1. Leadership: All Members as Leaders—Leaderful Teams
Working in Teams
Leadership: All Members as Leaders—Leaderful Teams
Lecture a
Welcome to Working in Teams: Leadership: All Members as Leaders —Leaderful Teams. This is Lecture a.
This material (Comp 17 Unit 7) was developed by Johns Hopkins University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC This material was updated in 2016 by Johns Hopkins University under Award Number 90WT0005.
This work is licensed under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. To view a copy of this license, visit
Health IT Workforce Curriculum Version 4.0

2. Leadership: All Members as Leaders─Leaderful Teams Learning Objectives─Lecture a
Develop and implement standards for shared leadership roles in complex, stressful, and often hierarchical health-related environments,
Discuss progression from self-awareness to self-leadership to team leadership,
Demonstrate collective, concurrent, collaborative, and compassionate activity.
The Objectives for Leadership: All Members as Leaders—Leaderful Teams
are to:
Develop and implement standards for shared leadership roles in complex, stressful, and often hierarchical health-related environments.
Differentiate progression from self-awareness to self-leadership to team leadership.
Demonstrate collective, concurrent, collaborative, and compassionate activity.
In Lecture a, we will touch upon each of these objectives.

3. Leaders—1 Leaders do not command excellence, they build excellence.
Excellence is “being all you can be.”
To reach excellence, you must first be a leader of good character.
You must do everything you have committed to do.
(Clark, 2010)
To fully address the objectives for this unit, we must first cover some of the detailed concepts of leadership—what makes a good leader, what characteristics a good leader is apt to exhibit, and how leadership has changed over time. To begin—Leaders do not command excellence, they build excellence. Excellence is, “being all you can be,” within the bounds of doing what is right for your organization. To reach excellence, a leader must be of good character. Leaders do everything that they have committed to do, and the organization must instill a sense of business ethics and integrity that guides the leader along the way. Organizations will not achieve excellence by setting a goal, then having leaders do whatever it takes to get the job done. Without an organizational culture that supports honesty and integrity, even an inherently strong leader may become compromised—by throwing roadblocks into the journey to excellence. It is also important not to confuse the simple accomplishment of a project with excellence. Engagement in the leadership experience, combined with ethical behavior and actions that reflect integrity and fairness, is the starting point for excellence.
In the world of health and health care, leaders emerge from many different levels. Within the course of any given day, it is easy to see the behaviors that should be emulated—the billing clerk who goes the extra mile to work out a coding issue, the nurse’s aide who helps a family member to bathe and dress a patient, a systems IT person who spends face to face time with a system user to make sure that the application is working correctly. These are examples of, “being all they can be.”

4. Leaders—2
Think about the leadership traits being expressed in the following quotes:
“Never tell people how to do things. Tell them what to do and they will surprise you with their ingenuity.” George S. Patton
“The best executive is the one who has sense enough to pick good [people] to do what he wants done, and self-restraint to keep from meddling with them while they do it.” Theodore Roosevelt
“Management is doing things right; leadership is doing the right things.” Peter F. Drucker
“Leadership is the art of getting someone else to do something you want done because he wants to do it.” Dwight Eisenhower
Consider how the behaviors reflected in these quotes may evidence themselves in HIT teams. The quotes by Roosevelt and Patton are two that ring particularly true. An HIT project and its team can be totally derailed by an executive who meddles—or by an executive who believes that he or she knows the best solution for a problem and does not let the leader “lead” or fails to let the team develop as a normal team would. Patton’s quote is an excellent tidbit of advice. An HIT team that has a good leader and members who are resourceful, passionate, and diverse will exhibit creativity and ingenuity that can surpass all expectations.
“The best executive is the one who has sense enough to pick good [people] to do what he wants done, and self-restraint to keep from meddling with them while they do it.”
Theodore Roosevelt
“Never tell people how to do things. Tell them what to do and they will surprise you with their ingenuity.”
George S. Patton
Health IT Workforce Curriculum Version 4.0

5. Leadership Traits Competency Forward-looking nature Inspirational
Intelligent
Fair-minded
Broad-minded
Courageous
Straightforward
Imaginative
The list of leadership traits reflected on the slide was compiled by the Santa Clara University and the Tom Peters Group. These traits include:
Honesty
Competency
Forward-looking nature
Inspirational
Intelligent
Fair-minded
Broad-minded
Courageous
Straightforward
Imaginative
Although these traits are present in leaders from across the board, health IT leaders need to have additional depth in a few of these traits. Which ones do you think might be traits that are even more important for an HIT leader to possess? There is no right or wrong answer, but many would say being broad minded, imaginative, forward-looking, and courageous. This might be because HIT is ever mutating, what looks certain one day is less certain the next—the technology is constantly changing, the regulations that govern practice and payment are ever-shifting. Because HIT requires changes in behaviors and processes, an HIT leader is one who can imagine a new future, and take courageous and sometimes unpopular steps to lead toward that new future. Leading HIT initiatives is not an easy venture and it requires a strong personal commitment and conviction.

