Many healthcare executives have acknowledged that organizational silos are still present or are reemerging, with leaders of functional areas and their teams acting independently, as they did before the pandemic.
However, today’s healthcare field is dealing with issues that are too complex and weighty for individual teams to navigate without the input of others. This is why the idea of interdependent leadership, a once desirable concept, is now crucial for achieving success.
During times of uncertainty and growth, people often want to revert to the comfort zone of individual expertise or to what was certain in the past. Additionally, teams are often internally competing for resources and striving for individual acknowledgement at the expense of exploring more significant possibilities together. This independent, survival-based, siloed mindset has created a segmented work environment that stifles innovative, interdependent thinking.
At Kaiser Permanente in California’s Central Valley, organizational silos had developed within functional areas such as quality, patient experience, finance, and human resources. This hindered the organizational growth and quality service the community deserves.
Recognizing the need to transition to a culture that encourages collaboration, the health system adopted an interdependent approach that created a more open culture to solve problems across the organization. Ultimately, this interdependent approach helped leaders and their teams deliver exceptional results and sustainable outcomes for Kaiser Permanente’s patients and employees.
From Dependence to Interdependence
As demands evolve, the culture of leadership within an organization typically transitions through three phases of a growth cycle: dependence, independence and interdependence. Organizations constantly transition through these phases of leadership independent of one another, although in today’s healthcare environment, they are cycling through these phases faster than ever before.
Each of the three distinct phases or cultures of leadership serve a purpose, and it’s important that leaders possess a sound assessment process and the skill to determine where an organization sits within the growth cycle and where it should be. It’s also critical to understand the constraints of each phase in relation to how one’s organization is changing and growing.
Dependence. In this first phase, when a new idea is considered, organizations depend on a leader to provide direction, and decisions are often made from a place of authority. The approach to change tends to be conservative, and in the current healthcare landscape, a dependent leadership culture will respond to uncertainty with questions such as, “Who’s responsible for this?” “Who’s doing this to me?” and “Why is this happening?”
Independence. With the emergence of a new idea, a new service line or a new product, organizations may move to a different leadership culture that is built around independence. Decisions are made from a position of mutual influence in which individuals, defined by their area of expertise, listen to and try to understand others’ perspectives but run their own agendas within their own silos. They approach change through anticipation and risk mitigation.
In healthcare, leaders often spend more time protecting the status quo than preparing our organizations for the future. When faced with uncertainty, individuals tend to retreat to their siloed area of expertise. This siloed thinking is what leads organizations to hit a wall, stalling progress. Walls can exist within organizations and teams, and they can be economic, technological and often out of one’s control. When organizations inevitably hit a wall, it’s important that leaders be able to recognize that and find a unifying element to reignite efforts, such as the shared values of a hospital or health system.
For example, leaders at Ochsner Health looked toward the organization’s shared values, which include putting patients first, to serve as a focal point for an interdisciplinary team tasked with consolidating two ICU departments into one. By putting the patient first, the team came together to implement a plan that resulted in one ICU department with enhanced and improved coordinated care results.
Interdependence. The wall leads us to the third phase of leadership in which organizations must deliver on what they promised to their stakeholders while reinventing themselves to solve problems in a more strategic way. Leaders in this phase are simultaneously trying to understand their new reality and make sense of it for others—balancing reality with possibility. Decisions are informed by a collective sense of direction and vision, and questions arise such as “Who are we partnering with?” and “Where are we going together?” In this phase, there is a sense of shared responsibility, alignment, new thinking and curiosity.
For example, when Kaiser Permanente tried to improve its quality performance—measured by consistently achieving a Leapfrog score of A and market-leading performance in the area of harm events—the organization had to transition from a dependent to an interdependent approach to see improved outcomes.
To move beyond the constraints of the dependent approach, which can include anything from past failures to the mindset of team members, leaders first had to help their teams clearly understand and define the problem they were tasked with solving. They also had to ensure teams knew the difference between the problem and the symptoms or emotions associated with it.
Placing the patient at the center of their conversations and decisions, teams met weekly to identify performance gaps in patient flow data. This strategic and operational use of data reflected the present quality performance and exposed future opportunities to improve.
Armed with feedback for improvement, multidisciplinary teams were created to focus on the patient process and take ownership for a collective solution.
Strengthening Interdependent Responses to Get Results
Achieving interdependence led Kaiser Permanente to attain market-leading quality scores and significant membership growth, with over 75,000 members added between 2017 and 2021. It also led to achieving consecutive years of a positive operating margin.
To achieve interdependent leadership is to cultivate a reflective space that balances reality with possibility and focuses on long-term results instead of seeking relief and short-term survival. In healthcare, every day is a choice to lead and engage with problems, obstacles and opportunities. Our calling is to accept that and to take a vision-directed versus fear-driven approach to problem- solving that focuses on building and strengthening relationships with others, thereby opening leaders and their teams to new thinking and creating safety and trust for others to take risks.
Corwin Nathaniel Harper, FACHE, is the senior vice president/chief growth officer for Ochsner Health, New Orleans (Corwin.Harper@Ochsner.org). Previously, he worked at Kaiser Permanente for 25 years, most recently as CEO for its Central Valley area in California.
Editor’s note: Learn more about moving to interdependent leadership with recorded session Transformational Leadership: Interdependence Achieves Performance.
Navigating Uncertainty With Collaborative Thinking
To become a transformational leader, executives should have a natural desire to develop and enrich the lives of others and the organization through disciplined practices, new thinking, inspiration, coaching and a deep personal commitment to performance results. To help foster transformational thinking in others, leaders and their teams should be able to answer the following four questions:
- Decisions: How do I make decisions that are aligned and directionally correct, especially when I lack agreement on how to proceed and am uncertain about the outcomes?
- Change: What challenges or complex problems most need my attention and creative energy?
- Conversations: How do I create and organize productive meetings that invite new questions and allow for the emergence of new thinking?
- Uncertainty: How can I remain curious and keep asking questions when facing the unknown while I gain confidence in others’ capacity to move forward together?