J. Bryan Bennett, MBA, CPA, LSSGB
Founder and Executive Director, Healthcare Center of Excellence, LLC, Chicago, IL
For a leader to be successful in today’s challenging healthcare environment, they have to fully understand and manage the influences that can impact the effectiveness of their leadership. These influences come in two forms:
- Primary influences: which are the influences most directly impacted and managed by the leader.
- Secondary influences: which are the influences that are not under the direct control of the leader, but are important to be managed effectively if the leader is to be successful.
Primary Leadership Influences
There are three primary influences that impact a leader’s effectiveness. They are:
- Leader: their personality, abilities and expertise;
- Followers: the leader’s constituents, comprised of their values, norms and status;
- Environment: the atmosphere in which the leader and followers interact with and includes the culture, tasks, change and government.
These influences must work in equilibrium for the leader to effectively lead. If any of the influences fall out of equilibrium, the leader cannot lead effectively. When any of the three influences exert a stronger or weaker influence, the leader has to adapt to bring the model back into equilibrium. This is illustrated by the influences being the same size in the figure below.
The influences can get out of equilibrium, such as when the leader has to work with strong or powerful followers. This can occur in working with doctors at a hospital, tenured professors at a university, professional (versus collegiate) athletes and even some volunteer organizations. All of these scenarios can make it difficult for a leader to be effective.
The influences can also get out of equilibrium when the leader is facing a challenging environment. This can occur when the industry is facing dramatic changes like what currently exists in healthcare. A shift in how consumers shop has also caused a challenging environment for brick and mortar retailers. They either have to adapt or go out of business.
Law enforcement officers regularly face challenging situations. One minute they could be directing traffic or handing out a speeding ticket. The next minute they could be faced with a domestic or hostage situation. They have to know how to adapt to the seriousness of each situation. These challenging environments make it difficult for a leader to be effective.
Another way the influences can get out of equilibrium is when the leader overwhelms the followers and the environment. This is not leadership in any form; it is simply intimidation. Not much can be done in this situation until the leader becomes self-aware enough to want to change. Until then, the leader will most likely experience a steady exodus of followers leaving the organization and the decline of the department or organization.
Whatever the situation, to be effective, the leader must adapt to return all the primary influences back to equilibrium.
Secondary Leadership Influences
In addition to the primary leadership influences, there are other influences at work that a leader must be cognizant of to be effective. Even if the leader is at the top of the organization, he or she still reports to a board of directors. If the person in the leader position is in middle or senior management, they have to also work with their manager and/or peers. The most effective leaders are the ones that are not only adept at managing their primary leadership influences, but also handling their managers and peers. A leader provides leadership of the primary leadership influences and manages the secondary leadership influences. Consequently, the total leadership influences model for any position in an organization should include all five influences.
The Healthcare Leadership Influences Assessment
Based on an analysis of the healthcare industry, the leadership influences would best be described as out of equilibrium with strong followers in the form of physicians and a very complex environment. The physicians account for the vast knowledge, expertise and revenue stream of the hospital. Without them, the hospital would be hard-pressed to survive. Because of their specialty expertise and their patient portfolio, many would be difficult to replace. Unfortunately, many physicians have resisted much of the technological changes. Some simply because they didn’t want to change the way they’ve practiced medicine for decades and others because of what was implemented and how it was implemented.
The environment is considered complex because of the technological and governmental changes that the industry has been expected to make in a short amount of time. Many recognize that the healthcare industry is behind other industries in the use of technology to manage the business. Technology is used regularly to examine and diagnose patients, but before the widespread use of electronic health records (EHRs), the notes were mostly written by hand and added to a paper chart. EHRs have made it easier to safely record patient information, but it is still a long way away from complete interoperability and the design of the EHRs has made the patient encounter more off-putting because the physician has to spend so much time trying to type the information in versus engaging with the patient. Added to this is new and changing governmental requirements for patient safety and quality and you have the formula for a very challenging environment.
To bring the influences back to equilibrium, the leader must adapt their leadership style to become more effective. Adaptive methodologies are discussed in Chapter Nine of the book Prescribing Leadership in Healthcare (www.prescribingleadership. com), although many healthcare leaders recognize what needs to be done.