SHELDR #4-2020: Lateral Leadership: A Needed Competency For Health Leaders STRATEGIC HEALTH LEADERSHIP (SHELDR) THOUGHT SERIES

Background

Recently, a colleague challenged me to explore the idea of lateral leadership or leading sideways. In his article, he wrote:

“Essentially, lateral leadership feels like we are violating the basic management principle that you cannot have responsibility without authority. But then, we’re not talking about management. We’re talking about leadership and maybe that’s the real difference. Management requires authority. Leadership does not. Leading without authority requires influencing others to give their discretionary effort to work toward a goal. And, that just might make lateral leadership the highest form of the art.”

Sounds lofty and risky. Am I leading without authority and resources but all the responsibility? I can’t empower or delegate responsibility? Accountability? These characterizations give rise to the courage to shift from the familiar vertical or command and control leadership and enter an unknown comfort zone. My colleague challenges readers to assess their past leadership development and experiences and ask themselves: given my current position and responsibilities, do I need modify my competencies to lead laterally. Answer: yes. Lateral leadership is a growing and recognized form of nonhierarchical leadership used as part of systems thinking competencies, change management strategies, and health system integration or engagement.

Purpose

The purpose of this article is to take an “earthier” to the competencies of lateral leadership compared to vertical leadership or command and control. While I have characterized it as leadership, many would characterize it as horizontal, cross-boundary, collaborative, or network leadership. All the same for now. The name is not important. What is important is development of the right competencies to carry out the tasks of health system transformation which now includes working with community health and non-health partners. 

Introduction

Let’s start by challenging the status quo. Healthcare is a partnership and process leading to a healthy outcome, and in any cases crosses organization silos, right? Shouldn’t leadership be the same? Today’s complex healthcare organizations are driven by vertical command and control leadership mentalities and if lucky, some form or degree of collegial leadership exist. Creating opportunities for improvement between traditional functional areas and hierarchies or “silos” within and outside the walls of their brick and mortar organizations may be stifling momentum. For example, many leaders recognize the need to collaborate and coordinate care and referrals with community health and social services networks to accomplish their missions.   

 Leaders are typically thought of as those who are followed.  It is natural to think leadership is a vertical proposition. Just think about all the charismatic John Wayne military movies, leader development training PPTs, and the engrained “bosses and subordinates" literature.  You know, “the few, the proud, the Leaders" who are rewarded with the next level in the organizations containing more subordinates and resources. This is all well and good. However, today’s world is turbulent, complex, unpredictable, yet remains rigid and stove piped reinforced by vertical leadership. Fortunately, the hierarchical and vertical relationship between “leaders” and “followers” giving way to lateral leadership as a council of co-equals.

Enter Lateral Leadership—Leading Sideways

The definition is straightforward, not so easy to practice. While vertical leadership is still necessary for some situations (not as many as you think), vertical relations works best with (and reinforces) organizational silos.  Leading hierarchically tends to sub-optimize human talent and organizational momentum within those silos. However, that's not how organizations carry out their duties especially when healthcare organizations today are integrating social services as part of their referral patterns. Today, accomplishing organizational goals requires more collaboration. On the other hand, lateral leadership connects individuals across inter and intra-organizational boundaries to help others see themselves as part of something more substantial within the value-stream of care or recovery. They create enlightened leadership – the energizer bunny--toward a mutually agreed upon goals.

No, it is, not a “you owe me one” scene. Unlike command and control, lateral leadership is about trust through influence, inspiration, mentoring and humility. Yes, the "skills" of vertical and lateral leadership overlap. There are differences. The biggest difference is a reciprocal and interdependent relationship and helps others see the whole system, especially when a no formal authority and resource constraints exists. Accountability is synonymous with follow through and the benefit is trust and confidence, especially at the speed of change and coordination of care.

Lateral leadership is best practiced by building trust as a collateral outcome of accomplishing organizational goals. Trust is the bi-lateral benefit of a reciprocal and interdependent relationship within and across organizational boundaries. Trust and confidence can be built by following through, especially between meetings on tasks and projects. Lateral leadership is about humility by knowing (and doing) when to lead and follow or interchangeability of roles. It is about also being resilient when colleagues opt-out or opt-in to certain requests. It is about sharing knowledge related to goals and influencing others to find improvement opportunities in-between their interdependencies. It can be about uncovering blindspots and sweetspots of mutual concern. Lateral leadership is about inspiring others whom you have absolutely no direct control to join you in a common cause. To be an excellent lateral leader, leaders must have the right mindset, actively listen, and mentor so trust becomes part of the journey.

