Beyond Leader Development: Insights to Igniting and Revolutionizing Strategic-Minded Leader Development for a Healthier Tomorrow

Blip-Zip Executive Summary and Takeaways

Healthcare is facing a critical bottleneck: inadequate leader development. This article goes beyond my Skill-Will Matrix article. It tackles the issue head-on, proposing innovative solutions to build a future of strong, visionary leaders who can transform healthcare systems and deliver optimal care. Join us on this journey to a healthier, more resilient healthcare landscape.

1. Smash the competency trap: Shift focus from individual skills to collaborative leadership development.
2. Embrace complexity: Equip leaders with systems thinking and adaptability to navigate a VUCA environment.
3. Go beyond the textbook: Foster a culture of continuous learning and real-world experience.

Key Words

Leadership Competencies, Healthcare Systems, Collaboration, Complexity, Innovation

Introduction to the Bottleneck: Leader Development

While the environment of strategic health leadership changes over time, the need for effective leaders has not.^1-3 Why? Most transformation efforts fail and the health system is infinitely more complex and turbulent and must transform.^4,5 To be the world’s healthiest nation, an honest assessment of leader development programs must be completed.  A sense of urgency coupled with a new vision of leader development is required. 

Leader development is one aspect–the capacity to produce direction, alignment, commitment and achieve an aspirational vision–of the leadership development process is the other.6 If qualified leaders are not practicing the behaviors to lead complex transformation, collaboration, and changes in thinking, hiring authorities should consider other candidates. Human capital leaders should ensure the pool of candidates know and understand the criteria for success at all levels in a VUCA-driven environment. Do you? Why? 

With the proliferation of over 3,300 leadership books annually and over 900 nationwide leadership development programs, leader development is hard.⁷ US companies spend $14 billion annually on leadership development. Colleges and universities offer hundreds of degree courses on leadership. The cost of customized leadership development offerings from a top business school can reach $150,000 a person.⁸  Yet, leader development falls short in the health sectors. Why?

The Solution:  Better Strategic-Minded Leader Development

Transformational leadership—the ability to inspire, motivate, stimulate, and appeal to followers has become more prominent but not mainstream in health sectors.^1,7,9-11 At the same time, leadership theories such as collaborative and complexity leadership or a systems approach are challenging transformational leadership theories as a better fit with the healthcare environment. Compared to industrial-era leadership practices, the combination of transformational leadership, collaborative, and complex leadership practices holds promise for healthcare leaders at all levels—hence strategic health leadership (SHELDR).

Collaboration within and across organization boundaries to translate strategy, innovation, and individual behaviors into common practice and culture is lacking.^12-16 For example, transformational leadership does not consider the complex adaptive nature of creating whole system change including leveraging the social determinants of health (SDOH).

While thousands of publications and biographies on strategic, transformational, collaborative, and complexity leadership exist, few focus on the environment of healthcare and individual health leaders.

Except for the occasional CEO or CEO-equivalent interviews in popular peer-reviewed journals such as the Journal of Healthcare Management, few focus on cohorts of leaders. Operational leadership and management lessons are discussed in the book, Management Lessons from Mayo Clinic. However, they are not discussed in the context of transformational or change leader management behaviors. 

Dr. Toby Cosgrove, CEO of Cleveland Clinic, discusses trends and lessons defining the future of medicine and the need for optimism, innovative thinking, and a focus on solutions in his book, The Cleveland Clinic Way. It was difficult to acquire an understanding of his strategic leadership approach.

Former Kaiser Permanente CEO, George Halverson provides a prescription for change in his book, Healthcare Reform Now! However, it does not discuss the leadership skills to achieve such a complex change.17,18 Both have sat on panels to develop leadership principles such as the CEO Checklist For High-Value Healthcare and address the issues of complexity and required skill sets necessary to make the whole sustainable change, but they are not visible.¹⁹

As a federal health system (FHS) example, none exist on the leadership competencies of US Military Surgeon Generals (SG) either.  Why not? Do you know of any studies on strategic healthcare leaders?