6. Military Leaders Military Leadership Principles
Be tactically and technically proficient.
Know yourself and seek self-improvement.
Know your soldiers and look out for their welfare.
Keep your soldiers informed.
Set the example.
Ensure the task is understood, supervised, and accomplished.
Train your soldiers as a team.
Make sound and timely decisions.
Develop a sense of responsibility in your subordinates.
Employ your unit in accordance with its capabilities.
Seek responsibility and take responsibility for your actions.
The US military suggests the following leadership principles:
Be tactically and technically proficient.
Know yourself and seek self-improvement.
Know your soldiers and look out for their welfare.
Keep your soldiers informed.
Set the example.
Ensure the task is understood, supervised, and accomplished.
Train your soldiers as a team.
Make sound and timely decisions.
Develop a sense of responsibility in your subordinates.
Employ your unit in accordance with its capabilities.
Seek responsibility and take responsibility for your actions.
We could take out the words, “soldier,” and, “military,” and end up with a reasonable list of principles for the HIT leader.

7. Leadership Types The transformational leader The enforcer
The deal maker
The administrator
The visionary
The serial entrepreneur
The spin doctor
(Taffinder, 2007)
The following ideas are taken from The Leadership Crash Course, by Dr. Paul Taffinder. Dr. Taffinder's research has shown that seven distinct types of leadership predominate based on different combinations of five key leadership behaviors. (We’ll discuss those 5 leadership behaviors on a follow-up slide.) Leaders must recognize where they are strong, where they are weak, what their preferences are, what they seek to avoid, and which situations suit them best or least. As we go through these leadership types, think about where you would classify yourself—or your boss.
The first type is the transformational leader. These leaders show strength in all five leadership behaviors and are able to transform the commitment levels of those around them. They have deep conviction about goals, determination to execute plans, and are prepared to go against conventional wisdom.
The second type is the enforcer; these are leaders who can act in ways characterized by caution and a drive to make sure specific objectives are achieved. They display strong belief in what they are doing and commitment to stay the course, but tend to limit options and avoid taking action where risk is associated.
Leaders considered deal makers attract followers largely because of their energy and excitement for anything new. They thrive on change and frequently break the mold. In the business world, they often rise to prominence based on their reputation for the deals they pull off, but can be bored easily and have little regard for sustaining the performance of their efforts after initial success is achieved.
Administrator leaders are the leaders who execute everything strategically, who are very clear in what needs to be achieved, and ruthlessly follow through. They are authoritarian in their approach, letting nothing stand in the way of achieving the overall objective, and are likely to prefer detailed and rigorous project plans, constant monitoring and updating, and tight control over resources and people.
The visionary is a leader who inspires people to dream of greatness; but these leaders often fail to follow through. They have all the qualities of the transformational leader, including their ability to elevate ambition, but are weak at generating critical mass.
The serial entrepreneur is an imaginative, but calculating, gambler. These leaders display huge energy and commitment and sweep people along with them because they make seemingly impossible challenges achievable. They care deeply about their legacy but struggle to articulate the wider context of their decisions in a way that's meaningful to their followers.
Spin doctors seem to be everything a leader should be, but their behavior is inconsistent and self-serving. Most have a markedly underdeveloped conviction. What distinguishes these leaders most is their ability to convincingly argue the case, any case, and justify the change to followers.
Have you decided where your leadership styles fits? How about that of your boss?

8. Signs of Good Leadership
Most people know intuitively what effective leadership looks like.
Leadership is about action and results.
Good leadership needs to be practiced daily.
Most people know intuitively what effective leadership is and respect strong leaders when they work with them. However, even those who understand and recognize a good leader and are cognizant of the behaviors that are associated with a good leader often don't practice it themselves. The relationship between what the leader knows and what the leader does is critical. Particularly as related to HIT—and as we have discussed in prior slides– there is a great deal of complexity and coupling of numerous teams when HIT is being planned and implemented. Effective leaders perform well, not only within their team, but across numerous teams. The behaviors of a great leader therefore carry forth, also helping an individual team to intersect more smoothly with the greater ecosystem. Leadership is about action and results—both within and across teams. Some people are said to be born leaders, but it does require work and practice.

