Insights (Essays) April 2013

Asking, Listening, Talking

Hugh MacLeod and Chris Power


I am once again back on the balcony of personal reflection. This time, I am joined by Chris Power, a compassionate healthcare leader. Below us we see the full spread of the Canadian healthcare system and all its components. From this perspective, we can witness the degree to which it is a system and the degree to which it is not. We see its strengths and we see its challenges. We also see patients and their loved ones, as well as providers working their manifold tasks. We see quality care and even pockets of brilliance. And we see harm being done.

We begin to talk about the issues in quality and patient safety and the relationships between senior managers, middle managers and the front line caregivers. We are interrupted mid-conversation by a now familiar voice. It is the voice of the critic and the cynic. Like one of Scrooge’s ghosts, its aim is to shock us into consciousness:

“You two are such idealists, says the voice ... humans are naturally selfish ... people look after themselves first, community be damned. Your so-called system is run by egos and empire builders who obsess about their own power and influence, instead of inspiring a sense of loyalty to teamwork and quality of care. Middle managers mirror senior managers and conflicts extend to the front lines. Care providers feel like victims, divided and conquered by the absence of leadership and shared purpose.”

We pause for a time in thought. Are we idealists?

It is almost cliché now to say that an organization’s people are its most valuable asset. The concept is touted by both private and public institutions who espouse values like respect, trust, diversity and openness. Too often, we must admit, the words are inscribed in invisible ink. The organization carries on with little commitment to the values and visions it once proudly proclaimed.

But what if healthcare was committed to those values? How would we act? First, we’d be inclusive. We would invite opinion and involve people from all levels and walks of life in decision-making. We are asked, after all, to achieve sterling performance under conditions of extreme fiscal restraint and increasing service demand. We are forced to deal with factors outside our control, such as political agendas and their impacts on policy and funding. At any moment these factors can surge into an issue demanding immediate response, when wide inclusive involvement may not be possible, when a tough decision must be made with high-profile accountability on the basis of few facts.  But even in crisis we must fight the reflex to pull inward. We need to maintain open communication and decision-making. Critical tasks for leaders:

  1. Create opportunities for people to understand the risks and opportunities facing the organization.
  2. Foster broad participation that quickly identifies problems and solutions.
  3. Spark innovative and creative thinking and solutions by encouraging different points of view.
  4. Encourage collaboration throughout the organization, ensuring that people are connected not only to each other but to the issues as well.
  5. Ensure implementation with accountability by letting people know they have the freedom to carry out the agreed-upon plan.

Every organization has unique issues and circumstances, so leaders cannot mindlessly perform these critical tasks. They need to apply a proven set of engagement principles:

Together, these principles, along with the previously described leadership tasks, comprise a platform upon which any change process can be built.

Widening the circle of involvement: This means going beyond the dozens and usual suspects that are typically involved in a change process. In practical terms, widening the circle of involvement means expanding who gets to participate in a change process. And engaging those we serve, namely our public, is critical to a meaningful and successful outcome.

Connecting people to each otherIn a world that puts a premium on getting things done, how can we increase connection? Unfortunately, most organizations attempt to connect people only to the task at hand and rely heavily on inspirational talks and slide presentations by the leaders, minimizing the importance of dialogue. It’s all about relationships! The best successes have come from meaningful engagement with those who are impacted by the decisions.

Creating communities for action: We create community when we create the future together. Employing this principle means involving people in developing new plans and procedures from the very beginning. It is the opposite of having small groups develop strategies, plans, and processes – then trying to sell them to the rest of the organization.

Embracing democracy: Democracy is about voice. When we widen the circle of involvement, we hear new voices and perspectives. As leaders, we must listen deeply and honour the voices we hear. Truly embracing democracy involves dealing with four issues: equity and fairness, maximum information sharing, freedom and autonomy. When change processes demonstrate these characteristics – when people feel their voices count – the culture shifts from “You” and “I” to a collective “We.” When these four principles are applied, the leaders’ role shifts as well. The challenge then becomes one of demonstrating leadership in a way that achieves healthy, creative, optimal tension between the two poles of engagement and direction. When engagement occurs without direction, groups flounder because both the purpose and boundaries are unclear. And when direction occurs without engagement, the resulting superficial consensus saps energy and blocks creativity. Commitment suffers, ultimately leading to mistrust, energy depletion, and inconsistent decision-making.

To strengthen the people connectivity, focus is needed on mindsets involving information, relationship building, and finding the gifts people bring to the workplace. What are those secondary skills that people possess that make them the unique individual they are?

  1. Information mindset:With this mindset, the nature and role of information changes from being restricted and used for power to being openly shared.
  2. Relationship mindset:Relationships flourish when barriers are removed. People are able – even compelled – to bump into each other and create and circulate new information.
  3. Untapped Potential mindset:As people begin to see themselves in the larger picture and feel good about it, work becomes more meaningful. Creative energies are released, fuelling the transformation process.

Applying the engagement principles with the previously described mindsets is crucial to thriving in the current healthcare environment. Sustainable transformation works in organizations where people experience meaningful work, know their voice counts, and are substantively engaged in the critical issues. Not surprisingly, these organizations are also best equipped to effectively navigate in an increasingly turbulent healthcare environment.


Next Week’s Guest on the Balcony of Personal Reflection: S. Sharkey in a conversation titled “Self Organizing Change.” 

Click here to see the First Series of Ghost Busting essays.

Click here to see essays from the Second Series: The Ghost of Healthcare Consciousness.

About the Author

Hugh MacLeod is CEO of Canadian Patient Safety Institute. Chris Power is President and CEO of Capital District Health Authority, Halifax


Axelrod, R.H. 2002. Terms of Engagement: Changing the Way We Change Organizations. Berrett-Koehler Publications Inc. San Francisco. 



Robert Pental wrote:

Posted 2013/02/04 at 12:19 PM EST

Well said


You must sign in to comment Sign In or Create an Account to add comments