SixSEED Partners

Leadership Ecosystem

Moral Injury: HealthCare’s Public Health Crisis

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A Systemic Lens Perspective

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

Background:  

On March 10th of this year, I published a blog focused on “Caring for the Organization AND Caring for the Workforce.”  The higher purpose of that tension was to support a healthy ecosystem within healthcare.  Writing this close to six months later, not only is that tension still relevant, it has reached a crisis point in healthcare as droves of physicians and nurses leave their organizations and/or professions.  How do we take care of healthcare as a system, as we take care of the public’s healthcare needs?  In this writer’s opinion, right now we are failing.  The purpose of this blog is to invite creative, systemic solutions to this thorny challenge.

Impact and Case for Change:

Panagioti, Geraghty, and Johnson published an article in JAMA Intern Med 2018 (10) entitled: “The Association Between Physician Burnout and Patient Safety, Professionalism, and Patient Satisfaction.  Their review of the literature revealed that there is a 2-fold increase in odds for unsafe care, unprofessional behaviors, and low patient satisfaction amongst physicians experiencing burnout.   Reith published another article in Cureus titled: Burnout in United States Healthcare Professionals: A Narrative Review.   He expands the impacts from both physician and nursing burnout to include higher rates of patient mortality; transmission of hospital-acquired infections; increase in medical errors and an increase in medical student alcohol abuse and suicide.  Of note is that both of these articles were published in 2018:  prior to Covid 19.

One less quoted yet just as serious sequelae for nursing and physician burnout is your ability to get timely and effective care for you and your loved ones.

Complex and Interdependent Challenges:  Variations of Individual AND Team Tensions:

Many of us are familiar with the process of looking at root causes for problems to permanently eradicate the disease.  The challenge with Covid and burnout in healthcare is that they are not problems to solve.  They are systemic and interdependent challenges to leverage that can be boiled down to a tension between meeting individual needs AND meeting collective needs.

Look at the below examples:

Impact (So What?):

  As Einstein said: “The significant problems we face today cannot be solved at the same level of thinking we were at when we created them.”  We must facilitate dialogues that address these thorny challenges, and which include healthcare worker well-being. If we don’t, physicians and nurses will do more of what they are starting to do which is saying “no more.”  They are saying this as they submit their resignations; leave for higher-paying jobs; or leave the profession altogether.  This leaves hospitals struggling to manage the finances of healthcare with their mission to serve and meet the needs of their communities.  What solutions are people creating to respond to the fear of closing beds and not being able to meet expense needs?  We hear from our clients their staffing challenges as Traveling Nursing companies are perceived as stealing staff from hospitals less equipped to pay higher salaries and offering to those who can.  I liken this strategy to one that hopes to improve nutritional health by offering organic produce to affluent communities while depriving or limiting healthy food choices to lower socioeconomic communities.  When will we learn that localized or individual approaches will not eradicate systemic challenges?

SixSEED Partners Interdependent Solutions:

We believe that these times of epidemic crisis require a different way of thinking and acting to sustainably impact and transform these issues.  Examples include:

  • Leverage Competition & Collaboration:  bring local hospital systems together to look at community health needs and discuss how blending resources and talent might be able to better meet community needs and organizational needs.  Instead of three hospital systems vying for digestive disorder patients, consolidate and refer specialties across hospital systems, in service to patient care AND provider well-being.
  • Medical and Nursing Professional Associations uniting in lobbying their governments to establish temporary laws that promote access to resources and prohibit possible poaching of scarce resources by any one organization at the expense of others.
  • Leverage social media to impress the public of OUR responsibility.  Just as we’ve seen the near -death lung cancer patient with poor color, on oxygen, doing commercials on TV, healthcare workers should be posting photos on social media of their tears; their marked faces; bodies lining hallways due to lack of beds and/or staff.    The story of healthcare’s reality must be presented unfiltered, visible and in a media venue that the public see’s frequently and consistently.  The public has a role and responsibility for decreasing the demands on our healthcare systems and this is one way to keep the public informed of what is happening behind the scenes in the delivery of healthcare.
  • Gather regulatory, professional and education/ training organizations in dialogue around training that could take place to upskill volunteers or provide jobs for those needing work in supplementing nursing and physician staff.  As with scribes, how can we lessen the burden on our clinicians so that they are doing only the highest acuity patient care needs.  The  other tasks which require less clinical expertise can be done by other members of the care team.   

