Why It Matters
This list of five behaviors is intended to be open-ended — the starting point for health care leaders to thoughtfully examine their own leadership behaviors and practices.
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High-Impact Leadership Behaviors: Five Things Leaders Can Do to Promote Improvement

By IHI Multimedia Team | Tuesday, January 10, 2017
High impact leadership framework

What can leaders do on a daily basis to promote a culture of improvement?

An IHI White Paper lays out five high-impact leadership behaviors. According to its authors, Steve Swenson, MD, MMM; Michael Pugh, MPH; Christine McMullan, MPA, CPHQ; and Andrea Kabcenell, RN, MPH, “This list of five behaviors is intended to be open-ended — the starting point for health care leaders to thoughtfully examine their own leadership behaviors and practices."

“If they do nothing else, leaders should adopt these behaviors and know they will be moving themselves and their organizations in a direction that facilitates the transition from volume to value, driving to better performance.”

Below, we share an excerpt of the paper and provide more detail about the five leadership behaviors:

  1. Person-centeredness: Be consistently person-centered in word and deed

Person-centeredness is the sine qua non of professionalism. The most effective health care leaders are person-centered in word and deed, seeking opportunities to interact with patients and families frequently. A leader demonstrates person-centeredness with the following actions:

  • Routinely participating in rounds in the organization — whether in a medical clinic, hospital, or community service organization — to talk with patients and families.
  • Consistently inviting and supporting patient and family participation at board, leadership, and improvement team meetings.
  • Discussing results in terms of persons and communities, not only diseases and dollars.
  • Declaring harm prevention a personal and organizational priority.
  1. Front Line Engagement: Be a regular, authentic presence at the front line and a visible champion of improvement

The most effective leaders build trust and acquire and establish an understanding of the work at the front lines of care by regularly meeting with colleagues who deliver care at the bedside, in a clinic, or in the community, and exhibiting a genuine interest in the work performed. Behaviors like asking questions, sharing concerns, engaging in problem solving and improvement projects, and transparently discussing results (both successes and failures) help create leadership authenticity. A leader’s authentic engagement and presence at the front line of care helps motivate multidisciplinary teams, especially in the context of modeling improvement thinking and methods.

  1. Relentless Focus: Remain focused on the vision and strategy

It is leadership’s responsibility to create focus and urgency on high-priority efforts, starting with establishing a strategic vision for the organization and then translating that vision into an operational plan focused on the highest-leverage efforts. Relentless focus begins with framing the vision to be achieved and creating a sense of urgency.

In interviews with leaders, we discovered that most successful leaders intentionally develop and frame their “new vision,” then build a sense of urgency in the organization about the need to change to achieve that vision. These leaders also talk about how they build consensus, communicate with others throughout the organization (often personal communications, across many different settings), and monitor the organization to see if others are “getting it.” These leaders consciously spend time thinking about how to reinforce and role-model the vision through their own actions and behaviors.

Leadership behaviors that exemplify relentless focus include the following:

  • Talk about the vision every day, clearly articulating the measurable and unambiguous improvement aims. For example, to reinforce the organization’s current high-priority efforts, leaders may start every meeting with, “Remember, right now we are focused on three key safety initiatives and reducing wasted effort.”
  • Align leaders’ weekly schedules with high-priority initiatives in the organization.
  • Designate resources to high-priority efforts, and do not divert resources to projects that are not aligned with the organization’s strategic plan.
  • Review the results of the most critical initiatives weekly, removing barriers to progress.
  • Appoint the most effective leaders to high-priority initiatives and identify high-potential leaders in training.
  1. Transparency: Require transparency about results, progress, aims, and defects

In 1905, Dr. Ernest Codman pioneered the “end result idea,” contending that health care professionals should follow all patients to evaluate the results of their management and that the results be shared transparently with the public. Codman’s idea was unorthodox a century ago, but today it is recognized as the beginning of quality and person-centeredness. He understood that studying outcomes and transparency in sharing results promoted meaningful change and superior results.

Transparency is a powerful catalyst for organizational change and learning. It entails sharing data that demonstrates both positive results and defects, and helps reveal opportunities for improvement. Leaders need to be open and firm about the organization’s commitment to — and expectation for — transparency and a path to action for eliminating defects.

Deliberate use of transparency for transformation enables accountability and trust to develop, and promotes self-study and learning. Active transparency begets humility, and humility begets trust, the currency of leadership. The most successful health care organizations and leaders collect the most meaningful data on the most important patient care features and then relentlessly work to improve them. A leader’s transparency has many salutary effects; transparency helps to:

  • Build the will to improve care
  • Shape the culture into one of openness, with attention to eliminating defects
  • Raise improvement capability through access to real-time data
  • Track the progress to results such that mid-course corrections are possible
  • Engage partners and empower teams across boundaries
  • Provide patients and community members with opportunities to participate in improvement and motivate change
  1. Boundarilessness: Encourage systems thinking and collaboration across boundaries

The concept of boundarilessness bridges two closely connected leadership behaviors. The first is the genuine, action-generating receptivity and openness to ideas, or “mental boundarilessness.” It can be applied to an active search beyond one’s immediate confines for best practices when approaching problems. It is a model for successful engagement across boundaries, fostered by greater social capital, and an attribute of a learning organization. Leaders who play a key role in modeling and leading engagement across boundaries should establish the expectation for both adoption and active diffusion of practices and learning. Mental boundarilessness is tightly coupled with innovation and displayed by behaviors that emphasize curiosity — asking open-ended questions, encouraging others to seek and try new ideas, encouraging and promoting diversity, and encouraging non-traditional approaches to problem solving.

The second type of boundarilessness is reflected in the leader’s willingness to cross traditional boundaries, both internal and external, in the pursuit of Triple Aim results. With an increasing proportion of care aimed at persons with chronic conditions, care delivery organizations of all kinds will need to work together and with social service organizations to coordinate care across the continuum and deliver person-centered care. Their shared aim is seamless, coordinated care that answers the question, “What matters to me?,” for the people receiving care. Leadership across organizational boundaries requires new actions and relationships.

Each of these five High-Impact Leadership Behaviors accomplishes several leadership aims at once. For example, a leader who demonstrates person-centeredness by engaging patients or community members in key planning or improvement meetings, or by starting each meeting with a patient story, will reinforce a vision and build will, shape the culture, and of course foster a person- and community-centered organization. Taken together, they serve as a simple but powerful guide for the daily behavior of an effective health care leader.

You may also be interested in:

IHI White Paper - High-Impact Leadership: Improve Care, Improve the Health of Populations, and Reduce Costs

The IHI Quick Course - High-Impact Leadership - Developing Core Leaders

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