SixSEED Partners

Case Study

Healing Drama in the Workplace

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An Application of Three Models to Heal Healthcare

By: Joy W. Goldman RN, MS PCC:  CEO SixSEED Partners

The Drama:

Let’s see if this situation sounds familiar to you:  You have a senior, C-Suite leader, or high-volume surgeon, or your flagship hospital CEO who is widely perceived as demonstrating obstructionist behavior.  In polarity language, they tend to over-leverage the “I” focus: they over-advocate for their organization/ service line/ system entity to get more resources to the detriment of the rest of the system.  They are perceived not as team players and are perceived as being an “urban legend” in the systemic fear of their power and intimidation.   You may hear the following spoken in hallways or in private zoom chat rooms: “Everyone knows that “he/she” wants total control and you best not mess with him/ her because there will be repercussions!”

The Impact:

When systems perpetuate these urban legends and make up stories around motivations for behavior, everyone suffers and healthy cultures are undermined.  There is toxic energy that is spent on workarounds, defensive positioning anticipating a negative outcome, disrespect to the senior leader with many talking behind their back, and a crystal-clear message to everyone witnessing this behavior of: “it’s not safe here.”

The Solution & Invitation:

There are three frameworks we use to help shift these cultures from unhealthy, unsafe and low trust cultures to engaged, supportive, healthy and safe cultures:  @theconsciousleadershipgroup ’s “Above and Below the Line;” The Collective Leadership Assessment from the Leadership Circle,  and Polarity Thinking—adding both/and thinking to traditional problem-solving thinking. When used recently with a group of nursing and patient care leaders, over a series of several sessions spanning six months, their comments included: “we now call each other for support;” “we are more solution-oriented,” and “we can be vulnerable with each other since we now share a common language.”

Let’s hear from you:  

We’d love to hear your perspective on what you and your organizations are doing to shift your cultures from blame and persecutor-victim relationships to healthy, trusting partnerships.  Please post your responses on our LinkedIn page or send us an email here.

Leveraging Accountability for Self and Others

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By: Lisa Hompe MSOD, BSN, ACC

Background:

In the current healthcare climate of uncertainty, complexity, and change, how do we manage accountability? That is a question I often asked myself as a former healthcare leader managing a very busy ambulatory surgery center, and a question that I frequently encounter as I coach other healthcare leaders. In my previous leadership role, I was often faced with the dilemma and tension of holding oneself and others accountable. Accountability can have various meanings to different individuals, teams, and organizations, and is often rooted in organizational culture, norms, and behaviors. 

Assessment:

Self:

As a leader, when the work was stressful or challenging, I noticed my own internal challenge of wanting to take the path of least resistance. I found it was easier to delegate to those people who were more willing to take on additional tasks while avoiding those that were less interested or approachable. According to Harvard Business Review, recent data shows it is a common dilemma leaders face in holding others accountable successfully. Difficult conversations and creating an environment of accountability require a thoughtful and intentional approach. Approaching things with diplomacy and candor can help to create awareness and develop teams.

Team: 

What was I showing and modeling to my team by not having these crucial conversations? I realized as a leader, I was doing a disservice to those that needed to grow and learn. How was I holding myself accountable? When difficult conversations needed to take place for undesirable behavior or actions, I may have been unintentionally communicating that only a select few of the team were capable. Self-awareness is a first step and a key leadership and emotional intelligence competency. 

Impact:  

I believe no one intends to go to work every day creating problems and issues. The stressors currently impacting many healthcare workers place undue burdens on an already constrained and overtaxed system. This context can lead to undesirable or suboptimal behavior. It may be possible that leaders are unknowingly playing a part in perpetuating a lack of accountability with individuals and teams. If we’re honest with ourselves and our teams, we all have blind spots. What we model matters. It is possible to consider the well-being of others, while holding them responsible for their actions. I learned that having crucial conversations and asking others to step up creates an environment of shared interests; it creates an environment where everyone feels heard and valued, willing to show up and do their best. I encourage all leaders to take notice of how working with team members to create shared accountability and responsibility helps foster a more positive work environment.