Lateral Leadership Competencies

Today, leading or collaborating and coordinating within and across silos includes building relationships between systems. It means actively listening to fuse ideas or pinpoint opportunities to improve. What are the emerging skills for lateral leaders? Here are a few ideas to on leading laterally:

1.     Leading in the Intersections or the Seams: Lateral leadership means being an information gatherer, sharer, negotiator, and “nudger.” Lateral leaders look for opportunities to take their organizations to the next level through constant intelligent inquiry and asking the right questions and actively listening.  They use YES AND versus YES BUT as means to fuse ideas, solutions, and excitement.

2.     Are Great Storytellers: As active listeners, lateral leaders can package ideas, efforts, and observations as a storyteller. They recognize the power of language and how carefully-chosen imagery and powerful narratives can reach across the boundaries of conventional thinking. This skill gives lateral leaders the tools to speak about what is often difficult to express.

3.     Leads with an Aspirational Vision: The lateral leader knows creating positive momentum to articulate commonalities within a vision leads to finding sweet spots for action across the organizational boundaries. They also understand apathy and negativity plague many organizations. Rather than chase the metric of the moment or a “50 reasons why we cant do something” culture, they create a sense of vision and destiny even mystery, ambiguity paradox, and surprise is what creates the momentum. They present it and despite the lack interest or resistance, they keep “nudging” away.   

4.     Leading as a Peer, not Position or Title: Lateral leaders recognize the significance and power of place, positive, and negative. These leaders look for answers or solutions, especially when navigating unfamiliar areas or looking for sweet spots where there are no rules, no consensus, and no clear way forward. They thrive and humble themselves in helping others develop micro-visions, encourage brainstorming, and help them succeed through informal coaching, guiding, and mentoring.

In essence, lateral leadership utilizes a processes of creating shared understanding, changing power games and generating trust for one's own purposes. In this way, leaders can disrupt rigid patterns of thought, combine the divergent interests of the people involved, and build trust.

Leading Peers in a Lateral Fashion

Of particular interest to lateral leadership is leading peers. Aside from followership, this is one of the most difficult and least talked leader development topics: leading peers. You can succeed departmentally and fail organizationally or community system-wide. Remember, silos are created from a lack of intentional lateral leadership. This approach may challenge your personal constructs of leadership and an inherent sense of competition. Not good. 

Lateral leadership is difficult because it is about building trust through follow-through and humility. The fact is, functional, community leaders or leading throughout the community, and even corporate headquarters (pick a level), leaders don’t have the leverage to lead up or down, yet most leaders need the other silos to accomplishment their tasks. Go figure. 

In most cases, it's easy to just put your head down, work harder, and accept the status quo. When you do, you suffer. Your team suffers. Ultimately, the organization suffers. You can spiral up or spiral down. To spiral up, here are as few mindful or self-reflective questions to ask yourself as you venture into lateral leadership, especially with your peers:

1.     Am I more loyal to the team as a team member or the team I lead? Define your team; it may be bigger than you think. Do you know when to lead, follow, just bite your tongue?

2.     Do I willingly share my best ideas with my team? If you don’t feel safe, then how can others feel the same safety. Do you create safe zones within and outside your sphere of influence? Or do I overwhelm them? 

3.     Do I share the credit even when I don’t need to? This one seems obvious, but do you? If so, how willingly? How often? In other forums outside your own?

4.     Do I say we more than me? Wouldn't it be nice to record your conversations for a week just to find out. You might find out you’re dreaming of A (we) but reinforce B (me).

5.     How many times have I gone to someone else’s office/cubical/community or social service office just to talk and understand their constraints, pressure points, and aspirations?

6.     Do I believe the best in my peers or their strengths? If so, how to draw that out? Are you performing CPR: complement, praise, and recognize on a regular basis? 

7.     Do I find my significance in always being right?  A challenge may be for you to openly admit you had a bias, had outdated information and clung to your fears.

As you ponder the answers and reflect on the past, to succeed as a lateral leader you have to provide your colleagues reasons to respect and follow you. How do you do that? By helping your peers see a bigger picture, sharing information, help them uncover their blindspots, and reinforcing their contributions as they relate to the bigger picture by performing CPR. If you can help them win, you not only help the organization but yourself and teams.

Make Lateral Leadership Thinking Habitual

Here is a set of thinking principles to guide you toward leading laterally in habitual manner:

1.     Understand, Practice, and Complete the Leadership Feedback Loop: If you want to gain trust through influence and credibility with others, don't take shortcuts. Follow-through on obligations. The leadership feedback loop begins with caring – taking an interest in people – and ends with succeeding – winning with people across the silos. People with big aspirations want to be on a team who moving forward. Success begets success.

