2. Adaptive Leadership Beliefs Behind Dr. Ron Heifetz’ work Problems are embedded within complicated and interactive systems. Problems are embedded within complicated and interactive systems. Much of human behavior reflects an adaptation to circumstances. Much of human behavior reflects an adaptation to circumstances. People adapt more successfully to their environments by facing painful circumstances (aka FEAR) and developing new attitudes and behaviors. People adapt more successfully to their environments by facing painful circumstances (aka FEAR) and developing new attitudes and behaviors.

3. Why Apply Adaptive Leadership in Health Care? Describes what people do Describes what people do Describes what people exercising leadership can do if they see differently Describes what people exercising leadership can do if they see differently A way of developing a shared language to describe group dynamics A way of developing a shared language to describe group dynamics Describes a way to be an active engaged organizational citizen Describes a way to be an active engaged organizational citizen Really resonates with clinicians Really resonates with clinicians Describes what people do Describes what people do Describes what people exercising leadership can do if they see differently Describes what people exercising leadership can do if they see differently A way of developing a shared language to describe group dynamics A way of developing a shared language to describe group dynamics Describes a way to be an active engaged organizational citizen Describes a way to be an active engaged organizational citizen Really resonates with clinicians Really resonates with clinicians

4. Opportunities Opportunities Enhance capacity to exercise leadership Build a framework to help others make progress on tough problems Create resiliency to withstand the work of leadership Enhance capacity to exercise leadership Build a framework to help others make progress on tough problems Create resiliency to withstand the work of leadership

5. Productive Range Threshold of learning Limit of tolerance Time Tension of change Based on Heifetz, Ronald A. and Marty Linsky. Leadership on the Line, Harvard Business School Press, Boston, MA,2002, pg. 108.

6. Type of Situations Requiring Leadership Technical -- Apply abilities that already exist in the system’s capabilities Adaptive -- People deeply and broadly within the organization need to learn new capabilities

7. PRODUCTIVE RANGE OF DISTRESS Threshold of learning Limit of tolerance Technical problem Time Disequilibrium Disequilibrium Technical vs. Adaptive Work Adaptive challenge Heifetz, Ronald A. and Marty Linsky. Leadership on the Line, Harvard Business School Press, Boston, MA,2002, pg. 108. Tensionofchange

8. Adaptive Work Adaptive work diminishes the gap between the way things are and the way things need to be to create a better future

9. The most common cause of leadership failure is treating an adaptive problem with a technical fix.

10. What is hard about leading others in improving care?

12. Adaptive Work Adaptive work diminishes the gap between the way things are and the way things need to be to create a better future Adaptive leadership is the activity that mobilizes people to perform needed adaptive work

13. Technical and Adaptive

16. Delivering high quality care with optimal stewardship of resources You Who Cares About the Work? Patient Other team members Family

18. Productive Range Threshold of learning Limit of tolerance Time Tension of change Based on Heifetz, Ronald A. and Marty Linsky. Leadership on the Line, Harvard Business School Press, Boston, MA, 2002, pg 108.

19. Heifetz, Ronald A. and Marty Linsky. Leadership on the Line, Harvard Business School Press, Boston, MA, 2002, pg. 108. Are you reading the signals others are sending? Adaptive Challenge Productive Range Holding Environment Threshold of learning Limit of tolerance Time Tension of change Work Avoidance Technical Challenge Work Avoidance

20. Work Avoidance Signals Being Out of a Productive Range of Tension Displacing responsibility Displacing responsibility Attack authority Attack authority Kill the messenger Kill the messenger Scapegoat Scapegoat Distracting attention Distracting attention Make the problem too big Make the problem too big Make the problem too small Make the problem too small Meetings with only information exchange when engagement and deep conversation is needed Meetings with only information exchange when engagement and deep conversation is needed Ask more consultants Ask more consultants Denial Denial Collude in magical thinking Collude in magical thinking

21. Can you imagine some Can you imagine some work avoidance examples you might see?

23. You How are you and others reacting to the work? Delivering high quality care with optimal stewardship of resources

24. Begin to Plot a Strategy

25. Help People Make Progress on Adaptive Work Use yourself differently Use yourself differently Create productive tension Create productive tension Keep people engaged who are making progress and figure out what you need to do to reengage others. Keep people engaged who are making progress and figure out what you need to do to reengage others.

