Fundamentals of Adaptive Leadership Val Ulstad MD, MPH, MPA

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Fundamentals of Adaptive LeadershipVal Ulstad
MD, MPH, MPA
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Adaptive LeadershipBeliefs Behind Dr. Ron
Heifetz work

• Problems are embedded within complicated and
  interactive systems.
• Much of human behavior reflects an adaptation to
  circumstances.
• People adapt more successfully to their
  environments by facing painful circumstances (aka
  FEAR) and developing new attitudes and behaviors.

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Why Apply Adaptive Leadership in Health Care?

• Describes what people do
• Describes what people exercising leadership can
  do if they see differently
• A way of developing a shared language to describe
  group dynamics
• Describes a way to be an active engaged
  organizational citizen
• Really resonates with clinicians

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Opportunities

• Enhance capacity to exercise leadership
• Build a framework to help others make progress on
  tough problems
• Create resiliency to withstand the work of
  leadership

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Human Systems
Limit of tolerance
Tension of change
Productive Range
Threshold of learning
Time
Based on Heifetz, Ronald A. and Marty Linsky.
Leadership on the Line, Harvard Business School
Press, Boston, MA,2002, pg. 108.
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Type of Situations Requiring Leadership

• Technical -- Apply abilities that already exist
  in the systems capabilities
• Adaptive -- People deeply and broadly within the
  organization need to learn new capabilities

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Technical vs. Adaptive Work
Limit of tolerance
Adaptive challenge
Disequilibrium
PRODUCTIVE RANGE OF DISTRESS
Tension of change
Technical problem
Threshold of learning
Time
Heifetz, Ronald A. and Marty Linsky. Leadership
on the Line, Harvard Business School Press,
Boston, MA,2002, pg. 108.
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Adaptive Work

• Adaptive work diminishes the gap between the way
  things are and the way things need to be to
  create a better future

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The most common cause of leadership failure is
treating an adaptive problem with a technical fix.
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What is hard about leading others in improving
care?
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Properties of Adaptive Work

• Gap between aspirations and reality
• Tension between between points of view
• Difficult learning required
• Involves tolerating loss
• Perspective needs shifting
• New competencies must be developed
• People with the problem have problem solving
  responsibility
• Takes longer than technical work
• Requires experimentation
• Generates disequilibrium, distress and work
  avoidance

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Adaptive Work

• Adaptive work diminishes the gap between the way
  things are and the way things need to be to
  create a better future
• Adaptive leadership is the activity that
  mobilizes people to perform needed adaptive work

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Technical and Adaptive

• Fishbone diagram
• Affinity diagram
• Decision analysis tools
• Measurement tools
• Technical pieces are necessary and insufficient
  for adaptive work

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What is the work?

• Gap difference between the way things are and
  the desired state
• Technical or adaptive?
• Hearts and minds need to change?
• Process of exclusion
• Persistence of conflict
• Crisis
• Where do we begin?
• Meaningful and Manageable

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AIM Statement

• The work you are doing together
• Addresses a gap
• A big enough improvement target to be meaningful
• A contained enough project to be manageable
• Has key components
• Clearly articulated statement of intended
  improvement
• Aligned to organizational strategic focus
• Supports system quality or operations goals

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Who Cares About the Work?
Delivering high quality care with optimal
stewardship of resources
You
Patient
Other team members
Family
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Who cares about the work?

• Important stakeholders
• Team members
• Those affected by the change
• Those who support it
• Those who do not want to see it happen
• Project sponsor
• You
• Who else?

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Delivering high quality care with optimal
stewardship of resources
Based on Heifetz, Ronald A. and Marty Linsky.
Leadership on the Line, Harvard Business School
Press, Boston, MA, 2002, pg 108.
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Are you reading the signals others are sending?
Work avoidance is triggered when the heat is too
high or too low
Heifetz, Ronald A. and Marty Linsky. Leadership
on the Line, Harvard Business School Press,
Boston, MA, 2002, pg. 108.
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Work Avoidance Signals Being Out of a Productive
Range of Tension

• Displacing responsibility
• Attack authority
• Kill the messenger
• Scapegoat

• Distracting attention
• Make the problem too big
• Make the problem too small
• Meetings with only information exchange when
  engagement and deep conversation is needed
• Ask more consultants
• Denial
• Collude in magical thinking

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Can you imagine some work avoidance
examples you might see?
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How are the people who care about the work
reacting to it?