Takeaways:

For yourself, look at what you can control-

  • Assume positive intentions for all individuals  
  • Notice who and how often you may be tapping into? Are they often the same people?
  • Check yourself. Did you have all the correct data and facts before you acted? Ask yourself, what if the opposite were true?
  • What is the intention of your messages? And how does your communication impact others?

For your team, start with open dialogue and conversations-

  • Intentionally create coaching conversations. Learn to ask open-ended questions in a psychologically safe environment
  • Listen and be open and curious for the answers your team is providing
  • Be clear on roles and responsibilities and get feedback if people need more clarity, communication, or training
  • Embrace the challenge and use the support of a coach or colleague 

This is simple but not always easy. Learning to manage these leadership challenges can make a world of difference. How you define accountability reflects the agreements and commitments you are willing to make. What are you committed to? How do you support and grow others to be aware of their behavior and actions? What is the culture you intentionally want to create for your team and the broader organization? Part 2 of the series will address creating a positive culture in the current healthcare environment. If you’d like to learn how to increase the accountability of your team while holding yourself accountable in a courageous and compassionate way, contact sixseedpartners for more information.

Developing Integrated Accountability in Healthcare

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By: Joy W. Goldman RN, MS, PCC, CEO, SixSEED Partners

Background:

SixSEED Partners (SSP) was engaged by a senior health system leader to complete a 360-degree feedback process in support of the client’s ongoing systemic leadership and development.  This leader was brought into the health system to integrate service line leadership from a decentralized and competitive model to a more centralized and collaborative model.  The Leadership Circle 360 Profile (LCP) was administered after the client had been in the system for a year.

The Strategy:

The client had previously completed the LCP at another system so we were curious to see if the themes would be any different from his prior results.  In reviewing the results from 32 respondents, the client’s attention went to two variables:  there continued to be a theme of his strength in relationships and in his overdoing that strength with complying behaviors (for detail, see The Leadership Circle Website).  This leader’s development opportunity was courageous authenticity and achieving results and decisiveness—dimensions well known to him. 

However, his greatest concern was that the ratings from his direct reports was drastically different (lower) than other stakeholder groups. 

The Solution:  

As we explored internal and external dynamics, we found support in the theoretical frameworks of the Empowerment Dynamic, and Polarity Thinking which correlate perfectly with the LCP framework of reactive and creative modes of energy management.  Through coaching and much reflection, the client was able to see how his direct reports were placing him in a rescuer (hero) role and were presenting themselves as victims to system leaders, mainly hospital Presidents who were perceived as villains (see graphic).  This dynamic was evident through numerous cultural stories in the organization—not only did this dynamic occur within his organization:  it was prevalent throughout the system, with a displacement of accountability to “higher ups,” which was also convenient when something didn’t work.  Blame was a well -known song sung throughout the system.

The Impact:

From the client’s perspective, he was able to see that he was re-enacting that dynamic with his boss and part of his development was to be conscious of the roles he was playing and putting on others.  He started individual meetings with his direct reports and shared the distinctions between victim and creator, encouraging them to take ownership and identify actions they can take to influence what they wanted to create in the system.

The client was also challenged to lead a system-level leadership development effort where both/and thinking (polarity thinking) would be introduced and measured for the prevalent tensions of Centralization and Decentralization (system service lines AND local hospital entities) and Individual AND Team accountabilities.  In this way, he would broaden the leadership capacity of system leaders which would minimize the victim/persecutor conversations and support mutual accountability throughout the system.

Are victim/ persecutor conversations rampant in your organization?  Are you fatigued in having to spend time on these draining discussions that result in stagnation and energy drain?  We feel your pain!  Contact us to learn how you can lead sustainable, empowering change in your system!

