Women Leaders, Wicked Problems - School of Medicine -...
50
Women Leaders, Wicked Problems Catherine R Lucey MD Vice Dean for Education UCSF School of Medicine
Women Leaders, Wicked Problems - School of Medicine - …casemed.case.edu/wfsom/calendar/springdinner/2012/2… · · 2012-07-02Women Leaders, Wicked Problems Catherine R Lucey
• Today’s health care problems will not be solved by
yesterday’s leadership models.
• Today’s health professionals must accept that fulfilling
their obligations to society will require leadership skills.
• Today’s health leaders must commit to creating
strategies to optimize the leadership potential of all
professionals.
VS
Presenter
Presentation Notes
Society affords us many privileges as a profession in exchange for agreeing to use our expertise in service to the needs of society. So it should really come as no surprise that medical education should consider the needs of society as they construct curricula to produce the ideal health professional. A bit radical when it suggested just that ….that currICULUM SHOULD be driven by the competencies needed to fulfill the social contract. T This is a somewhat radical idea at this time– what it means is that medical education exists not to create physicians but to improve health.
Presenter
Presentation Notes
This is the famous painting “the Doctor” which was a painting done by Sir Luke Fildes in response to a commission for social realism. When Andrew Carnegie and Abraham Flexner reflected on how medicine was meeting the needs of society in the early 20gth century, they did not like what they saw. They admired the professionalism of physicians such as the one depicted here, who cared for Filde’s son , what they realized society needed was a physician who used science to enhance health
Insert Petri dish
20th Century Medicine
Presenter
Presentation Notes
The post flexnerian physician was tbe hero physiican-- educated in the university, using a core set of biomedical sciences. He learned from and for his patients, moving effortlessly from bed to bench as he did everything– he WAS the health care system. This was an era of acute disease; koch’s postulate had been accepted and with time, the doctor filled his black bag with the few therapeutic agents that existed. The post flexnerian physician was the health care system. He didn’t share in decision making or work collaboratively, he gave orders and because they were symptomatic and because information was the realm of the doctor, patients complied, as did any other health professional who happened along.
Presenter
Presentation Notes
At the same time, the post industrialized nation was embracing the wonders of mass production to meet the needs of society for new goods and services that couldn’t be produced at home. An industry of workplace leaders was borh.
Technical
Presenter
Presentation Notes
There are two similarities between the way in which physician viewed their roles and plant managers viewed their roles at the turn of the 20th century. People in these fields had a high degree of certainty in what they needed to do to accomplish their goals and their was a high degree of agreement in that plan as well– neither patients nor assembly workers pushed back when told what the plan was.
Technical Problems need Transactional Leaders
Approaches followers with an eye towards exchanging one thing for another. ……Burns
Plan Control Organize Assign
Presenter
Presentation Notes
This was a time of predominantly transaction leadership. Where, as John McGregor Burns says, leaders approached their followers with an eye towards exchanging one thing ( a job, a salary, health) for another (accomplish the task or comply with the medication.) When we talk about leadership, we still fin a number of people who equate all leadership to Transactional leadership– being the boss.
Presenter
Presentation Notes
After a century of biomedical advances, we have a much more nuanced and complex understanding of disease and health care delivery. Koch’s postulate, where one bacteria and one host caused one disease, is almost laughably simplistic. We know have the wisdom to understand the various contributions of genome, epigenome, microbiome, exposome and the health care system to the delveopment and treatment of dsiease like tuberculosis Certainly Paul Farmer
Presenter
Presentation Notes
As medical educators look at the world around us today and ask what new competencies do physicians need to fully translate the striking scientific advances we’ve made in the past century into improved health in our communities, it has to be an understanding of complexity. This is the scientific and social challenge of our era. And the key to managing complexity is leadership
Technical/ Simple
Complex
Chaotic
Presenter
Presentation Notes
Complexity is present whenever there is no longer certainty about the problem or its solution or when there is substantial disareement about the problem or its solution
Welfare To Work Mandatory Sentencing Teacher Ratings Trickle Down Economics
Presenter
Presentation Notes
The problem with complex problems is that traditional transaction leaders approach them as if they were technical or simple problems. They like technical solutions so even if the problem meets criteria for complexity, the transactional leader will approach it with certitude or demand agreement. When that doesn’t work, they give up or try another solution, or commonly, they blame the one with the problem.
Health Care is No Different
Costs are High
Presenter
Presentation Notes
Health care expenditures now are encroaching on our abiltity to address the other social determinants of health– like educaiton, public safetyt and the environment.
