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BY: MICHAEL O'BRIEN, EdD, and JON ABELES, EdD

Dr. O'Brien is president and founder of the O'Brien Group, Cincinnati, an executive coaching and leadership development firm. Dr. Abeles is senior vice president, human resources and organization effectiveness, Catholic Healthcare Partners, Cincinnati.

We all intend to be good leaders: to manage ourselves and lead our teams with clarity, purpose, and integrity; to trust and rely on our team members to do what they say they will do; to be completely honest with one another. But in moments of stress or conflict, when leadership is needed the most, it is especially difficult to provide. On such occasions, we tend to become fearful and allow emotions to take over. Then we experience "breakdowns" that can get in the way of accomplishing our goals and objectives. Change occurs more slowly than we want; important work takes too long to accomplish.

Any large organization in today's complex economy experiences these breakdowns daily. Dealing with them is a normal part of leaders' work. But, unlike most organizations, a Catholic health ministry has additional layers of complexities, involving, for example, the management of the physical and spiritual aspects of its mission as well as the realities of a rapidly changing health care industry.

Sr. Doris Gottemoeller, RSM, PhD, senior vice president of mission and values integration, Catholic Healthcare Partners (CHP), Cincinnati, echoes this challenge. "It's tough to be a leader in a faith-based health system," she says. "CHP has thousands of employees, all working hard in an extremely segmented workforce. Trying to align everyone and translating the mission into meaningful terms that everyone understands is hard work. And, regardless of occupation, we want all our staff members to feel that their lives are being enriched — that work at CHP is more than sticking a needle in someone or paying a bill."

A growing multihospital health care system (CHP operates in 10 cities in four states) may be one of the most challenging organizations to manage. After assembling a top-flight executive team, Michael Connelly, CHP's president and CEO, was resolute in making sure that all these complexities did not get in the way of the goals of the system. "I wanted to take advantage of the richness and diversity of my executive staff without letting the meetings slow down the important work that needed to get done," says Connelly. He also wanted to find a better way to manage the issues and opportunities involving local hospital priorities, as opposed to those concerning the system as a whole.

All leaders want their organizations to work smarter and faster. In this article, we will describe how one large health care system employed a unique form of executive and leadership training that combined individual coaching with team coaching. We also will detail how the coaching methodology was applied directly to the system's daily operating issues, thereby enabling more work to get done with less effort while the executive team learned new leadership practices.

Coaching the Team and the Individual
In 2003 CHP engaged the O'Brien Group (OG), Cincinnati, to coach the organization's top senior executives: the corporate CEO, three senior vice presidents, six corporate vice presidents, and 10 regional CEOs. OG used actual business issues as a way to immediately begin applying key leadership principles. Working on the team level, OG observed issues, breakdowns, and opportunities during regularly scheduled meetings. Using such issues as a platform for teaching a leadership concept, OG was able to help the executives detect and remove roadblocks. As they experienced this "real-time" coaching approach creating actual breakthroughs, the system's executives became increasingly enthusiastic about the process.

What made these team sessions even more powerful was the fact that each executive also was being coached individually by an OG associate on a complete set of leadership practices (see Box). By getting to know each individual executive, OG could ask the right questions and coach the meetings in the direction appropriate for that particular team on that particular issue. Many organizations fall prey to a "smooth-over-and-avoid" communications style that stems from an admirable desire to move things forward by avoiding conflict. The result is that people often do not bring their best thinking to meetings, for fear of causing conflict. However, by working with both the team and the individual, OG is able to call attention to this "smooth over" style and replace it with high-quality executive dialogue that produces better, faster decisions.

OG did not begin its program at CHP with a laundry list of things that either the system or OG wanted to change. Rather, OG asked its senior partners — a mix of psychologists and former business executives — to work with CHP to uncover those conditions that were creating inefficiencies and drags in the system.

Some of these hindrances could be detected in stories that CHP staff members told each other — for example, stories about the system's executive management team. Other stories described tensions between the corporate office and various regional hospitals. Once the stories had been discussed and the dialogue structure underpinning them had been analyzed, both OG and CHP had a clearer picture of what was needed to take a really good team and make it even better.

Leadership Lives in Conversations
Leadership is often thought of as a role or a position to which someone has been promoted. But, at its most fundamental level, leadership is a relationship among individuals. Leadership "lives" in conversations. The more powerful the leadership conversation, the more people are moved toward purposeful action and the more goals are attained.

Sometimes the way these conversations are structured (as regularly scheduled meetings, for example) can make it difficult for leadership to occur. At other times, the way meeting participants think about a problem or issue can get in the way of good executive dialogue. And without good dialogue, decisions get stalled, work slows, and outcomes fail to meet expectations.

