Figures, Tables, Exhibits xiii Preface xxi The Authors xxix Part 1: The Challenge to Health Care Organizations and Creating the Leadership Team 1 1 Introduction: From Management Myths to Strategic Intelligence 3 Plan of the Book 8 Part 1: The Challenge to Health Care Organizations and Creating the Leadership Team 8 Part 2: Strategic Intelligence and Profound Knowledge for Leading 9 Part 3: Learning from Other Leaders and Creating a Path Forward 11 Key Terms 11 2 Why and How Health Care Organizations Need to Change 13 The Purpose of the Preliminary Research 18 The Model of Change 18 Changing Modes of Production in Health Care 20 Health Care in Learning Organizations 20 Leadership for Learning 23 The Human Side of Change 24 Approach to Service 25 The Role of Culture 26 The Mayo Model 27 Summary 29 Key Terms 31 Exercises 31 3 Leading Health Care Change 35 Summary 43 Key Terms 43 Exercises 43 4 Developing a Leadership Philosophy 45 How to Develop a Philosophy 46 Purpose 46 Ethical and Moral Reasoning 46 Levels of Moral Reasoning 47 Practical Values 48 Gap Analysis 50 Defi nition of Results 51 Using the Purpose to Defi ne Results: Cherokee Nation Health Services 52 The Mayo Clinic Organization Philosophy 53 Summary 56 Key Terms 56 Exercises 56 Part 2: Strategic Intelligence and Profound Knowledge for Leading 59 5 Leading with Strategic Intelligence and Profound Knowledge 61 Foresight 63 Visioning as Designing the Idealized Organization 64 Partnering 65 Motivating 68 Profound Knowledge 68 Understanding Systems 69 Understanding Variation 71 Understanding Psychology 72 Understanding Theory of Knowledge 73 Employing Strategic Intelligence and Profound Knowledge 74 Summary 75 Key Terms 75 Exercises 76 6 Changing Health Care Systems with Systems Thinking 77 Interdependence 84 What Do We Mean by Process? 85 Two Kinds of Complexity 87 Classifi cations of Processes 89 Defi ning the System 93 Why Systems Thinking Is Difficult 96 Changing a System 97 Leverage, Constraints, and Bottlenecks 98 Systems and People: Improving Behavior 100 Summary 102 Key Terms 103 Exercises 103 7 Statistical Thinking for Health Care Leaders: Knowledge About Variation 107 Interpretation of a Control Chart 110 Avoiding the Two Kinds of Mistakes in Reacting to Variation 114 Graphical Display Using Statistical Thinking 115 Power of Simple Run Charts for Data Display 120 Leadership to Improve Population Health 127 Summary 131 Key Terms 131 Exercises 132 8 Understanding the Psychology of Collaborators 137 Personality Intelligence 139 Talents and Temperament 139 Social Character 140 Drives 141 Motivational Types 144 Identities and Philosophy 148 Bureaucratic and Interactive Values 149 Bureaucratic and Interactive 149 Motivation: Popular Ideas to Unlearn 151 Maslow?s Hierarchy of Needs Theory 151 Maccoby?s Critique of Maslow?s Theory 152 Hawthorne Experiments: Maccoby Critique 152 Using Personality Intelligence 155 Creating the Environment for Intrinsic Motivation: The Five Rs of Motivation and the Seven Value-Drives 155 Leading with the Heart 160 Disciplines of the Heart 163 Seeing Things as They Are?Deep Listening 163 Listening and Responding to Others 164 Summary 165 Key Terms 166 Exercises 167 9 A Health Care Leader?s Role in Building Knowledge 169 How Do Theories Evolve? 170 Learning and Continuous Improvement 174 Shared Meaning and Operational Defi nitions 176 Utilizing a Standard Methodology for Learning in the Organization 177 Using Multiple PDSA Cycles to Build Knowledge 184 The Leader as Learner and Teacher 186 Summary 188 Key Terms 188 Exercises 189 Part 3: Learning from Other Leaders and Creating a Path Forward 191 10 Three Case Studies: Mastering Change 193 Case Study A: System for Mastering Change in Joenkoeping County Council, Sweden 197 Case Study B: A Medical Director-Leader Improves Care in Dialysis Clinics 219 Case Study C: Building a Learning Organization at OCHIN, Portland, Oregon, United States 232 Key Terms 256 11 Leading Change: First Steps in Employing Strategic Intelligence to Get Results 259 Assessing and Defi ning Purpose for the Organization 260 Assessing the Learning Organization 263 Aligning Roles to Support the Organization?s Purpose 264 Leading Health Care 269 Developing a Leadership Philosophy and Practical Values 270 Summarizing and Interpreting Results from the Practical Values Gap Survey for Leadership Team Learning 272 Strategic Intelligence and Profound Knowledge for Changing Systems 274 Summarizing and Interpreting Results from the Strategic Intelligence Inventory for Leadership Team Learning 277 Developing Personality Intelligence 281 Systems Thinking: Creating a System Map of Your Organization 283 Process of Change: Idealized Design 288 Understanding the Psychology of Partners and Collaborators 290 Translating the Vision and Strategy to Actionable Approaches 291 Leading Individual and Team Improvement Efforts to Achieve the Vision 294 The Sponsor Report: Keeping Leaders in the Communication Loop 296 Learning from Improvement Efforts 299 Redeployment of Resources 301 Removing Barriers and Obstacles 302 Summary 309 Key Terms 310 Appendix 311 Leadership Personality Survey 311 Social Character Questionnaire 318 Scoring of Social Character Questionnaire 319 Understanding Leadership Personality 320 The Caring (Freud?s Erotic) Leadership Personality 322 The Visionary (Freud?s Narcissistic) Leadership Personality 324 The Exacting (Freud?s Obsessive) Leadership Personality 326 The Adaptive (Fromm?s Marketing) Leadership Personality 328 Leadership Personality Examples 330 Combinations of Types 332 CARING-Dominant Mixed Leadership Types 332 VISIONARY-Dominant Mixed Leadership Types 335 EXACTING-Dominant Mixed Leadership Types 337 ADAPTIVE-Dominant Mixed Leadership Types 339 Mixed Type and Social Character 342 Farming-Craft Social Character 342 Bureaucratic Social Character 343 Interactive Social Character 344 Glossary 345 Index 367
Michael Maccoby, PhD, is president of The Maccoby Group in Washington, DC and an associate fellow at the Said Business School, Oxford University. Clifford L. Norman, MA, ASQ Certified Quality Engineer, is a consultant with Associates in Process Improvement (API) and co-owner of Profound Knowledge Products, Inc. He is a member of the American Society for Quality (ASQ).. C. Jane Norman, BS, MBA, ASQ Certified Quality Engineer, is a consultant and president of Austin API, Inc. and Profound Knowledge Products, Inc. Richard Margolies, PhD, is a psychologist and vice president of the Maccoby Group who assists leaders in developing their leadership and strategy.