Value is not
DC
Second quartile (77.2–89.9)
Bottom quartile (108.0–158.3) Worst: DC
Third quartile (90.7–107.5)
Top quartile (63.9–76.8) Best: MN
Mortality Amenable to Health Care by State Deaths* per 100,000 Population, 2004–05
White Only Total
* Age-standardized deaths before age 75 from select causes. Data: Analysis of 2004–05 Centers for Disease Control and Prevention’s Multiple Cause-of-Death data files using methodology from E. Nolte and M. McKee, “Measuring the Health of Nations: Analysis of Mortality Amenable to Health Care,” BMJ, Nov. 15, 2003 327(7424):1129. Source: Commonwealth Fund State Scorecard on Health System Performance, 2009.
In management science, These complex social problems are known as wicked problems– a term coined by Rittel in the 1960s. Wicked does not mean evil, it means challenging. And they behave in a capricious but somewhat predictable fashion. Effective leaders know that trying to solve a wicked problem with a technical solution is foolhardy at best and irresponsible at worst.
Insert scary picture
Recalcitrant
Insidious
Controversial
Slippery
Disruptive
Presenter
Presentation Notes
Set of complex interdependencies
Creativity
Collaboration
Purpose
Learning
Empowerment
Presenter
Presentation Notes
When the leader doesn’t have all of the answers, others can be empowered to step up to the plate and take a stab at it
Wicked Problems need Transformational Leaders
“It is a relationship of mutual stimulation and elevation that converts followers into leaders and may convert leaders into moral agents.” Leithwood 2000.
Envision Empower Experiment Entrust
Presenter
Presentation Notes
Wicked problems perform poorly in the hands of a transactional leader. They will appear to be solved and then flare up again. Single solutions will precipitate unfortunate and unintended consequences. The purpose will be lost and people will spend their time arguing about which weed to putll
Transformational leaders bring people together to envision a better world and then
create it.
Focus on Purpose
Presenter
Presentation Notes
They do with a series of strategies One of the best strategies for dealing with an insoluble small problem is to make it bigger– rather than worry about how to get PS37 to have better test scores, worry about how we can prepare students and their families to learn and succeed. Focusing on big picture, and purpose tends to unite people around goals that make them feel good about their work and decrease time and energy spent on stake in the sand tactics. Less time bickering about tactics that are slightly different and more time working collaboraitively to achieve goals
Insert network or think tank or town hall
Build Learning Coalitions
Presenter
Presentation Notes
Flattened hierarchy Can’t do it themselves Look for help and assistance from anyone impacted by the problem, regardless of their roles, education, ideas. They seek different opinions and they seek diversity And they guide the coalition to explore and learn together
They understand that fake harmony is as damaging to good decisions as is fighing. Ron Heifetz of the Harvard business school speaks of the need for the leader to build a vessel that can contain the type of conflict that helps people analyze all of the possibilities.
Experiment And Learn
Presenter
Presentation Notes
Transformational leaders know that you will never find a perffect solution to a wicked problem. They understand that you need to use good theories but that launching at 75% good enough is exactly what you need to do– your solutions need to be tested in the real world not continuously refined on paper. This means that they prepare their followers to fail and reward the learning that comes from failure. They never institutionalize a process until multple cycles of learning and failure have occureed
Share Leadership
Presenter
Presentation Notes
And, transf leaders share success and share leadership Margaret mead once said, you can get a lot done if you don’t care who gets the credit for it.
Physicians & scientists today must be transformational leaders.
Presenter
Presentation Notes
Successful physicians and scientists in an era of complex chronic disease and rapidly evolving science must have transformational leadership skills. Whether their zone of control is an office, a lab, a department or a medical center, they must have the skills to engage others to analyze problems, propose solutions, experiment with strategies and do it all again as situations and patients change.
World
Country
Institution
Department
Division
Office
Pt Career Advancement is Progressive Influence
Leadership is Influence
Presenter
Presentation Notes
The same skills that enable women to be outstanding physicians and scientists can be cultivated to help them have careers of progressively wider impact. – the essence of advancement. But herein lies one of the most insidious wicked problems of our time: the stagnant growth of women in leadership.
2.4% A Truly Wicked Problem:
The Glacial Progress of Women in Leadership
http
://w
ww
.cat
alys
t.org
/file
/541
/qt_
stat
istic
al_o
verv
iew
_of_
wom
en_i
n_th
e_w
orkp
lace
.pdf
Presenter
Presentation Notes
Despite the fact that women have been close to 50% of the workforce for some time now, they are not making it into the top leadership positions.
