Strategic Leadership Teams – HC1 (Post 3.1) (Health Care)

Years ago, I was part of a high-producing health care team. We had consistently achieved the highest levels of accreditation. We had a low risk ranking from our local health authority. Families gave us excellent feedback year over year. Turnover was very low, and we had an exceptional annual sick time of 0.1%. However, despite these accomplishments, I would rank this team to be a poor performer in strategic leadership. I give my former team this ranking based on the Strategic Team Review and Action Tool (STRAT) as described by Hughes, Beatty, & Dinwoodie (2014, pp. 290). Hughes et al. (2014, pp. 299-302) present STRAT data based on 12,364 respondents and rank the questions answered by score. For the sake of brevity, I discuss three of the top 20 items.

The highest ranked question in the STRAT is “This strategic leadership teams [sic] exhibits a high level of integrity” (Hughes et al., 2014). The team was part of a non-profit organization, and one of the unwritten expectations was to spend all annually allocated monies to prevent future claw backs. Sometimes this extra spending meant more supplies and equipment for residents, but sometimes the money was spent on additional education among selected staff members with no perceived benefit to the organization. Other times the money would be spent on expenses obfuscated from the team. The mindset of spending, even if superfluous, showed a lack of stewardship and by extension a lack of integrity.

The fourth highest ranked question in the STRAT is “Different opinions are welcome” (Hughes et al., 2014). Although the organizational chart had one Executive Director and two Directors of Care, one of the Directors of Care was the child of the Executive Director. The other Director of Care possessed decades of experience. These two did not get along and formed their armies within the team. Only the iron will of the Executive Director kept these two in check. Further, the Executive Director often pursued her interests or deferred to her child for the direction of the Care department. Therefore, the Executive Director’s goals restricted the diverse leadership perspectives of the team.

The eleventh highest ranked question in the STRAT is “There is a positive sense of energy and excitement around here” (Hughes et al., 2014). As I reflect on my experience, I recall episodes of positive energy, especially after completing an accreditation period. Otherwise, morale was low. The primary cause of low morale was the organization’s approach to accountability. The organization liked to hold people “accountable” for incidents, failing to address defensiveness. Leadership would respond to defensiveness through anger and doubling down on their stance. Lepsinger (2010) says empathy works better to combat defensiveness, but leaders lacked understanding and focused on blame.

These questions, among others, show the team’s ineffectiveness in strategic leadership. Blake and Mouton would instead describe the leadership style as Authority-Compliance (Northouse, 2016). Most of the staff were not consulted for direction but were tools to achieve results. The weakness of that leadership style became apparent when a new Executive Director joined – the team could not function in the old ways and suffered severe setbacks.

In my new role as Director of Care, I believe I have learned from this previous experience and now desire to avoid the missteps of others. I do not want staff composed of sycophants or the silent majority filled with resentment. I want a team that enjoys their work now and looks forward to making a positive impact.

Building this team will be a challenge. My current staff members have expressed an unwillingness to engage due to their experience with past management. They felt ignored, suppressed, and disenfranchised. Management and union leaders also built up an adversarial relationship over the years, reducing trust between leaders and workers. Further, a national team sets the overall direction of the “child” organizations, hampering local leadership’s ability to set the path.

Despite these factors, I believe my team can be effective. I have started asking team members, “what are we good at?” Salyers, Firmin, Gearhart, Avery, & Frankel (2015) call this appreciative inquiry, or discovering what works well and looking for ways to makes those things better. If both employees and leaders feel they excel in certain areas, they can set higher expectations for themselves. Stavros, Torres, & Cooperrider (2018) say a manager’s belief in an employee’s success increases the chances of an employee succeeding. Lepsinger (2010) calls this the Pygmalion effect. As the team grows its accomplishments, the team will move on to lofty goals and will continue to believe in themselves.

I believe this success can extend to my present working team and my team for this course, even though the composition of the teams differs greatly. Working teams in healthcare are generally interdisciplinary teams, defined as “different types of staff working together to share expertise, knowledge, and skills to impact on patient care” (Nancarrow et al., 2013). Galbraith (2014) would classify this group design as complex, as different disciplines including nursing, recreation, and dietary teams would work together for patient care. In contrast, my course team is simpler. Even if the team members have varying backgrounds, we are all students in MALEAD working towards group assignments and group learning. Despite the variation in teams, both teams require direction, alignment, and commitment (DAC) (Hughes et al., 2014) to accomplish their goals. In the case of the course team, we can develop DAC through increased communication and collaboration throughout the course. Currently, we are still working on strengthening our course team. Increased communication and cooperation would also assist in my current work environment.

Finally, challenges will test any team, be it the course team or a working team. Many of these challenges will happen because we seek change; indeed, there is no strategy to “keep everything the same” (Hughes et al., 2014, p.21). Ungerer, Ungerer, & Herholdt (2016) say people resist change actively and passively. Change in the working team could include new practice guidelines or better goals, while change in the course team could consist of working together on a project with new members, each with their backgrounds and perspectives. Ungerer et al. (2016) say empowerment moves the needle from resisting change to initiating change. Empowering others will solve many of the struggles and challenges any team faces.

References:

Galbraith, J. R. (2014). Designing organizations: Strategy, structure, and process at the business unit and enterprise levels.

Hughes, R., Beatty, K. & Dinwoodie, D. (2014). Becoming a strategic leader : your role in your organization’s enduring success. San Francisco: Jossey-Bass.

Lepsinger, R. (2010). Closing the execution gap: How great leaders and their companies get results. San Francisco: Jossey-Bass.

Nancarrow, S. A., Booth, A., Ariss, S., Smith, T., Enderby, P., & Roots, A. (2013). Ten principles of good interdisciplinary team work. Human Resources for Health, 11, 19. Retrieved October 15^th, 2018 from http://doi.org/10.1186/1478-4491-11-19

Northouse, P. G. (2016). Leadership: Theory and practice. Los Angeles, Calif: SAGE.

Salyers, M. P., Firmin, R., Gearhart, T., Avery, E., & Frankel, R. M. (2015). What we are like when we are at our best: Appreciative stories of staff in a community mental health center. American Journal of Psychiatric Rehabilitation, 18(3), 280–301. http://doi.org/10.1080/15487768.2015.1059383

Stavros, J. M., Torres, C., & Cooperrider, D. L. (2018). Conversations worth having: Using appreciative inquiry to fuel productive and meaningful engagement. Oakland: Berrett-Koehler Publishers, Incorporated.

Ungerer, M., Ungerer, G., & Herholdt, J. (2016). Navigating strategic possibilities: Strategy formulation and execution practices to flourish. Randburg: KR Publishing.