The Leader and Leadership Development Business

Leader development is based on competency frameworks with origins in the 1960s. A study by the American Management Association (AMA) in the 1980s defined competency as an underlying characteristic of an individual “causally” correlated to effective or superior performance. ^{20 21} Since, competency frameworks have emerged to link performance to competencies: knowledge, skills, behaviors and attributes (KSBA). These competencies are used for ongoing development, education, and training.

However, according to Henry Mintzberg, “Acquiring various competencies does not necessarily make a leader competent. There is neither a linear or causal relationship between competencies and performance.” 22,23 Leader development focuses on developing individual knowledge, skills, behaviors, and attributes (KSBA) whereas leadership development focuses on building relationships among people in an organization dedicated to an outcome or vision. ^24,25 

Most health professions associations such as the American College of Healthcare Executives (ACHE), Association of Nurse Executives (AONE), American Association of Physician Leaders (AAPL), and the American Public Health Association (APHA) have developed competencies for their members.

However, competencies for leaders capable of leading their organizations at the strategic level in a VUCA-driven environment are in short supply and fall short of expectations. The ideal health system leader development program will challenge all healthcare professionals to work together to improve the health of a community.

Business And Healthcare Leaders Lack Confidence In Their Future Leaders

A 2012 poll by the Center for Public Leadership at Harvard University showed as many as 70% of Americans blame the leadership crisis as a factor in the national economic decline of which the healthcare industry is a big part. Trends in executive development study found many CEOs are concerned their up-and-comers lacked the ability to think strategically and manage change (yet, many of them sponsored or mentored them).²⁶

The 2014 Deloitte Business Confidence study surveyed 300 full-time C-level executives and found a majority did not believe their direct reports had the skills for greater leadership roles citing a lack of leadership training for other reasons.²⁷  Say What?

When upward of 500 executives were asked to rank their top three human capital priorities, leadership development was included as a priority; two-thirds of the respondents identified leadership development as the number-one concern.8  From a healthcare perspective, a 2011 survey of hospitals and other health systems found executives indicated their leadership development programs were variable from organization to organization.²⁸

The 2014 ACHE Professional Development Task Force (ACHE PDTF) recently identified the core and emerging leadership competencies needed for healthcare executives to succeed in a rapidly evolving VUCA-driven healthcare environment.²⁹ The ACHE PDTF stated the emerging competencies are similar to strategic leadership competencies identified throughout the literature.³⁰

Organizations Agree: We Need to Modernize Leader Development

The leadership development challenge in healthcare is considered to be in a state of crisis today.^31,32 Experts think healthcare education and leader development communities fall short of expectations. According to a survey sponsored by the ACHE, given the rise of complexity and integration over the past 15 years, healthcare leadership development in healthcare has faltered. When compared to other business sectors, the healthcare industry has been slow to respond to changing trends.³³

Recent surveys 355 (collected 104 responses 29% of the sample) healthcare executives in July 2007 indicated only 50 percent of the respondents reported having a formal leadership development program in place and most of those programs had been established after 2003; another 12% reported having a program under development.^31,32 The driving force to create these programs was healthcare organization dissatisfaction with how prepared healthcare executives were when promoted to positions of senior leadership.^31,34

Many associations and experts report leader development programs fall short of developing leaders capable of transforming a complex health system at any level. For example, the Center for Creative Leadership (CCL) identified gaps and opportunities in health leadership development practices. The results indicated the environment has changed—it is more volatile, unpredictable, complex, and ambiguous or VUCA-driven. The skills needed for leadership have also changed—more complex, adaptive, and system thinking abilities are required.³⁵  Sound familiar?