2.     Put Coaching, Guiding, and Mentoring in some Form Ahead Of Competion: The whole goal of healthy competition is to leverage it for a win. For organizations, the success of the entire team is more important than any individual wins. Therefore, build your teammates and peers up, and they'll want to win with you.

3.     Be A Role Model Peer: Good relationships make influence possible. Colleagiality is a positive relationship you can develop. The goal should be to be a peer. You must work at being a resourceful peer even when others don't reciprocate the efforts. Ultimately, being a role model peer will give you the opportunity to influence your peers when the time comes.

4.     Avoid Petty Office Politics: People who might be described as 'political' are ruled by their desire to get ahead at all costs. d of a desire for excellence, productivity, teamwork, or consistency. To succeed at leading across boundaries, it's important to stay true to whom you are and not act differently. Become a statesman with a the higher calling and a "go-to" peer.

5.     xpand Your Circle Of Acquaintances: To get outside of your comfort zone, start with those in your comfort zone. New acquaintances can be crucial connections as you grow as a leader. As you build trust and confidence, and lead your peers, your relationships will benefit them. You'll ultimately provide more value and gain influence among them.

6.     Let The Best Idea Win: Being a lateral leader is not about getting your ay. It's about winning trust, confidence, respect and influence with your peers so you can create win. Just because you don’t like drones, having a collaborative spirit helps when you discover your idea may not be the best idea or you squash other ideas. Recognize you can add value when you let your ideas go and let the best idea win.  That's when you will win friends and influence people.

7.     Don’t Pretend You’re Perfect: Nobody is perfect - not you, not your peers, not your boss. Quit pretending. People who are genuine with their weaknesses and strengths, draw others to them. Pretending we are perfect will get you nowhere. Admitting faults, asking for advice, being open to learning, and putting away pride and pretense are essential steps to building trust within and across entrenched silos.

Overall, these the principles showcase the best ways to lead laterally. While each one takes time, they will help you gain influence within your organization from wherever you stand. Getting in the habit is the hard part.

What are You Waiting For?

Many opportunities exist for leading laterally. Become involved. When you take the lead and involve others, it is good for both the organization and for your relationship with your peers. Start with an open discussion or leader development moment. There is always the chance you will be viewed as “pushy,” or taking on tasks for personal. Do it anyway. Besides, what will your peers think about you if all you do is work in your silo?

Lateral leadership difficult colleagues can be, at best, a negotiation and active listening challenge. Do your homework, rehearse, and engage. Make it habitual. For example, if two co-leaders are at odds with each other-- one is a millennial male clinician and the other a baby boomer female administrator-- about a crucial issue such as the value of culture survey or ethical dilemmas a conciliatory agreement may be necessary. It would be troublesome to different positions on the issues. Active listening and finding sweet spots for action through negotiation become the paths to building trust.

Forge strong ties with peers by building momentum. You can build momentum across the silos, by leading with inspiring stories and a clear action plan to deliver tangible results. Doing so ignites a virtuous circle of recognition by energizing a cadre of early followers. Leaders could do many interactions on video and email these days. However, that's rarely inspiring. Leading laterally means walking the halls, getting out of the office to share ideas with peers, listening to concerns, and working together to implement plans—purposeful rounding. The best lateral leaders connect directly with as many people as possible across silos in-person ways and help them connect the dots and succeed.

Summary

The world is not static, nor should leadership paradigms. In a complex world of border-crossing and boundary-spanning, leaders don't just look ahead; they look laterally to position their organizations to align mission, vision, and values. Lateral leadership is resonating in a world where disruptive innovation, unexpected competitors, and new partnerships are emerging. Customers, patients, and families experience organizations laterally. So should leaders. 

Forget those flamboyant John Wayne movies and hierarchical leadership models. They’re needed when needed but the style is not the norm. Learning the lead laterally is an approach, all leaders should embrace. Today’s leaders must learn to lead laterally. Breaking current habits wont be easy. The future of lateral leadership is determining the value of trust, interchangeability of roles, and humility.

What's your best tip for leading laterally—leading sideways?

Do you have another topic? Suggestion on how to develop leaders in innovative ways and accomplish your mission simultaneously?  Send it to SHELDR Health Consulting: [email protected], and we will check it out.

About the Author: Douglas “DrQD” Anderson, DHA, MSS, MBA, FACHE shares his 30+ years of experience and research as a consultant, coach, speaker, facilitator, and educator on strategic management and thinking, CQI, communication, and strategic health leader (SHELDR) development. His focus is on helping local communities integrate social services with healthcare delivery systems. 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 and his Strategic Health Leadership (SHELDR) E-Zine. Contact him at [email protected] for opportunities to help you and your team succeed.

Disclosure and Disclaimer:  Douglas E. Anderson has 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. 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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