Professor Marilyn Taylor joins me on the “balcony of personal reflection.” For decades we have been attempting to improve how we lead and organize ourselves in healthcare, business, the public sector, the civil sector, protective services, the military, education etc. We have made progress on many fronts. Thanks to a highly educated population from which to recruit and advanced approaches to training development within organizations, we have, more than ever, a talented and capable workforce. We have workplace practices more widely than ever before that ensure safety and fairness. Yet the attention in the last 10 years to employee engagement as a workplace challenge signifies that it is a problem to fully engage that talent. We have technical capacity none of us have imagined 40 years ago to accelerate productivity and enhance communication. Yet most of us have too frequently spoken or heard of some astonishing example of ‘the left hand did not know what the right hand was doing’; communicationremains a key challenge in most organizations. We have accumulated a large repertoire of organizational innovations and a rich array of approaches to organizational and transformational change but there is a growing consensus about their remarkable lack of lasting success. We have been working with leadership and organizational change for the past three decades and the ‘read-out’ in the literature matches our own experience and observations. The challenges are replicated across all sectors and, for that matter, across borders.

The Ghost of Healthcare Hope arrives...

“ No major public policy arena in Canada is more in demand of courageous leadership than healthcare. What do I mean when I talk about leadership? I believe strong leaders share a number of key characteristics: insight, initiative, influence, impact and integrity. Courageous leaders are able to look at complex situations, gain clarity and determine a course of action. They are willing to go first. They do not sit on the sidelines waiting for a change in circumstances. They do not ask others to do what they are unwilling to do themselves. They lead by example. They are able to inspire people to willingly follow their ideas. They are able to create real and lasting change. They make a difference.

I am hopeful given that healthcare organizations are beginning to recognize the nature of the problem and I am seeing the possibility for breakthrough. In addition, a growing number believe that innovation in healthcare organizations will not be sustained if it is incompatible with the underlying organizational culture, very much like transplanted organs will be rejected if they are not sufficiently matched to the host genetically. Sustainable change, then, must begin with the organization’s culture that shapes choices and behavior.”

The practical concepts and tools to improve organizational cultures have been developing over the past 25 years. Edgar Schein was the first to elaborate the significance of and articulate principles of working with organizational culture. Other thought leaders like Kim Cameron and Robert Quinn developed a competing values framework and a related instrument for engaging members of organizations in discussions about organizational culture. Brian Hall and Richard Barrett have articulated theoretically based developmental frameworks and have generated instruments to ‘measure’ values and culture to align corporate and member values as part of delivering organizational change that radically reduced wasted resources and energy, significantly improved employee satisfaction, and enormously improved the financial picture. These practical approaches based in developmental leadership mindsets shifts are especially helpful to our discussion here because they chart the contrast between the leadership we have and the leadership we need for sustainable change to meet the challenges of dynamic and unpredictable context.

The Ghost of Healthcare Hope re-appears...

“ Healthcare organizational culture shift has to be led ‘from the top’ since culture is fundamental to all aspects of organizational life; it is about changing the ‘DNA’ of the system. It is not a discrete project to be delegated to Strategic HR or Organizational Effectiveness units. For an organization to be working effectively on improving its culture, its leaders (senior team) require a significantly different focus and approach to their job than most of us were socialized to deliver as leaders.

Familiar to most of you is the Albert Einstein quote: “ the significant problems we face today cannot be solved at the same level of thinking we were at when we created them.” That means stepping away from traditional leadership models and making way for new, integrated practices. Inter-professional care in partnership with active, attuned patient participation isn’t a new-age theory; it’s a fact of life as you embrace the next generation of leaders.”

For the most part, current positional leaders have been appointed because they are capable of leading the organizations we have, largely, bureaucratic hierarchies, whether in the public, private or civil sectors. Our 20th century organizations are firmly rooted in a mechanistic worldview in which, among other things, the leader as ‘engineer’ is the source of all significant knowledge about the organization’s direction, operation, and what employees should be doing to achieve success. Leadership is focused on ensuring that organizational structures, processes, and personnel optimize the use of resources, personnel, time, and energy required to produce its product. Attention is directed primarily to organizational strategy, policies and incentives that optimize employee output, administrative responsibility/control structures, and problem-solving capacity. While enlightened bureaucratic leaders have softened this with extensive consultation, the discourse is focused on the ‘what’ and the ‘how’ with decision-making authority concentrated ‘at the top’. This approach to leadership and organization that began to be perfected 100 years ago is out of ‘synch’ with today’s highly educated and networked employees, instantaneous communication capacity, and the global context of accelerating change that demands continuous adaptation.

INTEGRATIVE LEADERSHIP for the 21st CENTURY

The integrative leader brings social coherence and adaptive capacity to organizations in a changing context. Attention is on the whole organization, its context, and its long range future. Employees are genuinely regarded experts in their métiers whose full engagement in the organization is critical to sustainable success. The integrative leader does not need to have all the answers but is confident that others do or can find them; her/his job is to enable communication processes and structures that integrate the talents of personnel and generate creativity and innovation to meet unexpected challenges.

