SHELDR #31-2019: Loyal Dissent: Is The Juice Worth The Squeeze? (Part 1/2) Strategic Health Leadership (SHELDR) Thought Leadership Series

Introduction

Transforming health systems is challenging. Change is hard, resistance is rampant. Emotion and personalites get in the way. Part of the solution is development of strategic minded heath leaders who understand transformation and the dynamics of change.1,2  What does that mean? For starters, if I had to define strategic health leadership, this is what it would be:

The ability to apply strategic thinking to find opportunities in a turbulent environment, express an aspirational vision, develop strategies to inspire and influence others to translate vision and strategy into common practice and culture and develop future strategic minded leaders. 1,3-9

Yet, few strategic health leaders understand the differences between operational level and strategic leadership. Many are placed in these positions for many reasons, some of make you scratch your head. In fact, few leaders know how to build trust in organizations and create transparent, open and safe environments for ideas and issues to surface or prevent future crises. The purpose of this article is to summarize the root causes of dysfunction, options, actions, factors, and principles for engaging in loyal dissent.

As a result, many teams become dysfunctional. Leaders resort to political and emotional versus rational responses to issues and avoid conflict. Problems fester. Employees become frustrated. A powder keg organization tends to emerge. Employees either become ineffective, vent in various ways, do the minimum with respect to their job, move on, walk the chain of command, or engage in whistle blowing. Or, they can engage in loyal dissent – a progressive means to offer another perspective or idea on doing what’s right for the mission. 

As part of my dissertation I developed a 4 Part, 17 competency strategic health leadership (SHELDR) model. The Bass Transformational Leadership Model (BTLM) served as a foundation, 8,10,11 however, given the model’s disadvantages of being too focused in individual traits and lack of recognition of solving complex problems across organization boundaries,12-15 further analysis to develop an enhanced version was completed. The result was the Strategic Health Leadership (SHELDR) model. The SHELDR model’s 17 competencies are based on a synthesis of 76 strategic leadership documents using 2,045 phrases related to transformation, collaborative, and complexity leadership. A crosscheck of 22 CEO or CEO-equivalent interviews in the Journal of Healthcare Management, found similar competencies compared to the SHELDR model and served as the study’s `evaluation framework. The model is summarized below: 1,2,16,17

So What? 

The real root cause and need for loyal dissent is function of poor and insecure leadership. Note Component A of the SHELDR Model. Implementing successful teams of leaders is imperative, yet many strategic level health leaders are blind to the effects for poor leadership and leading teams of leaders. Sadly, integrating the needs of others and the organization becomes a side show.. Unchecked dysfunctional teams rule. The systemic effects, often invisible don’t surface for long periods of time. Teams become dysfunctional for many reasons. Most blame quantum change, wicked complexity, downsizing, reorganization, petty politics, digitation, generation divides, increased spans of control, or lack of strategic thinking at the highest levels. Leadership is the root cause. Poor and insecure leadership drives team members to leave, become numb, or decide to engage loyal dissent -- a willingness to stand up and take actions beyond the normal supervisor-employee relationship while remaining loyal to the mission and purpose of the organization.18

Just because something is too hard to do, it is not in my control, or I don’t like it, is not an excuse to not do it! The second and third order visible and especially invisible effects on organization culture are more devastating than leaders health leaders think. It’s just downright corrosive. Sound like your organization? Maybe, maybe not. How do you know? Sounds like the song, Stuck in the Middle With You, eh? Consider the top ten reasons for dysfunctional teams. When considering interventions for dysfunctional teams or engaging in loyal dissent with your supervisor, seek first to understand before launching off on the “jokers to the left of you and to the right of you.” 

1.     Lack of Education About Teams And Leadership: Many executive-level teams do not get a thorough education on leading teams of leaders, leader development, and the effects of their actions and inactions. About half of all health care systems do not have or are thinking of creating a leader development program. For teams to succeed, executive-level teams must embrace complexity, uncertainty, and ambiguity and work to translate vision and strategy into common practice and culture.

2.     Lack of Commitment: Implementation of initiatives requires teams of leaders. Yet, leaders underestimate resistance: fear, anxiety, loss, exposure of incompetence much less the forming, storming, norming, and performing high performance teams. They have a hard time connecting the tasks at hand or initiatives to the “higher calling.” Sabotage runs rampant, morale hits bottom, and leaders or employees become walking zombies. This upheaval requires committed leadership to connect the dots in various forms. Submitting a “cheerleader letter” at the beginning of a major project won’t cut it. Commitment starts at the top. Commitment must be ongoing. It no wonder individuals take formal and informal actions to remedy situations.

3.     Lack of Time: The design, implementation, and maturation process of teams is a commitment of time. Yet leaders have a hard time pinpointing where teams might be stuck. They don’t take the time to actively listen including the voices in the wilderness or outliers. Organizations fail to realize there is a significant learning curve involved with team development and implementation of an initiative.

4.     Lack of Money: When teams of leaders are created, design, implementation, and maintenance of teams must be considered. Education and training, coaches and facilitators, and support are required. 

