Edgeware - Tales

 

Unleashing People Potential:
When trouble makers become superstars

A story from Mary Anne Keyes, Vice President of Patient Care, Muhlenberg Regional Medical Center

Told by: Birute Regine and Roger Lewin

Illustration of:

  • emergence
  • attractors
  • complexity lens
  • self-organization
  • tune to the edge
  • min specs
  • generative relationships
  • wicked questions
  • paradox

By the time Mary Anne Keyes came on board in 1992 as the new VP of Patient Care, nurse manager Janet Biedron had pretty much seen it all at the Muhlenberg Medical Center. She had worked there off and on since 1975, and had had her share of dealing with different management styles. Before John Kopicki came on board as CEO in 1991, it was a heavily command/control culture and Janet, like others, had stagnated in that environment. Janet, a straightforward, cut-to-the-chase kind of person, often found herself stepping on people’s toes. A free thinker, she couldn’t accept a decision just because she was told to: she needed to understand the decision, and it had to make sense to her, or she wouldn’t accept it. She took her work seriously and expected others to do the same, so she held people accountable. For instance, when she worked as the supervisor on the weekend shift, if a nurse manager left Friday, knowing that there was only one nurse to take care of 30 patients the next day, Janet couldn’t ignore it. She’d pick up the phone and confront the nurse manager. "You knew the situation you left," she’d say, bluntly. "What do you plan to do about it?" Janet wasn’t known for mincing her words.

Although she was respected, she fell under mixed reviews with her bosses: some felt threatened by her; others would get annoyed; still others would be upset. Instead of being regarded as a hard worker and a good common sense thinker, Janet began to be perceived as a troublemaker. And a troublemaker, as someone who challenged the status quo, who recognized what was not working rather than pretending it did, who had courage to stand up for what was right rather than conform to what was expected, was regarded as bad in a command/control culture that demanded compliance. With no one telling her that she was doing a great job, which she was, or that the place was running fine, or appreciating that there were no problems, she began to feel perhaps her efforts to improve the work procedures and workplace was a battle not worth fighting. With no one listening, why bother any more? She stopped opening up; she stopped looking for better ways to do things. If she saw something that could be improved, she wouldn’t talk about it, or try to do anything to make it better. In essence, she refused to participate. By the time Mary Anne joined Muhlenberg, Janet was out of the loop in many ways; there seemed no opportunities to be creative, no reason to innovative. She did her job of pre-hospital service, supervising eight people, and did it well. But something was missing in Janet, something essential had become dormant—her passion.

At first, Mary Anne Keyes had mixed feelings about working at Muhlenberg. Previously, she had worked exclusively at tertiary hospitals involved with large teaching institutions, and she had grown accustomed to being part of academic circles, where new concepts were discussed and applied. Continuous learning was important to her and so she didn’t know how interesting a 396-bed community hospital would be in the long haul, even if it was affiliated with NJ-Rutgers Medical School. She knew she could run a nursing department: that wasn’t what interested her. The challenge was figuring out how she could do it better and different each year. It wasn’t long before she discovered that Muhlenberg was aswirl with innovative ideas about management that promised a kind of learning she’d never experienced before, no matter how high-powered an intellectual environment she’d been in.

Principles
Complexity lens
 

 

Muhlenberg’s CEO, John Kopicki, was participating with senior management in a VHA leadership initiative, headed by Curt Lindberg, that explored something called complexity theory as applied to the workplace. Mary Anne hadn’t heard of complexity theory, and at first it seemed foreign and a little abstract to her, couched in a new and strange language. But very soon, in the midst of a collective learning experience about the theory, she could see that it wasn’t abstract at all. It gave her and her colleagues a new perspective on the day-to-day demands on their jobs, and provided a language that named things that Mary Anne knew intuitively to be right but that had no external validation. In short, complexity theory gave the group a common language with which to bring their efforts together, and it created a support system for change.

"What I think the language has given us, as we learned some of these things together, is more courage to do things, sometimes scary things," says Mary Anne. "It gives you that willingness to take a leap into the dark, not knowing where you are going to land, but trusting you’re going to land safely, and you’re going to be okay. For me, that was the most fun—the seat of your pants kind of stuff. Doing what seemed like the right thing to do."

