Leadership Resource Center
Leadership Primer

How did that happen?

Why don't they do something about that?

Do these questions sound familiar?

Unfortunately, they are all too common in our everyday personal and work life.

Where is the leadership?

Successfully leading the pharmacy enterprise means that you need to choose to lead, whatever your practice role, title or experience level, fostering strong connections between peers and colleagues, and across organizational levels and functions. You can choose to lead, to do "something" about the challenges, issues and obstacles you face in your role and your organization. Building leadership skills, experience and capability is a lifelong commitment, a journey that starts now, from where you are today, to gain the confidence and behaviors that will drive the decisions, actions and results that will define your personal leadership legacy . . .

IOM Highlighted the Leadership Need

In 1988, the Institute of Medicine urged that leadership -- or lack of it -- was at the core of many of the issues facing the healthcare system. While leadership has been a growing focus of attention across many industries, including healthcare, there has been a lot of talk, and far less skill building. As social values and expectations have changed, there has been a dramatic shift from authority-focused leadership (also referred to as BIG L leadership) to collaborative, team-oriented leadership, but professional education and training support have not kept pace with the need for skills development and knowledge transfer. Even less developmental attention has focused on leadership skill building for mid-level and line managers, and almost none is dedicated to the clinician, staff pharmacist, technician and anyone else who provides a strategic role in the fulfillment of the everyday work of the overall Pharmacy Enterprise.

NQF Placed a Laser Beam on Pharmacy Leadership

More recently, the National Quality Forum (NQF) has endorsed best practices that should be universally applied to to reduce the potential of harm to patients. A culture of leadership for safety has been a pivotal component from the initial recommendations in 2003, but the most recent update in 2009 underscored the importance of leadership and organizational culture across the continuum of care, but specifically dedicated a chapter to medication management, and even more directly focused on the role of the pharmacist as a vital leader with a strong role in administrative leadership to reflect their authority and accountability for medication systems performance across the organization. This is a critical time for pharmacists to choose to lead. What are your skills, how ready are you to take up the challenge, and where do you need to strengthen your capabilities?

Personal Leadership Assessment Tools

Your natural leadership skills and style are the foundation and starting point for your journey. Self-assessment of where you are, where priority opportunities for self-development should be focused, is a first step. This resource will enable you to evaluate critical aspects of your leadership capability, to identify areas for growth and nurturing and to begin the development of a personal plan for your leadership journey, future and legacy. 

Developing Collaborative Leadership Practices

Several assessment instruments are designed to provide you with a line of sight to your potential and the opportunity to make the most of your leadership journey, including a range of self-assessment opportunities, including

Assessing the environment

Creating clarity for vision to mobilize change

Building trust

Sharing power and influence

Developing people

Self reflection

Enjoy the journey!

Click on the title of the assessment of interest to link to the assessment questionnaire. Once you complete the assessment, you can enter your email address to receive a summary of your results. The contents of the Primer and the topical modules listed on the home page are designed as a resource to build personal insights, knowledge and skills for areas of self-development.

Periodic reassessment will help you to measure progress toward your personal development goals.

Leaders need to develop the personal capacity to recognize patterns and common interests, particularly to recognize and understand other perspectives in order to arrive at shared vision, purposes and values. Connecting the dots, bringing different points of view into perspective, and encouraging a diverse group to think clearly about change opportunities, benefits the organization, the team and its individual members. With an aim to setting priorities, analyzing barriers and obstacles to develop actionable strategies, environmental assessment capabilities are a fundamental leadership building block.


Clarity of values, commitment to a cause that transcends self, and clarity of purpose for a goal involving commitment to a better future are inherent components in visioning to mobilize people to confidently take action and sustain energies toward common vision. Clarity of purpose and the focus it engenders inspire people to commit their best effort to achieve. 


Trust is an essential foundation of effective leadership. Without trust, commitment, support and inspiration are fleeting and change initiatives are at risk to the whims of organizational pressure points of the moment. 


Few leaders understand the capacity to share power and influence widely as a strategy to not only achieve, but to expand success. Shared effort, a wide range of experience and input, and empowerment of the team through development of dispersed influence, not only rewards the individual, but increases advocacy position within the organization.


Bringing out the best in others, developing talents and capabilities, building power through shared influence and abandoning the need for control build individual and organizational capability. Training, coaching, mentoring, feedback and networking support the development of individual confidence and capacity for creativity, innovation, goalsetting and transformation.


To be an effective leader, self-reflection must be an active and continuing thought process, with focus on understanding and evaluating personal values and how congruently behaviors match those values. Analysis on verbal and nonverbal communication, the impact of actions and words on goal achievement and the capacity to self-adjust behaviors are essential to effective collaborative leadership in an increasingly complex environment.



Developing leaders is a formidable task in our society, particularly in the current healthcare environment, where leadership development hasUntitled.png become a critical focus for many professions and organizations. The shear volume of change we face every day -- with growing demands for quality, safety, cost effectiveness and value -- makes the need for transformational change of the healthcare system ever more obvious. And transformational change demands exceptionally strong leaders -- who like a river-- flow around the obstacles, challenges and impediments that can slow or stop the progress of transformation. New insights, skills and perspectives will be needed at every leadership level.

Pharmacists as Leaders 

Pharmacists are in a unique position to provide strategic and valued leadership organization-wide, with impact on both the blunt and sharp end of patient care. With the growing cost and complexity of medication treatment alternatives, as well as systems of administration and distribution and their effects, pharmacy has evolved to a complex business component with the unique clinical, distributive and administrative potential to materially impact the patient's and the organization's bottom line. At every level, in every role, pharmacists have the opportunity to exert leadership to influence a culture of safety, efficiency/effectiveness and results. 

Building leadership skills and knowledge will prepare pharmacy leaders -- at every level of the organization -- to use strategic influence and to serve as advocates for critical issues of safety, quality and value in the services provided and their impact on patients. (Click to hear a Leadership Conversations with ASHP Past President Andy Anderson.)



SP2009Cover.jpg Beginning in 2003, the National Quality Foundation (NQF) published Safe Practices for Better Healthcare: A Consensus Report, with a 2006 update that incorporated input from other national groups including Centers for Medicare and Medicaid Services (CMS), the Agency for Healthcare Research and Quality (AHRQ), The Joint Commission (TJC), Institute for Healthcare Improvement (IHI) and The Leapfrog Group. Recommendations reflected current evidence, standards and guidelines, supporting literature and guidance for implementation. In 2009, NQF Safe Practices were again updated, and a separate chapter was dedicated tonqf_logo.jpg Medication Management (Recommendations 17 -- Medication Reconciliation -- and 18 -- Pharmacist Leadership Structures and Systems.) Recommendation 18 specifies the active role pharmacy leaders should have on the administrative leadership team, reflecting their authority and accountability for medication management systems performance across the organization, including the full continuum of care. This opportunity to reinforce pharmacists' leadership role represents a significant platform for changing the role of the pharmacist. Click here to link to a Leadership Conversation with Sharon Murphy Enright.)

Who should use this Primer? 

This primer is designed for aspiring and new leaders as well as for seasoned leaders. It provides:



What's Driving the Need for Leadership Development?

The increased emphasis on leadership development is a result of an number of business and social drivers which have moved many organizations into crisis mode, and a recognition that leadership bench strength is a critical asset for continuing success.


dv804087 b.jpg As the baby boomer generation moves toward retirement (even if the economy causes retirement to be delayed) more than 70 million people will retire between now and 2023, while only 40 million will enter the workforce. This resulting talent shortage and knowledge drain also portends a leadership gap. The impact on pharmacy practice was well documented in the April 2005 article by Sara White entitled, "Will There be a Leadership Crisis?" With fewer opportunities to develop leaders in traditional ways, there are also fewer candidates actively seeking the traditional leadership pipeline.


Past staff consolidations in healthcare organizations wiped out layers of middle management and depleted the leadership talent pool, and training and development programs were reduced or eliminated. There is diminished opportunity for experiential learning in leadership skills, at the same time that growing management pressures that have served to decrease the "attractiveness" of traditional leadership positions. This has resulted in an unwillingness of many potential leaders to abandon direct patient care and more clinical aspects of practice. All of these factors coincide with an even greater need for strong leadership that is less positional, increasingly collaborative, and with an need for a dispersed leadership aspect of every role. The way we view and exercise leadership must change.

Changing Workforce

Today's employees are "different," demanding more involvement in decisions that impact them. This difference requires a new set of leadership skills and capabilities, a willingness to solicit ideas, listen, abandon the notion of having "all the answers" and regular, ongoing coaching, mentoring and feedback.

Changing Organizational Structure

The top-down, hierarchies of the past are evolving to flatter, leaner and more decentralized operations, often geographically disperse and sometimes "virtual." There is an evolving collaborative team orientation that requires development of leadership skills and new behaviors for every team member.

Diminished Engagement, Urgency and Accountability

Recent research suggests that the average healthcare worker is only engaged at 30% of overall capability, clearly leaving organizational capacity for change, improvement and quality of care on the table, and in too many organizations this is compounded by a lack of urgency for change. Stronger and more dispersed leadership is essential to increasing engagement, a stronger sense of urgency for results and a vision for the needed transformational changes required. Positional leaders must commit to dispersed and structured leadership development within the ranks of the organization, putting substance behind the common pronouncement that our people are our most valued asset, with reward structures tied to development of emerging leaders.

Changing Technology and Automation of Critical Functions

Dynamic changes in technology and automation create the proverbial challenges and opportunities. These technologies allow organizations to take advantage of speed and efficiency, improve consistency and reliability of connectivity and communication within the team, but introduces a continually increasing level of complexity which introduces additional levels of stress, anxiety and need for adaptation, as well as need for new skills and dispersed leadership.


Today's Leadership Expectations

The challenges of today's healthcare environment are more demanding than ever. New insights and capabilities are essential to anticipating and dealing with change, managing complexity and focusing on results. The old ways won't work, and each pharmacist must assume elements of leadership, charged with the responsibility of influencing others to go the extra mile to achieve established goals, keep patients safe and manage resources effectively. Successful leaders need to shift thinking and behavior to meet the challenges of a new world of expectations.

While the need for leadership attributes and skills is vital, but just as important is a focus on results. In a simple formula, Ulrich and colleagues identify a simple formula: Effective leadership = attributes x results, making the critical point that both factors are essential and that they are not cumulative, they are multipliers. Cultivating an environment where people thrive is essential and demands new insights, skills and attitudes. Successful leaders in this new environment understand these critical shifts in thinking.

360-degree-performance-appraisal.jpg Competition is at the heart of our society and its corporate and financial growth, but despite this, leaders in today's organizations -- including healthcare -- need to cultivate a culture to allow people to thrive, grow and contribute in new ways. Today's leader must go far beyond the traditional management lessons, roles and functions to influence and engage team members, convincing them to give more to achieve organizational goals. Shifts in thinking and behavior that are necessary include:



Aligning goals, breaking down siloed or "stovepipe" behaviors, reaching across business lines, departments and functions, and forming partnerships and alliances with other organizations to expand influence, impact and efficiencies are essential considerations in the new environment. Collaborative interaction, communication, information sharing and decisionmaking must be fostered at every level of leadership to tap into new thinking, creativity and innovative ideas and breakthrough concepts and processes.

Empowerment and Engagement

Engaging employees fully for their best effort is challenging, yet enormously enriching for both the individual and the organization. Creating a culture where leaders at every level can feel confident with both the desire and skills to make decisions without first asking permission. Personal accountability and responsibility for one's own work and results is vital to this transition, allowing leaders to focus on vision, strategy and continual development of people.

Proactive Innovation and Risk-Taking

Strategic and critical thinking skills are essential in the new challenging environment we face. Being innovative, taking risks, forging new directions in clinical and operational services, while balancing those decisions with an understanding of the implications, consequences and opportunities that the changing environment brings.

Listening and Letting Go

listen_attentively.jpg Today's leaders simply can't have all the answers. Asking the right questions, listening -- not telling -- and engaging in dialogue to evaluate options will be increasingly important to leaders. One-on-one and group meetings, building relationships to understand values, aspirations and ideas, and active solicitation of ideas and suggestions create an environment of openness, receptivity to suggestions whatever the source, even if they oppose existing practices. Letting go of the notion that you, as the positional LEADER, must have all the answers is liberating, eye-opening and may just lead to some amazing new ideas and options.

Coaching, Mentoring, Networking

Command and control, edicts and wisdom from the top are eroding as leadership behavior options. Coaching, mentoring, and networking relationships are essential to understanding the values, motivation and aims of each individual, helping them to improve their performance, contribution to the organizational whole, and to achieve greater satisfaction with their work.

Leadership Competencies and Development

leadership_dev_prog_ico.jpg Leadership starts with the individual, and every person, regardless of role, can implement some aspects of leadership. Developing this leadership expertise is necessary for success through one's career, initially mastering skills to become a high level individual contributor, taking advantage of natural talent and taking time to learn and master leadership through job opportunities, interactions with peers, colleagues and other leaders, and through educational opportunities.

What Are Competencies?

Competencies are the primary clusters of knowledge, behavior and motivations that organizations expect of leaders. These underlying characteristics of an individual are causally related to superior performance and essential to leading others toward a purpose, vision and mission. Core competencies are those elements vital to getting a job done well. Competency domains are aggregations of core competencies into broader categories of classification, defining a coherent subset of knowledge. Competencies should be observable and measurable, and should be linked to ability to achieve desired results. A recent study identified five top competency domains most desired for current and future executives, including:

Core competencies for effective leaders have been studied for decades, and the following emerge consistently as essential, regardless of industry, role or seniority:


Determining Leadership Competencies

Once the vision, mission and values of the organization are clear, it is essential to understand the leadership competencies that will achieve the desired results, and should be part of your strategic planning process. SWOT analysis can be a helpful tool in identifying both the business processes and challenges of interest, and the competencies that will take you to your destination.

With a clear understanding of the essential leadership competencies, the next step is to further define them by developing behavioral anchors -- statements that define in concrete, behavioral-based terms the behaviors that lead to desired outcome. As an example, a critical leadership competency for most organizations is Leading Change. A basic behavioral anchor statement might be:

fish_training3.jpg The ability to lead and manage change within the organization and to help others cope with and manage change so that the organization can respond rapidly and effectively to a challenging business environment to achieve the desired benefit or outcome.

This type of behavioral statement clarifies for all parties what is expected and links expectations to business purpose. It serves as a starting point for metrics and a basis for performance evaluation, the baseline for developing individuals and teams, and offers a consistent set of criteria for use in selection, development and leadership assessment, consistency of leadership behavior and stronger alignment on strategic goals, forming the basis of behaviors, knowledge and skills essential to achieving success in the organization. Competencies also serve as a baseline requirement for an effective leadership development program.

Components of a Leadership Development Program

Any leadership development program must focus on the organization's critical success factors -- those few high priority issues that must be achieved for the organization to be successful. They are typically characteristics, conditions and metrics, that when properly managed, can positively impact strategic aims, including the bottom line. Some common examples include:

While leadership development is a hot topic of discussion, it does not just happen. Careful planning and attention to consistent follow up are vital to success, with attention to:

Test your organizational readiness for implementing a leadership development program by answering the following questions:

  1. Does the organization truly value its employees?
  2. Has senior leadership clearly identified and communicated the organization's vision, mission and values to all employees?
  3. Are some leadership development and management skills programs already in place?
  4. Is there a structured performance management system focuses on pay for performance?
  5. Are employees encouraged to take advantage of educational and personal development opportunities?
  6. Are leaders involved in coaching and mentoring employees, with regular feedback?
  7. Do leaders encourage feedback from employees?
  8. Are performance standards in place and clearly communicated to all employees?
  9. Are employees encouraged to behave proactively and to take risk?
  10. Is senior leadership willing to allocate the necessary resources -- including time -- to assure a successful and meaningful leadership development program?

Completing this checklist of questions yourself and having others on your team complete it should give you a perspective on the perceptions of your organization's commitment to leadership development. Compare discrepancies in response, meet with those involved to discuss their perceptions and identify steps that might be needed before launching a formal leadership development initiative.


Evolving Leadership Thinking . . . and a Look Back at the Journey

Our notion of leadership has evolved over time, changing with social values and business practice. Several thought leaders and their ideas have shaped our contemporary view of leadership, including work by Max Weber, James McGregor Burns, Bernard Bass, Warren Bennis and Burt Nanus and Edgar Schein, each of whom makes substantial contribution to our evolving understanding of the critical importance of leaders to our organizational successes.

