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Opinion: 3 essential skills for health care leaders

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Health care leaders face many challenges other industry leaders don’t have to think about. Decisions made by health care leaders not only affect growth and profitability, they affect patient safety and well-being.

Three essential skills can help health care leaders make aligned decisions: leadership clarity, conflict capacity and the ability to initiate and engage in difficult performance conversations.

Leadership clarity and alignment

Leadership clarity is more than good decision-making. Leadership clarity is essential to aligning top priorities.

An example of misalignment is making exceptions for disruptive behavior because the individual is a rainmaker. Conflict between health care workers, no matter what their level in the organization, poses a risk to patient well-being. Assuming that patient safety is a core value, allowing disruptive behavior indicates a lack of clarity and alignment.

Leaders must know how to look for the signs that leadership clarity is missing:
• policies that are not enforced;
• senior managers overriding mid-level management decisions;
• poor performance is tolerated;
• micromanaging;
• role confusion; and
• insubordination.

A leader without clarity is like a ship without a rudder. Without clarity there can be no alignment, and without alignment there can be no accountability.

Conflict capacity

The harsh reality about leading is that you will be criticized. As a result, many leaders are driven to be liked or to be viewed as congenial.

The too-nice leader creates just as much drama as the overly aggressive autocratic leader. As a result, many organizations offer leadership development institutes, academies and annual workshops intended to help leaders manage conflict.

Unfortunately, most of these workshops fail to produce results. Without the right environment, executive support and active practice, learned skills become academic knowledge that lack pragmatism.

Increasing conflict capacity requires a willingness to expand the comfort zone and practice emotional discomfort until a new comfort level is acquired.

Self-awareness is a prerequisite to overcoming the first barrier: emotional aversion. Conflict almost always feels bad, and no one wants to feel bad. The go-to reaction to feeling bad is either avoidance or aggression — two sides of the same coin.

To expand conflict capacity, the leader must learn how to identify triggers — the stimulus — and then build space between stimulus and the go-to reaction to respond productively and consciously.

Learning conflict management skills without self-awareness is like trying to ride a bike from reading about it. You won’t understand balance until you get on the bike.

No matter how many techniques an executive learns at a leadership academy, real conflict management skills require increasing conflict capacity.


Executive conversation

If there’s workplace drama, disruptive behaviors, and lack of productivity, it’s because conversations have been avoided. If, however, you’ve had the conversation and told them “a thousand times” it means the behavior has been allowed 999 times and there’s a lack of accountability within the system.

Often there’s at least one elephant in the room that a leader hasn’t had the courage to address. There’re many reasons for avoiding difficult conversations: the timing is off. It’s the company picnic. The employee is going through a rough patch. These delays are due in part to lack of skill in what I call “executive conversation.” Instead, there is avoidance and a lack of accountable conversations.

Think of executive conversation as an executive function of the brain where the prefrontal cortex helps you make strategic decisions versus the primal part of the brain, the basil ganglia that’s responsible for survival and reactive to threats. Executive conversation is an intentional process for initiating difficult conversations and using straight talk that gets accountable results.

Executive conversation is strategic, focused forward, responsible and respectful, versus reactive conversation that’s unplanned, easily distracted, blaming and disrespectful.


Leading in health care calls for leadership clarity, conflict capacity and the ability to engage in executive conversations to discuss performance and issues of misalignment.

Marlene Chism is a consultant, executive educator and LinkedIn global learning platform expert. Her books include “Stop Workplace Drama,” “No-Drama Leadership” and “7 Ways to Stop Drama in Your Healthcare Practice.” She can be reached at marlene@marlenechism.com.

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