ATD Blog

Transformational Healthcare Leadership Competencies

Tuesday, February 13, 2018

An important truism in healthcare today is that change is the only constant. Indeed, it seems as if the entire world is changing at warp speed. The external and internal environment seems to be populated with a whole new set of rules, regulations, devices, diseases, and demands. Consider the following set of terms added to the healthcare landscape: MACRA, population health management, accountable care, retail medicine, value based purchasing, bronze/silver/gold/platinum plans, Zika, personalized medicine, consumerism, big data, and augmented reality. To quote the late Dr. Ken Cohn, the tectonic plates (of healthcare) are shifting.

Whether by incremental movement or in large, unexpected jolts, the environmental forces confronting healthcare leaders today are creating conditions that pose significant challenges to even the most experienced executives. But the healthcare is not alone. Most sectors of the economy in the United States are facing similar rapid changes in their environments. Technology, consumer demand, globalism, supply chain, and workforce challenges are forcing nearly every industry to rethink their business model and make rapid adjustments to their operations. Those who fail to do so become obsolete and soon disappear from sight. Those who adapt live to fight another day. 

Case in Point

Let’s consider the case of healthcare delivery to examine how the industry has responded to the environmental forces affecting organizations. While there has been consolidation in the industry, healthcare delivery in the United States is still concentrated on hospitals and independent practitioners (recognizing that many physicians are moving into group practices that are affiliated with hospitals) that are paid by some variation of traditional fee-for-service reimbursement. 

Physicians are still trained using a template that was first put forth in 1910 within the Flexner Report.  Nurse education continues to be fragmented between associate degrees, bachelor degrees, and master’s degrees. And despite the presence of policies, procedures, rules, regulations, and overwhelming good intentions, estimates are that 400,000 people die in U.S. hospitals every year due to medical errors, and between 10-20 times that number are harmed but do not die as a result of the error.

Meanwhile, information technology that makes up the backbone of almost every other industry sector has been slow to adoption in healthcare. Many physicians continue to use paper-based medical records. Organizations that have bought in electronic health record (EHR) systems find that patient records don’t always “talk” with the EHR from a different vendor. The key point here is that healthcare delivery in both the out-patient and in-patient settings continue to operate in ways that were effective 30 years ago.

Call for New Competencies

If the healthcare industry is going to survive and thrive in the years to come, leaders need to quickly adopt a new set of competencies and personal practices. Here are five essential competencies required by healthcare leaders in the new world of healthcare.

#1. Emotional intelligence

For too long, we assumed that intelligence as measured by IQ was the critical measure of leadership and organizational success.  If we filled the management ranks with the smartest and most insightful among us, all would be well. As we know, though, that is not the case. Indeed, with so many intelligent members of the workforce, why is healthcare still in such a mess.


My observation is that in healthcare delivery, emotional intelligence (EQ) is probably more important than IQ. In Emotional Intelligence, Daniel Goleman notes that there are five key elements to EQ:  knowing one’s emotions, managing emotions, motivating oneself, recognizing emotions in others, and handling relationships.  Given the centrality of human interactions at all levels in healthcare delivery all five of these skills are vital for healthcare leaders. The good news is that rather than IQ, which is relatively fixed, it is possible to improve on each of the five elements of EQ.

#2: Systems Thinking
Healthcare delivery organizations are by their nature, complex organizational forms with multiple layers of management. Too often, within a single organization, healthcare operates as multiple silos, with each member of that silo isolated from others outside their domain. As expected, members of a group/department/division typically work to optimize their world without consideration for how others might be affected.  Experts refer to this as sub-optimization.

While not inherently bad, sub-optimization tends to detract from the function of the whole system.  The challenge for highly effective healthcare leaders is to create organizations where the walls of the hardened silos are transformed into semi-permeable membranes that allow for the free flow of information and best practices out of one part of the organization into another. Collaboration and cooperation between and among departments is the key to highly effective systems.

#3. Enhanced Conversation Skills
Human relationships are based in large part on the quality of conversations we have with one another. Assuming that none of us are truly telepathic, conversations require three elements: a sender, a message, and a recipient. But conversations go beyond a simple sharing of information,  and generally suggest that the sender and receiver are genuinely interested in one another and the quality of the message being delivered. Conversations imply a back and forth in which both parties are interested in the welfare of the other.