Weber defined three leadership "ideals" -- frames of reference for leader behavior -- at the turn of the century. Those three include

While Weber stipulated that none of these types occurred in "pure" form, and that gradual transitions and combinations of the types were displayed, this balance was typically driven by the "will to power" and the "will to serve" which correspond closely to McGregor's Theory X and Theory Y.

xy.png McGregor believed that leaders were either amoral or moral, based on the hierarchy demonstrated at left. Moral leadership must be based on the fundamental wants and needs, aspirations and values of the followers, with the assurance that followers have both knowledge of alternatives and the capacity to choose among them, with leaders taking responsibility for the commitments made to followers. With higher purpose, leaders could be transactional or transformational, with clear distinction between the two. Transactional leaders lean toward focus on the means, rather than the ends, while transformational leaders value ends over means. The path to transformational leadership could be intellectually based -- focused on ideals and values that transcend practical realities potentially putting these leaders out of step with their own time and environment; reform leaders who embrace large numbers of allies with a mix of their own goals, focusing on the elemental parts and with endless potential divisions among the ranks; revolutionary leaders who focus on the whole, with strong sense of vision, mission and end values, motivating masses of people to "revolt" for change; and charismatic leaders who engage followers in a belief system.

Bass took a slightly different view, with the belief that good leaders were both transactional and transformational in differing amounts and intensity depending on the need. In transactional mode, leaders inspire group confidence and desire by clarifying performance demands and resulting impact on results, working within the existing culture. In transformational mode, leaders engage followers in extraordinary effort with sharp increases in individual confidence and elevating the personal value and benefit of the anticipated outcomes to the follower, typically effecting change in the organizational culture and arousing the follower to a higher level of need, based on Maslow's hierarchy. Transformational leaders radically reshape the social, physical and behavioral environment, making way for a new future state.

Bennis and Nanus studied leader traits, including logical thinking, persistence, empowerment and self-control, rediscovering distinct differences between transactional and transformational leaders. Based on their findings, a critical difference between the two is that transformational leaders engage and empower followers to become leaders themselves and to act as critical change agents within the organization. Transformational leaders accomplish this through vivid articulation of vision, clear and unambiguous values and sense of personal purpose that leaves the follower (sometimes designated the small-l -- non- positional -- leader) with a clear sense of direction, and a decision making compass that aligns with organizational strategy and goals. The leader is a role model, inspires and motivates the team providing meaning and challenging stretch goals, offers the intellectual stimulation of creativity and innovation, and provides active attention to the individual with coaching and mentoring.

Schein focuses on the vital role of culture, with the belief that meaningful transformation demands a change of culture and that everything that leaders do, say, pay attention to, measure and control sends symbolic symbols to the rest of the culture that in turn shapes what the culture becomes. The leaders focus of attention, behaviors and actions in word and deed, frame the organizational priorities. (Click to hear Conversations with Joseph Oddis on Leadership.) Goal directed activity with orderly monitoring and assessment of results must derive clearly from the mission and strategy of the organization as a whole. An emphasis on people, engagement of followers in the vital purpose of the organization, individual development commitment is vital

leadershipborder.jpg Over the last century, there has been a dramatic leadership paradigm shift (click to hear Leadership Conversations with John Gans and Gloria Francke), much of which relates to the speed and intensity of change we face in contemporary society, and the resulting issues and expectations leaders face every day. Major categories of influence define this shift. If the 80's were about quality and the 90's about reengineering, we have quickly moved into an era that focuses on velocity, transformation and engagement, with leadership a vital force for dealing with an increasingly complex -- sometimes chaotic -- environment. Declining reimbursement and growing numbers of uninsured, staff shortages and leadership gaps, increased demand for services and customer dissatisfaction with systems designed to meet provider needs rather than patient needs line up with burgeoning technology opportunity as well as associated cost, and the knowledge that our clinical and operational systems are not as safety as they should be, creating significant risk to patients. Yesterdays thinking and solutions will not solve today's or future challenges and problems.

Organizational Culture

In the past, leaders have focused internally on processes, operations and procedures, with the luxury of long and regular cycle times, fairly stable environments, time for planned change strategies and the ability to assess and avoid risk. Our organizations have been fairly hierarchical, with centralized controls to monitor and govern performance, and with sharply defined boundaries between departments, functions and teams. But the demands facing today's healthcare organizations and their critical functions are far more customer focused, driven by the need to demonstrate results and the value contribution of every element of what we do. Our organizations are far more complex and care integration requires that leaders (both big L and small) operate in a multitude of subcultures on a daily basis. The focus is on results and customers, and increasingly healthcare organizations are realizing that integration of teams and processes is vital to this focus. Rapid response, calculated risk-taking and applying creative and innovative thinking to entrepreneurial opportunities -- including thinking outside our traditional four walls -- are becoming the norm. (Click here for a Leadership Conversation with Mary Jo Reilly.)


Historically, healthcare organizations, particularly hospitals, have been designed with a top-down hierarchy, providing excellent examples of collections of high level individual contributors working side by side, occasionally in a coordinated way. Policies, procedures, job descriptions, organizational charts, hierarchical structure defined how work was defined and completed.

But a lot has changed: loyalties, commitment to long term employment, expectations -- on both sides of the employment equation. Leaders are needed at every level of the organization, with every individual solving problems that impact the ability of the overall enterprise to achieve results. Everyone needs to be strategically focused -- leading, thinking, doing, working effectively in teams with joint accountability for results. The focus on production workers has transformed to a demand for skilled knowledge workers, often focused on a project basis fully integrated with other professionals of many disciplines. Commitment to individual development, engagement of every employee in the strategic goals of the department and organization and an aligned focus on results is essential to leading in the current environment.


Today we have to think more about the whole system, with less singular focus on the parts. With multiple performance systems and metrics, complex interdependencies, often still dependent on legacy systems that don't communicate, the values, principles, accountabilities and joint targets bind somewhat separate systems in working order. Decisions are increasingly value-, quality- and safety-based, with comprehensive supply chain management principles, just-in time inventory/delivery/learning the norm rather than the inventory stockpiles and long lead times of the past.


Paper-based communication and face-to-face meetings are fading, replaced by digital tools and teleconferences and GoToMeeting. Virtual teams, transparency and free flow of information, decisionmaking at the speed of light and thought (rather than talk and paper), are becoming the norm. Emergence of EHR, telemedicine, and personal medicine are changing the process and substance of our work and the demands of leadership. The pace of change is stunning. The amount of information that is accessible challenges our leadership ability to transform it to insight and wisdom to keep pace with the demands of the environment.

Leadership Style

With the demand for collaborative team effort to keep pace with the complexities of our healthcare organizations, everyone must be a leader, focused on doing the right things -- not just doing well what we do in isolation. Our content knowledge is less valued than our understanding of the context of challenges and the options for potential solutions. Appropriate risk taking is replacing risk avoidance because the solution options are simply not as clear cut as they once were. Simply telling people what to do doesn't work as well as it once did, and an approach using coaching and shared delegation of accountability recognizes that no one leader can have all the answers, have access to all the necessary information or stay on top of all the issues. (Click here for a Leadership Conversation with Current APhA and Past ASHP President Harold Godwin.)

Job Design

Finally, job design is evolving, with less segmentation, more cross-training and shared responsibility. Everyone must be engaged, accountable and a critical thinking problem-solver, not waiting for a problem to be identified, but stepping in to resolve issues before they become problems . The reality is that we are always working on multiple cross functional teams, systems, performance systems and metrics, with a common focus on patients, safety and results.



The Evolving Healthcare Paradigm and the Need for Revolutionary Change

Change is ubiquitous in healthcare, and the pace is increasing. Despite this growing pace of change, and our struggle to "manage" it, we remain locked in a craftsperson model of work that evolved in the 18th century. Paired with the wonders of technologic innovation, capacity and capability, we retain systems that are fragmented, disjointed, and sometimes capable of harm to patients. Changing this will demand a dramatic paradigm shift to a patient-centered system focus.

Kuhn and Morrison defined paradigm shifts -- a change in thinking, structures and processes so radical that the before and after bear little resemblance or relationship to each other -- and their application to today's healthcare organization. The shift they describe is neither linear nor incremental, and the shifting assumptions, beliefs and attitudes that define the second curve are not simple transitions, in fact discontinuous, dramatic and often disruptive. We are talking revolution, rather than evolution. Being caught "between the curves" is dramatic, stressful and fraught with ambiguity.

HCParadigm.png Healthcare's first curve starts just after the turn of the last century, signaled by the benchmark report calling for a dramatic transition to the academic medical education model establish by William Osler and colleagues at Johns Hopkins late in the 19th century. This sentinel event ushered in a stream of medical and surgical interventions for cure and care. But these wonders of modern medicine have brought not just the ability to cure, but as demonstrated in a series of Institute of Medicine (IOM) Reports, the ability to bring harm to patients as a result of lingering complexity, fragmentation and lack of strategic goal alignment. This enormous multi-trillion dollar industry -- the largest in our society -- is still built on a pre industrial craft model: train craftspersons -- physicians, nurses, pharmacists, therapists; license them; supply them with resources; . . . and turn them loose to care for patients as high level individual contributors. This worked well when care was defined by individual encounters with a single health professional, when costs and the complexity of care were far smaller and simpler, and where care was typically "covered" by some affordable health insurance. Some of the assumptions and beliefs that characterize the first curve include:

Over time, the isolation of clinical care decisions and the operational/financial decision making has created safety, quality and cost issues that_moments-in-time_36_x36_.jpg challenge every leader, caregiver, organization and function in the patient care system, regardless of the care setting. Recognizing this, most healthcare organizations are in some stage of transformation, including essential physical and informational infrastructure changes -- that will permit us to evolve to the second curve. The second curve is anticipated to shift many of these beliefs and assumptions:

The transition to the second curve is not smooth and seamless. A whole new set of assumptions and beliefs come to play on our reality of work. Leaders must understand both the first curve and the emerging second curve, bringing along the best values from the first curve and incorporating them into the design of the second curve, creating a future, not just rearranging deck chairs on the Titanic. Balanced scorecards focus economic, clinical health status and satisfaction aims will be the norm, not the aspiration. Keeping a close watch on the transition indicators, adapting our practice, services and decisionmaking and taking advantage of opportunities in the transition vortex will be critical for pharmacy leaders.


Systems Thinking

As healthcare becomes more complex, it is important for leaders to understand the critical concepts that are fundamental to human systems and behavior, where the interactions between parts can be more important than individual actions. Simply stated, a system is a collection of interrelated and independent parts, processes and subsystems, linked inextricably by the interaction of behavior. The following video illustrates some basics of systems thinking.


What you might consider a system is somewhat arbitrary: the health-system enterprise is a system made up of many interrelated component subsystems, but so is the pharmacy enterprise a system with many component subsystems, as is the investigational drug service. Where you draw the line determines the boundaries of the system you choose to examine. Where you set the boundaries defines a "closed system", and in the past, these closed systems operated as silos or "stovepipes", behaving as if each operational entity was independent of all others. One of the advantages of systems thinking is the recognition that any organizational system operates within, or proximate to and with impact on, all other parts.

Systems thinking operates on the basic premise of finding patterns inside and outside of the system -- however it is defined -- then seeking to understand those internal patterns, to identify ways to avoid problems and optimize the overall system. How you define the system depends on what you are trying to accomplish. You might for example place a system boundary around the medication-use process to clearly understand how it functions and where the subsystem issues are, then remove those boundaries to assess how the system is impacted by (and impacts) other systems, and fits into the larger system.

Complex Adaptive Systems

global-intelligence-full-page1.jpg Complex adaptive systems (CASs) are collections of individual agents with freedom to act in ways not always totally predictable, but with interconnectedness so that the action of one changes the context for others -- for our purposes, the people who function within the medication use process, the healthcare delivery system and the health policy framework. The human immune system, the world financial market, a colony of ants, a flock of birds or a pharmacy and therapeutics committee all represent complex adaptive systems, which are characterized by fuzzy boundaries, with changing membership, crossover among different systems, all of which can lead to unexpected individual responses to change. Internalized rules -- often not shared or explicit -- govern individual and group behavior -- which may not always seem logical -- and these rules are constantly changing. Because the individual agents can change, the system can and will adapt over time; development of antibiotic resistance, viral mutation and the influence of a bully on adolescent group -- or work group -- behavior are all examples of this adaptation.

Because systems exist within systems, the evolution of one influences the other related systems. Since the systems are nested, overlapping and interrelated, no one system's behavior can be understood without the context of the whole; the interaction among systems leads to continually emerging behaviors that are fundamentally non-linear and not predictable at a detailed level. Despite the lack of predictability at a detailed level, overall patterns are typically identifiable and often governed by "simple rules", an internal sense of order, innovation and progress that emerges naturally from the system, simple shared rules of behavior that emerge as common patterns: driving in traffic, rules of interaction in meetings, pedestrian patterns of staying to the right, deference to medical staff . . .

Thinking about organizations as complex adaptive systems opens the way for new and more productive leadership and management approaches to emerge. Goals and resources are established with a view toward the whole system and its results, rather than artificially allocating them to parts of the system, and focuses attention to service delivery across the full care continuum. The resulting integrated thinking can result in more creative and holistic thinking instead of the segmented solutions, within tight departmental or functional boundaries, that healthcare organizations have traditionally pursued. How the system addresses patient medication management, discharge medications and associated patient education and how it defines roles and accountability as an example, can have an enormous effect on adherence, compliance and persistence for patients with complex medication regimens for treatment of chronic illnesses. This shift in perspective facilitates a broader focus on an overall aim of better patient care.

Complex adaptive systems provide some significant barriers to leadership effectiveness:

Simply put, human systems differ from mechanical and process systems. They are far more complex and adaptive. As leaders, we need to be aware of the differences and shape our behaviors, attitudes and approaches to take full advantage of opportunities that arise.


Leader's Decision Domains

The Need to Think and Act Differently 

Healthcare organizations face challenging goals in today's increasingly complex landscape. As a result, leaders at every level of the organization need to think and act differently. Understanding the critical factors that drive the environment is a key skill for leaders in changing environments because it allows them to see options and appropriate choices.  Since each domain requires different actions, differentiating the variousdecisiondomains.png environmental signs is extremely important.

The ordered domains are essentially fact-based and the unordered worlds require a pattern based approach to leadership.

Disorder is far harder to identify and particularly difficult to deal with. . . multiple issues and perspectives vie for prominence, factional leaders argue, with a plethora of rules to confuse.  Breaking down the situation into component issues and assigning them to the other realms allows the leader to make decisions and intervene in appropriate ways.

The more familiar these contexts and their characteristics become to pharmacy leaders, the easier it will be to first recognize patterns, identify strategies for dealing with them and to target new ideas, approaches and strategies for dealing with the challenges.

Simple Domains

Simple contexts are those we as pharmacy leaders were most likely trained to recognize and deal with. They are characterized by known facts, the expectation of stability, and the ability to identify – confidently -- one right answer, with a clear linkage between cause and effect.

Leaders "know" how to respond because of their training and their hindsight.  Leaders SENSE – assess the facts of the situation, CATEGORIZE them and RESPOND, basing reaction on established practice. Heavily process oriented situations are simple contexts.  If something goes wrong, the problem can typically be easily identified and response is fairly routine. Operational processes, financial functions and guideline driven decisions are examples of simple contexts.

In general, problems that arise in simple domains are related to improper classification and oversimplification, sometimes driven by condensed or incomplete information. Leaders in simple domains are vulnerable to entrained thinking – reacting with conditioned response -- and potentially blind to seeing new options and opportunity. As a result of the vulnerability, leaders can become complacent and may miss a key change or see it too late to respond effectively. Micro management is also a pitfall, since in simple environments those closest to the actual work are most capable of independent judgment and handling virtually any issue that arises.

In this simple domain, best practice is past practice. Hindsight based on past experience guides decisions about best practice, but does not translate to developing foresight so leaders may be vulnerable to missing signals that traditional "best practice" does not work any more.

In this decision context, leaders CATEGORIZE information and facts.  Our first tendency is to match the circumstance with the familiar and proven answer, and to simply apply it. No wonder we tend to struggle in today's changing world!

Complicated Domains

Complicated contexts represent the domain where experts prevail.  There is at least one, but more likely multiple right answers, and while there may be a clear relationship between cause and effect it is "oh so not obvious" to everyone.  Here we deal with known unknowns, where leaders must first SENSE, then ANALYZE to formulate a response.  Since this is not always easy, expertise is essential. With many options for solutions, GOOD practice (not best) is appropriate. Leaders must explore and evaluate multiple options to determine the best course of action. Entrained thinking is a real risk among the experts who tend to dominate, potentially overlooking the novel ideas of others.  Analysis paralysis can occur when experts disagree and collide.

