Transforming Health Care Leadership

Michael Maccoby, PhD, is president of The Maccoby Group in Washington, DC and an associate fellow at the Said Business School, Oxford University.Clifford L. Norman, MA, ASQ Certified Quality Engineer, is a consultant with Associates in Process Improvement (API) and co-owner of Profound Knowledge Products, Inc. He is a member of the American Society for Quality (ASQ).C. Jane Norman, BS, MBA, ASQ Certified Quality Engineer, is a consultant and president of Austin API, Inc. and Profound Knowledge Products, Inc.Richard Margolies, PhD, is a psychologist and vice president of the Maccoby Group who assists leaders in developing their leadership and strategy.

• Figures, Tables, Exhibits xiiiPreface xxiThe Authors xxixPart 1: The Challenge to Health Care Organizations and Creating the Leadership Team 11 Introduction: From Management Myths to Strategic Intelligence 3Plan of the Book 8Part 1: The Challenge to Health Care Organizations and Creating the Leadership Team 8Part 2: Strategic Intelligence and Profound Knowledge for Leading 9Part 3: Learning from Other Leaders and Creating a Path Forward 11Key Terms 112 Why and How Health Care Organizations Need to Change 13The Purpose of the Preliminary Research 18The Model of Change 18Changing Modes of Production in Health Care 20Health Care in Learning Organizations 20Leadership for Learning 23The Human Side of Change 24Approach to Service 25The Role of Culture 26The Mayo Model 27Summary 29Key Terms 31Exercises 313 Leading Health Care Change 35Summary 43Key Terms 43Exercises 434 Developing a Leadership Philosophy 45How to Develop a Philosophy 46Purpose 46Ethical and Moral Reasoning 46Levels of Moral Reasoning 47Practical Values 48Gap Analysis 50Definition of Results 51Using the Purpose to Define Results: Cherokee Nation Health Services 52The Mayo Clinic Organization Philosophy 53Summary 56Key Terms 56Exercises 56Part 2: Strategic Intelligence and Profound Knowledge for Leading 595 Leading with Strategic Intelligence and Profound Knowledge 61Foresight 63Visioning as Designing the Idealized Organization 64Partnering 65Motivating 68Profound Knowledge 68Understanding Systems 69Understanding Variation 71Understanding Psychology 72Understanding Theory of Knowledge 73Employing Strategic Intelligence and Profound Knowledge 74Summary 75Key Terms 75Exercises 766 Changing Health Care Systems with Systems Thinking 77Interdependence 84What Do We Mean by Process? 85Two Kinds of Complexity 87Classifications of Processes 89Defining the System 93Why Systems Thinking Is Difficult 96Changing a System 97Leverage, Constraints, and Bottlenecks 98Systems and People: Improving Behavior 100Summary 102Key Terms 103Exercises 1037 Statistical Thinking for Health Care Leaders: Knowledge About Variation 107Interpretation of a Control Chart 110Avoiding the Two Kinds of Mistakes in Reacting to Variation 114Graphical Display Using Statistical Thinking 115Power of Simple Run Charts for Data Display 120Leadership to Improve Population Health 127Summary 131Key Terms 131Exercises 1328 Understanding the Psychology of Collaborators 137Personality Intelligence 139Talents and Temperament 139Social Character 140Drives 141Motivational Types 144Identities and Philosophy 148Bureaucratic and Interactive Values 149Bureaucratic and Interactive 149Motivation: Popular Ideas to Unlearn 151Maslow’s Hierarchy of Needs Theory 151Maccoby’s Critique of Maslow’s Theory 152Hawthorne Experiments: Maccoby Critique 152Using Personality Intelligence 155Creating the Environment for Intrinsic Motivation: The Five Rs of Motivation and the Seven Value-Drives 155Leading with the Heart 160Disciplines of the Heart 163Seeing Things as They Are—Deep Listening 163Listening and Responding to Others 164Summary 165Key Terms 166Exercises 1679 A Health Care Leader’s Role in Building Knowledge 169How Do Theories Evolve? 170Learning and Continuous Improvement 174Shared Meaning and Operational Definitions 176Utilizing a Standard Methodology for Learning in the Organization 177Using Multiple PDSA Cycles to Build Knowledge 184The Leader as Learner and Teacher 186Summary 188Key Terms 188Exercises 189Part 3: Learning from Other Leaders and Creating a Path Forward 19110 Three Case Studies: Mastering Change 193Case Study A: System for Mastering Change in Jönköping County Council, Sweden 197Case Study B: A Medical Director-Leader Improves Care in Dialysis Clinics 219Case Study C: Building a Learning Organization at OCHIN, Portland, Oregon, United States 232Key Terms 25611 Leading Change: First Steps in Employing Strategic Intelligence to Get Results 259Assessing and Defining Purpose for the Organization 260Assessing the Learning Organization 263Aligning Roles to Support the Organization’s Purpose 264Leading Health Care 269Developing a Leadership Philosophy and Practical Values 270Summarizing and Interpreting Results from the Practical Values Gap Survey for Leadership Team Learning 272Strategic Intelligence and Profound Knowledge for Changing Systems 274Summarizing and Interpreting Results from the Strategic Intelligence Inventory for Leadership Team Learning 277Developing Personality Intelligence 281Systems Thinking: Creating a System Map of Your Organization 283Process of Change: Idealized Design 288Understanding the Psychology of Partners and Collaborators 290Translating the Vision and Strategy to Actionable Approaches 291Leading Individual and Team Improvement Efforts to Achieve the Vision 294The Sponsor Report: Keeping Leaders in the Communication Loop 296Learning from Improvement Efforts 299Redeployment of Resources 301Removing Barriers and Obstacles 302Summary 309Key Terms 310Appendix 311Leadership Personality Survey 311Social Character Questionnaire 318Scoring of Social Character Questionnaire 319Understanding Leadership Personality 320The Caring (Freud’s Erotic) Leadership Personality 322The Visionary (Freud’s Narcissistic) Leadership Personality 324The Exacting (Freud’s Obsessive) Leadership Personality 326The Adaptive (Fromm’s Marketing) Leadership Personality 328Leadership Personality Examples 330Combinations of Types 332Caring-Dominant Mixed Leadership Types 332Visionary-Dominant Mixed Leadership Types 335Exacting-Dominant Mixed Leadership Types 337Adaptive-Dominant Mixed Leadership Types 339Mixed Type and Social Character 342Farming-Craft Social Character 342Bureaucratic Social Character 343Interactive Social Character 344Glossary 345Index 367