Leadership

Action Learning–Based Leadership Development at an Academic Medical Center

Article · March 22, 2018

Today’s health care leaders are tasked with significant challenges in how they deliver patient care and manage the workforce. These challenges have highlighted the need for leadership-development training to enable physicians to transform how health care organizations function. The competencies that are required for a physician to be an effective leader have evolved substantially over the past decade in accordance with a growing view of health care as a complex adaptive system. However, competency-based training in the form of classroom lectures, role modelling, hypothetical practice scenarios, and self-help activities are not sufficient to develop physicians to lead the future of the complex health care industry.

In the current environment of complexity and uncertainty, a different approach is needed. Action learning is a leadership-development process in which small groups work on real-world organizational business problems. As part of this process, individuals and teams reflect on their own work in a supportive environment in which a balance of action and learning is key. While most leadership-development programs focus on leadership characteristics only, action-learning scholars have come to discover the value of designing programs that recognize the context in which the leaders perform. Questioning, reflecting, and listening promote exploration and creativity among team members, thereby generating innovative solutions. Learning happens as an iterative cycle of action-learning-action-learning, and coaching is necessary to guide the group members in reflecting on how they are approaching the problem.

Action learning has been shown to improve broad executive and managerial leadership skills as well as the ability to develop integrative, win-win solutions to challenging situations. As such, it can be an excellent solution to help leaders navigate through the adaptive challenges currently facing health care organizations.

The “Fresh Eyes” Program at Mayo Clinic: A Case Study

In September 2015, Mayo Clinic embarked on an action-learning program called “Fresh Eyes” involving a group of 30 participants comprising physicians, scientists, administrators, and nursing leaders in the leadership succession talent pool. The program objectives were to develop strategic thinkers who would be able to effectively lead in the VUCA (volatile, uncertain, complex, and ambiguous) world of the health care industry.

Program Structure

The program was structured as a 6-month process that started with a 2-day face-to-face kickoff, three subsequent video conference meetings, and a 1-day report-out at the end of the program. Participants were assigned to one of six multidisciplinary teams that were intentionally designed to maximize diversity in terms of roles, functional areas, geographical sites and regions, gender, and ethnicity. Each team was assigned a project that required its members to address a key business challenge related to such topics as physician referrals, test utilization, patient access, integrative medicine, and so on. The team projects were selected by institutional leaders in clinical practice, research, and education based on organizational strategic priorities.

The projects and teams were chosen so that most of the program participants had very limited knowledge of and experience with the subject matter. Team members were thus expected to bring a “fresh eye” perspective that could shine a new light on topics that were both important and challenging for the organization. Each team was assigned two executive sponsors and two project sponsors whose role was to guide the team to information and resources without providing too much direction. Each team was also assigned a team coach whose role was to engage the teams in deliberate reflection for facilitated learning and to meet with the team members on a one-on-one basis to help them to achieve their individual learning goals. The final deliverables were a business plan and a 20-minute presentation to all Fresh Eyes participants and sponsors.

Learning to Work as a Team

Once the projects had been assigned, the team members met as a group once a week or every other week, gathered data and information on the topic; asked each other critical, reflective questions; and moved quickly to propose plans within the given time frame while learning how to work together as a highly functioning team. Thus, the program created a sense of urgency to move forward by letting go of the need to have all information before making decisions.

As the teams had no assigned leader, each team had to identify one or more leaders whose role was to clarify the roles of the various team members and to move them toward the achievement of a common goal. The team leaders had to gauge intuitively how much to step in or step back in group interactions. In the process, the leaders learned to listen to other team members and incorporate their perspectives by acknowledging that there are multiple ways to view a single problem, depending on each member’s role, type of practice, or level of knowledge in the subject matter. This was an important part of leadership development because Mayo Clinic is unique in its dyad/triad leadership model in which physicians partner with their administrative and nursing leaders, and the physician participants had to learn how to best leverage the wide range of organizational and business knowledge that their administrative counterparts brought to the project.

During the team meetings, the team coach engaged participants in reflections to question their habitual thinking to expand the range of their consciousness. The coaches challenged the participants to be in their discomfort zone, where actual learning occurs, by asking reflective questions such as “What did I experience?” “What are my reflections?” and “What did I learn?”

One of the main challenges was setting aside time to work on team projects. There was a clear concern among participants at the start of the program about doing project work in the midst of their busy schedules. To find a time that worked for all members, some teams met early in the morning before work or late in the evening despite having to accommodate individuals in three time zones.

Presentation and Implementation of Business Proposals

All business proposals were presented to the sponsors during the report-out portion of the program. Teams were also asked to present their proposals in executive team meetings, committee meetings, and department meetings. Six months after completion, a follow-up email was sent to all project sponsors for updates on the status of the implementation. We found that some short-term recommendations had been implemented, sub-projects had been identified and were underway, and many participants had expressed interest in taking part in the implementation phase.

Impact of Program

The impact of the program was studied with use of a qualitative case-study method after the completion of the program. Twelve physicians in various specialties who took part in the program agreed to participate in semi-structured interviews, which were recorded and transcribed. The list of the categories in which the program contributed to learning are listed in Table I, and sample testimonials from the participants are provided in Table II.