Complex Domains

Finding the next best step to the right answer can be very time consuming and when the right answer is hard to find because of incomplete data, you may be dealing with a complex context.  Thinking differently is essential, as is the patience to tease out creative and innovative solutions. In complex contexts, it is very hard to figure out what the right answer might be, or even know if there are answers at all.  This is the realm of "unknown unknowns", where most pharmacy leaders operate most of the time, and where major, unprecedented changes introduces unpredictability and churn.

Here, the whole is far more than the sum of parts.  We understand only in retrospect.  Tempting as it might be, any attempt to impose order and a singular plan of action is likely doomed to failure.  We watch, wait and recognize instructive patterns that form a path forward.  The behaviors are to PROBE, wait to SENSE the reaction, then respond.

As a leader in this context, it is often all too easy to fall back into command and control mode, when in fact, what is required is the patience to experiment, evaluating options for solutions, to tolerate failure.  Leaders may try to over control and may be tempted to try to impose order.  Stepping back for perspective, providing your team room to experiment (and potentially fail) to allow patterns to emerge is essential.  Encouraging interaction within the team is vital to understanding and to stimulate new thinking, new insights and new solutions.

Chaotic Domains

In Chaos, searching for answers is pointless because change occurs so frequently, causal relationships shift constantly, and there are no reliable patterns to serve as decision markers. The leader's role is to ACT to create some order, to SENSE where opportunities exist to return the context to complex.  Command and control leadership is vital in dealing with an unknowable environment, and essential skills include clear and direct communication.

Chaotic environments provide the best opportunity for innovation to take hold since there is more openness to novel ideas and opportunity can emerge from chaos. Parallel teams can be used to resolve identifiable issues and to counter with improved suggestions.

Shifting Leadership Styles

Clearly, different leadership styles and responses are needed for each decision domain.  Understanding and identifying the context is is a vital first step.  Once the context is identified, leaders must develop the capacity to change style nimbly to guiding the team in understanding changing contexts, or even more likely multiple simultaneous contexts. This is a learned skill that relies on experience and awareness. (Click here for a Leadership Conversation with Max D. Ray)

It would be simple if we only had one context to deal with but certainly in healthcare and pharmacy practice that is seldom the case and we are likely dealing simultaneously with multiple and constantly changing contexts. While pharmacy decision contexts vary, pharmacy leaders all too often try to apply traditional knowledge-based strategies and tools when they too often do not apply and may worsen the situation.

So we wonder why we fail, or at least do not meet our expectations when in fact our responses and our actions, too often do not take the situational context into account. (Click here for a Leadership Conversation about Clifton J. Laiolais.)


Simple Rules and Minimum Specifications

Early in the development of complexity theories, a belief emerged that complex phenomena arise from simple rules. The migratory flockingmigrating_birds.jpg behavior of birds is the classic example. 

The good news is that as human complex adaptive systems we have an amazing ability to change the system in which we operate, and to create new or transformed systems. . . Once we understand the nature of complexity, we can cultivate new skills for recognizing when to use them, and to adapt.

The Institute of Medicine has identified 10 simple rules for the redesign of healthcare, intended to focus the attention of leaders to the critical elements that should define care.

10 Simple Rules for the Redesign of Healthcare


1. Base care in healing relationships – not visits, as in the current mode

Give people help through many routes and in many forms, around the clock. Don't rely on the bottleneck of face-to-face visits as the only productive form of care. So if a patient wants to send an e-mail, or talk on the phone, or check the web, don't fight him; help him.


2. Customize care to the individual patient

Let's have more variation in response to varying needs. But let's stop the unscientific, irrational variation in care that seems based on unexamined local habits or some vague sense of the importance of clinical autonomy. We still vary by 50 percent or more in the United States from place to place in the rates of sinus operations, breast cancer surgery, and dozens of other procedures. Let's stop it.


3. Regard the patient as the ultimate source of control in the system

Agree that clinicians and institutions can take over control only with the permission of the patient. Not all patients want so much control, but we should accommodate every single patient's wishes for the degree of control they desire over the decisions that affect them.


4. Share knowledge and let information flow freely

We should regard the sharing of information itself as care and healing. Patients should have unfettered access to their own medical records – no permission, fee, or delay. Period. And they should also have easy access to clinical knowledge and scientific resources of any and all types. Whatever they want to know, we should help them learn.


5. Base decisions on evidence, the best science

We need to get serious about promising every patient the benefit of care that draws on the best knowledge available anywhere. Put science into practice reliably. Guarantee it. Promise it. We are now just about the only industry in America that basically guarantees its customers absolutely nothing. We should warrant our work.


6. Make sure we see safety as a system property, and build patient safety deeply into the designs of care

Stop relying on exhorting the workforce to give safe care; we have a health care workforce already trying very hard not to harm anyone. We need to make it possible for these good people not to do harm just because they are human. We need to raise respectable and respectful barriers against normal human frailties.


7. Become transparent

Anyone who wants it should have information on how well we are doing, on the performance and characteristics of all components of the care system. We need to stop hiding what we do. Disclose.


8. Anticipate needs rather than reacting

Stop acting surprised when patients come to us because they are sick. Get ready. Use information, modeling, systems thinking, and scientific designs to make care proactive, agile, and adaptive. Plan our care.


9. Continually reduce waste in all of its forms, including waste of time, space, ideas, supplies, information, inspections, and spirit


10. Foster cooperation and collaboration among clinicians and between clinicians and organizations, recognizing these as the highest professional values

Reduce the sub optimization that comes from thinking and acting in terms of guilds, from organizational and departmental fences, and from social and professional separation.


Effective, results focused leaders will need to think and act differently.  It does not happen automatically, will not be easy, and for sure just showing up, suiting up and even working harder is not going to produce the real results we need to achieve.

How do these rules apply to your practice? What are your simple rules?




Collaborative Leadership 

In 1988 the Institute of Medicine urged healthcare organizations to consider the vital importance of leadership. The leadership development process evolves at three levels:

Leaders motivate us to go places we would otherwise not consider, they are essential to organizational change and to producing the results we desire to achieve. This is broad agreement that leadership is a critical competitive advantage in an increasingly complex healthcare environment.

For leaders to actually lead, they need talent, skills and a vision, but they also need the ability to attract followers, and that is becoming and increasingly significant challenge. That ability to attract followers is based on the relationships that collaborative leaders foster. 

What is Collaborative Leadership?

There are two popular myths about leadership. First that leadership is an innate quality and second that only a few can lead. In fact, leadership is not contained in a gene, any more than other abilities. Neither is it a place, a position, or decreed by title. In fact, it has everything to do with behavior and is demonstrated by skills and abilities. You don't have to be in a position of power to lead -- leadership is not a place or a position, it is a process that calls for skills and abilities. And it is a path of self-development and developing others to build those skills, abilities and a capacity to drive change, to make a difference in the lives of others and to learn and grow in an evolving world.

Leadership is about relationships between those who aspire to lead, and those who follow. Individual and group relationships are at the core of leadership success, and to be successful, every leader needs to master a range of relationship skills.

This continuum of mutually beneficial relationships are compared to competing relationships, which involve exchanging some degree of information -- never proprietary -- and shaping decisions, activities and communication to meet self-needs, with minimal sharing of resources, and leadership strategy.jpgoften with a hidden agenda. In contrast, collaboration relies on a foundation of perceived mutual benefit -- based on relationships -- to achieve common goals, build on shared concern, and reach an agreement to pool power and resources to resolve complex issues.

Healthcare organizations increasingly face complex, interdependent and "messy" or "wicked" problems that defy solution, having no simple answers. These are problems and issues that demand a systems approach to unravel, and diverse input and perspectives to begin to resolve, find solutions and make progress. Many players touch the problems and issues, and many players must be involved in finding the next best step in the right direction to solution.

Where do your relationships fall in this continuum? What percentage might fall into each category?

What are the implications of each type of relationship, and what is required to make each successful?

In any situation, effective collaboration requires that several key elements be addressed:

Collaborative leadership is challenging, and requires skills, commitment and capabilities. Six critical elements of collaborative leadership are vital practices to be mastered, forming the basis for essential skills:



Understanding the Context for Change

Leaders need the personal capacity to recognize patterns and common interests, particularly to recognize and understand other perspectives inConnect The Dots.gif order to arrive at shared vision, purposes and values. Connecting the dots, bringing different points of view into perspective, and encouraging a diverse group to think clearly about change opportunities, benefits the organization, the team and its individual members. With an aim to setting priorities, analyzing barriers and obstacles to develop actionable strategies, environmental assessment capabilities are a fundamental leadership building block.

Understanding the critical factors is an important first step is to understanding the context of collaboration. These factors include identifying the key players, providing accurate information and defining processes to ensure success. Understanding the situation and the type of decision domain as simple, complicated, complex or chaotic will help the leader to determine whether collaboration will be effective and to what extent it should be used. Sometimes there are issues that need to be resolved before collaboration can be effective, and some of those issues could include power and trust issues, leadership capacity, adequacy of resources, lack of vision or commitment, lack of information or data, all of which could affect how well people can work together to resolve the problem.

managing-up-300x225.jpg Identifying stakeholders -- anyone who affects or is affected by the problem or issue -- is an important next step. Consider all of the perspectives that touch on the issue and identify individuals who can address these perspectives. To reach agreement, what interests must be satisfied, and who represents those interests? What interest groups, individuals or organizations might have a role in allocating resources, implementing solutions or blocking progress toward a solution, and who might be affected by the optional solutions? Finally, what influencers could generate political or organizational momentum to move the change more quickly or effectively to resolution? These are the key stakeholders, and it is important to understand, not only who they are, but their relative positions in relation to the problem or issue.

Understanding the level of commitment to the significance of the issue or problem, agreement to work together and how, agreement on the definition of the problem, and the range of solutions are essential first steps to actually agreeing on a target solution and the implementation plan to execute it.

It is important to understand the organization's capacity for change and experience with past change initiatives and an number of instruments are available to complete that assessment.



Defining Shared Values and Engaging Followers in a Shared Vision

In today's healthcare organizations comprehensive pharmacy services are vital to integrated distributive and clinical services supporting patient safety and high quality patient care, across the continuum. We need to provide this span of service to patients from the moment they present to discharge and beyond. Coupled with the demand for quality, safety and value, assurance of regulatory and compliance diligence are increasingly vital, linking clinical, distributive and administrative roles to the optimal benefit of the patient and the organization.

When faced with escalating challenges, seemingly out of control costs, shrinking margins and bottom line pressures, hospital administrators sometimes question the ability of their pharmacy directors to manage the equivalent of multimillion dollar business ventures. Lack of understanding of the complexities of managing today's pharmacy operations, complex exception processes that differentiate pharmacy from other clinical and operational departments, and the uniqueness that makes pharmacy both a clinical and operational function underlie this concern. All too often, issues surface only after critical incidents trigger doubts regarding internal controls to manage specific functions, often with painful and disruptive results, that ripple up and down in the organization. Pharmacy leaders must be prepared with an effective vision, both to engage the pharmacy team and to keep senior leadership focused on the strategic alignment of pharmacy and organizational goals.

Mission, vision and values tend to blur for many leaders. Mission defines the overall purpose of the organization. Vision provides a vivid description of what the organization aspires to be. Values create the framework of priorities that are the underpinning of the culture of the organization that drives individual behavior, decisionmaking and actions on any initiative.

76549544 - Vision.jpg Vision is not about forecasting, but rather about creating a future image, as richly detailed and graphic as possible, and enlisting others in the pursuit. Your vision should paint a picture with words. Build a compelling and tangible vision of what COULD be, described in the present tense, clearly and vividly depicting an image that can be share widely within the team to captivate the imagination and energy of each individual. It is also important to establish urgency and connect to individuals need to be accountable for a role in the vision.

A leader's vision stretches boundaries and comfort zones to enable the organization to envision what it might become. Vision drives behaviors, creativity, commitment, personal engagement and the determination of your people. The right vision can set a standard of excellence, clarify direction and purpose. It will inspire, engage and motivate. It can bridge the past and the future. And to do that it must describe a destination -- clear, understandable, an ambitious stretch, but clearly attainable.

The vision statement itself needs to be big and bold to continue to engender passion and energy as you grow toward it, serving as an energy source and a rallying point. Ideally, it should inspire the imagination to think 10 or 20 or 30 years into the future to envision what could be achieved, how it might look and feel, how it will inspire and how satisfying the achievement could be. Stir passion, creativity and the desire to achieve . . .

A vision has two elements. The core ideology reflects the enduring character of the organization -- the glue that holds it together in growth, diversification, diversity, expansion and change. The envisioned future is the very specific description of what it will be like to achieve the vision, an image that translates words to a picture of the future that people can carry in their heads to preserve the core direction, achieve alignment, trigger progress and brings the dynamic to life.

To accomplish that translation of the message, you need to have the right people on the "bus." Prepare your message, get the right input, set the stage to build a sense of urgency, establish a process for full participation and an openness of sending the message. Make sure you have the right people involved -- your team, dotted line reports, project team members and all of the key stakeholders. Consider and account for outliers. Build the message for robust and clear blast distribution.

Remember, that even if you have the right vision, people may not naturally gravitate to it. You will need to inspire with images, metaphors and stories that engage the aspirations of your team (so relationships and understanding their aspirations definitely come into play.) Build a coalition for change. Let your team put their fingerprints on the vision, refining, modifying and enhancing the dream. Woo the detractors to pull them into the vision.

Above all, continue to sharpen your leadership tools, use your influence, build your advocacy position and continue to share your vision every day, widely within the organization as an investment in future success.


Creating Confidence for Shared Purpose and Collaboration

With relationships as the basis of leadership, trust is the fundamental foundation of all successful interpersonal relationships, whether business or personal. Trust is a reflection of the confidence than one person feels about another person or group, one of the primary binding forces in any interpersonal relationship. With trust, it is possible to overcome doubts and unknowns, to enjoy a peace of mind in confidently believing in the relationship. With trust, there is confidence that everything will work out, a prerequisite for enduring relationships.

Absence of trust causes anxiety, worry, fear, insecurity and an unwillingness to take action that might involve risk. Trust is an essential leadershiptrust.jpg ingredient that binds relationships into partnerships.

Unfortunately, trust has become a ubiquitous buzz word. "You can trust me." "Just trust that it will work out." We too often explain trust as our reason to explain good and bad relationships. Trust actually reflects caring, reliable and faithful relationships, consistent over time and predictability we can count on. Inconsistent and unpredictable behavior is not trustworthy.

Building trusting relationships within your team is fundamental to successful relationships. There are three basic elements to building trust:

Once a relationship is based on mutual respect, it is possible to achieve enduring trust, a feeling that binds people over time, through trials and past adversity.

Building trust is a leadership capacity that takes time, effort and commitment. And it is the essence of the meaningful relationships that define leadership.


Developing Individual and Organizational Commitment

 Few leaders understand fully the capacity to share power and influence widely as a strategy to not only achieve, but to expand success. Shared effort, a wide range of experience and input, and empowerment of the team through development of dispersed influence, not only rewards the individual, but increases advocacy position within the organization.

There are eight sources of power:

chakras.jpg Sharing power and influence -- whatever the source -- is a critical strategy for developing the synergy of people, organizations and communities to accomplish a shared vision, and a particularly useful strategy for resolving or avoiding disputes and conflict. This is challenging since often those who hold power are reluctant to relinquish it. Empowering others creates the opportunity to effectively participate in the dialogue, bring more diverse perspectives to the discussion and to potentially generate more and better options for action.

Collaborative leaders need to let go of the notion that they can and should have all the answers. Expanding the power base to bring a wider array of participants to the table engages emerging leaders and empowers them to bolder action, attention to results and generates ideas that might have been overlooked. A checklist of ground rules can be helpful in governing the power sharing, including:

In any influence situation there is push energy -- drive to the urgency and necessity of taking some action -- and pull energy -- feel drawn to7824_146829789113_105162454113_2531141_3091170_n.jpg people or ideas and the sense they understand your point of view. Knowing how to harness these two types of influence energy is a key to sharing power.

