The limits of technical leadership

Imagine the following scenario:

You’re the director of a hospital’s cardiac care unit. Patients have reported they don’t feel listened to by physicians. This has led to worse HCAHPS scores, financial penalties, and patients going to competitors in the area.

In response, you implement training on reflective listening to equip team members to actively demonstrate that they’re listening to patients and trying to understand their situation.

All physicians participate in the training, but few seem interested in adopting reflective listening with patients. Some report they don’t have time to ask additional questions during already busy days. Others say the new guidance is too much to keep track of. Many seem to feel they’re forfeiting their role as the expert by spending more time listening than sharing information. Some physicians are communicating even more brusquely with patients, leaving nurses to try to smooth things over.

After hearing the complaints, you hire another physician to distribute the workload, hoping this will give the doctors more time to spend with patients. You establish a financial incentive system — physicians who fail to practice reflective listening will miss out on bonuses. You also create small job aids with tips on reflective listening for doctors to carry in their pockets and reference with patients. This seems to backfire even more; you find the job aids in the trash. Nurses report feeling overburdened, and some decide to leave. The challenges keep compounding, and patients and staff are suffering…

There are many things that have gone wrong in this scenario, but perhaps one of the most significant is that the unit director has tried to address adaptive challenges — which require individuals to adopt new beliefs, attitudes, and behaviors — with technical solutions. The unit director has failed to account for the more complex components of the problem: the physicians’ sense of loss related to their identity as the experts, the mindset shift required to prioritize listening to patients, the new behaviors that require giving up old workflows and habits. The unit director, in short, has focused on exerting authority rather than exercising true leadership — and they’ve run up against the limits of technical leadership.

The value of adaptive leadership

Technical problems have known solutions. The electricity goes out; an electrician makes the necessary wire repairs. An individual has a broken arm; a clinician sets it in a cast. A software platform has an error; a coder fixes the bug. These challenges vary in difficulty, but the solutions are clear and require minimal learning.

By contrast, healthcare leaders face complex challenges that we can’t always solve with our existing knowledge, skills, and approaches. These challenges include shifting to value-based payment structures, managing mergers and acquisitions to bring together diverse capabilities, navigating workforce shortages, and adopting new models of care.

To navigate these challenges, we must adapt. The concepts of adaptive leadership, a framework developed by leadership experts Ronald Heifetz and Marty Linsky, offer a new way to think about approaching complex challenges and transformative change.

This adaptation is crucial, but it can be painful, because with change comes loss. As the top scholars of adaptive leadership put it in the book The Practice of Adaptive Leadership: “When change involves real or potential loss, people hold on to what they have and resist the change…Adaptive leadership almost always puts you in the business of assessing, managing, distributing, and providing contexts for losses that move people through those losses to a new place.”

This resource serves as an introduction to help leaders understand and internalize the core concepts of adaptive leadership, a starkly different approach to leadership than what most have us have grown up with. Leaders will learn the difference between technical and adaptive challenges. Then, they’ll practice assessing the losses associated with adaptive challenges.

This workbook contains three sections, each with guided exercises and reflection questions:

1. Understand the core principles of adaptive leadership
2. Reflect on adaptive challenges in your own life
3. Practice recognizing adaptive challenges and loss

While the exercises can be done entirely independently, we recommend finding a partner or small group of peers that you can debrief with after going through the exercises individually.