is: I knew more about my husband. I knew what he was like "well" and I knew he was deteriorating.

I agree with this physician--Hospital leadership needs to set the expectation that staff listen to patients and families. It needs to be a core value. It needs to be supported. It may prevent unnecessary deaths, and it also will lead to an overall much better hospital environment.

The human side of healthcare transformation

I just attended the Mid-Winter Leadership Forum co-sponsored by the Massachusetts Hospital Association (MHA)  and the American College of Healthcare Executives (ACHE)- Massachusetts chapter. It was quite interesting and it is exciting to be in Massachusetts where there are many innovative initiatives underway.

The title of the conference:"Making Connections: Crafting a New Healthcare System", was clearly meant to highlight Collaboration and Transformation. There were presentations of several innovative Massachusetts-based collaborative initiatives in which payors and providers have come together to provide better quality, cost effective solutions.

I was a little surprised, however, at the few references to the human aspect of transformation throughout the conference day, especially given the title "Making Connections". For example, what is effective leadership in these initiatives? How do leaders in healthcare organizations contribute to, or hinder, these transformations? What is the role of the physician leaders, healthcare executives, nurse managers and other leaders in ensuring the successful transition throughout these massive changes? What about those on the front lines?
 
Peter Straley, President & CEO, of Health New England, Inc. came closest to addressing the personal side of change by noting that what was really needed was to change the culture in which we grew up. YES!  A new vision...a new way of viewing and operating in a healthcare system within which we have been living.

Transforming healthcare is not about new technologies or new payor systems ALONE. Yes, those are critical, as are needed structural and systemic changes for delivering high quality care, more efficiently, effectively and at a lower cost. But, transformation requires personal change. It is about changing the culture. It requires collaboration, communication and compromise. It requires a new way of thinking. In essence, it is about changing behavior. And this is often the most difficult change of all.

Taking a Stand: Martin Luther King, Jr.

Today we celebrate a leader who died tragically and way too young: Martin Luther King, Jr.  We celebrate his accomplishments in moving civil rights forward and mourn our loss of a great man.

This 7 minute video is part 1 in a 3 part series in which Dr. King is interviewed by Mike Douglas on TV in 1967. The focus of the interview is primarily on his stance in opposing the Vietnam War, which was not particularly popular even among some people who supported his work on civil rights.  He speaks eloquently on the topic and remains steadfast with his convictions.

One section of the video I find particularly inspiring (around 5:20)  is when he is questioned as to whether his stance on the war may cause people to turn away from him, people who might otherwise support him. His response, in essence, is that people who really support equality will not change their views because some leaders in the civil rights movement take positions on other issues they don't agree with. He paraphrases a quote by T.S. Eliot in saying "...there is no greater heresy than to do the right thing for the wrong reason...".

In my mind, MLK was great not just because of the causes he supported and acted upon, but because he did not let the end justify the means. He remained an advocate of nonviolent resistance and his speaking out against the Vietnam War came from a genuine belief that the war was wrong. He did not waver even when his positions were not popular.  This is what integrity is all about.

Bully, Brute or Jerk: The importance of language

I recently attended a 4 day training seminar led by Dr. Laura Crawshaw of the Boss Whispering Institute. Dr. Crawshaw works with what she calls "Abrasive Leaders" and has developed a focused coaching approach for helping companies and individuals who are struggling with difficult management situations.

One notable issue  raised during the course of the training was the importance of language, and specifically why Dr. Crawshaw does not use the term "bully" when referring to these leaders.  Interesting.

It is true, there are psychopaths, bullies, narcissists and obnoxious people in the workplace, and, unfortunately, some are in high places (e.g. the executive ranks). However, it is also true that many people who exhibit controlling, berating and unprofessional behavior are not criminals or psychopaths; many are not even "jerks" but basically well-liked people behaving badly at work.  They may be acting this way because of learned behavior patterns, pressure on the job, a lack of insight and/or because their behavior has been rewarded over time.  In other words, they may not fully understand the impact of their actions.

Why are these linguistic distinctions important?  Primarily because how we intervene in these situations will depend upon how we define the problem.  A psychopath will not respond to behavioral coaching; a person with a serious psychiatric problem may require psychiatric treatment.  A real bully may need to be fired.  An "Abrasive Leader" may be someone who, when confronted with the negative perceptions that coworkers have of his or her behavior,  is motivated and able to turn that behavior around. Probably not without help,  but through  appropriate measures such as good management strategies and mentoring or coaching.

Language does matter.  It influences how we interpret the world and, therefore, how we choose to act.

Political leadership: moving beyond individual heroes

It is September 2012 and election day is fast approaching.  It is an interesting time to examine leadership in the political arena.

What can we apply from our knowledge of leadership in business and nonprofit settings to the political context? How are the issues similar, or different?

When applying leadership theory to the current political situation, I am struck by the importance of context and systems theory.  No leader operates in a vacuum. Even in business, but especially in politics, the larger setting in which the leader operates is critical.  A CEO entering a new organization has to contend with an executive team, an existing structure, an organizational history, a culture and sub-cultural groups, a diverse employee base and many other factors, both internal and external to the organization,  that will impact his or her success.  This is even more  true of the political context which is more complex and demanding.

So, when we think about the presidential election and the end result, we cannot think only of the individual leader i.e. the President. That is one individual, granted one with significant power; but one individual who works within a very large and multi-faceted system, that includes: other branches of the government, our business and social/cultural institutions and the global world in which we live.

In essence, we need to appreciate the total context in which leadership operates within our political system.  We live in a heterogeneous, and multi-cultural world. Collaboration and compromise for the greater good is the only way we will solve the critical problems we encounter. We don't need, nor should we expect, an individual hero to save the day, whether it is the economy or our foreign policy matters. We need a strong, competent visionary president, but we also need ethical, committed leaders in all branches of the government. Leaders who will keep us moving forward, even when it requires compromise or taking an unpopular position. We also need an educated, informed and engaged population that exercises critical thinking and understands the complex issues we face as a nation and a world. Wishful thinking? Maybe....but then again, I have always been an optimist!

Bringing ourselves to work

There is always a bit of controversy within the management community regarding the relationship between personality and leadership. This is especially true when discussing the selection of new leaders, because the role of personality and leadership success is hard to determine precisely as there are many factors that contribute including: experience, technical/business expertise, specific match between job requirements and the candidate, cultural fit AND personal qualities like cognition, motivation and personality.

Yet, when reviewing personality assessments with my coaching clients, I am always impressed by the interplay between one's personality and work behavior.  For example, the leader who is highly extroverted, social and spontaneous will bring this to work. Yes, it is "personal". Yes, it is not the same as education, training or work history. However, these characteristics impact one's work. And there is the potential for positive or negative impacts. It may be that the extroversion aspect of the leader helps him or her engage with others and develop the strategic relationships critical to success.  On the other hand, he/she may be less effective in work situations that require long periods of focus, reflection and analysis that are needed for complex decision-making. 

This is just one example, and, of course, there are many others.  The bottom line is this:  we bring our whole selves to work. Like it or not, when we arrive at work, our personalities arrive with us.  Of course, we moderate our behavior according to the context; what's appropriate at home is not necessarily appropriate at work. Nonetheless, understanding "who we are" as people will help us to be better at our jobs. It also, of course, helps us to be better at our lives.