Push energy is assertive, and specific, trying to get people to change their mind or position, and they may resist, withdraw or push back. Knowing when to use push energy assures you will let others know unconditionally where you stand, what you want and how you want it to happen. A set goal, specific assignments, deliverables and accountabilities, and a firm timeline uses push energy to drive the participation of others in the direction you want to achieve. Pull energy is inclusive and involving, requiring attentive listening, asking questions to draw out the thoughts of others and to engage them in the process. It moves with the thought flow to help people see options, alternatives and supports engagement by showing a greater understanding of their needs. While it may seem "soft", it can effectively help to gain commitment, break down resistance and build affinity for the ideas, issues and solutions you favor as a leader. Using pull energy is a smart strategy to get to know your talent, their needs, their passions and for understanding their individual development needs.

Engaging others, sharing power and influence and effective use of push and pull energy can expand and enrich your leadership position and impact.

Realizing the Best in People, the Key Asset

Leaders have a genuine concern and commitment in bringing out the best in others, developing the talents, resources and power of others to realized and promote their potential.

Coaching and mentoring creates power. Learning builds intellectual capital. And leadership capacity is built on both, with the growth of self-confidence, courage to experiment, set new outrageous goals and collect the feedback for new levels of performance. Coaching and mentoringfotolia_13541474_s_6zx2.jpg can be one-on-one activities, or group focused, and there are a variety of approaches, including:

While leadership may be easy to explain and to recognize, it is not easy to practice. It is about behavior first, then skills. While good leaders must have critical management skills, leadership relies more on personal qualities like integrity, honesty, humility, sincerity, passion, wisdom, confidence, sensitivity, and courage. Effective coaching and mentoring can model and build these leadership qualities in emerging leaders. Be sure to set mutual achievable goals, and identify issues to be addressed separating the behavior from the person by focusing on cause, not just effect. Explore a variety of options for solutions, suggest resources and other sources of input and agree on a plan of action, including targets, goals, schedule and benchmarks for success. A personal learning plan is helpful, and can be developed after completion of a self-assessment exercise, ranking the four or five lowest scoring items as targets for the plan. The plan should list both learning goals and the resources that will be used, including reading, peer support, journaling, coaching, training and other learning opportunities.


Self-awareness and understanding of values, attitudes and congruent behaviors

Collaborative leaders are personally mature and demonstrate emotional intelligence in their interactions with others.

To be effective, leader's self-reflection must be an active and continuing thought process, with focus on understanding and evaluating personal values and how congruently behaviors match those values. Analysis of verbal and nonverbal communication, the impact of actions and words on goal achievement and the capacity to self-adjust behaviors are essential to effective collaborative leadership in an increasingly complex environment.

lightbulb.jpg Self-awareness includes the ability to read and understand one's own emotions and their impact, understanding personal strengths and limits and developing a solid and accurate sense of personal worth and capability. This type of awareness is essential to a leader's ability to manage self. Self-management must include emotional self-control and flexibility to adapt to changing situations, complexity, ambiguity and obstacles. Effective leaders also pursue transparency, displaying honesty and integrity, and earn the trust of colleagues with consistent behavior. Optimism, passion and engagement in the moment -- always being ready to jump on opportunities and act to achieve results-- are hallmarks of personal leadership competence.

Leaders must also be socially competent in the ways that they manage relationships with others. The display of empathy, understanding the position and feelings of others, and taking active interest in those concerns is vital to managing individual relationships. Organizationally, effective leaders must be astute in reading the climate and culture of the organization, focused on how and why decisions are made and keeping a pulse of organizational politics. In building and maintaining social relationships, leaders inspire others with vision, and influence persuasively as advocates for necessary change, for their team, ideas and aspirations. Critical skills in conflict management and resolution, developing others as leaders, building alliances and partnerships and the capacity to build effective teams and to work collaboratively with others in the organization are also fundamental to effective leadership. A variety of techniques can be helpful in a leader's self-reflection, including journaling and writing, observation of yourself and others, peer dialog, meditation, exercise, inspirational reading and learning, and coaching/mentoring. Many organizations have adopted a 360-degree feedback process, which serves as an organized, effective and continuing framework for self-reflection, development and improvement.





How we organize our lives and our time -- both work and personal -- has a very direct impact on our leadership effectiveness. Every day, we havetime-management.jpg dozens of choices about how to use time, with lots of options for techniques routinely used by high achievers, successful leaders who focus on results, rather than just being busy. Employing these techniques improves the ability to function exceptionally well, even under extreme pressure. Taking control of time may just sacrifice the frenzy of activity and overload for the reward of achievement and lower stress levels.

Like most critical human behaviors, most of the principles of good personal leadership organization are not rocket science, we have heard about and maybe even used some of the techniques. But human behavior being what it is, we forget, get distracted, fall back on the easy way or old habits, and pretty soon our personal management of our leadership time has suffered. We need to be reminded of some of the best personal organization "tricks" to take full advantage of leadership opportunities.

So, how good is YOUR time management?

Do you ever run out of time? Every day? Once a week? Feel like the hamster on a treadmill constantly trying to keep up?

Does it seem like you never have enough time? In truth, people can generally make time for what they choose to do, and it is really not time but will that is lacking. So while time does fly, remember YOU are the pilot!

Time Management Self-Assessment

Understand the dynamics of how you organize and use your time by taking the TIME MANAGEMENT SELF-ASSESSMENT to help you to identify the aspects of use of time for which you need the most help. Your results will help you to select areas for self-development that you can immediately put to use . . . Do it now, so a year from now you're not still wishing for more time . . .

Assess Your Results for a Self-Improvement Plan

As you answered the questions, some thoughts probably began to form about where you might focus on your use of time. The results that were returned to you focused on five critical areas of attention:

Procrastination: "Just give me a few minutes!" . . . "I'll get to that later." . . . "I meant to do that and then forgot all about it!" Procrastination is a deadly habit that too often leads to work piling up to be virtually overwhelming. Recognizing that you procrastinate, and figuring out why is the first step to changing your behavior. Total your results for questions 2, 10 and 12 and compare to the possible total of 15. If your score suggests that there might be too many "laters" in your life, review the section on procrastination.

Goal Setting: Better time organization requires that you set some goals, guideposts to help you to know exactly what needs to get done, when and in what order. Many leaders tend to neglect goal setting because of the time it takes, totally overlooking the fact that a little time invested today can save an enormous amount of time, effort, anxiety and stress in the future. Look at your total for questions 6, 10, 14, 15 in comparison to the possible total of 20. If you scored low in this aspect of time organization, review the goal setting section.

Prioritizing: Setting relative priorities for goals and tasks tends to keep you from working very hard, yet not achieving the results you anticipate because you have missed the strategic value of the tasks. While most leaders have a to do list, too often they are simple an unstructured collection of things to do. Prioritizing means focusing your attention on the most important strategic and high value tasks. Tally your score for questions 1, 4, 8, 9, 13, 14, 15 and compare to the possible total of 35. Without good prioritization skills you may work very hard without significant progress toward the results you desire. Review the use of activity logs, to do lists and prioritization.

Scheduling: Knowing your goals and priorities, minimizing interruptions and overcoming the bad habit of putting off essential tasks leaves leaders with the need to master creating a schedule to keep on track and reduce stress. Scheduling for deadlines and priority tasks doesn't mean that you don't have to leave scheduled time for "interruptions", unanticipated events, unintended consequences and serendipitous events. Avoiding the chaos of the unexpected will greatly reduce stress and add to the balance of your life. What was your total score for questions 3, 7, 12 of the possible total of 15? If your score leaves room for improvement see tips for more effective scheduling.

Managing Interruptions: Planning and prioritizing your work is a good start, but you also need strategies for minimizing distractions, interruptions and activities that side track your leadership attention. While you will always need to be available, techniques for dealing effectively with interruptions can keep you focused without locking the door or scaring people away.Of a possible score of 20, how did you score on questions 5, 9, 11, 12? For improvement, review the Urgent/Important Matrix and tips for dealing with interruptions.

We'd all love to add a few hours to each day or another day to the week. Since that wishful thinking is not likely, leaders need to work smarter on the tasks of the highest priority, with a schedule that reflects our lives and priorities. By employing the leadership skills and tips in this section, you can improve your organization for leadership effectiveness, concentrating as much of your time and energy to the high value, high payoff aspects of your life. Use the time you have to your leadership advantage!

Staying Focused on What is Important

Busy leaders have two options on how to structure their work day: to be reactive to meet urgent demands, or to be proactive by focusing on what they decide is important.

In his seminal self-help book, The 7 Habits of Highly Effective People, Stephen Covey addressed three categories of "habits":stephen-covey-7-habits-of-highly-effective-people.jpg

According to Covey, moving from dependence to independence involves three habits:

firstthingsfirstbook.jpg All have time management implications for leaders. In a later book, First Things First, Covey suggests that time management is actually personal management -- the art of managing ourselves. Personal self-management demands organizing and executing around priorities, classifying all tasks as either urgent or not urgent, and then as either important or not important. Those screaming for action are urgent, and those critical tasks that contribute to mission, vision, values and high priority goals are important. Using a quadrant matrix, Covey defines four categories of tasks, in Quadrants 1 -- 4, as shown.

important & urgent.gif Urgent tasks include a screaming email that demands immediate attention, the impromptu request that will just take "a minute" but is finished two hours later, a report or spreadsheet that you have to have in hand before you walk into a meeting, the proposal for a just discovered business opportunity with a hard submission deadline. . . Urgent tasks can be characterized as firefights, busywork, short-term and typically "easier" than the intimidating project work that loads your to do list. We are distracted by and drawn to urgent tasks because they make us feel needed, provide closure quickly so we can cross something off the to do list, and can often make us feel important because we are able to personally resolve a problem. They keep us oh so busy. At the end of the day of dealing with urgent tasks, we are tired, a bit frustrated, out of time, and wondering why we feel so anxious about the still looming "real work" that still needs to get done.

Then there is important work. It doesn't always give you a rush of adrenaline. It typically involves a lot more thinking than doing, and honest assessment about where you are, where you want to be and options for getting there. It can be mentally draining, plain old hard work, that may not be immediately noticeable to those around you. In the middle of the important work, it is sometimes too tempting to avoid sneaking a quick look at something urgent -- like your email (there MIGHT be something urgent there to take care of!). Or, if your day involves you or those around you rushing around with "hair on fire" it may feel that it is impossible to focus on what's important versus what is urgent.UpsetWoman-main_Full.jpg

Quadrant I activities are urgent and important and they typically manifest as crisis, vital meetings, deadlines or demands for attention to critical emerging matters. Quadrant I focus can grow to overwhelm your life because the "urgency" can be almost addicting due to the temporary rush that accompanies solving urgent and important crises. The most effective leaders spend more time in Quadrant II than in Quadrant I, despite the "seduction" of Quadrant I. Too much time here means eventual stress and burnout.

Quadrant II activities are important but not urgent and are the core of personal time management, including preparation, prevention, planning, strategy, employee engagement, creativity relationship-building, intentional recreation and values clarification. This quadrant is key to short and long range planning, reading to expand your mind, professional development, physical fitness and exercise, leisure and recreation, systems thinking and design, and envisioning personal and work future, giving the leader vision, perspective, more control of the work situation and balance.

Quadrant III activities are urgent and not important, sometimes known as phantom activities. They can be (self)deceptively misclassified to Quadrant I items, and often waste our precious time. Some emails and phone calls, interruptions, some meetings, some projects, any activities to meet someone else's priorities that do not meet any of your own are examples that fall into this quadrant. Too much time here results in an exceedingly short-term focus, and the sense of being "out of control" and the victim of the system/organization.

Quadrant IV is our ESCAPE. Too much time in Quadrant I may cause us to drift to Quadrant 4 just to relief the pressure. This is typically trivial, time wasting STUFF such as net surfing, dealing with spam email backlog, office chit chat or coffee breaks, busy work, filing, etc. Some of this must eventually get done or it becomes Quadrant I crisis, but we need to recognize Escape Strategy for what it is. Time spent here tends to foster feelings of irresponsibility and dependence on others to make things happen.

Effective leaders stay out of Quadrants III and IV because they are not important. They work to shrink Quadrant I by spending more time in Quadrant II, allowing them to take advantage of proactive work by tackling issues before they become problems or crises.

Know How You Spend Your Time

Do you know how you spend your time? How much time talking to colleagues, processing mail, responding to email? Have you ever felt like you needed just one more hour in the day? Do you know when you are doing the most thoughtful and demanding work?

Most people have peak energy and effectiveness times in their work day, and it varies for individuals when that time actually is. Your effectiveness can also be influenced by blood sugar levels, the duration of concentration time, interruptions, stress and a host of other environmental factors. Know how you spend your time and when you take on challenging tasks is vital knowledge to maintain attention to the most important tasks. Believing we can manage that based on our recollection of where the time went is a fallacy that many leaders live by.

Keep a Log of Your Task Activity

Take several days to audit your activities, keeping a detailed log of every task and activity, noting the time each time you change what you are doing. Periodically during the day, make note of how you are feeling: alert and energetic, tired, distracted, preoccupied with something else. Once you have recorded activities for several days, analyze the data. Typically, people are surprised by the amount of time not dedicated to the most critical work and goals they have responsibility for. Energy peaks are likely to coincide with when you take breaks, what and when you eat, so take note of whether you might want to consider changing those patterns.

Some simple recommendations to consider:

Keep an Active To Do List for Action Planning

stickies.jpg Do you ever completely forget to do something? Or lose track of an assignent because you missed a critical step in the process or a conference call to recap on the rest of the team's progress? A prioritized list of To Do assignments is essential to effective time management., and once you start to use one effectively and consistently, it can mean an enormous breakthrough in efficiency. You will forget less, see the critical path or sequencing of tasks more clearly, and will be able to clearly identify tasks that can be put off until later. Most importantly, those around you will see attentiveness and reliability in your performance instead of flaky forgetfulness.

Write down everything that needs to be completed. For more substantial tasks, break them down into component tasks that will take no more than 1 -- 2 hours to complete. Assign simple priorities: A (critical), B, or C (not important or immediately urgent). If you have too many A priorities, review and either move them to another category or subdivide into primary and secondary groupings (1 or 2 priorities). Then reorder the list in priority sequence. Whether you manage the list sequencing daily or weekly, continue to review and revisit the To Dos and priorities as you tackle and complete tasks. Focus on completing the most critical tasks first, and don't be distracted by a large or growing number of unimportant tasks.

When the number of tasks is large (and growing), a simple To Do list may not be robust enough for you because while it serves as a reminder, it does not serve as a roadmap for action. Where the detailed specific tasks are clear, it is easy to take action. But for more complex projects, the lack of detailed action steps makes it easier to delay, procrastinate or simply ignore them. Without the detailed steps, its easy to "get lost" in a big project as the total focus of your attention, losing sight of other important or urgent work, and making multitasking difficult.

Leaders always have multiple projects, many times very large ones, to manage simultaneously. Action Programs are To Do lists that incorporate short-, medium- and long-term planning of your time allocation, allowing you to keep track of commitments, focus on things that matter, highlight opportunities for delegation and manage multiple simultaneous tasks.

Develop an Inventory List

First compile a list of responsibility areas that demand your attention -- urgent or not, big or small, personal or work related. Think about yourlets-get-organized-3.jpg email, voicemail, snail mail and internal mail inbox as sources of items for the list. Think about ideas on your mind, face to face or phone conversations that result in you needing to do "something", scraps of paper or restaurant napkins scribbled with notes or "aha's" notebooks or diaries with ideas for future projects . . . Inventory them all in one place. While a challenging task, this will immediately reduce your stress from managing all those mental To Dos you struggle to keep track of, always wondering what you have forgotten, or not having critical pieces in place when you "plan" to start working on a task. Reducing distraction is the first immediate benefit.

Trim the List

Carefully review each item and determine if it is something you should take action on. If not important, urgent or relevant, delete it from the list. Delegate where you can. This task typically takes several hours initially but can be managed on your computer or PDA with relatively minor updating once the initial framework is established.


Group or "bucket" like items or related tasks into larger project categories. For example, if you are implementing a new CPOE system or bedside bar coding, cluster all the related tasks including requirements input, selection, testing, training, etc under a single project header. Once you begin to think about the relationships between individual To Do items, the organization patterns becomes much clearer.

Allocate a priority value to each project: A, B, or C that reflects what is most important. You can prioritize based on the basis of what needs to be done first, what requires the greatest attention or what needs the most resources.

Priorities always involve tough choices, sometimes conflict and controversy. And establishing the priorities opens the process to decisions of how to allocate resources, including time, frequently a delicate balancing act.