• Interpret Factional Stances
• Is the faction above the limit of tolerance?
• Over the top
• Is the faction engaged in the work?
• Is the faction below the level of learning?
• Not my concern

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How are you and others reacting to the work?
What does the work avoidance suggest?
Delivering high quality care with optimal
stewardship of resources
You
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Begin to Plot a Strategy

• What do you need to do to make progress?
• What can you do to lower the distress on the
  factions that are above the limit of tolerance?
• How can you maintain engagement of factions that
  are currently engaged in trying to make progress?
• What can you do to raise the distress to a
  productive level for the factions below the level
  of learning?

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Help People Make Progress on Adaptive Work

• Use yourself differently
• Create productive tension
• Keep people engaged who are making progress and
  figure out what you need to do to reengage others.

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• Authority ? Leadership

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Authority

• Power in exchange for service
• A contract for service
• Direction
• Protection
• Order
• Formal and informal
• A resource and a constraint on leadership

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Informal Authority Influence

• Power to influence beyond job description
• General credibility and professional reputation
• Implicit expectations
• Critical source of leverage for formal
  authorities too

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Think of a time when you told people what they
needed to hear rather than what they wanted to
hear. What happened?
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Exercising leadership to do adaptive work means
disappointing peoplesexpectations at a rate
they can tolerate.
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Exercising leadership to do adaptive work means
disappointing peoples expectations (that
things will stay the same)at a rate they can
tolerate.(and not muzzle you)
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• Leadership is an activity
• There can be leadership from multiple positions
  within a social structure

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Get on the Balcony Fundamental Skill in Adaptive
Leadership

• Reflect in action
• Keep the pattern of the dance in mind while
  dancing
• Move back and forth

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Use Yourself Differently

• Exercise leadership and use your informal
  authority as a resource
• Reflect in action get on the balcony
• Set a great example
• Celebrate and learn from what is going well
• Talk about why you think this is important
• Ask questions
• Listen
• Pay attention

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Behaviors That Build Trust

• Talk straight
• Demonstrate respect
• Create transparency
• Right wrongs
• Show loyalty
• Deliver results
• Get better
• Confront reality
• Clarify expectations
• Practice accountability
• Listen first
• Keep commitments
• Extend trust

Adapted from The Speed of Trust, Stephen M.R.
Covey, 2006.
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Create Productive Tension

• Make it safe to disagree and debate but not OK to
  opt out and disengage.
• Talk honestly to one another about the challenge
• Listen with genuine interest to the various
  points of view
• Build trust
• Have difficult conversations

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Difficult conversations are inevitable

• Safety is critical for them to be productive
• shared purpose
• mutual respect
• Be willing to be influenced
• Be curious rather than judgmental
• 100 candid
• 100 respectful
• Lead with questions not answers
• Engage in dialogue and debate not coercion

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Create an Environment to Hold Attention on the
Work
Limit of tolerance
People need to feel safe enough to do adaptive
work but not so safe that they will do nothing.
Productive Range
Tension of change
Threshold of learning
Time
Based on Heifetz, Ronald A. and Marty Linsky.
Leadership on the Line, Harvard Business School
Press, Boston, MA, 2002, pg 108.
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Distressed System No Trust, Little Adaptive
Capacity
Limit of tolerance
Tension of change
Productive Range
Threshold of learning
Time
Based on Heifetz, Ronald A. and Marty Linsky.
Leadership on the Line, Harvard Business School
Press, Boston, MA,2002.
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What is a difficult conversation?

• Any conversation that you dread and perhaps seek
  to avoid, if possible
• Three inherent challenges present the source of
  difficulty
• There are inevitably more ways to understand the
  situation than any one participant is aware of or
  agrees with
• The situation is emotionally charged with strong
  feelings
• The situation is psychologically threatening to
  one or both parties

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Which Condition of Safety is at Risk?