Fresh Eyes Action Learning Categories

Table I. Click To Enlarge.

Sample Testimonials from Fresh Eyes Action Learning Program

Table II. Click To Enlarge.

Action Learning: Developing Creative Solutions to Complex Organizational Challenges

Health care organizations are a complex compilation of many different micro-environments. Physician leaders tend to view the world through the lens of their specialty, which has been formed through many years of training and practice, and usually have limited venues for exchanging ideas outside of their area of expertise. Those in leadership positions should understand that what seems to be true may evolve when viewed from a different perspective that they might not have considered.

We found that the Fresh Eyes action-learning program “forced” participants to network and to collaborate with team members in ways that would not otherwise have occurred to them. During the course of the program, participants had the opportunity to talk about the guiding values and principles of the organization. Some physicians confessed that they initially felt uncomfortable having to share their individual development goals and engage in open reflection with people they did not know, but they also noted that they eventually became more comfortable as the team members built a level of trust with one another.

The business proposals that resulted from the project were a testament to how much they could accomplish with sense of urgency, teamwork, and commitment. At the end of the program, the participants were amazed at how they could create proposals for seemingly daunting topics within such a limited time frame, with limited resources, and with team members whom they hardly knew.

We found that the Fresh Eyes program successfully achieved a balance of learning and action by stimulating the team members to engage in enterprise-level thinking, to learn how to collaborate as an effective team, and to develop specific proposals designed to improve organizational performance.

Call for submissions:

Now inviting expert articles, longform articles, and case studies for peer review

Connect

A weekly email newsletter featuring the latest actionable ideas and practical innovations from NEJM Catalyst.

Learn More »

More From Leadership
Health Care Organizational Culture Emphasizes Patient Care Only Slightly More Than the Bottom Line

Survey Snapshot: Who Should Lead Culture Change?

NEJM Catalyst Insights Council members feel that culture change at their organizations is heading in the right direction, but differ on who it should come from, and reveal too much balance between emphasis on bottom line and emphasis on patient care.

Culture Change Within Health Care Organizations Is Changing for the Better

Leadership Survey: Organizational Culture Is the Key to Better Health Care

Although three-quarters of Insights Council survey respondents say culture change is a high or moderate priority at their organizations, survey results show a lot of work on organizational culture remains to be done.

Metraux01_pullquote - dinners to combat burnout in the health care community

“Breaking Bread” to Combat Burnout

Can a simple dinner create community among health care providers?

IHI HPMS Visual Management Board Example

The Answer to Culture Change: Everyday Management Tactics

Adoption of a clear rhythm-of-performance measurement and communication via huddles and visual management can affect a culture of staff engagement and continuous value improvement.

ajor Themes from Cleveland Clinic Town Halls 2016

Reigniting the Passion to Practice Through a Multi-Pronged Approach

Cleveland Clinic formed the Practice Innovation and Professional Fulfillment Office to create and sustain an environment that allows clinicians and scientists to thrive through barrier removal, culture change, and support for personal well-being.

Percent in Highest Bracket in Patient Satisfaction Scores - Pre-Post Arm Differences for Hospitalists - Duke Coaching Communication Skills Study

Coach, Don’t Just Teach

The effect of one-on-one communication coaching on clinicians’ communication skills and patients’ satisfaction.

Two-Thirds of Organizations Have a Nurse Leader Career Path

Survey Snapshot: Do Nurse Leaders Need Advanced Degrees?

Though NEJM Catalyst Insights Council members acknowledge a lack of advancement opportunities for nurse leaders, two-thirds of their organizations have a nurse leader career path.

Nurse Leaders and Physician Leaders Should Be Considered Equals in Care Delivery - but Views of Nurses and Non-Nurses Differ

Leadership Survey: Nurses as Leaders: Broad Acceptance, Room to Grow

Nurses are traditionally the backbone of patient care. They form the largest percentage of the health care workforce, far outstripping physicians. But are nurses leaders as well as doers?

The CMO Role of the Future - Baptist Health Survey Results

Examining the Continuously Evolving Role of the Chief Medical Officer

Hospital and system leaders need to sharpen the focus of CMO roles to include system-wide considerations beyond the walls of the hospital.

Meyer01_header - Seven Challenges and Seven Potential Solutions for Large-Scale EHR Implementation

Seven Challenges and Seven Solutions for Large-Scale EHR Implementations

Salient lessons learned over multiple electronic health record implementations.

Connect

A weekly email newsletter featuring the latest actionable ideas and practical innovations from NEJM Catalyst.

Learn More »

Topics

Leading Transformation

259 Articles

Digital Health Care in China: Benefits…

China’s experience offers insights for integrating digital and non-digital health care services.

Team Care

103 Articles

Reigniting the Passion to Practice Through…

Cleveland Clinic formed the Practice Innovation and Professional Fulfillment Office to create and sustain an…

Quality Management

169 Articles

The Answer to Culture Change: Everyday…

Adoption of a clear rhythm-of-performance measurement and communication via huddles and visual management can affect…

Insights Council

Have a voice. Join other health care leaders effecting change, shaping tomorrow.

Apply Now