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Careers

How to Be a “Humbitious” Leader

Empirical evidence connects humility and ambition with high performance.

Humility is making a comeback as one of the most sought-after professional virtues organizations look for in candi- dates. The Wall Street Journal reported that humility is becoming the “flavor du jour” among executives in large companies, as boards are increasingly looking for humble leaders.

When Krispy Kreme Doughnuts was looking for a CEO a few years ago, the main traits it identified as important for the leadership role were that of humility and servant leadership. Similarly, humility is what Google has been looking for in its new hires. “Without humility, you are unable to learn,” Lazlo Bock, senior vice presi- dent, people operations, Google, told Harvard Business Review. A recent arti- cle in the Journal of Business Ethics agreed that, “the humble leader is pre- cisely the person who is best qualified to transform his firm into a profitable, successful and respected organization.”

What does humble leadership actually mean? The book Executive Ethics: Ethical Dilemmas and Challenges for the C-Suite identifies the five foundations of humility related to leaders as authen- ticity, teachability, transparency, humaneness and interdependency.

Humble, authentic leaders confess to their followers that they make mistakes

and ask for their patience in correcting them. They demonstrate their teach- ability by acknowledging openly when they are wrong and asking for forgiveness when mishaps happen. They are transparent and admit when they don’t know something, and they constantly ask their team members for their ideas. They show their humaneness by accepting that they can’t do everything and that they need all their followers’ talents to achieve their goals. And finally, they exhibit interdependency by stressing that they are there for a larger purpose and not for themselves. Humility is not, as some people believe, weak- ness, low self-esteem, lack of assertive- ness or absence of ambition. On the contrary, humble leaders are ambitious, strong, self-confident and fiercely deter- mined. They are also highly effective.

The Case for Humility The introduction of humility into lead- ership studies can be credited to Jim Collins and his management book Good to Great (Harper Collins, 2001). Collins and his team identified compa- nies that made the transition from good to great financial performance over time and concluded that they were all headed by “level 5 leaders” who are humble and fiercely ambitious. Collins and his team were surprised to discover the type of leadership required for

turning a good company into a great one. He notes: “Compared to high- profile leaders with big personalities, who make headlines and become celeb- rities, the good-to-great leaders seem to have come from Mars.”

These findings provided empirical evi- dence to what many had suspected for a long time: humility and ambition, or “humbition,” are related to high per- formance. However, what wasn’t clear from Collins’ analyses is how humility and positive outcomes are actually connected, and recent research is start- ing to clarify that connection.

One way leader humility can affect performance is through employee engagement and satisfaction. A study of a large health services organization asked employees to rate the humility of their immediate supervisors. The employees were also asked to assess their own job engagement and satis- faction. The results were published in 2013 in the journal Organization Science. Participants who viewed their leaders as more humble were more likely to report being happy at work and less likely to voluntarily leave the organization.

“In contrast to ‘rousing’ employees through charismatic, energetic and idealistic leadership approaches […], our study suggests a ‘quieter’ leader- ship approach, with listening, being transparent about limitations, and

Amer Kaissi, PhD

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Healthcare Executive NOV/DEC 2017

54

appreciating follower strengths and con- tributions as effective ways to engage employees,” wrote the authors of the study. In the current labor market, where organizations are struggling to attract and retain talent, humility can be a valuable competitive advantage. Another way leader humility works is by creating a culture of shared unpre- tentiousness that enables the team to grow and reach its full potential. For example, research published in 2016 in the Academy of Management Journal found teams that perceived their lead- ers as willing to learn, able to admit to not knowing something and likely to compliment others on their strengths had higher collective humility, team growth and performance. These find- ings provide empirical evidence to

support the old adage, “leaders should lead by example.” Similarly, humble lead- ers in private companies were found to empower their top and middle managers to collaborate, share information, make joint decisions and develop a shared vision in an Administrative Science Quarterly study, published in 2014.

The results from a study of healthcare organizations published in my book Intangibles: The Unexpected Traits of High-Performing Healthcare Leaders suggest that leaders who are approach- able not only create an environment where employees feel comfortable, but also foster improved outcomes in the organization. My team received sur- vey responses from 577 employees, supervisors, directors and executives working in nine different hospital and

health systems. When asked about the leadership traits that have had a negative influence on their career, 52 percent of the respondents chose arrogance as the top factor, making it the most common negative leader- ship trait chosen. Many respondents indicated that nothing has been more damaging to their career than having an arrogant boss. Similarly, when asked to describe the one leader that has been the least successful in terms of improving outcomes in the organi- zation and getting things done, 44 percent of respondents described this leader as “self-focused” and 42 percent described the leader as “arrogant.”