These examples require both/and thinking and require us to get out of our silos, holding our greater purpose and not just our lone survival as paramount.

SixSEED Partners is looking for leaders and systems who are ready to do this work.  We have no time to waste.  The time is NOW.  Will you join us?  If you are curious, please email me directly:  joy@sixseedpartners.com.  

#systemintegration #leadershipecosystemcapacitation #wellbeing #burnout #ecosystem 

Both/And Thinking Requisite for Post-Pandemic Leadership

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

Background: Three strategists from PwC published in April’s Harvard Business Review: “6 Leadership Paradoxes for the Post- Pandemic Era”. As we await the publishing of Barry Johnson’s:” AND: Making a Difference by Leveraging Polarity, Paradox and Dilemma: Volume 2 Applications,” in which we have contributed numerous chapters, we feel affirmed in focusing on this essential capacity for post-pandemic leaders. We’re also pleased to see that SixSEED Partners has worked with several individual and system clients to measure these exact tensions.

Both/And different from Problem-Solving

As a reminder, (see prior posts) both/and – polarity thinking supplements traditional either/or problem-solving thinking in order to best manage complex, ambiguous, volatile and uncertain situations- all of which are part of healthcare’s NOW. It’s an advanced thinking capacity as it requires a leader to be able to see (the first step of the SMALL polarity process: seeing-mapping-assessing learning-leveraging) what seems like opposing perspectives. Leinwand, Mani, and Sheppard highlight six of these interdependent tensions. Below we’ve highlighted their six and translated them into language we’ve used and measured with our clients:

We take HBR’s leader-focused tensions and expand into individual, team and systemic tensions. We’ve adopted the ethos behind the quote from a GE leader: “you don’t put a changed leader into an unchanged system.” As we partner with clients, we focus on individual, team and systemic tensions to ensure sustainable results.

Applications to our current work

SixSEED Partners has integrated these tensions in our individual coaching as part of the 360 feedback and development process; in our culture work with Information Technology and Healthcare organizations and medical groups; and in developing and strengthening nurse and physician leader partnerships. Pasted below you can see the results of measuring the tension of Centralization and Decentralization. At a glance, you can see the opportunity to better leverage centralization in this heart and vascular institute. The White infinity loop represents their actual scores as compared with the ideal grey loop. Through dialogue, it was eye-opening for this group of physicians to objectively see how often they fall into feeling victim to the needs of the larger organization instead of noticing their opportunity to better consider system factors as they plan their decentralized program efforts. In being able to consider and measure the both/and, they save time, energy and resources that go into over focusing on their division needs alone.

Let’s hear from you

We’d love to hear how you are helping your leaders see the both/and of these six paradoxes and others. If this work seems like it could help you and your teams, we’d love to talk with you to explore how this approach might help your clinical leaders. Please post your responses on our LinkedIn page or send us an email here.

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Celebrating Nurses and Healthcare Workers: An Exercise in Diversity and Inclusiveness

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

History of “Nurses and Hospital Week Celebrations”

The first effort to provide national recognition to nurses was in 1954 when Dorothy Sutherland submitted a proposal to then President Eisenhower:  the proposal was rejected.  It wasn’t until twenty years later, in 1974, that President Nixon signed a proclamation indicating that there would be expansion to individual State recognitions of Nurses’ Day to be an entire week.  In 1996, the ANA (American Nurses Association) initiated May 6th as National RN Recognition Day.  