9. Leadership Behaviors There are five leadership behaviors to consider:
Impose context.
Make risks and take risks.
Have conviction.
Challenge and change.
Generate critical mass.
As we mentioned earlier when discussing Taffinder's research on leader types, the point was made that distinct types of leaders emerge based on different combinations of the five key leadership behaviors listed on this slide.
We live in a noisy and busy world. Imposing context is a behavior that results in the cutting of clutter and imposing context by concentrating people's attention on what matters most. This behavior is characterized by providing a clear sense of direction; outlining what the key goals are; and distinguishing between the day-to-day actions that are important and those that are not.
Making and taking risks is a hallmark of a leader. Leaders break rules— it's their job. A leader must make and take risks by understanding what opportunities exist, or can be created, and then converting them into results. Doing so allows the team to do the following: pre-empt otherwise hidden risks that might damage the enterprise; take advantage of windows of success in the present or future; create new, better ways of doing things; and develop themselves and others through exposure to new situations.
Great leaders believe strongly in what they are doing—they have conviction. It is this deep personal conviction and the ability to communicate it to others that justifies their authority, attracts energy, and removes uncertainty. Having a clear view of the aim to be achieved helps guide decisions, inspires people to follow, overcomes obstacles, instills the courage to stand firm, and builds confidence in the team.
Challenge and change asserts that leaders do not rest on their laurels. A good leader must challenge and change the status quo by experimenting and creating excitement in order to grab people's attention, energize followers, take competitors by surprise, and jolt people out of accepting things as they are.
Inspiring individual action, though important, is not enough to create large-scale change. Leaders generate critical mass by turning knowledge into action and influencing people in a way that channels energy into the appropriate activities; mobilizes the teams to work together in a coordinated way; creates a culture of human development; and makes things happen.
Health IT team leadership really calls upon these behaviors. As we have discussed, shaking up the status quo, taking calculated risks, mobilizing teams to work together, trying to maintain focus in a time of great change in health care and health IT, takes a special kind of person and a new kind of leader.

10. A “New” Kind─ The Leaderful Concept
A different brand of leadership is needed.
Knowledge-based organizations require shared experience as leader
Leaders serve at the same time and all together.
(Boston Consortium)
In our new and ever changing world, we require new types of leaders, far different than we have had in the past. For example, particularly in the 1940s and 1950s leaders gave directions that were not to be questioned, and it took a brave team member to step up and suggest alternatives. More often, workers just did as they were told, which resulted in lower productivity and lesser job satisfaction. Contrast this with today, where the need for high productivity is constant, and individual contributions and/or suggestions to the team are needed. Moreover, as job and task specialization accelerates, it takes an interdisciplinary mix to move a project forward—and at any given time, the leadership must be assumed by someone with the expertise to propel the team. In other words, leadership has become more of a shared concept—with numerous leaders serving either at the same time or at a certain point in the lifecycle of a given project.
What is new approach to leadership called? According to the Leaderful Institute, the new term is, “leaderful.”
A leaderful team is one that seems to perform very well, almost as if they are a single unit—where the teaming experience is enjoyable. The team members work exceptionally well together—electively stepping out of their specialized roles to fill in for another—so that the team keeps moving along. Team members are comfortable speaking for the entire team. This is not a leaderless team—instead, the Leaderful Institute classifies this as a, “leaderful team.”
For you personally to adopt leaderful behaviors, it is important to realize that you do not have to be in the designated position of leader in your organization. Anyone who works with others in any capacity is capable of exerting leadership. You do not need to be the boss or the chief executive.
According to the Leaderful Institute, “Managers and employees in teams and organizations might find this approach especially useful. Why? We're in an age of lean operations, of doing more with less. Many managers feel overwhelmed by technology or by contractors who replace them. Meanwhile, as an employee, life isn't any easier. You're given assignments that are nearly impossible to accomplish in a specified time by supervisors who have far less understanding of the problem than you do. We desperately need to share leadership. The process described here may require executives to give up some control, but they’ll gain far more. They'll rid their community members of a suffocating dependence, releasing them to contribute their natural leadership abilities.”