According to these results, not only do self-focused and arrogant leaders

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frustrate their followers and disen- gage them, they also may drive their organizations into poor performance. Here are some day-to- day techniques and behaviors healthcare leaders can adopt to increase their humility:

How to speak: Use “we” instead of “I”; talk about team accomplish- ments; greet team members and gen- uinely listen, understand and reply to them; and use respectful language.

How to be approachable: Have a true open door policy but protect your time when necessary; talk to employees at all levels; turn off elec- tronic devices while listening; avoid cell phone use in the hallways so you are able to greet others as you pass by; and—much like clinicians—do rounds in your units regularly and purposefully.

How to give credit to others: Give credit frequently but only when it is due; acknowledge employees doing something good; say, “You went above and beyond,” to employees who exceed expectations; and provide prompt, accurate and sincere feed- back to those looking to improve.

How to handle mistakes and failures: Be calm and controlled; identify root causes, not scapegoats; have tough conversations with low- performers; admit mistakes, accept responsibility and move on.

How to respond to success: Brag about and celebrate team and organi- zational accomplishments; share credit; don’t show off with status symbols; build on successes for future improvements.

Effective leaders are admired for their humility and are respected for their ambition. They are humbitious. There is an abundance of empirical evidence that strongly suggests that these types of leaders achieve signifi- cantly more success in the long run for themselves, their teams and their organizations. s

Amer Kaissi, PhD, is an executive coach, speaker and professor, the Department of Health Care Administration, Trinity University, San Antonio. He is also the author of the Health Administration Press book, Intangibles: The Unexpected Traits of High-Performing Healthcare Leaders ([email protected]).

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58 NOVEMBER/DECEMBER n 2017

HEALTH CARE ORGANIZATIONS

BRINGING VALUE

AT TOP ORGANIZATIONS, LEARNING MEANS LIVING n Eugene Fibuch, MD, CPE, CHCQM, FACPE, FABQAURP, and Jennifer J. Robertson, MD, MSEd, FAAEM

In this article … In a “learning organization,” knowledge is power. Acquiring information and processing it into useful business insight is essential in every industry, including health care. Physician leaders have an important role to play.

THE CONCEPT OF ORGANIZATIONAL LEARNING includes both acquisition and dissemination of knowledge that an organization can use to shape its future. To efficiently man- age the information, learning organizations use knowledge management systems to facilitate sharing and integration.1,2

Using these systems, learning organizations have the ability to think for themselves, communicate effectively internally, and use the knowledge they acquire to create and innovate.

It is important to know the difference between “organiza- tional learning” and a “learning organization.”3

Any institution may participate in ongoing organizational learning, yet only a few can be called learning organizations, especially in health care. That’s because there are environ- mental, organizational and ecosystem constraints on every health care organization that limit their planning, financing and operational functions.4 Accordingly, the scope and prac- tice of a health care organization as a learning organization should be viewed in that framework.

Successful organizations are those that continually evolve, using specific tools and strategies to adapt to the changing marketplace. The best ones take a learning organization ap- proach. While organizations can offer learning activities, they aren’t learning organizations until they undergo key process changes. That includes a transformation in which all primary stakeholders are involved — senior management, the board of directors, the medical staff and, of course, the workforce.4

Specific conditions within an organization are essential to facilitate learning, including the capabilities for continuous im- provement, a willingness to practice the newly acquired skills, taking the necessary risks to learn, providing feedback to the participants, and fostering a climate of rewarding all learning participants.4 Often, that means major cultural change must occur within every aspect of the organization and its related processes.

In addition to the conditions noted above, six additional critical elements5 help define a learning organization:

THE CONCEPT The idea of “learning organizations” took root after the publication of organizational expert Peter M. Senge’s seminal book, The Fifth Discipline (Currency, 1990). It focuses on group problem-solving through “systems thinking” — understanding how a system works by examining the relationships among the unique components.

With that understanding, an organization’s employees can create, acquire and transfer knowledge that allows the organization to adapt to unpredictable market conditions more quickly than competitors.

American Association for Physician Leadership® n Physician Leadership Journal 59

Organizations that are able to acquire knowledge faster than their competitors, and process it into useful insights for business, have a distinct advantage in the marketplace. This isn’t a new concept, but it has taken on contemporary importance in today’s ever-changing business environment.

60 NOVEMBER/DECEMBER n 2017

n A process of continuous knowledge acquisition by the workforce and the integration of this knowledge into routine institutional processes.

n Effective knowledge generation and sharing among participants.

n Critical systems thinking.

n A culture of learning.

n A group spirit of flexibility and experimentation.

n An organizational culture that values its workforce.