According to the free dictionary, in 1921, the United States declared National Hospital Day to encourage trust in hospitals in the wake of the Spanish Flu outbreak of 1918, and to coincide with Florence Nightingale’s birthdate:  May 12th .  The observance was expanded to a week in 1953 to allow hospitals to plan and implement more extensive public information programs.  

I’ve worked in healthcare for the past forty- plus years and during that entire time, I’ve witnessed sentiments of appreciation for both Nurses’ Week and Hospital Week,  AND sentiments of exclusion:  “Why them and not us?”

Adapting To Present Day: Both/And

I was on LinkedIn recently and saw a similar posting expressing emotion around a desire to expand “National Physician’s Day” (March 30th) to other disciplines/ providers.  The perspective of the person posting was resentment that attention would be paid to a broader cadre of professions and that the expansion took away the special recognition that was deserved to physicians.

What do you think?  Some of you might be saying: “I agree.”  That’s the “right perspective.”   What is the “right” perspective in how to offer these well-deserved recognitions, particularly during a pandemic year when so many have sacrificed time, energy, and sadly, their lives, in service to their profession?  Does sharing make the recognition less special because it includes others and is not exclusive?

Honoring Individuals AND Teams:

While many can and will get into an argument of “right/wrong” in solving this problem, at SixSEED Partners, we would say that this is a perfect example of complexity and interdependent tensions or polarities to leverage.  This is also a wonderful variation on the theme of diversity, equity and inclusion.  Is there a way to celebrate and recognize distinct disciplines while also recognizing the whole?  We would say yes…. This is an interdependent tension to leverage:  A both/and.

Looking at the polarity map below, you will notice the universal tension often experienced in organizations around attending to unique disciplines and individual contributions (parts)—diversity in our associates, while also trying to be equitable in our practices (considering the whole).  If we effectively leverage these tensions, we stay in the upper quadrants.  When we overfocus on either pole, we inevitably get the downsides of that pole.

How does this play out with Nurses’ Week and Hospital Week?  We can imagine nurses saying that they don’t want to share their day with nursing support staff because it distracts from the unique profession that is nursing (Value:  the upside of Individual – Fear: downside of Team).  We can hear the same theme (value—fear) with physicians who want to preserve National Physicians Day for their profession alone.

On the other pole, we can see that an overfocus on diversity/ individuals to the neglect of the whole interferes with equity and inclusion.  Why shouldn’t there be a “recognition week” for each unique discipline?

Leveraging the Both/And:

In our polarity map, the next steps would be to identify action steps and warning signs for each quadrant.  Imagine engaging a diverse workgroup in this process:  what would they say means the most to them in how we might recognize their unique contributions while also appreciating the unique contributions of others?  What might the impact be if other disciplines heard from peers what they appreciate about that discipline/ profession?  How might a spirit of abundance… there is enough for all, contribute to cultivating a spirit of appreciation and gratitude for all:  not only for one week a year but every day of the year?

The pandemic has brought the intimate stories of the work of ALL healthcare workers to our attention.  And, truth be told, while scale might be different, saving lives; witnessing and escorting death and everything in between IS The WORK of healthcare.  

SixSEED Partners has had the privilege of witnessing the courageous work of healthcare leaders and their teams for the past forty-plus years. We celebrate your stamina and courage, AND we honor and hold space for your tears, trauma, grief, and fatigue.  Our commitment in offering gratitude to your work is to courageously offer our work which is to provide integrated solutions to heal healthcare.  Working in healthcare HAS to be healthy.  We honor you every day through partnering with you to make it better.  There is no other choice!

Let’s hear from you

We’d love to hear your insights in celebrating unique disciplines while also celebrating the whole of your teams that contribute to patient care and service. If this work seems like it could help you and your teams, we’d love to talk with you to explore how this approach might help your clinical leaders. Please post your responses on our LinkedIn page or send us an email here.

