Excerpt from “Stewardship:The Noblest Form of Leadership – Part II,” Compass Clinical Consulting Profile in Healthcare Leadership Interview with University of Virginia Medical Center Chief Executive Officer, R. Edward Howell, by Cary Gutbezahl, MD.
Dr. Cary Gutbezahl : How did you prepare the organization for the type of change that you were embarking on? You made a pretty significant structural change in the organization, and obviously there were some people that weren’t going to be happy with it. Beyond the individual impact, there was also organizational impact.
R. Edward Howell: We did a lot of questioning, talking and investigation. We sought input. The input wasn’t so much to determine what to do, but more as an affirmation of what needed to be done.
Talking with leadership within the organization, university and governance, all through the process was an affirmation that we needed to move this organization to the next level, and a recognition that there was going to be some turbulence that resulted from it.
CREATING TURBULENCE
I teach health management in the classroom, and one of my topics is managing change. I don’t think that leadership in healthcare has studied the basic concepts of change management thoroughly enough. Frankly, some of the best work and research in change management came from Kurt Lewin, a professor at MIT back in the late 1940s and 1950s. His research on the interaction between turbulence and change is stellar.
“Turbulence” is a word he used to describe the discord in an organization when you bring about change.
When you introduce change, almost any kind of change, you get some discord. That’s what he called turbulence. Even with the smallest change—change in the line for your cafeteria in terms of whether you put the utensils on the right or left side or the front or back—you get discord. After you introduce that discord, you get a level of stability, and you can introduce a lot more change without a lot of discord. But the real challenge for the leader is to make sure you don’t take it too far because it can get out of control, and this is what we call chaos.
So, for all of us who are change agents, we need to realize that we have a responsibility to our organization that when we introduce change and we create discord, we maximize the amount of change we get for the discord we create.
And so I recognized when I was going to make these changes, we needed to make all of these changes at the time I created the discord. We spent a lot of time planning and getting a comprehensive picture of what needed to be done. We announced it and then did it in a very short period of time.
I brought in interim leadership, had a number of sessions that were very structured, and planned well in advance to making the change so that when it happened and we created turbulence, we maximized the change. We were ever aware that there was only so much we could do before chaos reigned. You want to avoid that.
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