These additional critical elements characterize and define the organization’s knowledge management system. An effec- tive system creates the ideal framework for an organization’s workforce to learn and compete.

FIVE ENABLING DRIVERS

In today’s competitive business environment, an organization’s only sustainable advantage is its ability to acquire knowledge at a faster rate than its competitors.2 Understanding this is critical in a modern, ever-changing health care environment.

In addition to the concept of rapid knowledge develop- ment, there are five enabling drivers that, if mastered, will pro- pel any health care organization to higher levels of knowledge acquisition. These drivers began appearing approximately 20 years ago but only now are starting to converge into an or- ganizational learning model. These drivers include:

n Systems thinking: Seeing the big picture and how work processes are linked.

n Personal mastery: Making individual commitment to lifelong learning.

n Mental models: Managing preconceived ideas that could hinder new insights and ideas.

n Shared visions: Building visions that will survive good times and bad times.

n Team learning: Realizing organizations cannot learn and improve if team members cannot learn and improve.

One could argue that these drivers can be organizationally grouped under one common strategic initiative: the ability to innovate faster than your competitors.

Employees must become skilled at acquiring, mastering, and transferring and/or teaching new knowledge. Senior lead- ers must be able to allow their organization to remain flex- ible, take risks and use newly acquired information within the framework of the organization’s strategic plan.

Despite a significant amount of information advising lead- ers how to put a learning organization into operation, there has been significant difficulty in doing so.6 Senior leaders have had problems measuring organizational progress, using important tools of a learning organization successfully, and managing knowledge for innovation.6

To help direct physician leaders, three primary operational pillars are key starting points for organizational learning and adaptability.6 They are:

n Developing a supportive learning environment.

n Building strong learning processes into the culture and work systems of the organization.

n Developing leadership behaviors that reinforce organi- zational learning and knowledge acquisition.

THE ROLE OF PHYSICIAN LEADERS

To help develop a supportive learning environment, physician leaders should consider directing attention to creating psy- chological safety for their employees.6 The idea of removing psychological risk from the workplace first was proposed in the 1950s by Edward Deming in his famous “14 Points for Total Quality Management.“ Workers must feel safe, rather than fearful of their superiors, so that they can work effectively with their leadership team, rather than withdrawing out of fear of retribution.7

Physician leaders also should be open to differences of opinion and opposing ideas. This attitude energizes individuals and tends to spark creativity and innovation. Third, employees should be encouraged to explore new ideas, even if these new ideas entail some risk. Finally, physician leaders should factor in some time during the day for problem-solving and thoughtful reflection among their employees.

Another major task for physician leaders in helping to de- velop a learning organization is to create the subsystems of the learning processes and practices.6 These include the processes of generation, collection, interpretation and dissemination of information.

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American Association for Physician Leadership® n Physician Leadership Journal 61

Information in any organization resides not only in the formal written arena of protocols and white papers, but also in the minds of the workforce. For physician leaders, the ability to tap into this workforce knowledge for organizational innova- tion is important. Many successful companies are using their employees to advance innovation and learning through team interaction, knowledge sharing across silos, and shared infor- mation data banks. Finally, senior leaders must reinforce the learning environment, which entails human behavior. When the environment is safe and leaders are supportive, employees will be willing to entertain alternative ideas without fear of losing their jobs.

CREATING THE STRUCTURE

Learning organizations neither can be developed nor sustained without understanding the underlying structures that allow organizations to constantly acquire and maintain new knowl- edge.8 Think of these as the foundation, pillars and roof that compose a physical building.

n Foundation: management science, computer science, organizational development and cognitive psychology.

n Pillars: the organization, its people, knowledge and acquired technology.

n Roof: the environment, the economy, society, politics and evolving technology.6

For physician leaders, each of these components has im- portant ramifications for guiding and directing not only the organization, but also in helping facilitate the ongoing devel- opment of the medical staff.

The list of substructures might sound fairly abstract, and it might be unclear how to ensure an organization has a realistic, easy-to-understand and actionable definition of a learning organization that is also acceptable to all levels of the work- force. Many suitable definitions have been proposed over the years, but here’s one of the best: “A learning organization is an organization skilled at creating, acquiring and transfer- ring knowledge, and modifying its behavior to reflect new knowledge and insights.”6

What should be recognized is that learning begins with newly acquired ideas. New ideas sometimes are created in- ternally, but they may also be acquired from the outside. It is not simply the act of generating new ideas but rather the act of generating and incorporating these new ideas into the fabric of the organization.

How many team events generate lots of ideas that are never actually implemented? Learning organizations find ways to translate ideas into action. They know how to positively change the behavior of the workforce. Physician leaders who wish to ensure their organizations are learning organizations should develop an understanding of organizational dynamics and personal interplay among key constituencies.