28. Informal Authority = Influence

31. Exercising leadership to do adaptive work means disappointing people’s expectations (that things will stay the same) at a rate they can tolerate. (and not muzzle you)

32. Leadership is an activity There can be leadership from multiple positions within a social structure

33. Get on the Balcony Fundamental Skill in Adaptive Leadership Reflect in action Keep the pattern of the dance in mind while dancing Move back and forth

35. Use Yourself Differently Exercise leadership and use your informal authority as a resource Exercise leadership and use your informal authority as a resource Reflect in action – get on the balcony Reflect in action – get on the balcony Set a great example Set a great example Celebrate and learn from what is going well Celebrate and learn from what is going well Talk about why you think this is important Talk about why you think this is important Ask questions Ask questions Listen Listen Pay attention Pay attention

36. Behaviors That Build Trust T alk straight T alk straight Demonstrate respect Demonstrate respect Create transparency Create transparency Right wrongs Right wrongs Show loyalty Show loyalty Deliver results Deliver results Get better Get better Confront reality Confront reality Clarify expectations Clarify expectations Practice accountability Practice accountability Listen first Listen first Keep commitments Keep commitments Extend trust Extend trust Adapted from The Speed of Trust, Stephen M.R. Covey, 2006.

37. Create Productive Tension Make it safe to disagree and debate but not OK to opt out and disengage. Talk honestly to one another about the challenge Listen with genuine interest to the various points of view Build trust Have difficult conversations

38. Difficult conversations are inevitable Safety is critical for them to be productive Safety is critical for them to be productive shared purpose shared purpose mutual respect mutual respect Be willing to be influenced Be willing to be influenced Be curious rather than judgmental Be curious rather than judgmental 100% candid 100% candid 100% respectful 100% respectful Lead with questions not answers Lead with questions not answers Engage in dialogue and debate not coercion Engage in dialogue and debate not coercion

39. Productive Range Threshold of learning Limit of tolerance Time Tension of change Create an Environment to Hold Attention on the Work the Work Based on Heifetz, Ronald A. and Marty Linsky. Leadership on the Line, Harvard Business School Press, Boston, MA, 2002, pg 108. People need to feel safe enough to do adaptive work but not so safe that they will do nothing.

40. Productive Range Threshold of learning Limit of tolerance Time Tension of change Distressed System No Trust, Little Adaptive Capacity Based on Heifetz, Ronald A. and Marty Linsky. Leadership on the Line, Harvard Business School Press, Boston, MA,2002.

41. What is a difficult conversation? Any conversation that you dread and perhaps seek to avoid, if possible Any conversation that you dread and perhaps seek to avoid, if possible Three inherent challenges present the source of difficulty Three inherent challenges present the source of difficulty There are inevitably more ways to understand the situation than any one participant is aware of or agrees with There are inevitably more ways to understand the situation than any one participant is aware of or agrees with The situation is emotionally charged with strong feelings The situation is emotionally charged with strong feelings The situation is psychologically threatening to one or both parties The situation is psychologically threatening to one or both parties

42. Which Condition of Safety is at Risk? Mutual purpose or mutual respect Mutual purpose or mutual respect Conditions make the conversation difficult Conditions make the conversation difficult much more than content much more than content Mutual purpose or mutual respect Mutual purpose or mutual respect Conditions make the conversation difficult Conditions make the conversation difficult much more than content much more than content Adapted from Crucial Conversations

43. Productive Range Threshold of learning Limit of tolerance Time Tension of change Shared Vision Delivering high quality care with optimal stewardship of resources Based on Heifetz, Ronald A. and Marty Linsky. Leadership on the Line, Harvard Business School Press, Boston, MA,2002, pg. 108.

