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Personal Mastery for Transformational Leadership

Neil Baker M.D.

IHI 25th Annual National Forum

December 10, 2013

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objectives

• Explain how to identify and respond effectively to reactions in oneself and others that may interfere with progress.

• Identify key elements for facilitating creativity in order to change habits and patterns.

• Define ways to exercise authority which also help to preserve positive engagement.

NO DISCLOSURES

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Personal Mastery for Transformational Leadership

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• Introduction

• Complexity + stress in organizations

• Reactivity and creativity--case study

• Reflect. Explore.

• Explore: engagement and authority

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Introductions

When there are problems with improvement

initiatives, what percent of the time is the

predominant cause of these problems on the

people/organizational side of change?

• < 20% of the time

• 20 - 50% of the time

• 51 – 80% of the time

• > 80% of the time

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ACADEMIC MEDICINE 2012;87:1-8

Despite extensive efforts by many institutions and individuals, recent studies show little improvement in the rate of preventable patient harm since the Institute of Medicine sounded the alarm 12 years ago.

We believe, however, that the fundamental cause of our slow progress is not lack of know-how or resources but a dysfunctional culture that resists change.

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• Introduction

• Complexity + stress in organizations

• Reactivity and creativity--case study

• Reflect. Explore.

• Explore: engagement and authority

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30%

40%

50%

60%

70%

80%

90%

100%

Jan-02 Jan-03

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Education & Training

Audits & Feedback

Reminders

Multi-disciplinary

teams

Systematic performance improvement

models

Knowledge

Attitude

Behavior

Sufficient staff Structural

Capacity Policies, Procedures &

Processes

Leadership: Administration

Leadership: Clinical

Safety Culture

Involvement

Knowledge

Acuity

External Environment

Used with permission, Radcliffe Publishing, Bate et al Organizing for Quality 2008

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Used with permission, Radcliffe Publishing, Bate et al Organizing for Quality 2008

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Goals of conversations

Robert Crosby, Cultural Change in Organizations 2009 Mary Beth O’Neill Executive Coaching With Backbone and Heart 2007 Edward Deci and Richard Flaste Why We Do What We Do 1996 Ronald Heifetz, Alexander Grashow, Marty Linksy The Practice of Adaptive Leadership 2009

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Mastery

Transformational

Leadership

Personal

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• What did you hear?

• What ideas and associations come to mind?

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• Introduction

• Complexity + stress in organizations

• Reactivity and creativity--case study

• Reflect. Explore.

• Explore: engagement and authority

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reactivity and creativity

See references posted on IHI extranet and Albert Ellis The Road to Tolerance 2004 David Emerald The Power of TED (The Empowerment Dynamic) 2009 Ed Oakley, Doug Krug Enlightened Leadership 1991

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• What did you hear?

• What ideas and associations come to mind?

• Choose a challenging situation.

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• Introduction

• Complexity + stress in organizations

• Reactivity and creativity--case study

• Reflect. Explore.

• Explore: engagement and authority

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Reflect: recognize, decide, prepare

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Reflect: recognize your triggers + clues

Am I having the impact I intend?

Identify possible clues in feelings and thoughts.

• Stuck

• Hooked

• Defeated or victimized

• Have to have it my way

• Need to prove you wrong

• Judgment, blame

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Reflect: decide (personal accountability)

• What are my goals?

• What kind of relationships

am I trying to build?

• What impact do I want to

have in this situation?

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Reflect: prepare

• Everyone acts at their worst at times,

including me.

• My first impulse is likely to make me

part of the problem.

• My strongest conviction is just a theory

to be tested.

• Results come first but only if

relationships come first.

• I will give others what I need.

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• What did you hear?

• What small test of reflection might you put into action by next Tuesday?

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• Introduction

• Complexity + stress in organizations

• Reactivity and creativity--case study

• Reflect. Explore.

• Explore: engagement and authority

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Explore

Active

telling

Check understanding

Active listening

Check understanding

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Explore: use Active Listening • Listening that focuses on the speaker and assures

that the speaker is understood. You work to champion the speaker’s cause! Get in their shoes!

• Method: – use journalist technique: who, what, when, where, how – search for underlying data and observations – summarize, paraphrase – ask about feelings

• Avoid:

– judging – jumping to solutions – steering to your agenda

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Explore: use Active Telling

• Telling that assures the speaker is understood without provoking defensiveness or withdrawal and without abandoning a position. This is not about winning, convincing, cajoling.

• Method: – “I” statements: “This is what I think” or “This is my

perception” as opposed to “This is the way things are” – share basis for perceptions--data and observations – ask for questions and alternative points of view

• Avoid: – extreme language: e.g. always, never – pushing your point of view

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Explore: Check Understanding via powerful questions

• Can I tell you my ideas/perceptions?

– What did you hear me say?

– What am I missing? Where might I be wrong?

• What are your ideas/perceptions?

– Here is what I heard you say. Did I get that right?

– What observations are you basing that on?

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Explore: test a strategy

Level of risk

Communication Strategy Decision Strategy

Active listening No Decision

(or a very low stakes decision)

Balance Active listening and Active telling

Input into Future Decision

Balance Active listening, Active telling and Deciding

Decision to be Made Now

• State your intentions, goals and values.

• Pay attention to and correct for the presence of power differentials and decision authority.

Level of risk

Communication Strategy Decision Strategy

Active listening No Decision

(or a very low stakes decision)

Balance Active listening and Active telling

Input into Future Decision

Balance Active listening, Active telling and Deciding

Decision to be Made Now

Explore: test a strategy

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Level of risk

Communication Strategy Decision Strategy

Active listening No Decision

(or a very low stakes decision)

Balance Active listening and Active telling

Input into Future Decision

Balance Active listening, Active telling and Deciding

Decision to be Made Now

Explore: test a strategy

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• What did you hear?

• What test of exploration might you put into action by next Tuesday?

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• Introduction

• Complexity + stress in organizations

• Reactivity and creativity--case study

• Reflect. Explore.

• Explore: engagement and authority

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Explore: engagement

Shared understanding

Importance

Choice

Ongoing review

Confidence

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Explore: authority

Clarity

Ongoing review

Alignment

Explanation and exploration

Creativity our best selves

vision, goals, values, skills

Complexity and stress at work

The reptilian brain

Reactivity

Reflect recognize, decide, prepare

Explore ask, tell, check understanding

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Articles on IHI Extranet Are you leading from reactivity or creativity? Reactivity vs. creativity, possible indicators

Invisible barriers to communication References

Additional articles at: neilbakerconsulting.com

Email: neil@njbaker.net Phone: 206-855-1140

The antidote to change fatigue