Complexity theory can seem scary in itself, at first, because it says that in complex adaptive systems—and the workplace is such a system—you simply can’t predict how things might change, but you can be certain that some kind of order will emerge. Given the right conditions—the right kind of management approach—the order that emerges is going to be beneficial for the workplace. To some managers, this lack of predictability, lack of control, is anathema. But to Mary Anne, it was exactly the kind of management style she had come to intuitively on her own: she knew the direction she wanted to go; and she knew she couldn’t predict where she would end up; and she trusted it. Validated in her beliefs in trusting that some order will emerge, Mary Anne became, what Kopicki called, "a fearless context changer."

Principles
Tune to the edge

Express admissions

Mary Anne’s initiatives for change don’t come out of the blue—she listens. She pays a lot of attention to what matters to patients and what matters to her people. Through patient surveys and written responses, and asking around the units, one of the things she heard was that admissions was taking too long. It could take up to twenty hours before a patient received their first dose of antibiotics—that’s serious, with someone fighting infection. And the endless waits were distressing for the patients. Mary Anne discovered that this wasn’t just a Muhlenberg problem: a VHA study, published right at the time she was exploring the issue, showed Muhlenberg to be pretty typical. Mary Anne put herself in the patient’s position and asked herself the question, What must it feel like to experience her organization as a patient? Lacking patience in the line of waiting herself, Mary Anne’s reaction was outrage. "How could we let that happen?" she demanded of herself, and then of others.

Aides
Min specs

There were several existing committees at Muhlenberg looking at the problem, but none was making any headway. Mary Anne discussed it with the management committee, who suggested integrating pre-hospital services, which was Janet’s job, into other areas— it didn’t need to stand alone. But Mary Anne had something else in mind. Maybe Janet could be part of the solution, part of improving the process she mused to herself. Soon after coming on staff, Mary Anne had made it her business to spend time getting to know her people, and they her. When she had met Janet, a seedling of an idea had formed, that here was someone with great potential. So, Mary Anne went to John and asked if she could have a shot at trying something different, to get something going on the admissions problem. "Sure, go ahead and do what you want," he said. "You have until the end of the year."

Aides
Generative relationships

Mary Anne started up a new task force, pulling people from all the departments, leaving the project open to anyone who wanted to participate. Among the twenty who joined was Janet, unaware that her job was in jeopardy. This was the first time in Janet’s twenty-plus years of experience that she attended a meeting chaired by a senior management person. Usually it was middle management that headed these types of task forces. What Mary Anne’s presence said to Janet and the rest of the members was that "this woman means business." Although her mostly negative experience with management made Janet guarded at first, she sensed in Mary Anne something different, someone who genuinely cared, who wanted change. The status quo was shifting and Janet began to feel hopeful–there might be a chance to improve something, an opportunity to change and grow. Maybe something would finally get done. Mary Anne began the meeting by simply and directly stating that the current admission time was unacceptable. And she had some ideas on how to change it, something different at the front end.

As Mary Anne began to sketch out her ideas and interact with people on the task force, Janet experienced a chemistry of connection with her that held the promise of transformation. "I thought of it as a new beginning for me," she recalls, still moved by the power of the moment. "It was like coming up from the trenches." The connection was mutual. From the first meeting it was clear to Mary Anne that Janet could not only conceptualize what she, Mary Anne, was trying to do, but Janet was the one who could implement it. Their meeting was synergistic, connecting each of them to their passion, their knowledge, and their wealth of experience.

Principles
Tune to the edge

Aides
Wicked questions

Even though she had been told Janet was trouble, that was no trouble for her. "I was looking for someone who could do what was needed to be done," explains Mary Anne. "I didn’t worry about the fact that someone was ticked off because Janet disturbed the equilibrium. In fact, that’s what I wanted—someone who could shake things up." Mary Anne perceived a troublemaker differently and appreciated rather than devalued Janet’s characteristics, because, she was one herself. CEO John Kopicki recognizes these attributes in Mary Anne, and values her for those very qualities. "She drives me nuts," he says with a laugh. "Mary Anne has no satisfaction. She’ll ask a million and one questions as to why. She has this constant quest for trying to understand and what can we do about it. Unfortunately, that’s not always understood by everyone."