Focus on the highest priority items, and identify the next action steps that are needed to move the project forward. Some tips:

Keep that list within sight as you work through the day as a reminder of the tasks that need attention

Overcoming Procrastination

Do you procrastinate?

Most people do, just putting things off . . . don't want to buckle down, too many other things to do, or too many more tempting distractions, or something. Often we don't mean to procrastinate but before we know it . . . boom. Looming deadlines, not much time left to achieve, worries that we can't get it done right or at our best, but . . . deliverable due. Not really enough time to edit, proofread, revise, get it right. But if we had moreprocrastination.gif time, it would be perfect.

It feels good when you get it done by the deadline, but is the procrastination worth the anxiety, burden of a building workload, the sense that your work is taking over your life, and the guilt that it could PROBABLY have been done better?

Everyone procrastinates, in fact 20% of people identify themselves as CHRONIC procrastinators, a lifestyle that crosses all aspects of their lives. (For example: chronically pay bills late, miss opportunities for social activities because they never get around to the planning or responding to invitations, don't use gift certificates or coupons because they expire, file for every tax extension then flirt with the final deadline, leave Christmas shopping for Christmas Eve . . . evening.)

But if you feel that you are in the 95th percentile, take heart. There is hope and help, this is a bad habit that can be overcome. Just don't be lulled to thinking this is an easy fix, since there are no silver bullets!

Procrastination is learned behavior, one that can emanate from resistance to controlling behavior that stems from reaction to parenting styles, even may even represent a form of rebellion ("You can't make me do that." or " You are not the boss of

Procrastinators support their habits with excuses:

Most procrastinators actively look for and use distractions -- checking and responding to email is the classic example -- but the reasons for procrastination differ.

time_711x250.jpg Procrastinators work as hard and long as others, sometimes longer, but they focus attention on the wrong tasks. That misplaced activity may be the result of confusing urgent and important tasks, responding to the loudest and most vocal demand. Not knowing where to begin or simply feeling overwhelmed the task and their own ability -- including decisionmaking and organization skills -- is a critical factor. And, at times, perfectionism lends an influence: without all the skills and resources required, the outcome can't be perfect so why not score some triumphs on easier, quicker tasks.

Procrastination has lots of implied costs, surely to your work, but also to your health, sleep patterns and to personal and workplace relationships.procrastination toon.gif The key to controlling and overcoming procrastination is to recognize this destructive habit when it occurs, understand why and take action for better personal behavior management.

Recognize Your Procrastination

Knowing when you procrastinate requires that you understand the priorities of your work. Use tools like the Action Priority Matrix, illustrated below, to identify your priorities, and work from a Prioritized To Do List. Focus on quick wins (Quadrant 1) and major projects (Quadrant 2). Delegate low impact, low effort projects that may not require your attention or treat them as "fill in" work (Quadrant 3.) Avoid -- to the extent possible -- the Thankless Tasks (Quadrant 4.)

Be aware of personal choices in how you fill time and take note when you begin procrastination behaviors:

Figure Out Why

While there are lots of reasons, they come down to two categories:

Which is it?

Take Action

If you just don't want to do it because you find the task unpleasant, consider delegating. If you can't delegate the task, figure out how to motivate yourself to action. Some possibilities:

If the task is simply overwhelming:

Create a productive environment. Find a place where you are likely to focus your attention on the task. This does not mean: cleaning your office, desktop or home first; refurnishing your desk with new supplies, or refiling all of the papers that are in your path. While these are worthy tasks, if you are only tempted to do them when you are facing a deadline, you are procrastinating.

Think about the times of day when you are most productive, can best concentrate and focus on being productive, then schedule your time to focus on the most challenging tasks when you are most attentive.

Get a new attitude. Avoid negative self-talk about how awful, unfair, impossible, boring . . . the task at hand is. Just get started.

Ask for help. Turn to someone who is well organized and focused and ask their assistance in thinking through the project, keeping you track and checking in to make sure you are making progress. Sometimes just talking through the task helps to identify a logical path for completing it successfully. You can also pair up with a peer and work on the task together. Choose someone who will benefit from the outcome, has insights to the process or unique expertise to contribute.

Make yourself accountable and set a schedule for yourself to maximize the effectiveness of your time.

Start your day as early as possible. Even a half-hour earlier can make a difference. The idea of planning to get two tasks completed by noon and actually finishing three or four is very compelling and energizing.

Cluster and tackle smaller tasks back to back. This strategy will help you clear your task list and c clustering similar tasks keeps your active mind in similar thought processes.

Don't count on the advantage of "the final push." Too often, it is easy to divide a project into smaller tasks but to leave a huge proportion for the final work. Instead, divide up a project so that the longest/hardest is first and that each successive task is smaller -- hence perceived to be -- easier to complete. Otherwise you might still meet the deadline but be "dead on your feet", letting other tasks slip in the process.

Knowing yourself, and understanding your work behavior is an important first step in managing yourself for effective leadership. 

Goal Setting

goal-sm.jpg Goal setting focuses attention to personal aspirations, personal vision and the "ideal future state". It is hard to be successful without goals, a lot like trying to sail to a destination without a compass, not knowing what direction we are traveling, when or where the "destination" might be reached. Without personal goals, we effectively abdicate our futures to others who will set goals for us if necessary, or to the random events of the environment. External goals may be effective, but they are not necessarily personally beneficial.

Exploring and knowing what you want to achieve helps you to set a course of action to focus your efforts, and to help you to avoid frustrations and distractions might detract from your achievement. Focused attention to the specifics of what you aspire to will enable you to organize your time and resources, and to create the balance of interests that a healthy and happy life is based on. Moving from "big picture" concepts to incrementally more discrete and refined elements of what will be needed to achieve the broader aspirations allows you to develop a personal plan and to begin to build toward completion.

Think BIG

Think first about what makes your life meaningful and where you see yourself focusing attention in setting lifetime goals. What do derive pleasure from? What would you do if you did not have to "work"? Because this should not be just about your immediate work life, consider some of these categories as you do your planning:

Think about these components of your life, brainstorm with yourself and others. Set broad goals for lifetime achievement based on this reflection, then incrementally begin to establish sub-goals within shorter time frames: 5 years, 1 year, 6 months, one month to identify specific steps toward the lifetime goals that will allow you to make progress every day. From these lists, establish entries for your to do list that move you another step in the right direction. Periodically review and revise the plan as your perceptions change and as you make progress toward goals.

A few thoughts:

State your goals as positive growth statements to strengthen their motivational impact, and be as discrete in defining the goal as possible to clarify the achievement you are seeking.

Put your goals in writing to clearly articulate them and to solidify the commitment you are making to achievement. Having a goal "in mind" isstrange_attractors-0086.jpg fleeting, simply won't last. Written goals are five times more likely to be achieved than those we "think about." The best time to record your goals is when your mind is most powerfully engaged, without distraction: when you first wake up, or just before you go to sleep. Short term goals should not exceed 20, and long term goals lists should not exceed 50. Keep them with you and review them frequently. Visualize achieving your goals every day to increase attractor awareness to situations and attributes that will help you to achieve your goals sooner.

Set performance goals, as opposed to outcome goals, to manage your realistic ability to meet your personal expectations and to avoid being sabotaged by circumstances outside your control. By focusing on your personal performance you increase the sense of accomplishment and satisfaction you can realize when they are achieved. To motivate, goals must be clear, measurable and unambiguous, represent a challenge to stimulate the best effort possible, mutually agreeable to stimulate commitment and offer the opportunity for feedback for immediate and long-term skills and performance improvement, all intended to facilitate personal success.

SMART Goal Setting

SMART goals represent a technique to assure that your goals are Specific, Measurable, Attainable, Relevant, Timely, and Engaging. And SMARTEST goal setting, adds Engaging, Shifting and Team-focused as equally critical factors.

goalsetting.jpg For a goal to be accomplished, it needs to be SPECIFIC, defining at a level of detail what you are actually intending to accomplish. The goals should answer the who, what, when, where, why questions related to each goal. As an example, I am going to apply for and complete the ASHP Foundation Pharmacy Leadership Academy curriculum in 2011.

MEASURABLE goals allow you to define your career outcome destinations, with a clear understanding of how much further progress is needed. Measurability is easier to achieve if you target a time frame for achievement, keeping you on track for achievement and marking opportunities for success celebration.

Goals that are most ATTAINABLE are those most important to you because their significance drives you to finding creative ways to identify more opportunities, particularly those that might have been overlooked, ignored or rejected if your goals did not highlight their importance.

We all set goals related to things we aspire to achieve. Those that are unrealistic set unreasonable and unachievable expectations that lead to disappointment and dissatisfaction, effectively demotivating personal development. Choose your RELEVANT goals realistically and wisely as you are the only person who can establish, work toward and realize goals that are within reach, but always a stretch.

Achievement is best framed within the context of time. Without a timeframe, it is all too easy to lose track of the importance of the goal, losing attention, interest and the opportunity to achieve. TIMELY goals allow you to focus, measure progress and achieve steady incremental gains.

SMARTER goals add a few more concepts to think about . . .

Whatever your goals, they need to be sufficiently challenging and stimulating to be ENGAGING enough to keep you attentive and focused over time. With the world around us changing continually, goals need to be big enough and challenging enough to maintain interest and commitment, despite the incremental life and work changes. . . focus on strategic and longer term change issues to increase the likelihood your commitment will not be diminished over time.

Truly, life today is all about change . . . SHIFTING sands beneath our feet. It is one constant we can count on that continually influences what we see, think, believe and do. Keep touch with your environment and the forces that change it. Nothing is static, so be aware of change vectors, agents and influences so you can adapt your goals, shifting your focus and attention as the world around you changes. Your goals need to shift with the changing environment.

The days of individual contributors, triumphing independently, are past. We live in a complex world where no one individual can house enough knowledge to understand and resolve the totality of problems, particularly in the complex world of healthcare. Integrated TEAM-BASED efforts, with the messy and diverse opinions of many players -- engage the broad knowledge and insight that can improve process and avoid error -- are essential.

Goal setting is an ongoing activity, not just a means to an end. By setting incremental goals, you are defining what you intend to achieve and setting the course of action to get there.


If you are going to make the best use of your own and your teams resources -- time and otherwise -- you need to master the skill of effective prioritization. In the current healthcare environment the demands seem limitless, time is in short supply and resources are a moving target, making dynamic prioritization even more important to day to day and longer term success. When you prioritize effectively your path is clear and logical, with prioritization you are subject to the whim and chaos of the loudest voice, competing demands and random choices.

Setting Simple Priorities

At a most basic level, you can prioritize based on constraints, relative profitability, benefit to completion or the pressure factor of the demand for a completed task.

In most cases, these simple measures of priority work for us on a day to day basis, but there are other, more sophisticated ways to prioritize projects, tasks and priorities.

Prioritization Tools and Techniques

changed-priorities.jpg The role of prioritization is to help you to achieve the desired strategic results with a little effort as possible, using the resources -- including time, which is not replenishable -- as efficiently as possible. That requires evaluating projects and tasks in terms of their importance and their drain on our resources, including time.


Criticality, Accessibility, Return, Vulnerability, Effect and Recognizability -- is a acronym for a military method of target selection. Rigorous use of the process applies a Likert like value of 1 to 5 to each element of the matrix, summing the values for each target, or project/task. This score represents relative priority, and the higher the score, the more important the target. Consider these aspects in the context of prioritizing your work.

Criticality: How critical is the target with respect to your overall goals, objectives and strategic purposes? Will it move you significantly closer to goals or your vision, or is it insignificant in relation to those larger aspirations? Is completing the task going to make a difference in your life?

Accessibility: Is the task achievable and does it link to the main objective? Will it move you closer to your goal(s)? Can you successfully complete the task independently or are there prerequisites that require the cooperation of others/

Return: How great is the return on commitment of resources?

Vulnerability: What commitment of overall resource is required for full achievement? The shorter the time frame for delivery and the higher the cost in resources, the more vulnerable the effort.

Effect: What will the impact be if you achieve the task successfully? What will be the effect on your life and that of others around you? Is the impact worth the effort?

Recognizability: Is the target achievement visible or is it a moving target or envisioned poorly? Is the definition crystal clear or fuzzy: How easy is it for you to recognize the steps that will be involved in successful completion, and do you have experience with this type of task? Clear goals with a clear path to achievement score higher that ambiguous goals with an uncertain methology.

Creating a matrix and assigning values to the component valuations is simple and straightforward. The total numbers should tell the story of the priorities, separating those projects worth the effort and those that are not, IF YOU HAVE A CHOICE. It also helps to identify when to reach for a piece of low hanging fruit or alternatively to kick off a really big project first. But don't get carried away with hours of analysis, this is a quick and dirty application to give you the next best step in the right direction.

Grid Analysis or MAUT Analysis

Sometimes the number of options available confuse us or slow down decision making, but Grid Analysis can help to sort through the decision, an you only need a pen and a piece of paper. Grid analysis is a technique designed to take options into account, factor in details and come out with an optimal choice. It is an ideal technique to use for important decisions where there isn't a clear and obvious preferred solution. It is also known as Decision Matrix Analysis, and as Multi-Attribute Utility Theory Analysis.

Using Grid Analysis will enable you to make a decision relatively quickly when others around you might be struggling to sort out options and has been used successfully as a technique for evaluating formulary product selection decisions.

List your options as rows on a table and the factors to consider as columns. Score each option/factor combination, weighing the score, then add scores to give an overall score to the option.

Work your way across the columns to determine the relative importance of the factors in your decision, showing numbers from 0 to 5 where 0 means the factor is absolutely unimportant and 5 means it is very important. These values will reflect your preference or confidence in the factor's significance.

Next work your way down the rows of the table to score each option for the factors, with the same 0 to 5 scoring values.

Multiply the factor scores by the option scores to determine the weighted values. Add the weighted scores for each option to identify the "optimal" decision.

Grid Analysis is the simplest form of MAUT, useful as a quick decision tool to evaluate complex decision options. Sophisticated MAUT involves highly complex modeling of scenarios and sophisticated mathematical analysis.

Action Priority Matirix

The Action Priority Matrix, also known as the Impact Feasibility Matrix is a simple approach to diagramming the relative importance of activities and hence their priorities. It is particularly useful since most leaders have far more on their radar screen than there is time available -- lots of great ideas, wishful thinking, interesting possibilities and a range of "must do" activities. Selecting those activities to focus on most wisely allows leaders to be more effective and to better use time make the most of efforts. By choosing badly, leaders can become bogged down in less meaningful, but time consuming efforts that thwart movement toward goals.

Priority Matrix.jpg Use a matrix, illustrated at left, each activity is evaluated based on its potential impact and the effort involved, allowing you to quickly see relative value, the greatest return on effort and to move quickly to initiate that decision or activity. This allows you focus on the tasks with the highest impact by avoiding crowding them out by dedicating your time to less valued work.

Using your best judgment, plot the activities in the matrix based on the information available and input from trusted colleagues.

Quadrant 1 represents Quick Wins, "low hanging fruit" that offers a quick return for minimal effort

Quadrant 2 gives good returns, but they can take a long time to complete, so one activity in Quadrant 2 can obviate time for many in Quadrant 1. Be attentive to completing these activities as quickly and efficiently as possible, and be cautioned to avoid failure to disengage as soon as possible.

Quadrant 3 is Fill In Work to be done in spare time, and put back on a rear burner if more valued options come along.

Quadrant 4 represents the proverbial Thankless Tasks. Try to avoid them. They take time from other important work, show poor impact returns, minimize opportunity to take on more valuable work and often fall in the category of "no good deed goes unpunished."BCG_Matrix.png

Boston Matrix (or Boston Consulting Group Matrix)

The Boston Matrix, also known as the Growth-Share Matrix, provides a visual display and vivid category descriptions, useful in looking at available opportunities, and analyzing which opportunities are a good fit with the strategy and which are not. That allows leaders the opportunity to prioritize the investment of resources, in this case time, to maximize advantage achieved. The measures at the attractiveness of the opportunity and the relative advantage offered, two critical determinants of potential profitability or value. The vivid imagery of "stars", "questionables", "cash cows" and "dogs" allows for rapid categorization of the tasks at hand, and subjective evaluation to prioritize, divest, invest or kill the initiative. This technique is helpful in sorting out those projects to take on or not, allowing leaders to quickly focus attention to most attractive opportunities with the highest potential for successful impact.

