Insights (Essays)

Insights (Essays) February 2015

Soft Side of Healthcare Meets the Hard Side

Hugh MacLeod

A common message in this essay series is: healthcare is made up of living systems, webs of relationships, conversations and decisions between people. It is time to acknowledge that whatever challenges, as solid and as personal as they seem, may have less to do with personal characteristics than with the conditions of the space people share. The bottom line is healthcare organizations and systems hum or sputter in the white space between the black hierarchical power lines on organizational charts.

The Ghost of Healthcare Hope emerges...

Healthcare today is about managing the things that management can count. The future will be about managing the things you can't count... or at least you didn't think you could.

I hope there will be a sudden awakening of the soft side of healthcare… the value of stuff like culture, purpose, collaboration, human and relationship capital.

I hope all the things that have been traditionally labeled as the intangibles will become important and visible. It is easy to add, subtract, multiply, divide and manipulate numbers. It is hard to understand what you do not know, do not control and do not want to learn from. The awakening of the soft issues represents the need to shift how you manage and lead. Much of this shift is being fuelled by the early outcomes of the Social Era where power has shifted to the many (the patient and families) rather than the few.

It is time to think about healthcare organizations as living systems with the capacity to self-organize, to sustain themselves and move toward greater complexity and order as needed through adaptive patterns and structures without any externally imposed plan or direction.

What will it take to balance your search for machine-like tools, techniques, and change levers with soft skills? Machines follow instructions and work in specific conditions predicted by engineers.

These days as I walk the healthcare hallways I hear people say they want their organization to be adaptive, flexible, self-renewing, resilient, learning... sounds like a living system, yet many leaders only know how to lead and manage healthcare as if it was a machine.

The reengineering gurus of the 1990s used to say: “the soft stuff is really the hard stuff.” So, what is the “soft stuff” that makes the “hard stuff” work? The “soft stuff” includes: how people think and behave; the organization’s human dynamics; the extent to which people experience a safe, supportive environment where there is respect, empathy and compassion; the degree of internal capacity and skills for strategic and leveraged thinking and whether top management has mastered the art and science. Simply put, it’s soft things like organizational culture, teachable moments, effective collaboration, ability to experience change and learning at the rate needed to create breakthroughs that solve all the problems with the hard things like healthcare consumer satisfaction, crisis frequency, retention of staff, cost of performance and cost of service.  

At the core of all this “soft stuff” is the discipline of a learning organization. Learning healthcare organizations invest the learning and growth of their people – so that they have the internal capacity to achieve their organization’s vision with focused, well-executed strategies that leverage resources and mobilize people to achieve the results required. Peter Senge believes that building learning organizations requires basic shifts in how we think and interact. The journey involves an exercise in personal commitment to being “open to learning.” Without communities of people who are genuinely committed to learning together, there is no real chance of moving forward.

True learning organizations have the ability to perceive and evaluate the tacit depths of an organizational and departmental environment “within a nanosecond.” This is an empathetic skill. It requires one to be present in the moment and access the stillness from which organizational identity arises and to perceive the effect of relationship patterns. Coining the term “presencing,” MIT’s Sloan School of Management Senior Lecturer, C. Otto Scharmer, describes a critical skill of self-mastery. The further we move into the high-velocity context of the 21st century economy, the more leaders will have to develop their “blank canvas” capacity—their capacity to sense and go with what emerges from nothing. The core process of future leadership is deeply connected with the capacity of presencing: to use one’s Self as a blank canvas for sensing and bringing into presence that which wants to emerge.

Margaret Wheatley suggests the path of self-organization can never be known fully ahead of time. There is no prescribed stages or models, “the road is your footsteps, nothing else,” as the South African  poet Machados wrote.

How does a leader “sense and go with what emerges from nothing” This requires leaders to have confidence in the organization’s intelligence created by strong and healthy relationship patterns?

First, recognize that individuals, groups and institutions have an unconscious process supporting or limiting their performance and evolution. Second, intentionally drive to evolve in consciousness, by making the unconscious conscious. Third, recognize early that increasing consciousness in an individual, a team or a system creates the fuel for transformational change.  

One of our biggest challenges, and therefore our biggest opportunity, is that we spend much of our time evaluating the evidence pertaining to the hard side of healthcare. Our attention is constantly focused on outcomes, cost and harm. We do not spend nearly enough time, if any, talking about the soft relationship side of healthcare.

The Ghost of Healthcare Hope returns...

The longer a healthcare organization has been in operation the more likely it is that much of what occurs in the organizational culture is happening at the level of unconscious norms and basic assumptions, built on mental models that are completely out of view. Any challenges to these basic assumptions—which provide individual and shared organizational minds with stability and security—are likely to give rise to anxiety and social defence mechanisms. As I previously mentioned, the Social Era represents the need to understand how to feed minds. This shift requires an understanding of value created from intangibles such as human relationship, strategic and structural, which are gained by strong minds. A strong mind is not afraid to learn to understand what they don't know, let go what they thought they knew and learn from anyone and everyone that knows something they don't know... sounds like patient-centredness.

I hope you have active conversation on the following:

  1. Healthcare metrics matter, but people matter more.
  2. Employee engagement and discretionary effort must be led, not managed.
  3. A soft side leader confronts truth within a people-centric philosophy.
  4. Leadership authenticity begins with personal awareness.
  5. The purpose of leadership is to build the next generation of leaders.
  6. Hope sees the invisible, feels the intangible and achieves the impossible.

The faith in the organization’s ability and intelligence will be tested on a regular basis. When there are failures, pressures from the outside, or employee problems, it will be easy to retreat to traditional management processes and structures with an illusion of control from the top. The real test is for leaders is to discover how much they really trust their employees and honour the voices of patients and families.

Next week my guest is Dr. Joshua Tepper. We explore five questions that we will have to wrestle with in moving from the idea of patient engagement to effective implementation.

See essays in this series.

See essays from series 2

See essays from series 1

About the Author(s)

Hugh MacLeod, concerned and engaged citizen.


Mayo, William, D. (2011). Why is Soft Side the Hardest Part. AuthorHouse.
Deragon, Jay. (2013). A Shift to Managing the Soft Side of Business. Web Posting Smarter Companies.
Wheatley, M. Kellner-Robers, M. (1998). The Irresistible Future of Organizing. M Wheatley Website.
Scharmer, C. Otto. (2001). Senior Lecturer, Massachusetts Institute of Technology. Lecture.

Senge, P. (2002). The Fifth Discipline. Doubleday, New York.  


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