Lightning Health Care Leadership

Alaina Love may be stating obvious in her June 2 Business Week commentary Leading at the Speed of Thought when she says: “Never before have leaders experienced the scale and complexity of change that they face now” but she thankfully gives us something worth pausing over as she considers some of the leadership adjustments that need to be made simply for survival as a result.

None of us knows what it really felt like to be a leader coping with the radical new inventions of the printing press, the automobile, or the telephone. But we assume those were times of relatively incremental and sequential environmental change than leaders were able to manage more expectantly than we can today. Even the introduction of the mainframe computer seemed to come at us relatively slowly. But the capacity for even small changes to cycle rapidly through introduction, dissemination, mutation, replication, and obsolescence is a contemporary phenomenon. And it seems, if anything, to be accelerating. Ms. Love reminds us that this demands a radically different approach to leadership:

In this high-stakes game of survival, the most successful leaders will demonstrate the ability to simultaneously monitor these forces, measure their impact, and create new opportunities rather than wait for them to appear. The rules of business have indeed changed — in a way that demands leadership at the speed of thought and the capacity to build measured, decisive, and inventive teams.

The article offers some insights and principles for survival that frame how leaders can retain sanity and perhaps improve effectiveness in this warp speed environment. Most applied pretty well to health care leaders. I divide them into three dimensions in which executive leadership competency is crucial: perception, decision making, and communication/engagement. Notably, “action” is a dimension left to managers.


The need to expand the number of radar screens: Love refers to the multiple signals coming to leadership’s attention simultaneously, like: tonight’s Board meeting requiring a crucial financial presentation; a bed/census crisis requiring 15 discharges immediately; a surgeon calling from the OR because a piece of equipment needed intraoperatively is malfunctioning and there is no backup for it; negotiations with several electronic health record vendors at a delicate stage; a belligerent family in the ED complaining about a prolonged wait; a fresh and time-limited opportunity to develop a piece of real estate in partnership with other parties; etc.

Ms. Love’s elixir is building leadership capacity: “.. for discerning what to ignore and what is critical to address because it affects success.” Health care leaders today must have the personal skills and hard-wired processes to help them prioritize, delegate, and – at times – defer issues that when standing alone would demand attention but in the context of competing signals must take a back seat.

100% Certainty is a luxury purchase: While careful decision making remains a leadership priority: “successful organizations in this new economy will be comprised of leaders who are decisive, measured risk-takers.” With fewer incoming signals leadership can afford to seek more certainty. With multiple, competing demands for leadership attention, requiring the highest degree of confidence for most decisions will be paralytic.

Physicians who practice in acute or critical care settings are accustomed to making decisions with less than perfect information, knowing the patient will deteriorate if the wait for confirmation is too long. In this case, executive leaders have something to learn from the trauma surgeon’s playbook. There’s a critical amount of information necessary for decision making – sometimes that also needs to be sufficient.

There is no time to solve the wrong problems really well: Healthcare leaders are creative, thoughtful, and improvement oriented. Even mission focused dreamers sometimes. According to Love, those are assets to be deployed in a measured fashion only for the highest priority issues: “Opportunities have long since evaporated for developing elaborate plans and strategies that aren’t applicable to the organization’s most pressing issues.”

Decision Making

Redistribute the authority to say ‘Yes’: In the article, this was all about enabling customer service representatives to please the customer. Good enough, but I’d like you to consider this to apply more broadly to the delegation. If there’s any failing I’ve seen frequently among senior healthcare leaders struggling to get on top of the multiple radar signals, it lies in the tendency to centralize rather than distribute authority and accountability.

The pace and complexity of problems and opportunities facing healthcare leaders absolutely require a layered accountable infrastructure comprised of competent and trusted decision making. If there’s any way to avert some of the leadership “no win” choice scenarios brought on by too many decisions on the plate, it’s to have some of the fly balls fielded well by subordinate and emerging leaders.


Trust and transparency are your allies – verify that you’ve communicated effectively: Ms. Love wisely counsels: “If leadership messages and crucial information about the state of the business are not penetrating all levels of the organization, the business will function with a handicap that may derail its success.” Right next to limited delegation on my list of healthcare leadership foibles is the tendency to communicate insufficiently, inadequately, unilaterally, or without sufficient intentionality to get people on board and committed to the direction required by the organization. And being unaware that they have failed.

As leaders, we are asking a lot of our followers. Not only to do more with less, and do it more quickly and more accurately, but bring others along and do so in a way that satisfies customers, colleagues, and partners. You simply can’t obtain that sort of allegiance without telling the story of organizational strategy well, completely, frequently, and with enough detail to make it an imperative. And oh yeah, by the way, listening to questions and concerns not only with an ear to giving good one line answers but as a barometer of understanding, support, and of constructive – and potentially initiative saving – advice and criticism.

You can’t win without smart, passionate people: I certainly can’t say it better than Alaina Love did:

“Everyone in this business environment needs to bring an A game, making it essential for leaders to identify the very best talent and then support their ongoing development. This is not the time to dial back on employee-development programs; it is the time to ensure that your development dollars are being spent where the return will be greatest.”

Your people are the only asset that can get leadership from today’s challenges to tomorrow’s success. Lightning or no lightning, ignore any other pithy advice given above and always take time for them.