Adaptive Leadership and Health Care

Honestly.  Did no one really see this coming?  Did those in leadership positions just chose to ignore the signs?  Maybe they saw the warning signs and just didn’t know what to do.  The story might be comparable to the auto industry here in the US.  Ignored external pressures.  No willingness to change or adapt.   Anyway here we are.  Our health care system is now in full crisis mode.  The system doesn’t deliver care as well as it should.  The two most important stakeholders, patients and physicians, are very unhappy and fed up.  And now the external environment has changed dramatically with the Affordable Care Act.  In all likelihood the current health care crisis was preventable if there were thoughtful leaders in place.

Adaptive leadership is a strategy that dates back to a 1994 book titled “Leadership Without Easy Answers” written by a Harvard professor by the name of Ronald Heifetz.  Professor Heifetz has studied and written about leadership, adaptation, systems and change.  The publications describing his work are available at his website (  The foundation of adaptive leadership is change that enables the capacity to thrive.  The concept is analogous to the process of evolution.  A quote from Charles Darwin at the website states: “it is not the strongest who survive but those who are most adaptable”. Professor Heifetz notes that we are in an ever-changing environment that requires leaders to appropriately respond.  He states that one of the key issues that enables the capacity to thrive is the ability to distinguish technical problems from adaptive challenges.  Technical problems are those that can be solved with an organization’s current structure and processes.  Two + two equals four.  Technical problems can be fixed by an organizations existing authoritative expertise.  An adaptive challenge is significantly different.  As the title of his book suggests there are no easy answers.  The solutions to adaptive challenges involve “changing people’s priorities, beliefs, habits and loyalties”.  To HCR this sounds like a culture change.

Some of the key points of adaptive leadership outlined by Professor Heifetz may be uncomfortable for traditional leaders.  The first is that organizational adaptation occurs through experimentation.  Not too many leaders responsible for a bottom line are comfortable with experimentation but when you think about it every new initiative is an experiment.  Second, adaptive change takes time.  This is another way of saying that we need to plan for the long-term not just short-term profit and loss statements.  Other key points of adaptive leadership would seem to be less stressful for traditional leaders.  Adaptive leadership does not require a complete overhaul of an organization.  Leaders must identify and preserve what is working and identify and change what is not working.

Health care take notice.  The leadership of the health care system in the US has spent decades applying technical fixes to adaptive challenges.  Leadership did not see, or chose to ignore, the adaptive challenges that were in front of them.  It is now time for thoughtful leaders to make adaptive change that will allow the health care system to thrive.

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