Managing Professional Performance Requires Leadership

Leading and managing are two different disciplines, which share some theories and practices with some important differences.

When it comes to processes, managers monitor for variance, look for reasons for variances and then attempt to correct those variances within the boundaries of the system within which they work. Leaders challenge current processes, redesign processes, and create new ones. Managers keep the status quo functioning as best it can. Leaders change the status quo. When it comes to people, managers perform essentially the same functions as above with some important modifications, which require leadership skills.

First, people require clear expectations followed by coaching and if need be training. They need to be told when they are doing something right so they keep doing it and when they are doing something not quite right so they can correct.  The first time they are told to adjust its done in a supportive manner where the manager assumes positive intent, meaning they assume there may be gaps in knowledge and/or inadequate skills that need to be filled, and most importantly they assume the person wants to excel in their performance.

The second time under performance is discussed the approach is still supportive but includes a more inquisitive or Socratic approach, meaning the manager probes with non-judgmental questions what barriers might exist to better performance. Two-way communication is established. The coaching becomes more specific to the individual getting at those root causes for the under performance that are unique to that individual and situation.

The third time is when formal action plans are required.  Good managers are good at anything that’s formal, so they excel at the beginning (although handing someone a job description doesn’t count) and at the end of the process. Good managers, who are also good leaders, are also good at the coaching part. Coaching implies that the manager’s number one goal is to help the person perform better and have more pride in their work. Good coaches are servant-leaders.

Second, people respond best when there is respect, trust and collegiality in the workplace, in other words the stronger the culture the more likely people are to perform well. Managers need to nurture strong cultures. This takes leadership.  Culture aren’t necessarily managed, they are nurtured, renewed, developed, given identity, and modeled.  In other words, cultures are led, not managed.

There are some coaching leadership principles that are worth mentioning. First, feedback whether it be positive or negative, needs to be as immediate as possible. This isn’t because it sticks better, although it might, and it isn’t because details are needed to provide good feedback, although that might help, it’s because the sooner the person knows the quicker they can start to correct before it becomes habit or before so much damage is done that they can’t recover.  Second, coaching needs to include explanations, encouragement and empowerment. Third, among professionals (e.g. physicians) coaching is more an act of persuasion and influence. Its about being non-judgmental, and establishing mutual respect and purpose before having the conversation.  It’s about humility and dedication to the truth, and its about playing the role of servant leader.



The One Thing

I was recently asked what was the most important thing I’ve done to bring positive change to the Children’s Hospital where I’m a leader. I was surprised by the question because we’re early in the journey, what we’ve accomplished so far certainly isn’t just my doing, and it isn’t just from one thing.   I replied, “Relentless alignment, disciplined improvement, and empowering accountability.”  But I quickly realized it didn’t answer the question: “What’s the One Thing?”

Is it Relentless Alignment?  This does take the most effort and time. Alignment is important and one must be relentless in pursuing it. I started with the creation of a vision and plan, followed by formulating specific metrics and milestones.  And then came the constant consistent communication, which included clarity around priorities and transparency regarding results.  Alignment is about inspiring a shared vision and creating a renewed culture of excellence.

Is it Disciplined Improvement?  Constancy of purpose around continuously improving quality is important, but without discipline, it doesn’t happen. Consistent use of standard methods at all levels, and especially by the senior leaders, coupled with a culture of open communication, experimentation, and learning are required. It’s about the 20-mile march. We are using Lean and the science of quality improvement to provide the needed discipline.  We manage our projects using a disciplined approach.  And we prioritize our projects using decision support tools when possible.  Lean and CQI work well when used consistently with an unwavering discipline.  Standard work is a powerful tool.  Quality improvement is about optimizing outcomes while minimizing waste engaging everyone in the process using standard work to do so.

Is it Empowering Accountability?  I call this Management by Leadership.  When things don’t happen as expected or performance is less than desired, its often a systems issue, a communication problem, a structural misalignment, a talent and/or resource issue. And often one of the root causes is a lack of staff engagement. Front-line management often isn’t equipped or empowered to address these higher level issues. We’ve been emphasizing leadership more than management and systems more then individuals when it comes to what needs to work better.  I will admit, however, that I’m a management fanatic underneath.  I have checklists for everything.  However, I consider myself a management disciple of W. Edwards Deming.  I follow his theory of profound knowledge:  appreciation of systems, theory of knowledge, the psychology of change, and understanding of variation.

In health care, superb leadership is a must-have.  Yes, management excellence is also needed, but its best when born from excellent leadership.  The Leadership Challenge articulated by Kouzes and Posner has been a useful frame for me.  Leaders 1) inspire a shared vision, 2) model the way, 3) challenge the process, 4) enable others to act, and 5) encourage the heart. I see these 5 things as enabling a leader to achieve relentless alignment, disciplined improvement, and empowering accountability.

So, to answer the question “what is the most important thing?” I would have to say leadership is the most important thing that has made a difference at our children’s hospital.