To improve leadership relationships and executive conversations, OG and CHP focused on four key areas:

• Identifying and managing polarities
• Structuring and managing executive meetings
• Improving interpersonal relationship skills
• Improving personal mastery

Managing Polarities
"Polarities" are sets of apparently opposed issues, ideas, ways of thinking, or structures that are in fact interdependent. For example, a common polarity in large multihospital systems is the needs of the system versus those of the regions. In such systems, leaders often believe they must choose between imposing the system's "best practices" on the region and letting the region do what is best for its local market. The polarity is thus seen as an either/or situation whose solution must inevitably result in winners and losers. The system's advocates complain that the regions are slow to move toward a common goal; the region's advocates argue that the system does not understand their particular market's uniqueness. People feel they must pick sides — and then each side digs in. Communication is degraded, progress is slowed, and leadership tends not to happen. The organization suffers.

The "polarity management" concept has been written about widely. However, OG's work with CHP focused on building polarity management into the system's daily business activities. In its coaching, OG taught CHP executives to view polarities not as problems to solve but as opportunities to manage. When executives "reframe" a polarity with a "both/and" statement, ("How can I take advantage of both the system's best practices and give the regions control and autonomy?"), high-quality dialogue begins to emerge and take hold. Once CHP's executives began to perceive this, their conversations became more creative and open. Teams, no longer locked into their views, began to find ways to reap the benefits of both poles. Solutions became both more creative and more fully supported by all stakeholders.

Once the thinking had been reframed, OG coached the executives through a set of tools that allowed them to minimize a polarity's negative aspects and instead focus their efforts on positive outcomes. OG also helped CHP's executives develop a working list of persistent polarities, many of which were once thought of as unsolvable problems.

As a result, CHP is now better equipped to manage polarities. "More work gets done, because we are able to discover the positives associated with both sides of an issue while avoiding many of the negatives when making a decision," says Connelly. In the past, CHP was challenged by what Connelly calls "loyal frustration."

We used to have over 100 initiatives going on in the field all at once [Connelly explains]. Quite frankly, the regions were overwhelmed. They were loyal to the mission, yet frustrated by the scope of demands we placed on them. I'll admit that the home office would sometimes go into meetings thinking the regions would say no to our requests and ideas, and this bias naturally affected our ability to be completely open to their input. When we began to look at it from their point of view, we started slowing down and prioritizing. Consequently, their commitment to the agenda increased.

OG worked with CHP to create a framework executives could use to document the polarity that needed to be managed and to view it from both sides. In system meetings today, a specific issue is described as a "problem to be solved" or a "polarity to be managed." The use of this common language establishes a safer environment in which executives can discuss a potential area of conflict in a multiregion health system.

Managing Breakdowns
Breakdowns and conflicts are a natural and ordinary part of business. It is hard work to keep all the various organizational and interpersonal relationships aligned and the polarities balanced. Breakdowns usually occur when one person fails to do something that another person expected to be done; or when something that should not happen, happens. Discussing these conflicts feels risky. If you speak up, you might be proven wrong; you might even make matters worse. But, as we have said before, it is during these breakdowns that leadership is most needed — and hardest to create. Breakdowns present opportunities for us to deliberately stretch toward our "best intentions." In its coaching, OG worked with CHP executive teams to show them a new set of skills that could be used to turn breakdowns into real opportunities for breakthrough thinking. The core of this approach is showing people how to accept someone else's concern and, just for a few moments, make that concern their own. The approach helps one to become genuinely interested in another's viewpoint and to see one's own view of the situation as an opinion and not necessarily the truth.

Sr. Doris observed how the expression of personal opinions muddled the outcomes of certain meetings. "Opinions are no more than grist for the mill," she says. "An opinion is not the same as a group's considered conclusion. It is not the whole truth. In some meetings, however, whoever spoke the loudest, latest, and longest prevailed. Yet these 'decisions-by-default' would lead many to disengage from the topic. We weren't even aware we were doing that."

OG coached teams and individual participants in the art of good dialogue — which is central to turning breakdowns into breakthroughs. Good dialogue occurs when executives are willing to:

• State their opinion and ask others for their reactions
• Be wrong
• Be curious as to why others think what they believe is correct and true
• Accept the fact that one may not be aware of certain facts, and, as a result, be open to new information that may change one's mind

"Group conversations would often be dominated by 20 percent of the group," Connelly says. "The other 80 percent would basically be silent through meetings that were sometimes eight hours in length. A big change for us now is how evenly the conversation is distributed among participants. As a result, the meetings' outputs now take full advantage of participants' differences and are of higher quality."

The success of this newfound participation can be partly attributed to the individual coaching component. Because OG became familiar with the behaviors, emotional "triggers," and communication style of each individual executive, it became natural to point out certain behaviors or breakdowns, either during or immediately following a meeting — all with the intention of ingraining the awareness and teachings in daily habits.

Managing Yourself
Effectively participating in and leading teams requires paying more attention to interpersonal dynamics and the issues at hand. It also requires paying more attention to one's own psychology — noticing, that is, when one feels withdrawn, afraid, threatened, or resentful. A health ministry leader's most important role is contributing to the growth and vitality of the Catholic mission. But when we operate in fear — which, again, is a normal part of managing a large health care organization — we shift into a self-protection mode and our contributions begin to run counter to our personal and organizational values. This shift is emotional and automatic. The self-protection mode typically manifests itself in recurrent problems going unsolved or important work not getting done.