Cultivating Both/And Thinking to Support Clinical Leaders to Effectively Lead through System Change

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

In the beginning :

SixSEED Partners (SSP) was invited to provide team development support to a high profile clinical executive committee in a regional healthcare system. We initially partnered with this physician and administrative leadership team last fall for a full day retreat focused on developing team dynamics and strategies. We introduced them to several frameworks and practical tools that gave them insights for how to leverage their complementary strengths to get their work done even more effectively. The system clearly supported this type of development because all team members were present and committed to this experiential learning process, despite it taking away from their revenue generating clinical work that day. The executive team found it so valuable, that they wanted more.  

Embarking on a Leadership Development Series (LDS) experiential learning process:

SixSEED Partners partnered with the Chief Physician Executive and the Managing Director of Strategy to create a SWOT (strength, weaknesses, opportunities, threats) analysis for team member input on relevant leadership strengths and challenges. We also used immediate and upcoming leadership transitions as the action-learning platform for the participants to apply their new tools and thinking paradigms. By using our “4D” framework of “Discover-Design-Deliver-Debrief”, the client helped shape a learning design that integrated real-time pressures and systemic forces for change. For practicality, these experiential learning sessions were integrated into their existing monthly strategic meetings to minimize time away from the clinical area and maximize their time together.

Discovering a new Thinking tool for unsolvable problems:

In looking at the real-time pressures and changes this executive team was facing in their system, we knew they could benefit from learning to look at their complexities with Polarity thinking. As mentioned in prior blogs, it has been proven that using polarity thinking (both/and) along with traditional problem-solving thinking has a measurable impact on leading through complexity and change. 

Experiential Learning Module (ELM): Doing S.M.A.L.L. for Measurement and ROI:

We used key themes from their SWOT analysis results to create three unique polarity maps that measured individual, team and system-level tensions for this executive team:

  • Providing Direction and Inviting Participation (Individual)
  • Tactical and Strategic (Team)
  • Centralization and Decentralization (System)

This work took the team through steps 1-3 of the 5-step polarity assessment process known as the “SMALL” methodology, which includes:

  1. Seeing
  2. Mapping
  3. Assessing 
  4. Learning
  5. Leveraging

In our most recent two-hour module, the leaders focused on Step 4 – Learning, about the polarity thinking framework and discussing it in the context of their complementary styles. The learning was deepened when the leaders began to see beyond their preferred perspective within the 3 polarity maps to seeing the broader context within the relative dynamic at hand in their actual work. Most notable was the dialogue around shifting from a place of system “blame” – the downside of decentralization – to better leveraging integration of the health system’s priorities with less energy being wasted in frustration. This traditional “right/wrong, either/or” approach began to shift to “how can we better integrate system factors as we design and execute our work”.

The map below illustrates this team’s scrubbed SWOT analysis, represented as a polarity map. As you can see, the 2 poles to leverage over time to create an effective and high performing team are the Strengths of Current and the opportunities of the Future, while minimizing the weaknesses and threats of both poles. The other scrubbed map shares the executive team’s results, which highlight an opportunity to better leverage Centralization. While these results are valuable as a baseline for this team, what was even more valuable from this experience already was the dialogue that emerged between the participants around an alternative perspective and way of thinking about systemic influences in their work. During our next session, we will take the team through action steps and warning signs to help them best leverage these essential tensions for sustainable change (Step 5 of S.M.A.L.L.).

Let’s hear from you

We’d love to hear your insights in helping clinical executive teams develop systemic thinking applied to current challenges. If this work seems like it could help you and your teams, we’d love to talk with you to explore how this approach might help your clinical leaders. Please post your responses on our LinkedIn page or send us an email here.