5.     Lack of An Implementation Or Organizational Restructuring Plan: In order to successfully implement teams, organizational restructuring is usually required. The physical structure may need to be altered too as a means to facilitate open communication among team members. Processes, lines of communication, reporting structures, and work flow processes must be modified. Leaders who do not align the team and themselves represent barrier to the team's success.

6.     Lack of Communication: There is always resistance when teams are implemented. If communication is avoided, dysfunction will likely increase. The transition is viewed without enthusiasm or commitment. In many cases, dissenting views are discounted due to insecure leaders, their cognitive biases, or pressure to please.

7.     Lack of Empowerment: So often, senior leaders don't truly relinquish the decision-making power to the teams or avoid making the tough decisions themselves when appropriate. They give the responsibility away without the authority. Aspiring leaders resist the concept of servant or adaptive leadership because they have worked years to attain a certain level of control. They are not prepared to empower and trust others, engage in strategic communication, or collaborate across organization boundaries.

8.     Lack of Purpose: Teams have been implemented in many organizations because teams are a popular, however, they lack a clear, specific purpose. They are instructed to "start teaming" in a rah-rah fashion, but for what? Team members don't understand why the team was implemented, know the rationale, or know what is expected.

9.     Lack of Training: Implementation requires ongoing training and maintenance: what and why; team building to include a mission statement, code of conduct, goals, and barriers; team player and leadership skills; cross training. When teams are correctly implemented, the chances for success increase exponentially. 

10. Responsibility Resides At Top: Teams can be set up to succeed or fail, and sometimes teams are doomed before the first team member is ever chosen. It all comes back to leadership. Teams succeed or become dysfunctional because of leadership. Strong leadership is the foundation for successful teams.18

The Courageous Follower’s Dilemma

Dysfunctionality drives followers in many directions. Followers need advice on thorny dilemmas such as expressing loyal dissent by being true to oneself and actively opposing supervisors while being loyal to the mission. They know in their heart, they are seeking a higher good. Sadly, they, among many works in a toxic environment driven by toxic leaders. Today, they are caught between the culture of followership versus authentic leadership, groupthink and safe spaces for freedom of expression, and personal ethics versus organization or leader’s ethics. At some point, they decide to become courageous followers, or not.

Before courageous followers engage in loyal dissent they must ask: Is The Juice Worth The Squeeze? To engage in loyal dissent as a courageous follower requires deep understanding and asking questions such as how should a courageous follower act if they seek to be virtuous and achieve the greater good? How should a person who is morally aware and sensitive to the inevitable dilemmas in organizational life act when serving in the role of the follower? Be careful, vilification can hurt, not help.

A courageous follower's actions—engaging in loyal dissent--should begin with defining the environment and situation most notably by confirming their observations with others as a check on their own biases. For example, hubris, office politics as a "cover" for incompetence, and the undisciplined pursuit of something are akin to the parable: On the Road to Abilene must be observed, documented, and corroborated. For example, courageous followers must ask: Is it the supervisor’s denial of risk or inability to make decisions, and capitulation? Is it a "I give up" or "it is what is" attitude that rubs you the wrong way? Does daily gossip and rumor talk consume the daily conversation at the expense of healthy team dynamics such as dialogue and debate? Courageous followers face dilemmas at the organizational, departmental, and personal levels, yet feel morally compelled to engage in loyal dissent. Many options exist beyond the hype in Hollywood movies!

Part 2 will provide a means for better assessment, options, and implementation of loyal dissent.

About the Author: Douglas “DrQD” Anderson, DHA, MSS, MBA, FACHE is a healthcare consultant, adjunct professor, strategist, executive coach and group facilitator. He has over 30 years’ healthcare experience in leadership, command, and corporate staff positions: military, international, academic, and commercial health sectors. He retired in the grade of Colonel in 2012. His last assignment in the military was as Director, Organizational Improvement and Strategic Communication in the U.S. Air Force Surgeon General’s Headquarters. He served on multiple deployments including Afghanistan as Medical Advisor to Afghanistan National Police Surgeon General. He is currently the Chairman of the U.S. Air Force Medical Service Corps Association. He specializes in health futuring, strategic leader development, strategy management, systems thinking, continuous quality improvement, and strategic communication. He is coauthor of Health Systems Thinking: A Primer and Systems Thinking for Health Organizations, Leadership, and Policy: Think Globally, Act Locally. Follow him on Twitter: @Doug_Anderson57. Contact him at [email protected] for information, comments, and opportunities.

Disclosure and Disclaimer:  Douglas E. Anderson have no relevant financial relationships with commercial interests to disclose. The author’s opinions are his own and do not represent an official position of any organization including those he consulted. Any publications, commercial products or services mentioned in his publications are for recommendations only and do not indicate an endorsement. All non-disclosure agreements (NDA) apply.

References: All references or citations will be provided upon request. Not responsible for broken or outdated links, however, report broken links to [email protected]

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