As Sr. Doris says, "We're a group of wonderfully talented and hard-working people. We always knew that. But we didn't always bring our best selves to meetings. Our negative assessments would go unchallenged. Some people were not effectively involved in some discussions. They were withdrawn."

As part of the individual coaching process, OG worked with CHP's executives, teaching them a new skill set, one that allowed them to better manage the upsets or breakdowns that can keep people from being their "best selves" and failing to contribute and perform to the best of their capabilities. The process began with the realization that all our upsets and fears are based on a story that we have created about why things are not the way they should be. Such a story is always full of "they shoulds" and "I shouldn't haves."

OG created a set of verbal tools that opened dramatic new pathways to action. This tool set starts with naming the upset or breakdown and then reframing it — shifting one's thinking — in order to open up new possibilities. One way to do this is by saying to oneself:

• "I don't know the whole story."
• "I don't know what else is on their plate."
• "How do I want this to end up? . . . What is my hope?"
• "What is life calling for?"
• "What can I contribute?"

Note that the above ways of thinking are very different than simply, "What should I do?" They open up the realm of possibility. As a result, participants discover that they can, with incredible clarity, see what is needed. It helps them discuss what was previously hard to discuss. It enables them to make offers and requests, which in turn leads to powerful conversations.

Jane Crowley, one of CHP's executive vice presidents, says, "By asking myself, 'What is life calling for?' in a particular situation, I've learned that I sometimes need to shift from being a change agent to being an information provider, and back again to being a challenger, one who raises the bar. And this is true whether I'm in a one-on-one with a hospital CEO or making a presentation to a group of 100. I can, by recognizing that leadership needs those constant shifts, now tap into my own unique talents even more and be a better leader."

Crowley describes a work situation in which a shift in leadership thinking led to genuine progress on what had been a particularly troublesome problem:

I had addressed the same specific issue for nearly two years. It was a classic breakdown. The topic was becoming tiresome to me and to those it affected. Every time we discussed the problem, I would find myself becoming immersed in its content, trying to solve it. My questions, therefore, always focused on the specifics of the problem's content. But last March, when this issue was being discussed yet again, I switched gears and asked, 'Why is this problem so sticky? You all have solved much greater issues. What is it about this problem that you can't get it behind you?' Just by asking that question and stepping out of the problem's content, so to speak, I shifted from low-impact to high-impact work. The right kind of problem-solving dialogue then kicked in. As a result, we moved forward. In the old way, I would have spent 90 percent of the time on content and only 10 percent on the main organizational issue.

Reframing their thinking in this manner helps executives come to a meeting with a much different mind-set. They are less reactive and self-protective and more open to the talents and contributions that others can bring to the table, and more aware of their own. They are better able to accept someone else's concern and, just for a few moments, make that concern their own. As a result, better, more creative work occurs — work that takes full advantage of the group's diversity.

Going from Good to Great
CHP's executives recognized that leadership coaching requires discipline, sustained over a year or more. In going from good to great, there is no quick fix. Enhancing leadership practices in a sustainable way requires hard work. Call it "leadership from the inside out." The turning of values into action begins in one's head and one's heart. It requires an ongoing discovery of and attention to those things that unconsciously hinder and impair leadership effectiveness.

What helps make these leadership principles become a way of doing business is that they are "taught" during the daily meetings and rituals that are already on the organization's calendars. At CHP, OG made its observations and provided its feedback in the context of practical issues and projects. Dealing with these "live" issues in "real time," CHP's executives gained momentum from day one. OG's observations and feedback were better retained in the executives' minds because the executives were challenged to work through the very issues they face on a daily basis. Improved productivity, richer dialogue, better regional buy-in and improved meeting management have led to a more cohesive and focused executive senior management team at CHP. Although executive coaching continues in the system, OG's tools and methods have become ingrained in the minds of the system's executives and are regularly used in their weekly meetings and discussions.

Connelly believes that the coaching program has led to increased efficiencies. "These principles and teachings have freed up our team's ability to work through issues faster, with better outcomes," he says. "But because both I and the executive team are better armed to accomplish even more of what the mission intended, the ultimate benefactor is the health ministry."

Information about the O'Brien Group is available at www.obriengroup.us. Information about Catholic Healthcare Partners can be found at www.health-partners.org.

The Practice Domains of Masterful Leadership

Six of the O'Brien Group's 10 leadership practices are:

• Maintain absolute integrity Tell the truth. Say what you mean, mean what you say. Be authentic. Capitalize on your unique qualities. Be vulnerable when appropriate.
• Create power conversations for action Make requests and offers. Evoke promises. Expect positive results.
• Practice tough empathy Let your people know you care about them, their thoughts and feelings. And hold them accountable. Celebrate success.
• Put duty before self Your mission and your people come before yourself. You live in service to the mission and to the people who will complete it.
• Get out in front Lead by "enrolling" people in the new vision or goals. Get out in front where you can see and be seen. Encourage and manage desire.
• Master your emotions "Have" them or they will "have" you. Recognize and manage fear in self and others.

Copyright © 2004 by the Catholic Health Association of the United States
For reprint permission, contact Betty Crosby or call (314) 253-3477.