Supporting Clinician Well Being with Both/And Thinking

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By: Joy W. Goldman RN, MS, PCC, CEO, SixSEED Partners

Background:

The Institute for Healthcare Improvement (IHI) has, as one of their initiatives, “Improving Joy at Work.”  In their 2017 whitepaper on their “Framework for Improving Joy at Work,” Balik, Swensen et al quote Maureen Bisognano as saying: “You can’t give what you don’t have.” On the heels of the beginning emergence from the pandemic, Dr. Larry McEvoy, CEO of Epidemic Leadership and I partnered with Physician and Nurse Executives at WellSpan Health to design and teach polarity thinking to forty clinical leaders in their nursing and physician leadership academies.  We used the context of measuring two tensions: care for self and care for others, and continuity and transformation to illustrate the power of both/and thinking as a supplement to traditional problem-oriented thinking.  Our goal in working with the leaders was to help cultivate a more sustainable and impactful way to address complex, individual, team, and systemic challenges, with less wear and tear on individuals, thus contributing to improving “joy at work” (no pun intended).

The Strategy:

We were hoping that the pandemic recovery would allow us to gather the forty leaders in person yet, two weeks before our delivery date, there remained concern about social distancing and covid transmission so we adapted to a virtual gathering.  We met with the nurse and physician executive sponsors several times to discuss real tensions within the group and the system and decided to focus on the above polarities of Continuity & Transformation and Care for Self & Care for Others.  We wanted to provide validation through data for what these clinician leaders were experiencing while also providing a structure that supported their expanding perspectives and learning from each other.

The Solution:  

Dr. McEvoy and Ms. Goldman designed and administered a polarity assessment measuring the degree to which the participants felt they were leveraging the above -named tensions.  We presented a half-day workshop that integrated content that differentiated problem-solving with either/ or solutions from polarities which required both/and thinking.  We intentionally mixed nurse and physician leaders during breakout sessions; and we used whole-brain and somatic learning with liberating structures that demonstrated the power of using their peers as internal consultants while also hardwiring the learning.

The Impact:

Some tensions identified by these forty clinical leaders included:

  • System decisions being made without the input of the stakeholders whom they effect
  • Being burdened by administrative tasks that take us away from patient care
  • Conflicting messages; do more with less while also making self-care a priority. Decisions being made without stakeholder involvement.

We presented their data to them and demonstrated the ability to filter the data by relevant demographics:  in the case below, we were curious to see if there were differences between care for self and care for others between nurse and physician leaders.  As the below illustrates, all leaders were experiencing the downside of overdoing care for others, however nurse leaders were in the danger zone for all three markers.  This data served as powerful fodder as Dr. McEvoy facilitated the group through three rounds of Troika Consulting (Liberating Structure).  The group unanimously felt that the eight-minute exercise and process provided valuable feedback from their peers for ways they might individually better leverage “care for self” in themselves and in those they lead.

If you’d like to offer something like this with your physician and nurse leaders,  please reach out and let us know at info@sixseedpartners.com or by commenting.  

Case Study: Developing Dyad Trust and Partnership

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Joy W. Goldman RN, MS, PCC:  CEO and Founding Partner, SixSEED Partners

Background

OneSixSEED Partners (SSP) was contacted by a Chief Clinical Officer for a large faith-based health system concerning our providing coaching services to two cardiac surgeons who needed to partner for overall program success and were currently in conflict.  The behaviors demonstrated were interfering with the engagement of other team members and posed a risk of departure for one of the surgeons who happened to be a high-volume, high revenue producer.

The Strategy:

SSP met with the local hospital Chief Clinical Officer (CCO) to determine measures of success and also to assess dynamics within the larger health system.  As may be common with less urban areas, the CCO’s marital partner was a peer to one of the referred physicians which impacted the CCO’s proclivity in setting firm boundaries. SSP modeled being compassionate AND direct in establishing performance expectations and outcomes.  While there was some interest in bringing the two physicians together immediately, we agreed that our approach would combine the organization establishing firm expectations and providing coaching support in developing these physician leaders.