The methods being used to develop leaders have not changed (much).^36,37 CCL found an identical need in its 2011 White Paper Boundary Spanning Leadership—in interviewing over 128 senior executives they identified a mission-critical gap between the 86% who believed it was “critical” to work effectively across boundaries and the 7% who felt they were currently “very effective” at doing it.³⁸

Organizations have come to understand developing leaders is achievable. Developing leaders can be improved by strengthening the connection between, and alignment of, the efforts of individual leaders and the systems through which they influence organizational operations.³⁹ Strategies tend to fail when executives do not recognize their organization’s environment is changing and fail to adapt and integrate their emerging leader’s needs with the organization.^7,40

A Clear Healthcare Leadership Development Strategy Is Critical

Gaining clarity about what matters most within the health sector allows organizations to set a leadership strategy and individuals to direct their learning and development.⁴¹  CCL’s Benchmarks research analyzed a sample of 34,899 leadership-effectiveness evaluations taken between 2000 and 2009 from people working across the healthcare sector.  According to the results, the ability to adapt and lead others in an uncertain and complex environment was a significant competency or derailment factor. 

The top priorities for leadership development in the healthcare sector were the ability to lead employees and work in teams, create strategies to provide current and future leaders broad, cross-organizational experiences and learning, capacity to work across boundaries and communicate effectively.³⁷ 

The Academic and Association Community Is Taking Notes

In a recent study by Dr. Regina Herzlinger, Harvard University, found 25% of the interviewed healthcare organization CEOs noted they were so dissatisfied with traditional healthcare administration education they developed their own training programs.42 The study also underscored the need for entry-level graduates to continuously upgrade their KSBAs. For example, according to Dr. Regina Herzlinger’s study, content analysis of the top Master of Healthcare Administration (MHA) programs, and an article in the Lancet, curriculums tend to focus on isolated, theoretical subjects, such as analytics and problem-solving. 

For CEOs, MHA programs need to be team-oriented and contain practical problem-solving skills required for innovation and systems thinking.⁴² This observation is similar to studies that identified major gaps between current practice and leadership expectations.  According to the study, high-priority patient service improvements are seldom achieved due to management gaps and perverse volume-based reimbursement systems.  This dilemma is further complicated by a lack of information systems, trust and not communicating a vision more often.^43,44

Organizations such as the American College of Physician Executives (ACPE), American College of Healthcare Executives (ACHE), Association of Nurse Executives (AONE), and the American Public Health Association (APHA) have developed leadership competency models for their members. These competency models are similar, yet different, and concentrate on one aspect of leadership. For example, the AONE and AHPA focus on systems thinking and complexity as a competency while the ACHE focuses on leadership at the operational or single system level.^45-48  This finding is why it is important to understand the historical evolution and impact of leadership theories and models on healthcare leaders. Do you agree?

The Federal Health Sector Faces Similar Challenges

The federal health sector has also recognized a gap in leader development.  All have concluded, there is a need for more strategic-minded leaders at all levels in more numbers. A two-year RAND Corporation study, Developing Military Health Care Leaders Insights from the Military, Civilian, and Government Sectors reviewed medical leadership competency models—including the military medical leadership competencies identified by the Joint Medical Executive Skills Program (JMESP).⁴⁹

After 90 military health professions leaders and civilians interviews from 25 organizations including the Veterans Health Administration (VHA), the study concluded the federal health sector does a good job of preparing healthcare leaders for executive positions with job assignments, education and training, informal mentoring, and annual reviews. Their comments, along with those of the civilian and VHA respondents suggested several leader development improvement opportunities including understanding stewardship, understanding of the larger context in which the organization operates (or systems-level thinking), and understanding of the global environment ⁴⁹

Senior healthcare leaders also expressed the need for federal healthcare agencies to coordinate organizational development activities across organizational boundaries and learn about their organizations to ensure tomorrow’s executive interagency leaders will be developed from clinical and administrative settings.49 How do you propose the development of future strategic-minded leaders?