44. Productive Range Threshold of learning Limit of tolerance Time Tension of change How Do We Hold the Tension? Delivering high quality care with optimal stewardship of resources – respectfully? Based on Heifetz, Ronald A. and Marty Linsky. Leadership on the Line, Harvard Business School Press, Boston, MA,2002, pg. 108. and adaptationfrom Crucial Conversations

45. Conditions of safety Conditions of safety Mutual purpose Mutual purpose Do others believe you care about their goals in the conversation? Do others believe you care about their goals in the conversation? Do they trust your motives? Do they trust your motives? Mutual respect Mutual respect Do others believe you respect them? Do others believe you respect them? Conditions of safety Conditions of safety Mutual purpose Mutual purpose Do others believe you care about their goals in the conversation? Do others believe you care about their goals in the conversation? Do they trust your motives? Do they trust your motives? Mutual respect Mutual respect Do others believe you respect them? Do others believe you respect them? Widening the Productive Range Adapted from Crucial Conversations

46. Productive Range Threshold of learning Limit of tolerance Time Tension of change Increased Trust, Increase Capacity for Adaptive Work Based on Heifetz, Ronald A. and Marty Linsky. Leadership on the Line, Harvard Business School Press, Boston, MA,2002, pg. 108.

47. Keep people engaged who are making progress and figure out what you need to do to reengage others.

48. Heifetz, Ronald A. and Marty Linsky. Leadership on the Line, Harvard Business School Press, Boston, MA, 2002, pg. 108. Work avoidance signals being out of a productive zone relative to the work Adaptive Challenge Productive Range Holding Environment Threshold of learning Limit of tolerance Time Tension of change Work Avoidance Technical Challenge Work Avoidance

50. Lowering the Heat Validate feelings, acknowledge loss Validate feelings, acknowledge loss Simplify and clarify Simplify and clarify Address the technical aspects Address the technical aspects Break problem into parts Break problem into parts Restore, add, or reallocate resources Restore, add, or reallocate resources Temporarily reclaim responsibility for tough issues Temporarily reclaim responsibility for tough issues Give your attention Give your attention Take stock of what is available Take stock of what is available Allot more time, enrich knowledge and skills Allot more time, enrich knowledge and skills

52. Raising the Heat Raise the standards Raise the standards Increase accountability Increase accountability Change the task to something more motivating Change the task to something more motivating Refocus on higher, more widely shared and yet compelling purpose Refocus on higher, more widely shared and yet compelling purpose

53. Exercising leadership to do adaptive work means disappointing people’s expectations that things will stay the same but at a rate they can tolerate.

54. PRODUCTIVE RANGE HOLDING ENVIRONMENT Work avoidance Threshold of learning Limit of tolerance Technical challenge Time Adaptive Challenge Heifetz, Ronald A. and Marty Linsky. Leadership on the Line, Harvard Business School Press, Boston, MA,2002, pg. 108. Work avoidance Tension of change Give Work Back to People at a Rate They can Tolerate

55. Exercising leadership requires keeping an experimental mindset Work avoidance looks the same when the heat is too high or when the heat is too low. Work avoidance looks the same when the heat is too high or when the heat is too low. If what you try makes things worse try the opposite. If what you try makes things worse try the opposite. What looks like laziness may be exhaustion. What looks like laziness may be exhaustion. Keep rechecking your assumptions. Keep rechecking your assumptions. Work avoidance looks the same when the heat is too high or when the heat is too low. Work avoidance looks the same when the heat is too high or when the heat is too low. If what you try makes things worse try the opposite. If what you try makes things worse try the opposite. What looks like laziness may be exhaustion. What looks like laziness may be exhaustion. Keep rechecking your assumptions. Keep rechecking your assumptions.

56. PRODUCTIVE RANGE HOLDING ENVIRONMENT Work avoidance Threshold of learning Limit of tolerance Technical challenge Time Adaptive Challenge Heifetz, Ronald A. and Marty Linsky. Leadership on the Line, Harvard Business School Press, Boston, MA,2002, pg. 108. Work avoidance Tension of change Keep an experimental mindset When you try something and things get worse try the opposite!

57. Building Your Practice of Leadership Adaptive leadership helps people to make progress on difficult problems