1. Are Great Leaders Born,or Are They Made?DAVID A. OLSON, FACHETHE Q U E S T I O N I N T H E TITLE to this commentary has been debatedfor centuries and continues to dominate the study of leadership development,yet evidence is insufficient to support either answer. The feature article authorsin this issue of Frontiers do not attempt to answer this question, but they dooffer two different perspectives of leadership: one as a personal journey, andthe other as a process for accomplishing an organizational goal. In her article, Debra Sukin outlines her own leadership successes, high-lighting such qualities as passion, vision, quality outcomes, strong knowledgeof the industry, the ability to think critically, perspective, adaptability, andongoing learning. She describes each of these elements from an intense andpersonal perspective. This perspective contrasts with the article by StephanieMcCutcheon, in which she deliberately outlines her process for leading theHospital Sisters Health System through the transformation into a care inte-gration model. Ms. McCutcheon carefully outlines the elements and specificsteps needed for an organizational transformation of this magnitude. After reading these articles and noting the contrasts between leadershipas a personal journey and leadership as a process for change, one might con-clude that leadership must be one or the other. However, my personal experi-ence—one I am sure many of our readers share—is that leadership is oftenboth.MISTRUST AT BAY AREA MEDICAL CENTERMy recent journey at Bay Area Medical Center (BAMC) clearly showed me thatboth elements of leadership come into play in transforming an organization.David A. Olson, FACHE, is president of Columbia St. Marys Hospital inOzaukee, Wisconsin, and executive vice president of Columbia St. Maryshealth system. DAVI D A . O L S O N • 27
2. In February 1999, BAMCs medical gains that BAMC had made in recent staff had voted "no confidence" in hospital years were in serious jeopardy. administration. The mistrust was palpa- ble. The construction of a competing BRIDGING THE ambulatory surgery center was on the COMMUNICATION GAPS horizon, and BAMC faced an inability to In May 1999, as the newly appointed meet space needs for outpatient surgeries president and CEO of BAMC, I knew I and diagnostics, resulting in medical staff needed to begin my turnaround quest and patient dissatisfaction. This opened a immediately. I started with exhaustive door for the competing center. A not-for- efforts to bridge communication gaps profit organization with an approximately with the medical staff, community, and 48 percent Medicare population, BAMC county boards. I worked to develop open could have been devastated by the compe- relationships with honest communica- tition. The future was uncertain, the anxi- tion. Because BAMC had facilities in ety level of BAMCs board of directors and Marinette, Wisconsin, and Menominee, employees was high, and the atmosphere Michigan, this was a double effort. Soon I was one of non-support. was providing monthly reports to update Mistrust ofthe hospital was also high both county boards on the hospitals suc- among the community and county govern- cesses and challenges. I developed com- munication strategies with local newsThe most successful efforts reporters so they would feel free to partici- newspapers was consis- pate in hospital discussions or call within beginning this leadership tently negative, and the questions at any time. A new communi- transformation were Board of Supervisors from cation tool called "Insights" was sentbridging the communication Marinette County, which periodically to hospital board members, , , „ ,. leased the Marinette hospi- community leaders, and elected officials. gap and rebuildingconfidence by developing and felt that the county was All ofthese efforts were aimed at keeping deploying a strategic plan, being shut out of hospital our stakeholders informed. I made sure planning. The county that my door was always open to any com- board was asking for a renegotiation of munity member, medical staff member, the lease with the intent of gaining more or hospital employee who wished to pro- operational control ofthe hospital. The vide input or ask questions about the county had engaged consultants to per- future direction of BAMC. The most suc- form a community health needs assess- cessful efforts in beginning this leader- ment that painted BAMC in a poor light, ship transformation were bridging the insinuating that the hospital was not communication gap and rebuilding con- meeting the communitys needs and that fidence by developing and deploying a the strategic direction was misplaced. strategic plan. BAMC would not be able to garner the necessary support for a building project COLLABORATIVE STRATEGIC that would allow it to successfully com- PLANNING pete with a freestanding ambulatory The organizations last strategic plan had surgery center unless relationships were been developed in 1995. The initiatives it mended and trust reinstated. Financial outlined were completed in 1998, and 28 • FRONTIERS OF H E A L T H SERVICES MANAGEMENT 26:2