Nominal Group Technique

When prioritization becomes a group task, we often see the loudest and most vocal participants, or those with the most perceived power, setting the priorities, rightly or wrongly. Nominal Group Technique (NGT) is an easy to use approach to gain input and consensus from a group meeting face to face, with all members participating freely and with minimal influence from other participants. The process prevents domination by a single person, encourages everyone to participate and results in a set of prioritized solutions or recommendations that represent the entire group's preferences. Open group dialog assures discussion of all of the relevant issues before the evaluation of priorities occurs, then each member of the group is asked to "nominate" priority issues by ranking on a scale of 1 to 10.perform-nominal-group-technique-sessions-120X120.jpg

Begin by identifying the stakeholders to the issue at hand.

Summarize topic and objectives and ask the group to explore the topic, ask questions, raise issues and clarify understanding of the implications of the issue, allowing time for thoughtful consideration of all aspects of the issue.

Ask each stakeholder to write down their priority issues or projects, and give time for each participant to present and elaborate on reasoning.

Maintain a master list on a flip chart to record the dialog, working with the group to combine, as appropriate, and to eliminate redundancy. Reduce the list to a maximum of 5 -- 10 issues or projects agreed upon by the group, then ask each individual to rank the list in priority order. Collate the lists and provide a merged ranking to the group. The highest priority is the highest score.


sand.jpg Scheduling is the process of planning how you will use your time and is really a 5-step process:

Identify the time available for work.

Block in the essential tasks you must complete, including relationship time like coaching, mentoring, communicating and dealing with emerging issues.

Schedule in high priority, urgent tasks and essential logistic tasks that you have identified on your to do list.

Block in contingency time for unpredictable interruptions. Based on your experience, or the data from an interruption log, you can identify how much time you can normally anticipate on an average day for essential unanticipated occurrences that demand your attention and block out sufficient time so that you can deal with them, confident in the flexibility of rearranging your schedule.

Schedule activities for personal priorities and goals.

Managing Interruptions 

Interruptions can be a significant barrier to your success. Phone calls, emails, software notifications, pagers, PDA auditory cues, drop-in visitors distract and more importantly, cause a loss of focus. And in a culture of constant connectivity, we are available and interruptable at virtually any moment. While these gadgets are intended intended to help us multitask, they often outstrip our mental capacity to manage the diversity of self- and other-induced interruptions. The effect is an enormous drain on focus and concentration, and ultimately the ability to perform. We become so distracted by managing the inputs and outputs of interruptions, that becomes a primary focus of attention, rather than the important work that needs our concentration. The key to controlling interruptions is to know what they are, whether they are necessary and how to plan them into your daily schedule to minimize disruption. A recent study found that workers are interrupted once every 11 minutes on average during the work day. Other studies suggest that leaders seldom get more than 6 minutes before being interrupted by other tasks.

interruptions6a00e5538e53f98834011168cddd6f970c-800wi.jpg First, keep an interrupter log for a week, cataloging the date and time of interruptions, who caused it, a brief description of the nature of the interruption and whether it is valid and/or urgent in nature. With a weeks worth of data, analyze patterns, in particular, identifying those interruptions that were valid and actually deserved your attention. For non-valid interruptions, plan a proactive strategy to assertively discourage those types of interruptions, or to avoid their occurrence by planned opportunities to avoid the cause, for example regular times that you are accessible to colleagues and coworkers to deal with their issues of concern. For interruptions that are both valid and urgent, you know you must deal with them, so calculate how frequently they are occurring and the amount of time that is typically involved in a work day and plan that much "interruption time" into your schedule. If interruptions by colleagues is a routine problem, signal in whatever way you can when you are not available (closed door, wearing headphones, or some other identifiable "do not disturb" signal that coworkers will recognize.)

Too often, our interruptions are self-induced. If the phone rings we have to answer it. Or, there might be email that is urgent that demands immediate response, so let's check it every 5 minutes. A quick glimpse at the browser home page cues us to some breaking event, so take just a minute to read the full story. A push email blog is intriguing, so stop to read it and research some of the hyperlinked sites. Controlling some of these personal options that cause wasted time is an important strategy for reducing interruptions. Use your voice mail to screen calls. Forward your phone to voice mail, turn off your cell phone and either shut down your instant message capability or set your status to "busy" when you need to concentrate on a specific task. Shut down your email, or set it to eliminate audio and visual alerts. If you are working on your computer, keep only the programs you need for the task at hand open. Clear your physical desktop, and your digital one of the most likely distractions, visual temptations to derail your attention and focus from the task at hand.

When you do encounter an interruption, don't necessarily rush to resolve it. Take a minute to clear you head, take a breath and consider if it needs your immediate attention. Learn to say no, consider delaying the issue to a later and more convenient time if it isn't urgent, or to delegate if it really is an issue for someone else. Make sure you maintain accessibility by establishing "available time" and regularly scheduled check-in times with key coworkers. Schedule regular meetings in a conference room for a fixed time frame so you can leave at the conclusion, without the concern of how to get people to leave your office. For interruptions that you must deal with, set parameters (I have 5 minutes to address this now, but we can revisit it later) and don't extend the interruption with other issues or casual conversation.

It takes approximately 15 minutes of uninterrupted time to get into "the zone", that sense of pure attention and intense productivity that lets you focus totally on the task at hand and perform extremely well. Modern psychologists refer to this state focus on task as being "in the flow," the state of complete absorption in an activity for its own sake, without ego. Time flies, skills are totally engaged and it all comes together. To get to that state, you need to minimize distractions, manage interruptions and stress. Being more productive, driving personal performance are common quests, but there is there is no single life changing secret that is a quick solution. There are hundreds of tips, ideas and tricks that you can use to reduce interruptions, get into and stay in the flow and be more productive, all small changes and adaptations of your behavior that can make a huge difference.

Who's Got the Monkey?

Management Time: Who's Got the Monkey is a classic article that appeared in the Harvard Business Review in 1974. Written by William Onckenmanaging_management_time_logo_yoest.jpg and Donald Wass, this seminal article made the critical point that leaders deal with three kinds of time: boss imposed time, system-imposed time and self-imposed time. Often the boss- and system-imposed time requirements are "a given."

But the self-imposed time, including both discretionary time and subordinate imposed time, represents the point of time leverage we have control of. Using the metaphor of a monkey on the back, the authors describe our human propensity to assume other peoples' (time consuming) issues and problems, and the more we get caught up, the more we fall behind. Spending time on things that are urgent but not important will trap you in an endless cycle of dealing with other people's monkeys, while the gorillas take over. Getting control of the timing and content of how time is spent is essential to effective leadership. More discretionary time, and less subordinate or coworker imposed time, will allow you to increase your leadership leverage.

Take charge of your time. Recover your leverage. Reduce your stress. Get the leadership results you target.




To do things differently, we must see things differently.

When we see things we haven't noticed before, we can begin to ask questions we didn't know to ask before.

And the collective observations of many can contribute to breakthrough insights in innovation.

lightning.jpg While Ben Franklin performed his famous kite flying in a thunderstorm, discovering the connection of lightening and electricity, it took the subsequent discoveries of physicist Alessandro Volta -- the first transmission of electricity -- and Michael Faraday's invention of the electric dynamo (precursor of generators) to set the stage for the modern age of electricity. Their ability to see things differently led to Alexander Graham Bell's discovery of the telephone, transmitting voice by electricity and Thomas Alva Edison's development of the electric light bulb and the modern world of electricity.

Dee Hock saw the potential to systematize the then fragmented credit care industry in the late 1960s, which let to the creation of BankAmericard, later VISA International, which revolutionaized interbank transactions and led to a 10,000% growth since 1970. Hock believed that all organizations are a reflection of community and "can be no more or less than the sum of the beliefs of the people drawn to them." He based his strategies on the conviction that "given the right circumstances, from no more than dreams, determination and the liberty to try,Bridging-the-Gap.jpg quite ordinary people consistently do extraordinary things."

Bill Gates and Microsoft democratized access to computers and information. Steve Jobs and Apple revolutionized and simplified technology and transformed themselves from a computer hardware company to a service business that delivers music, entertainment, literature and connectivity to the internet world. Google provided an internet search engine capability, cloud computing and advertising medium designed to create an "ordered world of information that is universally accessible and useful," and stretched our imaginations, productivity and creativity.

Thinking differently is the only mental bridge that can get us from where we are today, to what we aspire to achieve in the future. How comfortable we are with thinking differently, and the extent to which we take that difference, often defines the significance of the difference we can make. While incremental improvement is worthy of our attention, truly transformational change demands that we challenge what we do, understand the process and impact at the most discrete and critical levels levels, and redesign where the opportunity is greatest.

First and Second Order Change

slinky-light2.jpg First order change involves innovation, but does not alter the basic mental model of how we think -- this is an improvement that enhances the current state. An example might be to increase the pharmacy clinical staff support for the transition of oncology patients between the clinic and the infusion center to improve timing and patient flow.

Second order change results when we think differently and transform the care process because we see new options for structure, process and outcome of care. An example would be realigning pharmacy clinicians within multidisciplinary patient care teams serving as the accountable care home for chronically ill patients with multiple illnesses to follow care longitudinally over the lifetime of the disease(s) with proactive and timely medication therapy management intervention designed to improve outcomes. Or, redesigning the care process to enable patients to interact technologically with providers and care givers in monitoring self-care and vital signs for early warning of non-compliance or adverse reactions.

How to Think Differently

Healthcare organizations and their leaders know that change is essential and inevitable, and that they cannot continue to think in traditional ways. What is more challenging is breaking the mental models and boundaries that define how each of us thinks.

Edward de Bono is a leading authority on creative thinking, innovation and teaching thinking as a unique skill. His approach is based on fundamentals of how the brain handles information. His techniques are simple, practical and easy to use, but profound in their ability to design thinking methods and cause us to pause and consider HOW we think.

mentalvalleys1.4.2.2_11.jpg His simple model of mental valleys and streams of thought illustrate the flow of ideas, just as rain falls into flowing streams. As rivers and streams are formed, our minds blends words, phrases and ideas into "streams of thought." These mental valleys approximate our personal mental models, paradigms, simple rule sets or simply the cultural norms of behavior that define how work gets done. Because we tend to think traditionally, our mental valleys are comfortable and seldom flow together with other streams of thought.

When we think differently, these streams of thought need to be connected in different ways -- through "random jumps" or the development of "purposeful channels" -- to challenge and reset usual thinking. Creative connections between the valleys allow leaders to rearrange information in different combinations, sometimes strange combinations. In fact, laughter is a typical physiologic reaction to unique and different mental connections, a good sign that the idea is quite creative.plsek51R4EH3J5GL._SL500_SS75_.jpg

Paul Plsek, an engineer with decades of consulting experience in directed creativity for healthcare and other industries, has written widely and is a frequent speaker on innovation. In his book Creativity, Innovation and Quality, Plsek discusses second order change idea generation -- thinking differently -- relies on three mental processes: Attention, Escape and Movement.

Attention involves awareness of what is, looking closely at details and understanding processes and taking a fresh perspective of what we assume to be familiar and known.

Escape involves challenging what is known, bending or breaking the mental "rules" that define what we do, allowing us to move out of the mental thought valleys that drive traditional thinking. Blue sky thinking, brainstorming, what if thinking . . .

Movement results when imagination generates new, exciting and challenging ideas encouraged by the free flow of thinking "outside the box." Paying attention to -- and overcoming -- assumptions, challenging how things work and stepping back to the basic purpose of our work allows us to think freely about what could or should be, rather than fixing on what is.

Generating ideas works best within the framework of a few "simple rules", established by Tom Kelly, CEO at IDEO in his book The Art ofartofinnovation.jpgInnovation.

IDEO is a public face of extreme creativity and innovation across many industries, and their approach was explored by ABC's Nightline in a classic segment entitled The Deep Dive. Explore IDEO's innovation concepts and triggers, as well as the way their teams work to turn old ideas new in this 8 minute video segment.


While thinking differently is critical, Plsek also points out that it is essential to alternate between divergent and convergent thinking in order to both think differently AND generate action for change.

Divergent thinking expands possibilities, perspectives and different approaches. It is focused on quantity and diversity of thought, creative imagination and the generation of lots of options. The risk of too much divergent thinking is that it can go on too long, with too many ideas and with no resulting innovation for change.


Convergent thinking focuses on analysis and reducing the list of options to focus -- selectively -- on the most favorable ideas, with an emphasis on quality of thinking, judgment and the best solutions. Convergent thinking allows the group to focus in order to increase the likelihood of successful change.

Alternating cycles of divergent and convergent thinking is important to thinking differently, and the ability to reframe issues.


Tools for Thinking Differently

The Leadership Resource Center Toolkit describes a host of tools that will encourage thinking differently and over the next three months new tools will be added each month to challenge leaders and their teams to escape their existing mental valleys to see new options.

Because the human tendency is to think in the same ways, our usual thinking is unlikely to generate new ideas. Reframing issues, describing challenges in new ways is likely to generate more and different ideas, increasing the opportunity to achieve transformational change. To think differently, tools for reframing can be helpful to trigger new thinking. Tools include:eye-perspective.jpg

Others' Point of View (OPV)

OPV -- a technique developed by de Bono involves thinking about a situation or issue by switching thinking from the traditional perspective of the healthcare organization or professional to describing the issue from the perspective of others. Naturally, always consider the patients (as well as family and caregivers), other professionals, clinicians and all staff at every level. But to be more expansive in thinking differently think about the issue from some unique and off-beat perspectives. Consider what the perspectives of other types might be:

The point here is to consider not traditional viewpoints. Traditional thinking helps establish minimum standards for performance. Thinking differently stretches thinking to new fronts of innovation and action.

Using OPV

  1. Identify the issue or situation for attention.
  2. Prepare a list of "others" to consider diffèrent points of view.
  3. Select one, and ask your team to describe service, process or problems that might come to mind from that view or perspective using the language of that "other". Spend about 20 - 30 minutes, with 3 - 5 minutes per point of view. Maintain a fast pace to identify other views, alternating usual (eg patient) and unusual (eg Martian) to free up thinking. Avoid problem solving this early in the discussion.
  4. Review and clarify ideas that cover the range of aspects you want to explore further. Select 5 - 10 statements that might warrant additional consideration when you move on to idea generation.


logoWORDPlay.jpg Wordplay involves taking a statement of a problem or opportunity and substituting synonyms or other phrases. The idea is to communicate the same message but in simplified language that is jargon-free.

Plsek offers several examples:

In addition to creating a new view of options, Wordplay Reframing offers the advantage of addressing head on the use of jargon -- terms that too often have different meanings for different people, professions and stakeholder groups.

Using Wordplay

  1. Begin with your list of issue statements. Highlight the jargon or overused words and phrases.
  2. Ask about the true meaning of the terms or phrases, looking for words and phrases to substitute: What does this mean in plain English?
  3. Capture the options and reframe the issue statement with "We want to think creatively about. . . "
  4. Take advantage of the PLAY aspect of Wordplay: roleplay someone from another background who does not understand and keeps asking for clarification, or ask to translate the message to an elderly relative or small child in simple terms.
  5. Make sure that the team has an understanding of mental valleys and the intent to create random jumps or purposeful channels between values through the use of this tool.

Pause, Notice, Observe

Creative people have a unique capacity to pause, notice and observe the world around them, while the rest pay limited attention to what goes on curiosity.jpgoutside our immediate point of focus. Creative people are curious, and Einstein once said he was no more intelligent than others -- just far more curious. The tendency to pause, notice and observe increases our understanding and can inspire us to generate new thinking about the familiar.

In her one woman show, Lily Tomlin portrays a character -- the cosmic bag lady -- as a collector of ideas, thoughts, interesting factoids and observations about the world around her, capturing and tucking away these unique ideas in her bag, knowing they will be useful one day, but not sure exactly how. The inventor of Velcro came upon the idea while hiking in the woods, noticing that the cockleburs he encountered clung to his clothes, and wondering how that idea might translate to a new type of fastener. You don't have to be looking for anything specific: just open your mind to think about the ideas and events that flow around you, storing away interesting observations to call on in reframing and thinking differently about some work issue.

Using Pause, Notice, Observe

  1. Restate the issue or situation of interest in general terms, how can we reduce turnaround time on medication orders?
  2. List other organizations or situations where the same issues are faced, for example, how lab results are handled or online ordering of retail products or package delivery services.
  3. Think about or observe how others handle these similar situation. Observation is important because people don't always do what they say or think they do, or what YOU think they do. Things are not always what they seem
  4. Consider how to apply these insights to your work setting.
  5. When you are immersed in a grove of trees, it is often difficult to see the forest, though blindingly obvious to others. Observation allows you to see beyond the scope of your limited view and look past your assumptions.
  6. Keep an open mind and ask questions about what you observe.
  7. Get people to share stories, not just answer direct questions.
  8. Don't just talk about process and tools . . . learn to say "Show me" for full understanding of what you are observing.


