Pamela M. Waymack

Leadership and management are distinct, but the nuances are often hard to define.

Managers focus on where we are today, making sure we are doing things correctly. Leaders are visionaries, taking us to where we need to be and making sure we are doing the right things. By nature, leaders have not only a clearly defined vision, but also the courage to bring their vision to fruition. Managers deal with the concrete. Leaders thrive with the intangible; they do business primarily in the realm of uncertainty. If everything in our world was certain, we would not need leaders and their sage advice and guidance.

Over the past 30 years, I have had the opportunity to work for and with some great leaders in the healthcare industry. What set these men and women apart is that they all thought strategically, built consensus, and executed impeccably.

Think Strategically

The best leaders tend to view all issues as strategic. Every issue-even mundane issues, such as setting charge levels-is examined for its strategic implications. When was the last time any of us thought of including our business development and marketing staff in a pricing discussion?

Every idea is examined by these leading-edge leaders, not against the current fashion, but against rigorous, introspective questions such as:

  • What are we good at, and does this play to our strengths?
  • Should we do this, and is now the right time?
  • Are we sure this is what the market wants?

These leaders do not try to do everything. They do not achieve greatness for their organizations by jumping on the latest trend bandwagon.

They have learned the importance of no as a strategic option. They understand the limitations of their resources and the inability to successfully execute multiple initiatives simultaneously. They realize that no is always a strategic option, and they are not afraid to pursue that course.

Great leaders are exceptional strategists, constantly thinking about the future and how to position their organization for continued success.

Build Consensus

Extraordinary leaders realize their greatest challenge may be managing agreement, not managing conflict. They have learned that agreement often masks dissension. They understand the slippery slope of groupthink where everyone in the orga-nization holds the same, often biased beliefs. They do not accept untested agreement to everything proposed.

Great leaders have learned that despite consensus among stakeholders, many organizations cannot meet their goals and objectives. Why do some fail and others succeed? The key is the effectiveness of debate leading to consensus. Without adequate airing of the options, consensus brings a false sense of security disguised as agreement.

A consulting engagement with a provider in a financial crisis highlighted the challenge of attaining agreement. The organization's cash crisis had resulted in significant management layoffs and the termination of the organization's top two executives. Then the organization received an interesting opportunity: An outside funder offered support for buildout of an existing service in a new location. The catch: The work had to be completed within the following four months.

Initially, the executive team agreed to accept the money and the stipulations. Even though all team members knew that the financial crisis demanded their full attention and that there were no available resources to distract from that mission, they agreed to the initiative without exploring alternative options. There was no discussion; no one raised concerns about the ability to complete the work given the limited management depth at the time. There was no debate on the project's implications for the financial turnaround that was needed.

As an outside adviser, I had to fill the leadership void and question the assumptions that this initiative would produce no ill effect on the organization's financial health. This effort included ensuring a candid debate of the real versus perceived options. In the end, the team agreed that taking on the project would harm the organization. They agreed to request a delay from the donor even though originally no one thought this was a viable option. The organization attempted to get approval from the funder three times before receiving approval,  putting the project narrowly close to the original four-month deadline for completion. Delaying implementation allowed the organization
to focus on its immediate financial challenges.

By not accepting a culture of yes, strong leaders achieve better decision making and a greater likelihood of success and commitment to their initiatives. They rock the boat periodically to ensure everyone is on board with the direction being taken, even when there seems to be a consensus.

Execute Impeccably

Many strategic plans are never implemented. The difference between successful and unsuccessful plans often is not the strength of the analysis, but rather the ability to execute precisely. Leaders often do not provide for enough resources and time to successfully implement the plan.

Great leaders understand the value of implementation. Every strategy is paired with a well-thought-out and executed implementation plan. These leaders understand that results are not easy to achieve. They do not try to accelerate implementation now,  leaving details for later. They ensure that adequate resources and talent are available for successful execution.

In a financial planning consulting engagement, one of the provider's options was to begin charging for a service that previously had been provided free. This idea had been suggested numerous times in the past but was never implemented due to the complexity of execution. This time the entire executive group endorsed the idea. The CFO was so excited that he implemented the charges the next day. Without any staff training, provider communication, or patient information, the result was chaos. By the end of the day, the charges were turned off. The provider learned it was necessary to plan execution and implement precisely. Once a plan that addressed all the constituents and requirements was in place, the charges were implemented in less than 30 days. Vision, even with consensus, can backfire without proper execution.

Great leaders understand that their responsibility is not only to formulate a vision but also to guide its implementation. They drive achievement of optimal results from their strategic plans.

The Leading Edge

Leaders lead. Some leaders are great strategists, many are good at managing consensus, and others are strong in operational implementation. But those on the leading edge take their organization not where it wants to go, but where it needs to go. Their achievements are a result of their often invisible hand that crafts the strategy, commitment, and execution of this different vision. Great leaders do not accept the status quo of where we are or where we think we want to be. Instead they take us where we need to be.

Health care needs more great leaders today as the industry faces unprecedented demands for change. I am hopeful that these three lessons learned from great leaders will provide some of the foundation we all need to support the changes ahead.

Pamela M. Waymack, FHFMA, is managing director, Phoenix Services Managed Care Consulting, Ltd., Evanston, Ill., and a member of HFMA's First Illinois Chapter (

Publication Date: Saturday, March 01, 2008

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