11. Becoming More Leaderful
The 4 C’s
Concurrent
Collective
Collaborative
Compassionate
(Raelin, Creating Leaderful Organizations)
What is the secret to becoming more leaderful? How can we encourage others to make the change and adopt the new way of doing? According to Joe Realin, in his book, Creating Leaderful Organizations, becoming more leaderful requires that people adopt new behaviors that he calls the four C’s of practicing in a leaderful way. Raelin asserts that the new leaders are collaborative, collective, compassionate, and concurrent. This is in contrast to the established view of leaders as individual, serial, calculating, and detached. We will discuss each of the four C’s of Leadership that Raelin proposes.

12. Leadership Is Concurrent
In any organization, there can be more than one leader operating at the same time.
Leaders willingly will share power with others.
Power can be increased by everyone working together.
Think, Pair, and Share:
Can you think of any example where leaders have shared power?
Leadership concurrency is the most revolutionary concept proposed by Raelin. He suggests that by sharing leadership, power can be increased. His rationale is that since there are pockets of expertise across an organization and that leaders lead in different areas of the enterprise, requiring that only one leader operates at any given time is foolish. For example, in an HIT team, during a time of finance planning, the member with the experience in finance may be the appropriate leader. At the same time, the lead billing clerk who, “knows the ropes,” in regards to how the resources flow through an office can be just as important as the finance officer. Both of these team members can serve as leaders, driving the team forward, and in turn the shared leadership actually improves the team product or outcome.
While this seems like a simple and logical concept, it might be difficult for some people to adapt. But adapt we must! The remaining C’s—collaborative, collective, and compassionate—will be covered in lecture b.

13. Leadership: All Members as Leaders─Leaderful Teams Summary─Lecture a
Leadership traits
Leadership behaviors
Changing leadership models
Deepen understanding of shared leadership
The concept of leaderful
This concludes Lecture a of Leadership: All Members as Leaders—Leaderful Teams
In summary, our objective was to discuss the traits of a leader, and to move towards a deeper understanding of the importance of shared leadership roles—particularly in health IT endeavors. We discussed the changing face of leadership—contrasting past models with current models. Finally, varying characteristics and behaviors of leadership were presented and the concept of being leaderful was presented.

14. Leadership: All Members as Leaders─Leaderful Teams References─Lecture a—1
Boston Consortium. What is the ‘Leaderful’ Concept? Available from:
Clark DR. Character and Traits in Leadership. (2010). Available from:
Dixon N. (1999) The Changing Face of Knowledge. The Learning Organization; 6(5): p MCB University Press.
 Katzenbach J, Palestrant. Team Leadership: Emerging Challenges, Innovative Leader. 482(9);
Raelin, Joseph A., (2003)  Creating Leaderful Organizations: How to bring out leadership in everyone. San Francisco: Berrett-Koehler Publishers,
Taffinder P. Leadership Crash Course. (2007 )Available from:
No audio.

15. Leadership: All Members as Leaders─Leaderful Teams References─Lecture a—2
Images
Slide 3: Meeting. Image courtesy of the US Centers for Disease Control and Prevention.
Slide 4.1: Theodore Roosevelt. Theodore Roosevelt. Photo used under Creative Commons:
Slide 4.2:General George S. Patton. Courtesy: U.S. Army Signal Corps [Public domain], via Wikimedia Commons. Available from:
Slide 5. Three adults presenting at a conference. Image courtesy of the US Centers for Disease Control and Prevention.
Slide 6. Image of several soldiers listening to their commanding officer. CC BY-NC-SA Image courtesy of Pierre Gazzola.
Slide 8. nurse with IV bag.jpg. Creative Commons by WisGuard pics.
Slide 9. Image of a surgical team in the operating room. CC-BYSA 2.0. Image courtesy of Marion Doss.
Slide 10. An image of a team all raising hands in victory. CC-BY Image courtesy of dc.John.
Slide 11. Two providers with an injured patient. Image courtesy of the US Department of the Army.
Slide 13. Image of chess pieces on a chessboard. CC BY-NC-SA 3.0 BY Jose Martinez
No audio.
Health IT Workforce Curriculum Version 4.0

16. Working in Teams Leadership: All Members as Leaders—Leaderful Teams Lecture a
This material (Comp 17 Unit 7) was developed by Johns Hopkins University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC This material was updated in 2016 by Johns Hopkins University under Award Number 90WT0005.
No audio.
Health IT Workforce Curriculum Version 4.0