Troublemakers are often misunderstood. Their resistance to buckle under cultural pressure is not seen as a healthy integrity; their challenges are not seen as potentially innovative. They are not seen as envelope pushers. In a command/control culture that is invested in predictability and constancy, troublemakers ruffle feathers, rock the boat–troublemakers need to be put in their place. But in cultures that value adaptation and change, as in Muhlenberg, troublemakers are the movers who push organizations to their creative edges, where new opportunities emerge. So it’s not surprising that Mary Anne and Janet would have a powerful connection, where they would mutually unleash their capabilities, where they would set each other off. All the characteristics of a troublemaker that were regarded as bad in a command and control culture, now became assets.

As with most task forces, the work quickly devolved to a few people, with Mary Anne and Janet at the helm. Their skills were complementary—Mary Anne had the clout to get things done and Janet knew how to get there. They were on a mission–working along side each other, determined to make the project a success. In less than two months they were ready to set up a two-week pilot project, with Janet overseeing it and Mary Anne "cheering her on." What emerged was something neither of them could have anticipated or predicted.

The first step was a natural one—to take the fragmented admitting process and do it up front, in a centralized location at the entrance of the hospital. The intent was to have all the paperwork and orders, including radiology, completed before the patient went up to the floor. "It seemed so simple an idea, so obvious," says Janet, "we thought it couldn’t possibly be the answer!" But it was. Notably, the project was largely supported by people who weren’t directly involved. For instance, assistant VP Beverly Rolstrum-Blenman recommended two people whom she knew would do an excellent job. Others cooperated by freeing people up from their regular duties in order to participate in the two-week pilot—not a small sacrifice.

Janet knew she had to have the right people for the job, people who could respond to the challenge of being pioneers, people who could come up with ideas of there own, and make them work. Here, Janet’s long tenure at Muhlenberg was an important asset: she knew everyone, and she was able to choose carefully. "Had we had the wrong people in the pilot, it may have had a different turn," Janet admits. There were lots of possibilities for things to go wrong, for other departments to get in their way—but instead they got cooperation, like X-ray squeezing patients in for them. The project was a huge success. In less than three months, admission time was down to 80 minutes. And much of it was due to Janet, who deftly navigated her way around any obstacle, who never doubted the success of the project. Uncertain how it might happen, yes. But doubtful, never.

Departments quickly saw the benefits of upfront admission, and support for the project grew. The management committee quickly approved full implementation. Janet insisted on not rushing the project–she wanted to do it right from the start. "We’ll be up and running when we’re ready," was Janet’s answer to "When is it starting?" Again, she recruited carefully, for the expanded unit. Her approach was to have each person be an expert in one of the skills needed in the unit, from secretary to lab person. Then she cross trained them. Given that no cross-training courses existed, she developed her own. It took a year for the staff to go from being an expert in one thing to being expert in everything. The staff were happy, because their jobs had expanded, they had learned new skills, and their work was more diversified. The staff set up the unit themselves, right down to the Band-Aids, because according to Janet, "The way I looked at it was I’m not going to set up my kitchen and ask you to come cook in it. They had to set it up; they had to make it theirs."

But the project didn’t end there; it continued to evolve and grow. As part of pre-admission testing and express admission, the unit’s staff were doing blood work, EKG’s, and so Janet wondered with Mary Anne why they had separate departments unnecessarily duplicating the services? Regular admissions on one hand and ER admissions on the other. So the two were consolidated. The unit was doing the registration and pre-admission testing and so was ER and outpatient admission testing. Why wasn’t it all one? So they collapsed that too. And since managed care required information from patients prior to actual admission, why not include the financial counseling up front as well? Steadfast throughout, Janet and Mary Anne, saw changes as opportunities rather than threats. As a result, express admission was flying.

The ward nurses loved it because all the admission work was done prior to the patient coming to the floor, and they could focus on getting the patient comfortable. The doctors loved it because, it was a "can do" unit–any additional services they requested were always possible. Most of all, the patients loved it. And Janet, director of admissions, now headed a department of eighty-seven people.

Professional growth through relationship

Leadership is obviously critical to the success of any project. So what was it about Mary Anne’s way of leading that created conditions for something new to emerge, something extremely successful, both in cost efficiency and in staff and patient satisfaction? What skills did she employ that helped people grow professionally?