Great thinking and great leadership go hand-in-hand. Leaders think differently….

Leaders think differently about themselves. WisdomwonderGHDDF00Z.jpg


Leaders think differently about others.


Leaders think differently about what's possible.


Leaders think differently about life and the circumstances that surround them.


Leaders think differently, and that's what distinguishes them from followers! Your thinking creates your beliefs, your beliefs results in a leadership philosophy, which results in leadership attitudes, your attitude, shapes your perceptions and your perceptions guide your actions. It all begins with your thinking….! View "Think Different . . . the crazy ones" below.



Creativity and Generating New Ideas

Why be creative? Why challenge the rules? Why risk failing or looking foolish?

creativity-02.jpg There are actually at least two good reasons:

Creativity depends on knowledge, but more importantly, what you DO with knowledge. It is also about an attitude of open exploration that encourages:

And sometimes it produces the most astounding results. . . looking in some very unusual places and some very common ones. A Nobel prize winning physician once commented that his discovery consisted of looking at the same thing as everyone else, but seeing something different.WEST.jpg

Take a look at the figures to the right. What do they represent? Or how could they fit together? Think about each piece and how you consider it for meaning.

Now focus at the spaces between the figures and the meaning becomes obvious. W E S T. Once your perspective changed, the meaning becomes so obvious, it is all you can see.



Thinking Creatively

critical-thinking.jpg Most people don't think of themselves as creative. We don't need to be creative all of the time because as humans we are such creatures of habit, which is helpful most of the time. Routine is indispensible learned behavior, and without it our lives would be chaos.

We also are not creative -- or at least don't feel we are -- because we have not been taught to be. Our educational system reflects scientific method's reflection of the assembly line of the early 20th century. As a result, most people have attitudes that lock thinking into status quo, more of the same, perhaps necessary for many daily tasks, but it has a brutal impact on creativity. We need to understand and unlock these mental barriers to being creative. In the 4:19 minute video clip, Edward de Bono discusses key concepts of creative thinking.

Stimulating Creativity

Back to a few more mental exercises designed to stimulate creativity.

7.jpg Look at the roman numeral 7 to the left.

By adding only a single line, turn it into an 8. Easy right? Just add a line to turn it into 'VIII'9.jpg.

But how about one a little harder. Look at the roman numeral 9 to the right. By adding only one line, turn it into a 'six'.

There are at least three good answers to solve this challenge. . .



flywin.jpg Now take a look at this abstracted set of human figures, interspersed with arrows suggesting flow. What does this mean to you? Likely, you don't see figures, largely because of your recent experience with W E S T that taught you to look at the spaces.

What you see is a reflection of the propensity to look at positive AND negative spaces for solutions. Most people concentrate on the positive spaces to the exclusion of the negative spaces, missing some insights.

The point is that everyone has a lot of knowledge. Shifting contexts -- the way you think about things and see them -- allows you to discover some new ideas.


The Barrier of Mental Locks

So what about these thinking habits? One explanation is offered by de Bono's mental valleys thinking model: our thoughts are channeled into the most useful learned thought processes based on our experience. Because we don't need to be creative about things like driving to work, standing in line in the cafeteria or riding an elevator, we tend to rely on routines which become indispensible. What happens though, is that these mentalwhack.gif valleys tend to lock our thinking into "more of the same." As a result, it is very difficult to be creatative when you assume there is 'A' right answer, you're being practical, following rules, afraid of mistakes, trying to not be be ambiguous, staying within the limits of your own 'turf', or worried about looking foolish. The more often you think or do something the same way, the more difficult it is to do it any other way. In A Whack on the Side of the Head, Roger Von Oech, teaches some very creative ways to shake up our thinking and unclutter our minds from more of the same thinking. Von Oech calls the ideas, events, situations, connections and relationships that shake us into new thought patterns, WHACKs. Learning to take advantage of life's surprises, crises, paradoxes, questions and surprising events, or looking at jokes or art in new ways helps us in the practice of thinking differently.

The Right Answer

2007_09_creative_spark.jpg Peter Senge, a systems thinker and creative thinker on many topics, has said that children enter the educational system as question marks and exit as periods, in the process learning to be selective about where to focus, reflecting the rule of order. And one of the rules of order is to find the right answer.

People tend to see what they are looking for, so if you are asked to identify blue items, you will find them everywhere. Buy a new car and it will seem that everyone is driving one in the same color. We look for right answers and we find what we are looking for, so it is important to learn how to set and reset your mental valleys because what you look for will determine what you find.

An example from Von Oech:

An English teacher puts a small chalk dot on the blackboard and asks her junior class what it is. After a few seconds, someone correctly answers " a chalk dot," then there is silence. The teacher tells the class that the same exercise earlier in the day from kindergartners generated much more imaginative answers: a birds eye, the top of an acorn, the center of a flower, a pebble, a bug, a star, a grain of sand . . . . the older students had learned how to find the right answer and lost the curiousity and imagination to look for more than one. Yet in our chaotic and complex world of healthcare, there is seldom one right answer.

More Creativity Exercises

onerightanswer.jpg Take a look at another of Von Oech's visual tests and select the one firgure that is different from all the others.

Did you choose B? You're right, the only figure with only straight lines.

Did you choose C? Right again, uniquely asymmetrial.

What about A with no points? Or D with both straight and curved lines? Or E, with a projection of non-Euclidean into Euclidian space.

In this example, all the answers are right depending on your perspective.

The answers you get depend on the questions you ask. Reframing -- a technique presented in the LRC toolkit -- helps you to think more effectively, to consider different points of view, collect a diversity of ideas and enrich our options with ideas and inputs we might not think about right first.

Why settle for the easy answer when their might be a better one?


Oh, and the answers to the roman numeral 9 challenge -- add one line to change IX to 6?romansoln.jpg

Put a horizonal line through the center of the figure, turn it upside down and use a paper to cover the bottom half. OR

Put an "S" in front of the IX ORSIX.jpg

Add the numeral '6' after the IXIX6.jpg


Rember that there is seldom a "right" answer and there are many solutions to every challenge. . .



That's Not Logical

Physicist Kenneth Boulding observed that there are two kinds of people:

logical thinking.jpg For creativity, the big two groups are HARD and SOFT ideas . . . objective vs. subjective . . . quantitative vs.qualitative . . . cognitive vs. intuitive.

The creative process of necessity must encompass both the imagination to think differently and the practicality of "getting it done." There are good art analogies.

Potters must have soft, malleable clay to create and form the shapes of vessels or scullpture, but the clay must be fired for strength and durability. Scultural welders and jewelers and glassworkers heat the steel or silver or gold or glass to work and shape it into the final image of their creation. Then they harden or anneal the product to ensure its durability.

Both the soft and hard approaches are needed at the right time. Soft thinking in the practical phase can prevent execution and hard thinking in the creative phase can limit options and the ultimate success of solutions. Ignoring the soft side can override the important aspects of intuition, hunches and insight so valuable to breakthrough thinking, and too many leaders tend to undervalue the soft side because we have been educated and trained to gravitate to the hard ideas. So how to give more attention to the soft issues?

Metaphors are a powerful tool to focus on similarity, connecting two very different ideas or concepts though some common factor, using one to better understand the other, bringing clarity to the complex. Some examples of metaphors:

Gardening as a metaphor for learning:gardening.jpg

Business framed in sporting terms:

Finance in the context of water and plumbing

Metaphors are a powerful tool to enable thinking differently. Creating a metaphor about a challenging problem will give you a fresh perspective.

Pay attention to the metaphors that other people use and those that you use, and remain aware that as valuable a tool as this can be, it can also serve to imprison your thinking if you are not aware of how significantly they shape your thoughts. Keep in mind that essentially we live in an illogical world. When you are searching for ideas, excessive logic can negate your creative side that is focused on fantasy, ambiguity and the metaphors of life. Once you have harvested the soft side for ideas, there is plenty of time for the hard side of thinking for the practical realities of the execution.


Challenging the Rules of Order

Alexander Pope observed that "Order is heaven's first law." The order of the universe, and the patterns created dominate our thinking and the way we explore complex issues.

Recognize the pattern here?

1, 4, 9, 16, 25, 36, 49, 64


Absolutely, the pattern is that each number is the square of it's position in the series, and you'd probably be able to predict the next numbers in the sequence.

nautilus_flickr.jpg Humans recognize the pattern of sequences -- the order of tasks, of cycles -- as in weather or the calendar, shapes -- the cracks in mud form 120 degree angles, processes -- the necessary sequence of ingredients to make a pie crust, and probabilities -- the likelihood of the ace being the next card at a black jack table. The point is that we see patterns everywhere sometimes even when they don't exist. And often the patterns become the rules by which we live.

Picasso believed that every act of creation was first an act of distruction (think about Picasso's art genre.) Being creative means playing with what you know, and often breaking out of old thought patterns to challenge the rules and create a revolution.

There is a great historical example:

Alexander the Great arrived in the Asian City of Gordium with his army in search of a winter encampment, and on arrival hears of the legend ofGordian.jpg the city's famed Gordian Knot. By prophesy, anyone who can untie this complicated knot will become the king of Asia. Intrigued, he studies the knot, unable to find the ends. So, he made his own rules, pulled out his sword, cut the knot in half and won the rule of Asia.

Some other famous rule-breakers:

What rules can you break?

Often we make rules based on reasons that make sense in the moment, but as time passes and things change we forget why we made the rules or that they may no longer apply. When you look at the image to the left, no doubt the letters are recognizable as the top row of key on a keyboard. So how did we get that configuration?

QWERTY.jpg In 1870 a leading typewriter manufacterer received complaints about keys sticking together if the typist was too fast. They redesigned the keyboard to slow the typist down, making it inefficient but less subject to jamming, by placing the "o" and "i" keys (incidentally the third and sixth most frequently used letters) in positions that required them to use the ring and pinky fingers which are relatively weaker. While we no longer have key strikes like a typewriter, and modern technology allows speak that far surpasses operator skill, we are still slowing them down.

Once a rule is implemented, it is really hard to extract it, even if it makes no sense. In addition to uncovering new ideas, look for the obsolete ones and try to dislodge them.

Sometimes creative thinking can be as simple as the realization that there is no particular reason or virtue in doing things the ways they have always been done.

Play the revolutionary. Slay a sacred cow. Institute a rule - inspection and rule 'sunset law' withing your organizations. Finding and eliminating outdated rules can be fun and profitable.



(IM)Practical Thinking

WHAT IF . . . ? An amazingly powerful question that can always get creative juices flowing . . .what if.jpg

"What if" questions are liberating. They free you of the rigid architecture of your mental thinking valleys.

Frame your perspective in totally different ways.

What if you ARE the dispensing unit -- Pyxis, Omnicell or the RobotRx -- or the nursing station? How might you observe what goes on around you? How you are used? What you might want to do to improve patient safety? How would you like being that machine and how nurses and pharmacists and technicians talk about you?

What if your questions alone will not produce practical solutions? Might they offer stepping stones to a solution, ideas that are perhaps not fully developed but stimulate other ideas? Stepping stones are a common tool at IDEO, an award winning concept design and development firm renowned for its innovation. IDEO brought the world the iMac and mouse, the Palm and countless other inventions, where 'hot teams' generate energy and ideas, new producats and services, and build on stepping stones . . . ideas thrown out on the table that have no practical likelihood of success, but serve to trigger new and better ideas. Remember, every child is an artist, just remember how be remain one after you 'grow up.'

IMPractical Magic.jpg When you take any activity, any art, science or skill, any discipline and push as far as you can stretch the envelope, beyond where it has been before, to the wildest edges of thinking, you have moved into the realm of magic. Cultivating imagination works magic, so set aside time every day for "what if" thinking, asking provocative questions to stimulate thinking -- yours and others.

Think about having a "WHAT IF" question of the week for yourself and other leaders, and the people who follow you. . . What might those questions be?

What if our practice model was declared to be illegal?

What if we had to provide direct patient care across the continuum of care to be reimbursed for products?

What if there was a universal pharmacy practice act across all states . . . what would we wish for?

What is your 'What if?'

Remember to use the CREATIVE NO (as opposed to just NO). . . Only veto an idea with the understanding that it is your responsibility to come up with a better one. . .



apple-globe_WupL9_6648.jpg Sometimes we we simply have to get creative to deal with a problem, a deadline or for a quick fix. Sometimes, when the pressure is on, creativity flourishes

But, just as many -- or perhaps more -- creative ideas are generated when relaxing, the mind is wandering or while engaged in some other activity than work, like golf, driving, mowing the lawn, times when thinking is not constrained by the "have to's" that so often dominate daily thinking.

Steve Jobs, founder of Apple, once said: "Play is what I do for a living. Work comes from organizing the results of my play." 

One of the important aspects of play is humor because it loosens up thinking, creates a better and more positive frame of mind and enhances creativity. Humor breaks set thought patterns -- de Bono's mental valleys -- leading you to generate different thinking. Humor is a vehicle to facilitate the combination of ideas that that are not typically associated (What to John the Baptist and Winnie the Pooh have in common?)

And, importantly, there seems to be a startling connection between the HA HA moment and the AHA moment.

When you have a problem, play with it. Or if you don't have a problem, make time to play anyway. Make your workplace fun. Laugh at your self, laugh at the events around you. As physicist Niels Bohr once said: "There are some things so serious you have to laugh at them."crayons-creativity.jpg

What about John the Baptist and Winnie the Pooh? The both have the same middle name. Tell funny stories, jokes, make people smile. . . they will be both happier and more creative.

Keep toys nearby -- kaleidoscope, puzzles, whatever -- for convenient play, to redirect your thinking or just to have some fun. Fun is contagious and everyone will work harder to get in on the fun.

Some helpful thoughts on how to be personally more creative are found in the following 1:47 minute video entitled: How to Stimulate the Creative Process.



Generating IDEAS as a Source of Innovation

newyears.jpg Problems cannot be solved with the same level of thinking that created them. Albert Einstein

We live in a complex world of challenges, often with no obvious answers. We need lots of ideas to figure out the next best step in the right direction. Pay attention to how you usually think about things, and how that approach might have constrained your vision. To step beyond traditional thinking you will need to challenge beliefs, "givens" and sacred cows. . . Deliverately challenge the underlying rules and concepts of the situation, and allow your mind to run free to step outside the boundaries of "thinking as usual."

The way to get good ideas is to get lots of ideas and throw the bad ones away. Linus Pauling


Brainstorming is the "shorthand" for audaciously pulling out all the stops to identify our best ideas on any issue. In brainstorming mode, there are no bad ideas, so reserve judgment for later. New ideas can be delicate, easily killed or worried to death by a frown or a sneer. At this point you are looking more forcreativelightbulb.png quantity more than quality -- even the craziest ideas might lead to thinking of one stupendous out of the box idea destined to be outrageous breakthrough thinking! In fact, the wilder the ideas, the more likely it will trigger out of the box thinking.

Take care to listen and build on the ideas of others: What can you add? What else? What does this idea make you think about? As you listen, make sure that there is only one conversation at a time to ensure that the group can capture all the ideas. Review and post the rules and hold the group to sticking with them.

Generating new ideas can be hard work, or it can be fun.

Use some of the following tools to expand traditional brainstorming and improve the thought output. New approaches can also take the pressure off a group that has been charged with finding creative and innovative solutions for complex situations where there are no obvious answers.


In times of crisis we all have the potential to morph up to a new level and do things we never thought possible. Never waste a good crisis, and if you have to, create one . . .



Fresh Eyes

New ideas come from differences, not from similar thinking. Making sure that diverse interests are represented in the group is one way to address this need, but just as useful is the approach of thinking "like" another person, or making links to other industries where practices are vastly different.

Process Steps

1. Define the issuenew-perspectives.jpg

2. Randomly select targets for alternative viewpoints and how someone in that environment might respond to the issue.

3. How might these ideas work for your situation? What could you do to explore the options and their validity?

Sample Fresh Eyes Perspectives

Use this list to select "Perspectives" you might adopt for a new view.



















Interior design













Fast food















Fine dining





Funeral homes






Law enforcement












Travel industry




















Child's view

Grocery industry



Wine making

















Hotel industry


South America




Issue: Infusion center patients are scheduled for clilnic visits and subsequent treatment and often experience long delays because pharmacy is notified of treatment orders only after the patient arrives at the infusion center.


