Written by: Juliane Tomlin

“Your inspiration taps hidden reserves of promise that sustain people through times that induce despair. You enable people to envision a future that sustains the best from their past while also holding out new possibilities.”
― Ronald A. Heifetz

“Patients are the most underused resource in health care.”
— Dr. Warner Slack

Practice Transformation is hard. It requires the courage of all involved — the courage to explore uncharted territory, the courage to challenge the boundaries of comfort and knowledge, and the courage to let go of what we believe are the answers and ask different questions.

Over the past few months, I have had the great opportunity to delve deeper in to the question of how the provider organizations participating in our Practice Transformation Initiative might better navigate this increasingly messy space of improving care delivery. When the best practices and waste reducing workflows have all been implemented, the remaining problems revolve around changing the hearts, minds, and behaviors of both your team and patients. How then can we truly achieve better health, improved patient and family experience, and more appropriate use of resources?

My exploration brought me to the sphere of “adaptive leadership,” a leadership language and conceptual framework that Dr. Ron Heifetz of Harvard University’s Kennedy School developed to help individuals thrive amidst uncertain and complex change. Adaptive leadership requires a shift in focus from applying “technical,” or known solutions, and exercising “authority” to solve problems, to recognizing that many of the issues at hand do not have quick fixes, require experimentation, and will without fail result in discomfort and resistance. Leadership, not authority, is required. True leadership harnesses the hearts and minds of the team. It “turns up the heat” to enable productivity, but not to an intolerable temperature where we’d arrive at the “freak out zone.”

While I could go on and on about adaptive leadership as a topic (and many study for years to become masters), please see below for some great resources to check out in your own time. What has really gotten me thinking though, is how adaptive leadership aligns with some of the challenges we have in engaging patients in their own journey toward health. Isn’t “health creation” an adaptive challenge? The care team can certainly offer well-researched solutions and interventions, but it is not the care team who “creates” health. It ultimately lies in the hands of the patients we serve, and it is the care team who needs to be the adaptive leaders to facilitate a patient’s journey toward health.

As I started to explore these ideas, I came across an excellent article called, Adaptive leadership and the practice of medicine: a complexity-based approach to reframing the doctor–patient relationship (Journal of Evaluation in Clinical Practice, 2010). This article outlines how viewing the practice of medicine as adaptive leadership might help us address some of our most significant challenges, such as:

  • Epidemic of lifestyle-related chronic illnesses.
  • Out-of-control health care costs.
  • Social, behavioral, environmental influences that are modifiable determinants of patients’ health.
  • Continued rates of non-adherence.

The authors suggest we can address these challenges by:

  1. Distinguishing the technical work that the care team does for patients from the adaptive work that they alone can do for themselves;
  2. Avoiding the inappropriate use of technical solutions to address patients’ adaptive challenges; and
  3. Developing and deploying adaptive leadership strategies and tactics to facilitate patients’ adaptive health work.

It is imperative to deliver health care in a way that acknowledges that while all of the challenges we face have technical components (where the problem and potential solution can be clearly defined), many of the challenges are adaptive, meaning they often requiring learning by the patient, fundamental behavior change (they alone can do this work, not the care team), and involve trade-offs and losses for the patient. The behaviors, beliefs, and attitudes that once served them no longer do so. For instance, managing a chronic illness requires technical solutions like medications to treat high blood pressure, but without the adaptive work of changing one’s lifestyle and medication adherence, health will not improve nearly as much. Substituting technical solutions where adaptive work is required may be effective temporarily, but it will always fall short and may actually perpetuate the problem.

It’s exciting that many health care systems are delivering care with the very understanding that patient care cannot be limited to technical solutions. Practices such as health coaching, assessing and improving patient activation, and shared decision making are becoming more widespread (with the health care safety net leading the way!), but we all know change is hard! We’re supporting patients in discovering “what’s in it for them,” tapping into what empowers them to believe they can make important changes, and helping them develop the confidence to make these changes. I’d suggest it’s all in the relationship! And the clinician-as-adaptive-leader will help patients “regulate the heat” by creating an environment that enables them to move forward, deploying friends and family to provide support, and managing the “heat” so the challenge doesn’t become paralyzing.

I intend to explore some of these ideas more deeply in the future, but would love to hear how you are seeing some of these concepts at play in your work! How are you exercising adaptive leadership in care delivery?




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