Principles
Complexity lens

We can find an answer here, by looking at it through the lens of complexity theory. In formal terms, the theory says that interesting properties can emerge from a complex system when the components of the system interact in simple but rich ways. Translated to the workplace, this means that emergence happens when there is a lot of interaction between individuals who mutually affect one another. Interaction between individuals are relationships; and when people mutually affect one another there is a quality of connection. Complexity theory therefore places positive relationships as central to the creativity, adaptability, achievement and effectiveness that emerges in an organization. And it is Mary Anne’s relational intelligence and her ability to foster connections that she brings to her management style— intentionally, skillfully, and strategically. Motivated by her desire for growth in people, she allows the organic unfolding of processes at work within the organization and within people. No wonder John Kopicki calls her a "grower of people." Mary Anne’s style of leadership emphasizes four relational skills that encourage organizational change and expand human possibilities: mutuality, acknowledgment, encouragement, and presence.

Mutuality

Mutuality in relationships is the shared power to affect, and shared vulnerability to be affected by, another person. Mutuality places people on a common ground that allows for new understandings, new knowledge to emerge. For Mary Anne, mutuality manifested in her being influenced by Janet’s ideas, just as Janet was by Mary Anne’s. As Mary Anne states, "My relationship with Janet is easy for me. I look forward to an appointment with her. It’s not a reporting relationship; she’s a professional colleague. We get together and try to figure things out together, doing the best we can." Through her relationship with Janet, Mary Anne realized her potential, just as Janet found hers through her relationship with Mary Anne.

Principles
Tune to the edge

Implicit in mutuality is an emergent and fluctuating authority, where expertise shifts from person to person, and where people recognize a dependence on each other for knowledge and information in order to achieve the best outcome. With their wealth of work experience, their education, fluctuating authority came naturally to Mary Anne and Janet. Generally, Mary Anne minimizes status differences in her interactions with staff, which allows her to learn from others and allows others to have an impact on the organization. "I think you need people to be engaged in the process," says Mary Anne, "and they have to trust that there’s a chance that they have some sway over what’s going to happen. If they feel like there’s no opportunity to influence, then you’re wasting everybody’s time around the table." In this way, mutuality creates a kind of feedback loop. Mary Anne listens to people’s concerns, which influences her focus on what needs to change, which in turn affects the organization, which impacts the people in the organization.

Underscoring mutuality of influence and authority is mutual respect–the relational dynamic that nourishes trust, that holds people accountable to each other, that inspires people to reach beyond what they think is possible. And with mutual respect, loyalty emerges. "I have a loyalty to the organization, but even more than the organization I feel a loyalty to Mary Anne," says Janet. "I wouldn’t want to let her down. She saw something in me and I wouldn’t do anything to jeopardize that. So I go that extra mile."

Acknowledgment

The ability to "see" the capabilities of others and acknowledge not only what they do but who they are is a powerful relational skill that Mary Anne brings to her leadership. Her capacity to see the visible (that is, what she observes) and the invisible (the competencies she brings out) enhances professional growth and achievement in her people. What was visible to some people was that Janet was a troublemaker. What was visible to Mary Anne was that "she was in the wrong spot, doing the wrong kind of things." In Mary Anne’s assessment, there aren’t any losers, but rather misplaced achievers–people in the wrong context.

Mary Anne also saw what was invisible to many people: "Janet knows what she wants, she’s very directed." But seeing without acknowledging it would not be much different from not seeing it at all. Mary Anne speaks of Janet this way: "By the time we got together and I started working with Janet, what she was capable of was much more than she was ever given the opportunity to do. How she’s grown in the last three years! Her’s is the only self-directed unit we’ve got here. She’s a real star in this organization!" And Janet recognizes and appreciates being seen by Mary Anne. "Mary Anne saw in me what only my mother saw in me," she says, with a peel of laughter. "She sees that I’m an honest player, I call it like I see it. If I believe in it you get hundred percent, two hundred percent. If I don’t you get zip."

Mary Anne and Janet’s relationship highlights the power acknowledgment has in generating competency, collaboration, and a pioneering spirit. Although Mary Anne acknowledges Janet with a sincerity and obvious pleasure in her achievement, this kind of behavior often gets minimized as simply "being nice." Such a view is extremely misguided, because what Mary Anne is displaying here is a highly successful relational skill for creating a team spirit, something that many managers often strive for in vain, by mouthing words like "empowerment" and "team building" while still holding a vice grip of control.

Encouragement

Mary Anne encourages people in many ways—she supports, she challenges, she nudges. But what is most striking is just how little it takes. "A lot of people in hospitals just feel they can’t do certain things," she explains. "And I say, ‘why can’t you?’ Once you start asking why you can’t, pretty soon it’s, ‘let’s go, let’s do this.’ I mean, you unleash some power. It’s just unbelievable. All people need is a little support and encouragement to get them going. People are capable of much more than we give them credit for. People think I have the power to give permission. All I have is the power to encourage. Maybe."

