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Transforming Health Care Leadership: A Systems Guide to Improve Patient Care, Decrease Costs, and Improve Population Health



Transforming Health Care Leadership: A Systems Guide to Improve Patient Care, Decrease Costs, and Improve Population Health

Michael Maccoby, Clifford L. Norman, C. Jane Norman, Richard Margolies

ISBN: 978-1-118-50563-2 August 2013 Jossey-Bass 416 Pages


Health care organizations are challenged to improve care at the bedside for patients, learn from individual patients to improve population health, and reduce per capita costs. To achieve these aims, leaders are needed in all parts of the organization need positive solutions. Transforming Health Care Leadership provides healthcare leaders with the knowledge and tools to master the unprecedented level of change that health care organizations and their leaders now face. It also challenges management myths that served in bureaucracies but mislead in learning organizations.

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Figures, Tables, Exhibits xiii

Preface xxi

The Authors xxix

Part 1: The Challenge to Health Care Organizations and Creating the Leadership Team 1

1 Introduction: From Management Myths to Strategic Intelligence 3

Plan of the Book 8

Part 1: The Challenge to Health Care Organizations and Creating the Leadership Team 8

Part 2: Strategic Intelligence and Profound Knowledge for Leading 9

Part 3: Learning from Other Leaders and Creating a Path Forward 11

Key Terms 11

2 Why and How Health Care Organizations Need to Change 13

The Purpose of the Preliminary Research 18

The Model of Change 18

Changing Modes of Production in Health Care 20

Health Care in Learning Organizations 20

Leadership for Learning 23

The Human Side of Change 24

Approach to Service 25

The Role of Culture 26

The Mayo Model 27

Summary 29

Key Terms 31

Exercises 31

3 Leading Health Care Change 35

Summary 43

Key Terms 43

Exercises 43

4 Developing a Leadership Philosophy 45

How to Develop a Philosophy 46

Purpose 46

Ethical and Moral Reasoning 46

Levels of Moral Reasoning 47

Practical Values 48

Gap Analysis 50

Definition of Results 51

Using the Purpose to Define Results: Cherokee Nation Health Services 52

The Mayo Clinic Organization Philosophy 53

Summary 56

Key Terms 56

Exercises 56

Part 2: Strategic Intelligence and Profound Knowledge for Leading 59

5 Leading with Strategic Intelligence and Profound Knowledge 61

Foresight 63

Visioning as Designing the Idealized Organization 64

Partnering 65

Motivating 68

Profound Knowledge 68

Understanding Systems 69

Understanding Variation 71

Understanding Psychology 72

Understanding Theory of Knowledge 73

Employing Strategic Intelligence and Profound Knowledge 74

Summary 75

Key Terms 75

Exercises 76

6 Changing Health Care Systems with Systems Thinking 77

Interdependence 84

What Do We Mean by Process? 85

Two Kinds of Complexity 87

Classifications of Processes 89

Defining the System 93

Why Systems Thinking Is Difficult 96

Changing a System 97

Leverage, Constraints, and Bottlenecks 98

Systems and People: Improving Behavior 100

Summary 102

Key Terms 103

Exercises 103

7 Statistical Thinking for Health Care Leaders: Knowledge About Variation 107

Interpretation of a Control Chart 110

Avoiding the Two Kinds of Mistakes in Reacting to Variation 114

Graphical Display Using Statistical Thinking 115

Power of Simple Run Charts for Data Display 120

Leadership to Improve Population Health 127

Summary 131

Key Terms 131

Exercises 132

8 Understanding the Psychology of Collaborators 137

Personality Intelligence 139

Talents and Temperament 139

Social Character 140

Drives 141

Motivational Types 144

Identities and Philosophy 148

Bureaucratic and Interactive Values 149

Bureaucratic and Interactive 149

Motivation: Popular Ideas to Unlearn 151

Maslow’s Hierarchy of Needs Theory 151

Maccoby’s Critique of Maslow’s Theory 152

Hawthorne Experiments: Maccoby Critique 152

Using Personality Intelligence 155

Creating the Environment for Intrinsic Motivation: The Five Rs of Motivation and the Seven Value-Drives 155

Leading with the Heart 160

Disciplines of the Heart 163

Seeing Things as They Are—Deep Listening 163

Listening and Responding to Others 164

Summary 165

Key Terms 166

Exercises 167

9 A Health Care Leader’s Role in Building Knowledge 169

How Do Theories Evolve? 170

Learning and Continuous Improvement 174

Shared Meaning and Operational Definitions 176

Utilizing a Standard Methodology for Learning in the Organization 177

Using Multiple PDSA Cycles to Build Knowledge 184

The Leader as Learner and Teacher 186

Summary 188

Key Terms 188

Exercises 189

Part 3: Learning from Other Leaders and Creating a Path Forward 191

10 Three Case Studies: Mastering Change 193

Case Study A: System for Mastering Change in Jönköping County Council, Sweden 197

Case Study B: A Medical Director-Leader Improves Care in Dialysis Clinics 219

Case Study C: Building a Learning Organization at OCHIN, Portland, Oregon, United States 232

Key Terms 256

11 Leading Change: First Steps in Employing Strategic Intelligence to Get Results 259

Assessing and Defining Purpose for the Organization 260

Assessing the Learning Organization 263

Aligning Roles to Support the Organization’s Purpose 264

Leading Health Care 269

Developing a Leadership Philosophy and Practical Values 270

Summarizing and Interpreting Results from the Practical Values Gap Survey for Leadership Team Learning 272

Strategic Intelligence and Profound Knowledge for Changing Systems 274

Summarizing and Interpreting Results from the Strategic Intelligence Inventory for Leadership Team Learning 277

Developing Personality Intelligence 281

Systems Thinking: Creating a System Map of Your Organization 283

Process of Change: Idealized Design 288

Understanding the Psychology of Partners and Collaborators 290

Translating the Vision and Strategy to Actionable Approaches 291

Leading Individual and Team Improvement Efforts to Achieve the Vision 294

The Sponsor Report: Keeping Leaders in the Communication Loop 296

Learning from Improvement Efforts 299

Redeployment of Resources 301

Removing Barriers and Obstacles 302

Summary 309

Key Terms 310

Appendix 311

Leadership Personality Survey 311

Social Character Questionnaire 318

Scoring of Social Character Questionnaire 319

Understanding Leadership Personality 320

The Caring (Freud’s Erotic) Leadership Personality 322

The Visionary (Freud’s Narcissistic) Leadership Personality 324

The Exacting (Freud’s Obsessive) Leadership Personality 326

The Adaptive (Fromm’s Marketing) Leadership Personality 328

Leadership Personality Examples 330

Combinations of Types 332

Caring-Dominant Mixed Leadership Types 332

Visionary-Dominant Mixed Leadership Types 335

Exacting-Dominant Mixed Leadership Types 337

Adaptive-Dominant Mixed Leadership Types 339

Mixed Type and Social Character 342

Farming-Craft Social Character 342

Bureaucratic Social Character 343

Interactive Social Character 344

Glossary 345

Index 367