Look through Fresh Eyes:


Eyes of a Travel Agent



earth-eye.jpg Before trying to introduce this tool to others, take a look at the examples and think through how you might use the tool to expand and extend your own thinking. This will help others to "connect the dots" to liberate their own thinking in how to use the tool most effectiveley with your own group.


Break the Rules

Underlying assumptions, implanted mental and practice models, unwritten rules and status quo thinking are a bear trap if you want to thinkrules.jpg differently, take a new path, or strike out in a new direction. The reason? These assumptions and mental channels of thinking drive our behaviors. By consciously identifying these mental rules and observing how we respond to them in decisionmaking, we disarm the effect they may have on auto-pilot thinking.


There are no rules here. We are trying to accomplish something.

Thomas Edison


Rules can get in the way of innovation.

"We've always done it that way."

"The policy won't allow me to do that."

"I wish I could change the way we do things to make this happen, but rules are rules."


Patient care flow, service provision, routine and followup care are all dictated by tradition and rules, all adopted for good reasons in a different time and place. Our pharmacy service models have evolved incrementally, with successive demands for change, innovation and system fixes. We seldom have taken the time for a fresh look at what might be . . .

Rules maintain the status quo, drive system behavior but keep us from thinking innovatively. As we -- as a profession -- examine our practice model, we need to be aware of the rule constraints that define and confine us, and to examine whether they make sense for patients, health professionals and the system, and to offer innovative options for moving forward. But first we have to think differently. Taking the current rules into consideration within the context of our current demands, changes within the rule structure for improvement constitutes first order change. Breaking the rules to redefine care process and outcome is second order change that provides breakthrough opportunity.

Process Steps

1. Identify the rules and the unwritten rules behind them.

rule breaker1-2991953-1166-t.jpg 2. Challenge the rules.

3. Think through your vision. What new rules might help you realize your vision? What might you do differently for different results? Design the new process and the behaviors that would support it.

Lots of breakthroughs look strange at first. The Fosbury Flop -- now an Olympic high jumping standard -- was once really strange.




Random Words, Pictures, Objects

vincent-van-gogh-paintings-from-arles-22.jpg Every word, image or symbol we use to talk about a topic is formed on the basis of our knowledge, beliefs and perceptions of the topic. We are bound by our preconceived notions of the topic, and this takes us into our typical mental valleys of thinking described by De Bono, channeling our conclusions to familiar patterns. The result: ideas that aren't very different from the current reality. Our mental limits keep us in the same thought cycles that have created our current systems.


Dare every day to be irreverent and bold. Dare to preserve randomness of mind, which in little children produces strange and wonderful new thoughts. Continually scramble the familiar to bring old into new juxtaposition. Anonymous


In this technique, a randomly introduced word, picture or object can help to think differently, activating thoughts not typically associated wit the topic and therefore creating the potential for new connections, unique ideas and concepts that move in a new direction. This tool has broad applicability for virtually any topic, individually or for use in groops.

Try some of the pictures found throughout the LRC to get started, or find your own picture or object to trigger random thinking.

Look around you for objects: choose a favorite from home, a rock, a plant, a flower, a building or ask someone to select a favorite object for you, without telling them why.

Choose a random word from the list below by simply closing your eyes and pointing your finger at a word in the window. Choose a book, a letter or report, open it to a random page, put your finger down on the paper and select the noun closest to your finger tip.

Scan through old magazines, picture books or any other good source of pictures -- preferably that have nothing to do with pharmacy or healthcare -- open to a random page with a picture and explore the image and what it makes you think about._Fish--Great-Barrier-Reef-nemo.jpg

Process Steps

1. Using a flipchart, draw a vertical line on the paper to create two columns.

2. Select a word, picture or object at random.

3. Discuss whatever the selected item causes the group to think about, and note in the left hand column.

4. Ask how these items might relate to th issue or topic of discussion and write those ideas in the left hand column

5. Spend no more than 10 minutes on each random item.



Random Noun Table























Stepping Stones


Opportunity is missed by most people because it is dressed in overalls and looks a lot like work.

Thomas Edison



Crazy, off the wall ideas and extreme solutions can transform your thinking, providing stepping stones to an intuitive leap and really great ideas. The idea is to begin with the outrageous out-of-the-realm-of-possibility idea, allowing us to suspend judgment, think freely, make the most of mental connections and links between what at the surface appear to be unrelated thoughts, processes or problems. The idea is to allow all the loose pieces of ideas in your mind to come together in new ways. This tool is particularly useful when the group is stuck in the status quo, or when thinking is dependent on system resources at the expense of creativity.



Provoke new thinking with the Stepping Stone technique in two ways:

stepping stones.jpg 1. Identify an exisiting issue you are facing and propose an extreme, crazy or unusual solution, then move to more practical solutions that eminate from the discussion. This will jolt your thinking into escape, allow you to step back to consider the emerging concepts giving attention to their worthiness, and then return to more practical alternatives that stem from the crazy concepts facilitating a move in a new direction.


ISSUE: Staff can't seem to find time to focus on improvement because time is filled with "stuff" that has to get done.


OUTRAGEOUS IDEA: All of the work that must be done should use improvement tools.






2. Identify an extreme situation or outrageous scenario which would make it necessary to completely redefine how we approach the circumstance (eg a legislative mandate to provide comprehensive clinical pharmacy care for every patient, 24/7) or imagine a crisis du jour. Change the "rules" to escape from the constraints of the situation as it has existed meeting the new challenge, using the "if money were no object" approach. Focus on the immediate solutions that come to mind: eg we can't (open a new service or unit, take on another clinic, add clinical services . . .) without more staff, then set the stage for refocusing of the discussion on regrouping strategy and tactics.

ISSUE: Comprehensive clinical pharmacy services for every patient to close the safety gap.


OUTRAGEOUS IDEA: A new federal legislative mandate to provide comprehensive medication management -- tied to outcome based metrics -- to every patient.





changeishard.jpg Change is often hard to deal with. Not everyone's idea of fun. It can be threatening, intimitading and scary.

This tool offers the opportunity for playful interaction within the team but serves the purpose of opening thinking to new ideas and potential. It allows for escape from the status quo, attention to new thinking for change and movement to ideas for practical change implementation. The major difference between the two alternatives is that the first approach is largely spontaneous with either the leader or group members providing the outrageous ideas for suspending reality. In the second approach, there is more thoughtful development of a scenario that leads the group into thinking through an unlikely, but plausible "crisis" that demands rethinking mission, goals and care process.

If you encounter resistance to the technique, stick with it. Insist they deal with the task at hand. Point out that this reaction is exactly what many groups experience in times of crisis . . . "This CAN'T be happening!" The reality is that you have to deal with the crisis and move on to take some positive action.


Good practice for the real challenges that lie ahead.



Mental Benchmarking

Many issues that we face have already been challenged and resolved in other industries. Reducing our issues to simple language, removing jargon and examining the nature of the problem for what it actually is can clarify some new options.

Writing about innovation in a recent issue, the editors of Harvard Business Review reminded us that the best innovators are not lone geniuses.my-name-is-rom1.jpg They are in fact people who can take an idea that is well defined and obvious in one context and apply it in a not-so-obvious way to a different context. Mental Benchmarking allows you to become one of those best innovators. . .

How to do Mental Benchmarking

1. Frame the issue in its plainest or most general terms.


2. Select an industry or business at random, or one that deals with a similar issue.


3. Describe how that industry thinks about the issue and borrow and adapt concepts to your issues.


Remember that not all ideas seem viable immediately. They might elicit laughter or even ridicule before they are refined. This should be an encouraging sign, signalling real creativity. It may not be such a crazy idea.


If at first an idea is not absurd, there is not hope for it.

Albert Einstei


Zeroing in on the Best Techniques for Testing Ideas

Idea-Funnel.jpg Divergent thinking techniques, help you to generate lots of ideas, giving you expanded options, "outside the box" thinking, and challenges to the status quo. With structured methods to help you to suspend assumptions, biases and judgment, you have hopefully explored widely to find new solutions and new ways of thinking.

Now that you have all those options, what to do with them? Convergent thinking allows you to prioritize the ideas, think about adapting them to your current circumstances and to take the next best step in the right direction to needed change. In studying experience with idea generation to realization across many industries, this process of convergent thinking is essential to the execution of every new idea, and for every one that is successful, somewhere on the order of 100 ideas must be processed and filtered to harvest the jewel of an idea for development, testing and execution. That tells you two things: generating ideas should be an ongoing process, not an episodica occasion, and while all the ideas you come up with may not be equal, each is important to the process of thinking differently and contributes to your ability to execute great new innovations.

Sometimes ideas that at first seem amazing, don't prove to work out in practice, so it is a rare idea that moves directly from brainstorming tofunnel.jpg implementation on one smooth move. So you need to be certain that you are selecting the best and most likely to succeed ideas to move forward. While it is really easy to come up with new ideas -- and using the tools described, a focused group can easily do that in an hour or two. Spending a little more time at that point to select the top 10 ideas considering the patient and customer needs, any barriers to implementation, or more detailed information needed for a decision. Keep in mind the Idea Funnel concept at right. Then, assigning those ideas to a smaller group for development, considering feasibility and practicality, cost and time estimates for implementation, SWOT analysis and any overlapping "ownership" or intellectual property considerations allows the group to continue to focus in on practical innovation, driving toward recommendations for ideas to test. Testing involves small scale implementation of the idea, studying, refining and if successful, strategy development for broader implementation and spread of the idea throughout the organization. Try to resist picking the "final" idea, just narrow the options for further exploration . . .

Don't lose track of the ideas that you filter out as you harvest ideas or in the assessment and development process . . . they should be reserved in a "concept bank for future thinking and use. Sometimes, ideas pop up before their time or there is some missing factor of ingredient or barriers that prevent acting on them in this moment, but who knows when they might just come into their moment, meet the situation and fill the current need. with a convergence of harmonics.

There are specific tools useful in this process of narrowing options and testing change.


Criteria-based Harvesting of Ideas

Since you can't and probably wouldn't want to use every idea, harvesting is the process of narrowing down the list to those most practical, valued and actionable. As a target, try to narrow initially to twice as many ideas as you believe you can implement, keeping in mind the Idea Funnel, above. Try to gain group support to the practical number of ideas that could be implemented, with practical consideration of other competing interests and intiatives, resources and alignment with organizational goals.

While the original brainstorming group can certainly complete this harvesting activity, consider expanding the group to include senior leadership, other process stakeholders and customers and other interest groups -- like patients. A group of 12 - 20 is ideal for harvesting ideas. This broader involvement builds potential buy-in, but more importantly allows stakeholders and key supporters to put their fingerprints on the improvement process and take some ownership in its success. It will help to sift through opposition, challenges and impedements to success, bringing broader perspective and new thinking to the ideas you have already generated, and might help to assure you are not caught in mental valleys of traditionalMajaroinnovationmatrix.gif thinking. Think through the "right voices" for this process, considering key champions, potential opponents and a broad view of the interested parties to the change.

You will need a valid basis for decisionmaking -- criteria -- upon which to make your harvesting selections. Think about using criteria in two broad categories for criteria:

Attractiveness relates to an idea's potential impact on stakeholders and asks the question "Will people the idea touches like it?" Think in terms of patients, staff, professional colleagues, those who support your service, the community at large and senior leadership.

Compatibiity relates to your perceived abilty to implement in your organization and situation, with realistic assessment of costs, personnel required, barriers and competing activities and organizational will to change.

Once your criteria are established -- determine how many ideas you can handle simultaneously. 2 or 3? 5? 20? Apply the criteria to select those ideas that meet the expectations of the largest group of participants. Each idea needs an "idea champion", individual or group warriors focused on supporting, enhancing and developing the idea.

Majaro's nine cell screening matrix can be helpful in the harvesting process, with ideas placed on a grid based on the group's subjective rating of attractiveness and compatibility. Ideas with the best chance of success fall in the shaded cells and should me considered for further development.

Dot Voting

Simple voting doesn't allow the group to explore a range of the ramifications and implications of most ideas. Using "dot voting", allows each individual multiple votes, and encourages discussion regarding the logic behind the vote in the context of the agreed upon criteria. See details onweb-red-dot.jpg how to use the dot voting technique in the LRC Leaders Toolkit.

Using a flip chart, list the ideas under consideration, agree on the number of ideas you want to come out of the process. Give each participant a number of "votes" -- roughly one third to one half of the total number of ideas under consideration Using colored dots, post-it notes or colored markers in a range of colors, have the partipants mark their votes on the flip chart.

The physical interaction involved is part of the concensus process, stimulating questions, comments and lobbying for ideas. Details on use of the technique can be found in the LRC Leader's Toolkit.

Six Thinking Hats

SixHats.gif This technique facilitates a group of individuals' exploration of an idea or topic from many perspectives, and often in ways very different from their typical thought process or approach to issues. In the use of this technique, de Bono encourages that we metaphorically wear different hats to redirect our thinking.

Shown at left, each hat of a different color represents a different mode of thinking. By approaching an issue from the perspective of each mode with equal time and consideration, the group tends to avoid "jumping to solutions" or making a decision without adequate information. With the entire group using the same "hat" at the same time, they can "think together", enhancing the efficiency of information exchange since there is parallel thinking rather than debating conflicting aspects simultaneously.

Recognized as a "thinking expert," de Bono considers thinking the ultimate human resource, and that this technique sharpens our most important skill. Particularly in thinking in groups, the main difficulty is confusion . . . trying to do too much thinking at once, sorting out balance of ideas and relative significance of various aspects of the issue. Emotions, information, logic, hope, creativity and the "big picture" all competing to crowd our ability to reason. Clarifying perceptions and focusing on a full range of implications of an idea encourages thinking differently. Details on the use of this technique can be found in the LRC Leader's Toolkit.


Enhancement Checklist

The world is full of ideas -- some of them great -- many of which never progress to being put to action. Developing an idea, putting it to action and reaping the benefits can be enhanced to build a higher rate of achievement and success if you explore a series of questions that are too often not asked and answered before the ideas are abandoned to move on to other new and "better" ideas. Thinking expert de Bono suggests thinking through this checklist of questions sooner than later, surely before you test the idea with small scale projects and prototypes. Running through the checklist to analyze factors that can further develop the idea to increase the likely success ration, move it into testing and to rule out flawed ideas, or those that might best be held for future consideration.

The idea champion or group is charged with getting the idea ready for implementation. A series of thoughtful questions guide the analysis to purposefully increase the likelihood of success, considering emotional and people issues, strengths and weaknesses, systems effects, impact and consequences and how to best trial the idea.

Shaping or Reframing



Focusing on Implementation

Comparing to Current State

Potential Faults or Defects



This tool can be combined effectively with de Bono's Six Thinking Hats, moving in a planned sequence of color hats to match the question sequence: White (good data) to Red (feelings and intuition) to Yellow (emphasis of positives) to Black (critical thinking) to Blue (big picture). Keep the idea funnel in mind


Documenting the Idea

Documenting the idea after enhancement can support a decision to implement, focusing on the critical element of evaluation of the idea. While you may not have all the information that will ultimately be required, you need to provide the critical details that will allow decison makers to be convinced of the value of the idea.

Document-Your-Business.jpg Explain the idea in two or three clear, informative, compelling paragraphs, using complete sentences and a narrative structure without bullet-points. Bullet-lists facilitate oversimplification, summarization to the point of losing the idea. Present a story or scenario that supports the idea, providing the description completely so as not to require other supporting documents for full understanding.

Describe features and benefits, using a bullet list. Consider both internal and external customers and remember to align the list to patient needs and organizational goals. Keep in mind that everyone impacted will be asking "What's in it for me?" and that everyone who supports the idea will need to see value and something that appeals to them in the documentation.

No matter how perfect an idea, there is always a downside, a risk or an offsetting objection. You will show your objectivity and lack of bias by clearly stating these points, rather than having them surface later in the evaluation or discussion. Being proactive in identifying the issues will diminish reactive or defensive positions later.

Supporting information should be provided, detailing facts and "the numbers" that define the idea as a good one that is actionable. Include supporting information that reflects your analysis of the idea, including satisfaction, revenue, cycle time, cost savings, waste reduction, moral/legal implications, potential for enabling other innovation, uniqueness, market differentiator, etc.

Finally, an intuitive conclusion that expresses powerfully in a sentence or two your sentiments regarding the idea. A range of sentiments might be


Never stop questioning. Curiousity has its own reason for being

Albert Einstein