3. they were largely effective in achieving center has won back the support oftheprogress and capturing additional market medical staff, the county government, theshare. However, I realized when I became community, and its own employees. TheCEO that these gains were in jeopardy, management team is strong, and a visionand future successes would not occur and plan for the organizations future isunless we developed a solid new plan. in place and is continually updated. TheCiven the climate of mistrust, the plan results so far have been positive. Netneeded to be a collaborative effort with a patient revenue and operating marginslarge sphere of input and buy-in. The only continue to grow each year. Days cash onway to bring back the confidence ofthe hand has grown to the highest levels ever,organizations key stakeholders was to and the organization compares favorablyengineer a completely inclusive strategic with its competition.planning process. Finally, others have noticed and recog- This process began with interviews nized our transition to success. The hos-with over 50 community members, repre- pital has been recognized twice in thesentatives of other community healthcare last four years as one ofthe "100 Top Hospitals" by Thomson Reuters and fourorganizations, community leaders, gov-ernment officials, members ofthe newsmedia, and medical staff members to times in the last four years by Health- Crades for patient safety and clinical nhear their concerns and solicit their input excellence. As the leader ofthe organiza-regarding BAMCs direction. Over 50 tion, I have been recognized as ACHEs Oadditional people were invited to a public Wisconsin Young Healthcare Executivemeeting to hear an outline ofthe plan- and won the Robert S. Hudgens Memorialning process, to learn about the chal-lenges facing healthcare in our country in Award for Young Healthcare Executive of the Year. 2general and BAMC in particular, and to We achieved these results primarily byoffer input. We collected and shared thedata. We held meetings with our employ- putting the right pieces in place for the organization, developing a strong strategic 2ees for the same purpose. Membership plan, and executing that plan precisely.on the strategic planning steering group,developed to design the plan, included We also created a culture of efficiency, cost management, quality outcomes, and mkey medical staff leaders, hospital board best practices achievement.members, members from both county governments, and BAMCs administrative LEADERSHIP PRINCIPLES Z staff Progress reports were provided reg- There are indications that certain princi-ularly to ensure a high level of trust in the ples are always present in a strong leaderprocess. or in an organizational leadership trans- formation. I believe that these principlesTRANSITION TO SUCCESS are apparent in the stories the featureNearly ten years have passed since those authors outline and in my own experi-initial, decisive steps. In that time, the ence. In his article "Great Leaders Areorganization has had its ups and downs, Made, Not Born," William A. Cohenbut the core elements of our transforma- (1998) lists the following eight principlestion have remained in place. The medical or "Universal Laws of Leadership": D A V I D A . O L S O N • 29
4. Maintain absolute integrity. Leadership your people, your people will take good is a trust, and others must trust you care of you. completely in order to follow you. • Put duty before self Strong leaders Know your stuff. All leadership always put the rewards ofthe organi- requires a set of competencies in your zation ahead of any rewards for them- particular area. Sukins article indicates selves. Only by putting the organization that industry knowledge is essential for and its mission first can you ever a healthcare leader expect to receive personal recognition. Declare your expectations. Strong • Get out in front. This principle clearly leaders always state their expectations indicates the need for leadership in in measurable ways. In her article, action to be visible and to set the ex- McGutcheon clearly outlines the ex- ample for others to follow. pectations that were necessary for her leadership transformation to take My personal experience in successful place. leadership through organizational trans- Show uncommon commitment. Both formation is that it requires not only a authors articles indicate that the lead- strong process, but also a high level of ers expected more of themselves than personal commitment from the leader. of others. So the answer to the initial question "Are Expect positive results. My own experi- great leaders born, or are they made?" is ence is that a leader must expect to that they are both: Great leaders are born, win. Those who follow need to see that and then they are made. expectation to achieve that result. Take care of your people or customers. REFERENCE Cohen, W. A. 1998. "Great Leaders Are Made, Strong leaders always ensure that their Not Born." Network World, December 21. followers are recognized, honored, and [Online document; accessed 9/19/09]. well taken care of This supports the www.stufFofheroes.com/Great%20Leaders%20 principle that if you take good care of are%2oMade,%2oNot%2oBorn.htm30 • FRONTIERS OF HEALTH SERVICES MANAGEMENT 26:2
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