Healthcare organizations are made up of a whole series of conversations.  Some are short, some are long.  Some are highly complex, some are relatively simple. Some are easy to engage in, some are extraordinarily difficult.  It is incumbent on healthcare leaders to have conversations that matter. This includes a number of important attributes, including carefully listening to others, clear and unambiguous language, checking for understanding, and assuring that commitments made are carried out.


#4. Change Management
For most of us in healthcare, change is hard—and often met with resistance, hostility, and downright anger. If we accept the premise that the only constant in healthcare is change, then how do we help others and ourselves deal effectively with change along with our own emotional reaction when confronted with change that is imposed on us by some outside group or agency?

Effective healthcare leaders need to start by accepting the fact that when encountering change, everyone is giving up something no matter how large or small. There is an emotional response that is automatically triggered and varies depending on the scope and intensity of the change at hand. It is not enough to tell staff to “simply get over it and get back to work.” Although there are multiple change models in the business literature, healthcare workers must be given a compelling reason for the change, a clear sense of hope, and optimism for the outcome of change—and then given the time to make whatever is changing part of the new normal.

While change is constant, the human response to change is also constant.  Healthcare leaders need to lead change with the understanding that change management is an ongoing and continuous process.

#5. Embrace Chaos and Complexity
No doubt, some days our organizations seem to be a chaotic and complex mess that is completely out of control.  This observation actually aligns with how the universe actually works. Chaos and complexity are the norm. Organizations try to manage chaotic and complex behavior by imposing rules and regulations or policies and procedures. But how well are those working for you?

There is a compelling body of scientific and organizational literature that suggests over controlling a complex system (like a healthcare organization) has little chance of lasting success. An alternative is to present a few simple rules that apply throughout the organization and then consistently put them into operation. While full control might not be possible, healthcare leaders who adopt this perspective can get all staff moving in the same direction and working with a common purpose.

Next Steps

It is worth noting that none of these competencies fall into what I refer to as the typical healthcare buckets, such as finance, IT, legal, and so forth. Many would characterize these competencies as soft skills, which by their name are typically not considered as important as those things that we consider hard skills. From my perspective, I would prefer to think of the competencies mentioned as “essential skills,” which must be part of the tool kit of every healthcare leader who wants to make a real difference in their organization.

The challenge for all of us is how do we learn about these competencies? What’s more, how do we continually improve in our daily practice? The consistent execution of the competencies will make a profound difference in the performance of healthcare organizations now and into the future.

About the Author

Leonard H. Friedman is a professor and director of the MHA programs in the Department of Health Policy and Management at the George Washington University. Prior to that, he was a faculty member at Oregon State University. He earned a PhD at the University of Southern California, School of Public Administration, where his dissertation examined technology acquisition in hospitals in Southern California. Leonard’s scholarly work focuses on the mechanisms of organizational change and strategic decision making in healthcare organizations. His research explores building the resilience of healthcare organizations to respond to environmental jolts, using systems approaches to reduce medical errors, and helping to clarify the roots of organizational excellence in healthcare. Leonard’s teaching responsibilities have included graduate and undergraduate classes in healthcare management, organization theory and behavior in healthcare, healthcare law and regulation, strategic management, and leadership in healthcare organizations. His work is published in a variety of journals, including Advances in Health Care Management, Health Care Management Review, Frontiers of Health Services Management, Journal of Health Administration Education, Managed Care Quarterly, Journal of Healthcare Management, Hospital Topics, Physician Executive, and the International Journal of Technology Assessment in Health Care. Leonard was the chairman of the Health Care Management Division of the Academy of Management from 2003 to 2004 and chairman of the Association of University Programs in Health Administration from 2005 to 2006. He is a member of the Studer Group’s Fire Starter Hall of Fame. Leonard is a fellow of the American College of Healthcare Executives and is president of National Capital Healthcare Executives.

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Yes, interesting observations. There is useful research-based work on this topic globally - for example with these 9 competencies:
Shared Purpose
Leading with Care
Evaluating Information
Connecting the Service
Sharing the Vision
Engaging the Team
holding to Account
Developing Capability
Influencing for Results
Tim @ Think Learning
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Very interesting article!
I have worked with Public Healthcare organizations within the UK, helping them to bring their L&D Systems into a more modern, streamlined and easier to manage space. I am currently in the process of realising a similar operation here in the States. From what you say, it seems that healthcare organizations are really struggling right now with ensuring staff are receiving a great L&D experience.
I wonder how we can engage the right people on the topic?
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