In two similar efforts, two federal future groups identified and described skills required of future healthcare leaders in the federal, military, state, nonprofit, and private sectors at the strategic level. The research utilized 47 senior healthcare federal sector leaders representing various federal health agencies to conduct focus groups during a two-day leadership summit.  Participants identified 165 possible skills; researchers conducted content analysis to derive 12 overarching skills. These 12 skills were the ability to build partnerships, develop trust, thrive in complex and ambiguous environments, listen actively, think with agility, create conditions for success, assert aspirational future-based leadership, develop present-moment awareness, create an interagency learning network, develop network leadership, develop network goal setting and maintain resilience.

According to the researchers, only the first six skills are noted in the literature.^50,51 A similar assessment of senior military leaders indicated the need to develop leaders who can better understand the environment, think critically and strategically, anticipate and adapt to surprise and uncertainty, recognize change and lead transitions, and operate on intent, empowerment, and understanding.⁵²

Further, in the wake of the Department of Veterans Health Administration (VHA) issues, an independent assessment noted the health system faced crises in leadership and culture along with other systematic problems. The report shed light on systemic, critical problems currently facing the integration of the VHA’s health system. Researchers probed (interviews, visits, and data analysis) hospital care, medical services, and other types of care at 87 VA facilities. According to the report, “VHA leaders operate within a challenging and disempowering environment that discourages emerging leaders from seeking promotion within the organization. 

A misalignment of accountability and authority exists within a broader culture of risk aversion and lack of trust. VA hospital leadership is characterized by unclear roles and responsibilities among staff. The researchers concluded the administration is not well positioned to succeed in the transformation of the VHA.⁵³

Summary: Organizations Succeed With Improved Leader Development

The US health system must become a more high reliable health system and the healthiest population in the world before it is too late.  The legacy of the lingering health reforms since the 1900s up until the passage of the PPACA underscores the degree of “wickedness” and an unsustainable health system on life support.  While the effects of the 2,800-page PPACA are uncertain,54 what is certain, leadership, especially strategic health-wide or multi-health system leaders, and equivalents must accelerate the transformation of the leadership in the right direction or suffer the consequences.

Today’s healthcare leaders must move beyond the current to an aspirational state. The bottleneck of leader development must be broken and modernized. 

Global, national, and local communities can become healthier if organizational structures, processes, and leader development change.  The compelling need for an innovative high reliable health system and healthier population must be a challenge for healthcare and non-healthcare sector organizations. Large and small agencies in both public and private sectors, which share a vision for a healthier community require strategic-minded leaders at all levels to realign structures, processes, and relationships as transformational and collaborative efforts rather than temporary, superficial or cosmetic modifications.¹⁶ Do you agree?

Deep Dive Questions

These thought-provoking questions encourage introspection and challenge assumptions about your own leadership journey and its alignment with the concepts discussed in the article. Reflecting on these prompts can spark personal growth and inspire action.

How can we cultivate a healthcare system that encourages risk-taking and experimentation, fostering leadership growth?

1. How do your current leadership practices align with the requirements of a complex, evolving healthcare landscape?
2. What are the biggest obstacles you face in fostering collaborative and innovative leadership within your organization?
3. How can you leverage your own strengths to bridge the gap between traditional leadership models and the demands of the future?
4. What steps can you take to advocate for more effective and impactful leader development programs in your field?
5. How can you personally champion a culture of continuous learning and adaptability in your leadership journey?
6. Can leader development bridge the gap between clinical and administrative silos, creating truly integrated healthcare teams?
7. How can we leverage technology and data to personalize leadership development pathways for individual growth?

Professional Development and Learning Activities

Ready to take your leadership to the next level? These activities provide opportunities to apply the insights from the article directly to your own journey. Experiment, explore, and discover your potential to become a transformative healthcare leader.