The Solution: 

Choosing the right coach for the clients was essential in establishing trust in order to provide both challenge and support.  We decided to use the @CoreStrengths Strength Deployment Inventory to help each physician deepen their emotional intelligence as they understood their motivators and values within the context of six other motivational value styles and conflict styles.  In debriefing the physicians individually, each client was true to their style, often demonstrating their strengths and overdone strengths within the debrief conversation.

As you will note from the attached SDI triangle, the two surgeons had very different styles which contributed greatly to their sense of conflict.  One physician valued inclusion and the other physician valued autonomy and competition. As with all interdependent tensions/ polarities, what was essential was helping each physician understand their unique gifts/ strengths and how to leverage those, while also understanding their overdone strengths and the impact on their teams.  Each physician’s development plan included strengthening the opposite pole/ style:  to better leverage competition and collaboration.

The Impact: 

One of the strengths of the Core Strengths platform is that it has an app that allows a user to review their results and also compare their style to that of others and learn “do’s and don’ts” for emailing, messaging, communicating, and meeting with those who are different than them.  They learn how to flex their style to their audience so they can partner better and perceive behaviors less personally.  In being able to do so, not only is the partnership strengthened but there is less wear and tear on the physicians so their energy can go where it is most needed which is program development and patient care.  I’m noticing the desire to want to tie a pretty bow and say this story had a happy ending, and I’m sure it will.  The work continues yet it might be easy to guess that the surgeon with a high-performance motivation (red) is considering moving on to what’s next.  As leaders, our roles include establishing cultures where all can thrive.  There are times when that might mean people leave our organizations.  If we’ve done our job in creating strong development cultures, we increase overall leadership capacity so that regardless of departures, the organization continues to thrive and patient care is sustained.

Case Study: Developing Capacity for Leading Autonomously AND Collaboratively

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Joy W. Goldman RN, MS, PCC:  CEO and Founding Partner, SixSEED Partners

Background

One of our clients was recently promoted from a clinical specialty department leadership role into a hospital-wide chief clinical officer position at an academic, inner city medical center that is part of a multi-hospital system.  SixSEED Partner’s coach offered to complete an onboarding 360 feedback process to assist this leader in integrating into his new role.  While we would do this for any C-suite new leader, transitioning to a larger scope role within a health system has the added complexity of reshaping existing perceptions and renegotiating existing relationships.

The Strategy:

SixSEED Partner’s coach engaged the client in providing names of key stakeholders, peers, and direct reports who have had an opportunity to observe him over the past four-five months in his new Chief Clinical Officer (CCO) role.  Interview questions were provided to the ten leaders and to the client’s boss: the Chief Executive Officer of the medical center.  The results of the interviews were summarized and presented to the client, linking the results to past assessments that included interview-based and online assessments.

The Solution: 

While many senior level roles require the capacity to manage complexity, the critical thinking capacity of being able to leverage paradox becomes magnified when one transitions internally and within the context of two National crises: the pandemic of Covid 19 and a national workforce shortage.  Amongst many noted strengths, numerous respondents acknowledged the need for this leader’s capacity to challenge the status quo and push the organization toward new ways of doing things and new levels of accountability.  With that strength, however, also came tension and resistance.

The coach integrated past learning from The Leadership Circle Profile 360® in shifting from reactive to creative behaviors and also continued application of noticing paradox (polarity) and seeming contradictory demands.  Prevalent for this leader was the ability to leverage his strength of internal (operations) focus with external (strategic) focus.  Another key tension, given the shift in his relationships with other existing leaders, was his ability to manage asserting the power (Individual) within his role of CCO, as he partnered with other system chief clinical officers (team). 

The Impact: 

As someone with a harsh internal judger/ critic—(perhaps this resonates for you, the reader?), being able to identify these tensions in a both/and approach allowed the leader to receive the feedback in a way that felt supportive and challenging.  Using both The LCP 360 frame and polarity thinking frames supported the leader in expressing their strongly held values and fears (often held in our reactive thoughts) and allowed the leader to lead into their creative talents of visionary leadership as they strengthened developing their bench strength and collaborative partnerships.  This process provided the leader an early compass amidst numerous strategic demands.