LEADERSHIP AT US MEDICAL SCHOOLS BY GENDER
AAMC 2008
Since 1982, more than 30% of all medical school graduates have been women
Presenter
Presentation Notes
As is characteristic with a wicked problem, there are those who don’t agree that there is any problem at all. And the refrain goes something like this when you speak of women in academic leadership “We just need to give it time and all the women who now make up the 50% of medical school graduates will systematically advance through their careers and ascend to positions of leadership”. But women have made up more than 30% of medical school classes for more than 30 years. And still, the percent of women at the highest levels of influence remains in the low double digits.
Mason & Goulden, Marriage and Baby Blues: Re-defining Gender Equity.
Presenter
Presentation Notes
The pipeline to traditiaonl academic leadesrhip is leaky. This is work done by Mary Ann Mason, previousy at UC B and now at Stanford, who wrote a very provocative book on “do babies matter in academia. The answer is yes. Men with children do better, women with children do worse.
Parity without Power
Mason & Goulden, Marriage and Baby Blues: Re-defining Gender Equity.
Presenter
Presentation Notes
Parity without Power Women are increasing in the Academic workforce but are taking on a decidedly second class role. Clinical , Auxiliary Faculty Tracks vs Tenure Education vs Research Primary Care vs Subspecialty Care Existing policies and procedures reinforce this tension Even more troubling is that our current approach to work life balance risks worsening the problem rather than alleviating the problem for this generation. Although women are entering academic careers at all time high rates, they are vastly overrepresented in the non-tenure tracks. There is that old saying, if you are a hammer, everything looks like a nail. —our one hammer solution to work life balance has been to offer women part time work on more flexible track and thus to start them off on a career that will prevent them, in current models, from ascending to the highest levels of leadership.
Leadership
Gender Inequity
Start off behind
Take the wrong path
Get less choice
assignments
Drop out more Aren’t
offered opportunities
Don’t accept opportunities
Judged differently
Presenter
Presentation Notes
Gender inequity in leadership meets all criteria for a wicked problem There are dozens of theories of why there are not more wome in leadership, all true to some extent but each of htose theories ahs theoriest
Women Leaders must approach this problem with transformation in mind.
1. Lead with Purpose
Diverse Leadership Teams Get Better Results
Presenter
Presentation Notes
The reason we want more women in leadership is not because we believe in women– although that helps The bigger purpose is that more diverse leadership teams, with people using diverse styles and people looking through diverse lens get better results. And it is resultst hat we are after as we seek to leave the world a better place. The problem isn’t how to get 50% of leaders to be women, it is to recruit the people who have the leadership skills we need to help our institutions change the world. When you focus on percent
2. Build a Learning Coalition
Presenter
Presentation Notes
When tackling a wicked problem, you will undoubtedly be surrounded by like minded people. I met many of them yesterday. A wise transformational leader will go after those who do not come to the table and make a compelling case that they can make difference, their world will be better because of this work and that you can’t do it without them. Refer back to #1– work with purpose. We often make the mistake of focusing exclusively on what is in it for them rather than what impact they can have on others. (we want a diverse workforce, you will learn something, vs you can make a difference. Who are the others we need to engage? We need to engage women who think that they don’t want to be leaders– often because their mental model of leadership is outdated. We need to engage men who may think that the problem is solved because there are so many women medical students around and, in health are, a number of women in the C suite. The nuances of who got where by when is not something that those peripherally connected to the problem appreciate. We need to engage young people who may not realize the struggles that they face. We need to appeal to senior leaders who may be looking for a legacy they can leave.
3. Experiment and Learn
Mentorship Sponsorship
Curriculum Work Place Learning
Leader Co-leader
No Yes, for..
Time Support
Productivity Competency
4. Challenge Assumptions, Accept Controversy
Is there a rationale for 2 class faculty system? Does academic success ensure leadership success? Should there be term limits? Who should choose leaders? What if 40 hours a week was a full time academic job? What if evaluations were tied to outcomes in gender balanced leadership?
Presenter
Presentation Notes
Engage in this thought experiment with me What if tomorrow, bill and melinda gatesannounced that they would give 100 million dollars to the academic medical center that solves the gender inequity problem in leadership by 2017. What type of ideas would you come up with to get that money. What assumptions would you be willing to put on the table about issues that cause leadershiop stumbles for women? I don’t know if any or all of these strategies would make a difference and as I talk I see some of you immediately rejecting these as imipossible. They are not impossible– they are hard. There is a difference. No wicked problem was every solved with an easy solution. If an easy solution worked, then either the problem wasn’t wicked or it wasn’t solved.
Conclusions
• Today’s health care problems will not be solved by
yesterday’s leadership models.
• Today’s health professionals must accept that fulfilling
their obligations to society will require leadership skills.
• Today’s health leaders must commit to creating
strategies to optimize the leadership potential of all