• Mutual purpose or mutual respect
• Conditions make the conversation difficult
• much more than content

Adapted from Crucial Conversations
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Shared Vision Delivering high quality care with
optimal stewardship of resources
Limit of tolerance
Tension of change
Productive Range
Threshold of learning
Time
Based on Heifetz, Ronald A. and Marty Linsky.
Leadership on the Line, Harvard Business School
Press, Boston, MA,2002, pg. 108.
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How Do We Hold the Tension? Delivering high
quality care with optimal stewardship of
resources respectfully?
Limit of tolerance
Tension of change
Productive Range
Threshold of learning
Time
Based on Heifetz, Ronald A. and Marty Linsky.
Leadership on the Line, Harvard Business School
Press, Boston, MA,2002, pg. 108. and
adaptationfrom Crucial Conversations
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Widening the Productive Range

• Conditions of safety
• Mutual purpose
• Do others believe you care about their goals in
  the conversation?
• Do they trust your motives?
• Mutual respect
• Do others believe you respect them?

Adapted from Crucial Conversations
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Increased Trust, Increase Capacity for Adaptive
Work
Limit of tolerance
Tension of change
Productive Range
Threshold of learning
Time
Based on Heifetz, Ronald A. and Marty Linsky.
Leadership on the Line, Harvard Business School
Press, Boston, MA,2002, pg. 108.
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Keep people engaged who are making progress and
figure out what you need to do to reengage
others.
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Work avoidance signals being out of a productive
zone relative to the work
Work avoidance is triggered when the heat is too
high or too low
Heifetz, Ronald A. and Marty Linsky. Leadership
on the Line, Harvard Business School Press,
Boston, MA, 2002, pg. 108.
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Think about a time when the heat was too high.

• How did you know?
• What did you do to bring things to a productive
  level of tension so progress could be made?

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Lowering the Heat

• Validate feelings, acknowledge loss
• Simplify and clarify
• Address the technical aspects
• Break problem into parts
• Restore, add, or reallocate resources
• Temporarily reclaim responsibility for tough
  issues
• Give your attention
• Take stock of what is available
• Allot more time, enrich knowledge and skills

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Think about a time when the heat was too low.

• How did you know?
• What did you do to bring things to a productive
  level of tension so progress could be made?

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Raising the Heat

• Raise the standards
• Increase accountability
• Change the task to something more motivating
• Refocus on higher, more widely shared and yet
  compelling purpose

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Exercising leadership to do adaptive work means
disappointing peoples expectations that things
will stay the same butat a rate they can
tolerate.
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Give Work Back to People at a Rate They can
Tolerate
Adaptive Challenge
Limit of tolerance
Work avoidance
PRODUCTIVE RANGE HOLDING ENVIRONMENT
Tension of change
Work avoidance
Threshold of learning
Technical challenge
Time
Heifetz, Ronald A. and Marty Linsky. Leadership
on the Line, Harvard Business School Press,
Boston, MA,2002, pg. 108.
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Exercising leadership requires keeping an
experimental mindset

• Work avoidance looks the same when the heat is
  too high or when the heat is too low.
• If what you try makes things worse try the
  opposite.
• What looks like laziness may be exhaustion.
• Keep rechecking your assumptions.

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Keep an experimental mindset When you try
something and things get worse try the opposite!
Adaptive Challenge
Limit of tolerance
Work avoidance
PRODUCTIVE RANGE HOLDING ENVIRONMENT
Tension of change
Work avoidance
Threshold of learning
Technical challenge
Time
Heifetz, Ronald A. and Marty Linsky. Leadership
on the Line, Harvard Business School Press,
Boston, MA,2002, pg. 108.
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Building Your Practice of Leadership Adaptive
leadership helps people to make progress on
difficult problems

• Develop a new capacity to see what is happening
• Learn to effectively analyze what you see
• Learn to strategically intervene to make progress
  on difficult problems