Paradoxical presence

Mary Anne’s presence as a leader has a profound impact on the environment of the organization. She validates a different way of knowing—that is, listening and acting on intuition. She intuitively does what is right, which allows others to do the same. As she herself says, "If it feels right, do it." Again, this might be dismissed as being "fuzzy" or not "rigorous." But it is an important management skill, and it takes courage.

Principles
Paradox
Her presence in the organization embodies many paradoxes. As a leader she gives direction to the concerns of the organization: what issues need to be addressed, what changes need to occur. At the same time she gets out of the way and allows others to act on these concerns. Direction without directives, authority without control. Mary Anne sees the impact of her presence in this way. "One of the things that I think makes this approach to management successful is having the ability to pick out a focus people can grab onto, giving them a little bit of support along the way–it doesn’t take much–so that they can do what they need to do."

Aides
Min specs

Janet experiences Mary Anne’s presence in the following way: "For me, what made her management style successful was that I was given freedom, but also guidance. You have to have both—you can’t just have space, independence and freedom without guidance. If she had approached me differently from the way she did, I doubt I would have supported her the way I did." The paradox of structure and no structure is a way of leading that nurtures emergence, self-organization, and innovation in the workplace. And we learn from complexity, that paradox is a positive sign–the presence of paradox is a hallmark of creativity and its potential.

In addition, Mary Anne’s presence, endowed with relational skill, allows people to see things for themselves, in their own terms and in their own time. "Mary Anne is a sounding board for me," says Janet. "I could say, ‘this is what I’m thinking,’ and with her experience, Mary Anne would know if I’m going down the wrong road, and she’d tell me. But she wouldn’t say, ‘that’s a cliff you are jumping off,’ but instead she’d say, ‘have you thought about it this way?’ She wouldn’t say, ‘don’t do that.’ I don’t have that kind of relationship with too many people. Talking to Mary Anne helps me organize my priorities."

An outcome of Mary Anne’s method of leadership–direction without directives–might be described as the Chinese-cooking style of management: you spend a lot of time preparing the food, but when you’re ready, the cooking goes fast. "I could be the kind of leader who says, ‘By God, this is what we’re going to do, and this is how it’s going to be done," Mary Anne allows. "I could make everybody do whatever I decided, but it’s not the most effective way of managing people." Instead, argues Mary Anne, it is better to take the time needed in order to involve people in figuring out what change needs to happen, and how to achieve that change. In Mary Anne’s style of leadership, acceptance is the endpoint of a project, not its implementation. With thoughtful and participatory preparation, which takes time, the change then gets done quickly and people are comfortable with it. "Overall, this approach might take longer in the upfront phase than the more traditional approach," says Mary Anne, "But I think it’s worth it, because the other way, you spend a lot more time fighting with everybody telling you why it’s not working and trying to fix it. You don’t have to keep explaining it every six months."

The source of adaptability

The power of these relational skills is not only in their promise to unleash dormant potential in others, but also, by example, demonstrating a different way of working. When Janet talks about managing her people, for example, she manages them much in the same fashion, according to the same relational skills that guide Mary Anne.

Unleashing potential is an obvious management goal. But it is not simple. Practicing mutuality, encouragement, presence, and acknowledgment are just that–a practice. And Mary Anne could vow for the fluctuating nature of such a practice–the waters are not always clear, in fact they’re more often muddy. But it is practice that recognizes the true source of success. John Howard Jr., the Director of Muhlenberg between 1935-1946, put it this way: "A hospital is a human institution. Its success is not built of bricks or beds or scientific equipment, but of human beings—doctors, nurses, employees, volunteers, patients and the public." The current culture of Muhlenberg, engendered under the leadership of John Kopicki through top managers like Mary Anne and Janet, has returned the hospital to its roots of care, as expressed by Howard.

Creating work relationships founded on the relational principles we’ve described not only makes for a better workplace but it is also sound business strategy. It is the quality of relationships in organizations that can foster a sense of community. And it is within a community that people have a greater willingness to change and adapt—qualities that can determine whether a health care organization can and will survive these uncertain times.

And whether troublemakers can become stars. So, look around in your own organization and hope to find some troublemakers.

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Copyright 2001, Plexus Institute
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