Why It Matters
It’s no secret that it’s a complicated time to be a leader in health care. Wherever we are in the world, we face a range of challenges — including financial, political, demographic, and technological ones — that, quite frankly, are unprecedented.
Traditional leadership approaches don’t equip us well to deal with these complex issues. Conventional thinking encourages leaders to think of themselves as heroes who need to act alone to save the day.
I don’t buy it. No leader — no matter how accomplished — has all the answers. No leader who wants to create viable, sustainable solutions and avoid burnout can afford to go it alone.
Instead, leaders must use all the assets at their disposal to address the complexity in health care. This means engaging our whole organization — and our whole community — to find the answers to the biggest health and health care problems we face today. Your organization will not make significant progress toward better population health, moving from volume to value, or health equity goals without meaningful contributions from people inside and outside of your health system. Leaders need to accept that they don’t know it all, be willing to ask for help, and then involve others in the implementation that must follow.
To do this, a leader must be humble.
Asking for help with difficult problems gets surprising results. People respond well to the vulnerability that requires saying things like:
- “I don’t have all the answers. Do you have any ideas?”
- “I’m not sure what the right approach is here. What do you think?”
- “I have some ideas, but I don’t have your perspective.”
- “I’m curious about how you might tackle this if you were in my shoes.”
People value humility. They appreciate the respect a leader shows by asking for their input.
Humility and Quality Improvement
Humility is part of what makes QI unique. Humility isn’t necessary to operate in a command and control environment or to conduct external verification of performance for quality assurance or accreditation. But humility is fundamental to quality improvement.
To use QI methods to truly transform health care, leaders must share power. We need to shift from control concentrated with a relatively small number of people, to power being in the hands of a larger number of people working at the point of care. It is their PDSA cycles that show us if a change is, indeed, an improvement. Leaders have to trust that the efforts of one nurse trying a small test with one patient can ultimately lead their organization to breakthrough levels of performance. That kind of trust takes humility.
I’m convinced that these leadership lessons apply in virtually any context. While I was at the IHI Africa Forum in Durban, South Africa, earlier this month, for example, I heard from leaders who reinforced my conviction that we need more humility and less heroism. They explained how they made improvement on a national scale, working their way through complex environments — not by doing everything themselves, but by harnessing and directing the energies of others.
Dr. Muhammad Pate, former Minister of Health for Nigeria, said that leaders need to be like band leaders or conductors. That idea — pun intended — struck a chord with me. I can’t play every instrument. I’m not even going to try because that’s not my job. A leader’s job is to make all the musicians sound good together. Otherwise, all we hear is noise.
The leaders I spoke with in Durban also talked about the importance of trust. For many people, the IHI Africa Forum was one of the first large conferences they had ever attended where most of the presenters were African. Even in 2018, big health care meetings often fly people in from other parts of the globe to tell attendees from Africa what to do. Many of the people serving patients and families throughout the continent have ideas about how to solve the problems their countries are facing. Ignoring this fact creates mistrust.
Is this so different from how many organizations implement QI initiatives? We may not jet in from thousands of miles away, but we may as well when we don’t approach the people closest to the point of care with a spirit of what Edgar Schein calls “humble inquiry.”
Asking questions is just the beginning. Leaders must also listen to the answers with humility because we won’t always hear what we want to hear. We may think we know the answers, but we need to be ready to receive messages that make us deeply uncomfortable. And that’s good because it’s discomfort that spurs innovation, and new ways to think about seemingly intractable problems.
Yes, sometimes heroism in health care is essential. In an emergency or a major crisis, for example, a command and control leader may be exactly what’s necessary. But I would argue that we need less heroism and more humility to make progress with the ongoing, complex problems that health care leaders face every day.
Editor’s note: Look for more from IHI President and CEO Derek Feeley (@derekfeeleyQI) on leadership, innovation, and improvement in health care in the “Line of Sight” series on the IHI blog.