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"Most people will not want to give the senior executives bad news. They will keep them from knowing the very things they need to know."
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What Leaders Don’t Know Can Hurt Them

By Donald Berwick | Tuesday, August 25, 2020
What Leaders Don’t Know Can Hurt Them

Photo by Ryoji Iwata | Unsplash

When I took over as Administrator of the Centers for Medicare and Medicaid Services in 2010, I knew it was going to be challenging to lead an organization of 5,500 employees who didn’t know me. A friend of mine offered me some advice by using an interesting analogy.

He told me to picture a crowded restaurant with a waiter carrying a full tray. The waiter is navigating her way around people and tables and she’s holding the tray way up high. She’s doing this to keep it safe and to keep anyone from touching it.

“You,” he said, “are now on that tray.”

What he meant was that often — perhaps always — distance develops between a leader — especially a chief executive — and everyone else. There are multiple reasons for this. One is kindness. One is fear.

Sometimes people are trying to protect the leader. They don’t want to make things harder for the executive. They don’t feel entitled to attention. This dynamic, despite its benign intent, keeps leaders from knowing what’s really happening in their organization. I’ve experienced this myself and understand that dynamic.

Most people will not want to give the senior executives bad news. They will keep them from knowing the very things they need to know: What’s the level of fear in the organization? What’s going wrong because I’m doing something wrong? What do you need from me that you don’t think I will offer?

All these questions should be asked with sincerity; people know when your curiosity is authentic. And, when people answer, you have to listen, even when — especially when — they’re telling you something that is difficult to hear, but important for you to know. That skill is very hard to develop.

Some leaders remain unaware of what is happening in their organization because of a different dynamic: they approach their job as if they have to be smarter than everybody else – as if they have all the answers.

Such leaders lack trust in their employees’ intent to do their jobs with pride and commitment; they believe that they have to make staff do their jobs. As a result, they use a control-oriented, incentive-based, and transactional approach to leadership. That approach denies leaders the information they really need because control-oriented management scares people. It makes employees fearful of being honest with their leaders. Sadly, relying on control and incentives is still probably the most common way to lead.

So, how do you create a dynamic that encourages relationship building, listening, and teamwork and helps you get the information you need to be an effective leader?

I think that the best approach, especially when times are tough, is to get people together to make sure employees feel reliable social and emotional support. Much more progress can happen when we’re together than when we are separate.

Of course, because we’re now forced into the virtual world, we’re having to learn how to connect in new ways. Instead of being in a room together, we’re on the web together. We’re all learning our way into using these new channels to provide the supports we need. Some things do work both in person and online. A willingness to be a bit vulnerable and human, for example, is important for effective leadership in face-to-face and virtual settings.

This reminds me of another story from 10 years ago. It took place in person, but I think its lessons would apply in the virtual world. When I took over CMS, I called an “all-hands” meeting with all 5,500 people on my third day of work. I wanted people to see me and learn a little about me.

Without thinking that it would be particularly noteworthy, the very first slide I showed was a photo of my family — my wife, children, and grandchildren.

In the months that followed, I probably heard about that slide more often than almost anything else I did with the staff at CMS. The idea that I would come and talk about my family made an impression. That hadn’t been my intention. It was an intuitive choice I stumbled into, but it taught me something about what builds relationships. It is tougher in the COVID period, but it’s still possible.

If I had to summarize my advice in a phrase it is this: effective leadership is not transactional; it is relational. What people value most in their leader are compassion, listening, humility, and seeking to understand. This was true long before the COVID-19 threat forced us into new forms of connection, and it is true now as well.

Donald M. Berwick, MD, MPP, FRCP, is President Emeritus and Senior Fellow, Institute for Healthcare Improvement.

Editor’s note: This post was adapted from remarks made during a recent episode of the IHI Virtual Learning Hour Caring for Caregivers call series delivered in partnership with Well Being Trust. This free series occurs every other Friday through September 11, 2020 from 10:00 AM – 11:00 AM ET. Learn more, register for future episodes, and watch past recordings.

You may also be interested in:

Why Is “Psychological PPE” Important for the Health Care Workforce?

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