1. Shadow a Leader: Experience leadership firsthand by shadowing a successful healthcare leader for a day.
2. Build a Learning Circle: Gather colleagues for weekly discussions on leadership challenges and solutions.
3. Lead a Community Project: Take on a community health project to apply leadership skills in a real-world setting.
4. Create a personal leadership development roadmap: Identify your strengths and weaknesses, set specific goals, and outline concrete steps to achieve them.
5. Build your collaborative network: Connect with other leaders in your field, share best practices, and learn from each other’s experiences.
6. Champion innovative learning initiatives: Advocate for leadership development programs that emphasize real-world problem-solving, systems thinking, and continuous learning.

Read More

Beyond Leader Development: Insights to Igniting and Revolutionizing Strategic-Minded Leader Development for a Healthier Tomorrow

Blip-Zip Executive Summary and Takeaways

Healthcare is facing a critical bottleneck: inadequate leader development. This article goes beyond my Skill-Will Matrix article. It tackles the issue head-on, proposing innovative solutions to build a future of strong, visionary leaders who can transform healthcare systems and deliver optimal care. Join us on this journey to a healthier, more resilient healthcare landscape.

Smash the competency trap: Shift focus from individual skills to collaborative leadership development.

Embrace complexity: Equip leaders with systems thinking and adaptability to navigate a VUCA environment.

Go beyond the textbook: Foster a culture of continuous learning and real-world experience.

Beyond Leader Development: Insights to Igniting and Revolutionizing Strategic-Minded Leader Development for a Healthier Tomorrow

Resources and References

Want to learn more? This list of recent and authoritative references provides a springboard for further exploration. Dive into research, discover inspiring case studies, and stay ahead of the curve in the ever-evolving landscape of healthcare leadership development.

1. Rubino, L., Esparza, Salvador, Chassiakos, Yolanda. (2014). New Leadership for Today’s Healthcare Professionals: Concepts and Cases. Burlington, Massachusetts, Jones and Bartlett Learning.
2. Belasen, A. T., Eisenberg, Barry, Huppertz, John W. (2015). Mastering Leadership: a Vital Resource for Healthcare Organizations. Burlington, Massachusetts: Jones and Bartlett.
3. The Center for Creative Leadership (CCL): Reports and research on healthcare leadership gaps and strategies.
4. American College of Healthcare Executives (ACHE): Leadership competency models and professional development resources.
5. Regina Herzlinger’s Publications: Unmasking the shortcomings of the healthcare system and traditional healthcare leadership education.
6. RAND Corporation Study: Developing Military Health Care Leaders Insights from the Military, Civilian, and Government Sectors.
7. Federal Futures Group Reports: Identifying skills needed for future strategic healthcare leaders. Available upon request.
8. National Center for Healthcare Leadership: Dedicated to advancing healthcare leadership and organizational excellence by building diverse, inclusive, and collaborative relationships in the US and abroad.
   

About the Author

I am passionate about making health a national strategic imperative, transforming and integrating health and human services sectors to be more responsive, and leveraging the social drivers and determinants of health (SDOH) to create healthier, wealthier, and more resilient individuals, families, and communities. I specialize in coaching managers and leaders on initial development, continuously improving, or sustaining their Strategic Health Leadership (SHELDR) competencies to thrive in an era to solve wicked health problems and artificial intelligence (AI).

Visit https://SHELDR.COM or contact me for more BLIP-ZIP SHELDR advice, coaching, and consulting. Check out my publications: Health Systems Thinking:  A Primer and Systems Thinking for Health Organizations, Leadership, and Policy: Think Globally, Act Locally. You can follow his thoughts on LinkedIn and X Twitter: @Doug_Anderson57 and Flipboard E-Mag: Strategic Health Leadership (SHELDR)

Disclosure and Disclaimer:  Douglas E. Anderson has no relevant financial relationships with commercial interests to disclose.  The author’s opinions are his own and do not represent an official position of any organization including those he consulted.  Any publications, commercial products, or services mentioned in his publications are for recommendations only and do not indicate an endorsement. All non-disclosure agreements (NDA) apply.

References: All references or citations will be provided upon request.  Not responsible for broken or outdated links, however, report broken links to [email protected]

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