How to Hire a CEO: Neglected Attributes

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

Introduction: Case for Change

Turnover at the CEO position remains high: According to the American College of Healthcare Executives, CEO turnover was 17 percent in 2019.* (ACHE: “Hospital CEO Turnover Rate Shows Small Decrease.” – press release. In Development Dimension International’s 2021 Global Leadership Forecast, that polled close to 16,000 leaders across the globe, 55% of CEO’s indicated developing the next generation of leaders as their top challenge. These statistics and personal experience working with clients who have been traumatized by making a wrong choice, motivated Dr. Larry McEvoy, Dr. Kevin Mosser and I to offer healthcare boards a webinar through The Governance Institute  called “How to Hire a CEO: A Guide for Ensuring Effective Selection at the Most Important Position.”  

For SixSEED Partners, we see the hiring of a CEO as only one part of our sixth seed: Leadership Ecosystem Capacitation.

 

Current Process:  Strengths and Gaps:

Whether in our country or within healthcare, we continue to look to the CEO as a heroic leader and in doing so, often place great emphasis on the CEO’s accomplishments and experience.  It was fascinating to us that the participants on the webinar placed low importance to the role of experience in their candidate selection yet, in practice, it was one of the top three attributes that they assessed. (see graphs below).  Bob Anderson and Bill Adams, in their book: Scaling Leadership: Building organizational capability and capacity to create outcomes that matter most” dispel the myth that leaders that prioritize results and technical expertise have the greatest impact on business results.  To the contrary, after culling through hundreds of thousands of 360- degree -feedback assessments and comments from around the globe, these skills were shown to be non-differentiators for high performing leaders.  Their research identified ten attributes, six of which were people-related.  Some of these include developing others; empowering people; team-builder; leads by example; and good listener.  

We were also surprised with the time paid to assessment results and interviewer ratings, given neither interventions were rated as having great importance to the participants.  In our experience, we agree, in part with this assessment, given our observation that this process is often incomplete, where the personality profile results remain with the search firm and are not used by the hiring company to integrate into designing behavioral interview questions targeted at possible gaps, nor using as development once the candidate is hired.

The Neglected Attributes:

If you’ve read this far, you are probably guessing where we believe you need to focus to have the greatest chances of success for the candidate; your executive team; and your organization.  The two attributes least assessed yet deemed most important to the CEO’s success is their ability to scale leadership, and to leverage and manage paradox (seeming opposite tensions).

Experience matters less in rapidly changing and volatile situations.  What matters more is the degree to which you’ve built leadership and thinking capacity in your organization.  As an example, SixSEED Partners was asked to offer change leadership training to a cohort of internal medicine physicians.  In partnership with the Chief Quality Officer, we designed a workshop where we introduced both/and thinking as an adjunct to traditional problem-solving thinking.  If these physicians have the thinking capacity to leverage individual AND team; mission AND margin; decentralized AND centralized needs; candor AND diplomacy; advocacy AND inquiry among others, then collaboration is strengthened and we increase their ability to lead sustainable change.

The Leadership Ecosystem Capacity Approach to Hire and Develop

What does this mean for you?  Here are several steps you can take make a better CEO hire:

1. Elevate talent development as THE FIRST Strategic priority- for the board; for the executive team and for each leader.

2. Ask your CEO candidates a question similar to the following:  “If your current organization were to give you a grade of A to F in relation to how well you’ve prepared them for your departure, what would they say?  On what would they be basing their rating?”  You want to listen for details around the use of development strategies like rotational assignments; creating a learning environment; internal promotions; and prepared successors.  You want to listen for a blend of “I” and “We” statements.

3. Assess for their thinking capacity to manage paradox:  “Give me an example of a decision you had to make where you felt torn between two or more competing perspectives.  Who was involved?  What was at stake?  What did you consider in your decision-making process?  What did you do?  What was the outcome?  What did you learn through the process?

Let’s hear from you

We’d love to hear your perspective as you and your board plan for your next CEO hire.  Please post your responses on our LinkedIn page or send us an email here.