355- Improving existing programs and processes
- Attempting simple strategic adaptation (e.g., targeting new patients, new locations,
new technologies, new competition, or new regulations) - Attempting more complex strategic adaptations (e.g., new markets and industries)
- Transforming the culture or recreating the organization, for example, reorienting
the organization by changing the focus from acute care to population health
When new leaders are settling into their jobs (situation 1) or they must reestab-
lish objectives and strategic plans (situations 2–5), what exactly do they do? To be
effective, their goal is to mobilize people to want to find solutions to challenging
situations. Research on effective leadership has discovered a pattern of behavior that
works quite well to build commitment. Here is a framework and timeline of what
effective leaders do over a period of 3 to 4 months^26 :
- During the first 4–6 weeks, leaders plan to spend 100% of their time deep inside
the organization talking with the people closest to the customers or the people
involved with key processes where the actual work gets done. The Japanese word
for this place is called Gemba, or place of value. - Effective leaders start with a hypothesis. There are solutions to all the five leader-
ship situations mentioned above; however, they are buried inside the organiza-
tion with the people who are closest to these problems. The leader must perform
a lucid diagnosis^27 of the root causes of problems and of the opportunities by
listening to what people—especially those in the front lines—say when they are
asked simple questions, for example:- Why are we in this situation?
- What can we do to improve?
- What actions should we take?
- The leader merely listens, takes notes, and begins grouping the issues and actions
to be done into a few logical categories. - Often there are open discussions with all internal and external stakeholders—
clients, customers, suppliers, bosses, peers, and direct reports. The leader’s
job again is to ask open-ended questions, to listen, and to take notes on prob-
lems and opportunities, as well as the strengths and weaknesses of the organi-
zation. Leaders will want to know, What is working in terms of strategy,
operations, services, culture, human resources, leadership development, and
the like? Alternatively, what is not working in the same areas. Leaders will
(^26) To prepare for this 3–4-month period, a leader must activate social networks to answer four
questions:
- Who has “organizational rights” to be involved with this situation?
- Who has the expertise to help us think about this situation?
- Who should be consulted prior to or during the dialogue?
- Who should be informed of the rationale for the decision and the expectations?
(^27) For an explanation of how leaders use tools and concepts to improve strategic thinking, see [ 13 ].
20 Teaching Surgeons How to Lead