FIVE ACTION PLANS

Physician leaders should focus on five specific action plans when thinking about how to develop their organization into a learning organization.6

n The first is related to problem-solving. Continuous- improvement organizations use specific tools, such as Deming’s Plan-Do-Check-Act Cycle, to ensure conclu- sions being reached by work teams are scientifically valid. In addition, using statistical methods ensures bias-free decision-making. This analytical approach creates workforce discipline and helps remove non- fact-based decisions. Systematically embedding these tools throughout an organization is critical to get every functional aspect of an organization aligned.

n The second is experimentation. For health care organi- zations, this often is difficult when they’re focused on protocols, pathways and policies. Ongoing experimen- tation requires risk-taking, employee time, educational programs, resource allocation, and a defined process that allows ongoing experimentation.

n The third is to learn from the past. Human nature tends to extoll success while ignoring failure. But learning from failure is powerful — and perhaps the ultimate teacher. Most physicians hate failure and rarely admit to it. Yet they have used trial and error to improve

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their practices for centuries. Using information from others is an important concept, sometimes known as “benchmarking.”9 We can learn from colleagues, other organizations, our own actions and from customers. Organizations that do learn and can incorporate it into cohesive processes to retain learning and knowledge will be more competitive.

n The fourth is to learn how to transfer knowledge. Learning shouldn’t be one person learning a new technique. It must be a widespread effort so it can be effective organizationally. For example, many medical staffs employ “grand rounds” in which all members participate and learn from a presented case study. Many organizations also use site visits, training pro- grams and cross-training to further the acquisition and sharing of knowledge.

n The fifth is to develop yourself as a teacher, a designer and coach. There is no easy process available for that. Learning organizations are not built overnight, but rather are cultivated over time. Same for individuals. Se- nior leaders should ensure appropriate commitments, management and processes are established to allow learning to flourish — not only for physician leaders, but also for medical staffs.

Consider starting with fostering an environment that’s conducive to learning.6 Physician leaders should build in time for reflection, analysis and strategic planning. This should in- volve all members of the workforce, who should be trained in brainstorming techniques and problem-solving. Problem- solving should be done in the context of team activity across the organization. Physician leaders should ensure that there are adequate resources, both in time and money, to support team activities of their organizations, and also should work to eliminate any boundaries or silos in their organizations. Reduc- ing boundaries allows an organization to develop powerful and stimulating learning activities. Creating an environment of openness also allows for effective communication, sharing of ideas and risk-taking.

Eugene Fibuch, MD, CPE, CHCQM, FACPE, FABQAURP, is professor emeritus at the School of Medicine and co-director of the physician leadership program at the Henry W. Bloch School of Management at the University of Missouri in Kansas City.

Jennifer J. Robertson, MD, MSEd, FAAEM, is an assistant professor in the emergency medicine department at Emory University in Atlanta, Georgia.

REFERENCES

1. Alavi M, Leidner DE. Knowledge management systems: Issues, challenges, and benefits. Communication of the Association for Information Systems. 1(7):1-37, 1999.

2. Senge PM. The Fifth Discipline: The Art and Practice of the Learning Organization New Yor, NY: Currency and Doubleday Publishers. 1990.

3. Finger M, Brand SB., The Concept of the Learning Organization Applied to the Transformation of the Public Sector. In Organizational Learning and the Learning Organization, Easterby-Smith M, Araujo L, Burgoyne J, Ed. London: Sage, 1999.

4. DeBurca S. The learning health care organization. International Journal for Quality in Health Care. 12(6):457-8, December 2000.

5. Liebowitz J. Building Organizational Intelligence: A Knowledge Management Primer. New York, London: CRC Press, 1999.

6. Garvin DV, Edmondson AC, Gino F. Is Yours a Learning Organization? Harvard Businsess Review, March 2008.

7. Deming WE. Out of the Crisis. Cambridge, MA: . Massachusetts Institute of Technology. Center for Advanced Engineering Study, 1986, p. 510.

8. Serrat O. Building a Learning Organization. Knowledge Solutions. Asian Development Bank. May 2009.

9. Cox JW, Mann L, Samson D. Benchmarking as a mixed metaphor: Disentangling assumptions of competition and collaboration. Journal of Management Studies. 34(2):285-314, March 1997

Do you have a “learning organization”? How has it helped your

organization in these uncertain times for health care? What are

some of the best practices your organization has developed?

Tell us — and your fellow physician leaders — what’s working.

The Physician Leadership Journal welcomes unique perspectives

and opinions from around the world. Send your thoughts to

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