This approach to leadership is best described by Richard Barrett as the fifth of seven levels of leadership consciousness he calls “the Integrator/Inspirer”. Jim Collins’ “level 5 leadership” which he says “builds enduring greatness through a paradoxical combination of personal humility and professional will.” Collins calls “ambition not for themselves but for their companies” and Barrett highlights their “focus on the common good.”

A distinguishing feature of the integrative leader’s orientation is to exercise of influence rather than coercive authority in relation to rules. A key capability of Integrative leaders is the capacity to inspire member participation, creativity, and innovation through meaningful engagement toward an inspiring organizational purpose. Innovative and adaptive organizational cultures cannot be ‘coerced into place’, an approach that generally produces cultures of fear. They require participation and commitment.

The 20th century bureaucratic leader would ask, how, if you do not closely design and monitor people’s jobs, do you get coordinated and capable performance. The integrative leader would say, by creating compelling shared vision and agreement about values that will characterize their work together. The discussion is not only the “what” and the “how” of the organization but also the “why”—making very explicit why everyone’s work matters. In this sense, non-coercive integration or alignment of individual purposes and values with the mission of the organization. In health care, the mission is obviously compelling. However, it is critical that each employee sees the meaning and value of their work through where it fits into the ‘big picture’ and as understood by others.

Integrative Leadership is focussed at fostering leadership throughout the organization; members are not only responsible for getting a job done, but for learning how it can be improved and how the organization more generally can be improved. This is a critical condition for ensuring organizational adaptability to emerging conditions of a continuously changing context.

In order to lead without coercion the integrative leader must inspire trust and credibility. The integrative leader must earn this through her or his authenticity, transparency, humility, and integrity. An essential quality of the integrative leader is integrity, the ability to model the espoused shared values of the organization. A further dimension of leadership credibility is that what is asked is known to be in service of the greater good of the organization as a whole and those whom it serves, and having nothing to do with leader self-aggrandizement.

Integrative leadership is a mind shift from a 20th century conventional understanding of leadership. The integrative leader understands that organizations are dynamic, living entities constantly evolving in the context of an uncertain, unpredictable environment. Change and the need to adapt is constant. This is a paradigmatic shift from the smooth-functioning machine which requires repair from time to time. S/he is in relationship to other members of the organization and that how s/he acts as a leader and a person is as powerful as any given policy decision; it either inspires trust or mistrust, the basic condition for full engagement and commitment. Corollaries here are, as leaders, a critical form of knowledge is self-awareness and a bold acknowledgement of what we do not yet know.

An important note is that the leader of an organization does not abrogate his/her authority. It is simply not used as the primary approach to leadership, and is always used reliably in service of the long term sustainability of the organization and its mission, and in line with the shared values.

On cue, the Ghost of Healthcare Hope returns to offer an opinion...

“A paradox...in some situations employees have outgrown their leaders? How does an organization grow if its leaders are not growing. On the other hand, how does an organization grow if its employees are not? What if their learning potential is crippled by the leadership that employs them? Whose job is it to fix it? The solution requires leadership from all.

What code of conduct must the executive create — and model — that will show everyone the rewards for making it work? The learning organization metaphor is a powerful tool, but how do you develop it practically?

I see a new vision of health care emerging. It is quite different from the familiar old-world management, characterized by silo-centered organizations and command-and-control hierarchies. A new world, created by a vertically integrated and functionally supported continuum across a geographic region.

I envision a system that is community owned. A system, in which healthcare providers regardless of organizational affiliation or interest, deliver integrated and efficient services. A system where members of the public exercise greater preventive responsibility in the pursuit of wellness. A system of high quality, that is, affordable and accessible to all.

Why am I hopeful? I am beginning to see a fundamental shift in expectations of positional leadership, one that is matched to a continuously changing environment, an increasingly sophisticated population of employees and citizenry, and the urgency for creating adaptive capacity. This has far-reaching implications for executive selection criteria and leadership education and mentoring. I further believe that you have been assembling knowledge and practical tools for some time in service of that sea change.

As you approach what I think will be a tipping point, your current task is to highlight exemplary leadership practice illustrating integrative leadership, and to amplify attention and learning opportunities for as wide a range of leader practitioners as possible. In a wider perspective, you can see yourselves in a historical moment of change in the wider social and cultural transformation with all the resources and challenges of a living system in a state of adaptation related to the complexity discussion elsewhere in this publication.”

Brian Swimme & Mary Tucker remind us: It is the nature of the universe to move forward between great tensions, between dynamic and opposing forces. If the creative energies in the heart of the universe succeeded so brilliantly in the past, we have reason to hope [our emphasis] that such creativity will inspire us and guide us into the future. Margaret Wheatley & Myron Kellner-Rogers frame it this way: The Worldwide web is the most potent and visible example of a self-organizing network forming around interests, the availability of information, and unbounded access to one another.

My guest next week is Tom Van Dawark in a conversation about bridging the governance leadership gap.

See essays in this series.

See essays from series 2

See essays from series 1

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