Unleashing People Potential:
When trouble makers become superstars
Told by: Birute Regine and Roger Lewin
Illustration of:
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.
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."
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.
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?
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.
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.
Paradox
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.
Next | Previous | Return to Contents List
Copyright © 2001, Plexus Institute
Permission to copy for educational purposes only.
All other rights reserved.