Principled Leadership in Public Mental Health


>>Sally Rogers: Hello and welcome to Boston
University Center for Psychiatric Rehabilitation Webcast. Thank you for joining us. I am Sally Rogers, Director of Research at
the Center and it is my pleasure and honor to introduce to you our distinguished presenter
today, Dr. William Anthony. Dr. Anthony will be speaking with you today about principle
leadership in public mental health. Who better to discuss with us, the topic of
leadership than Dr. Anthony? He is currently the Executive Director of the Center for Psychiatric
Rehabilitation which he founded in 1979 and was also a professor at Sargent College at
Boston University. Over the past 35 years, Dr. Anthony has authored
over a hundred professional articles, numerous text books and book chapters and a host of
other materials for the mental health rehabilitation fields. He has been in demand both nationally
and internationally as a speaker who can address cutting edge issues of concerned to us in
the mental health field. Dr. Anthony has also been the recipient of numerous awards for
leadership and the President Distinguished Service Award. Most relevant to his talk today, Dr. Anthony
has observed incredible changes in the mental health field over the past several years and
has also been a driver of those changes. He is a leader in mental health and rehabilitation
and has advocated for transformation to a recovery oriented mental health system in
a time when many were skeptical of that change. It is through that lens of our evolving field
and the need for innovation and change that Dr. Anthony will speak with you today about
principled leadership in public mental health.>>William Anthony: Okay, thank you Sally.
And I first want to welcome everybody here in the room and welcome the folks that are
listening on the, Webcast Live and the other folks who are listening at some later date,
welcome. I want to preface my talk on the principles of leadership with the few personal
comments, I guess, or some comments that allowed me to get to this place. What do I mean by principled leadership? To
me, what that means those are the basic principles and tasks that guide effective leader’s actions;
that’s what I mean by principled leadership. We’ll be talking about principles, focuses
on the basic question of what guided leaders in creating and maintaining and building their
particular organization. The focus is not on things like what is a leader’s system or
program or a big description of that. We’re not going to describe that except to put it
in the context of where the leader’s working. That would be a description of a lot of programs.
We’re also not going to focus on the characteristics of the leader. Are they warm? Are they cold?
We’re going to talk about the principles that guide the leader. So that’s one thing when
I mean principled leadership. The second thing is when I use the term ‘principled
leadership’ I mean it’s principled because the leader has developed a unit or a program
or whatever was designed to help people recover. Recovery is a vision, is kind of a basic truth
that guides these leaders, the ones I’m going to talk about, that guides their actions.
It’s principled in that aspect as well. I’m not going to go into the research that shows
recovery is happening. I think that’s Harding’s analysis of the research and so forth, stands
the test of time. People are, in fact, recovering. The President’s new Freedom Commission says
that and I’ll quote here, ‘To enable adults with serious mental illnesses and children
with serious emotional disturbances to live, work, learn, and participate fully in their
communities.’ We’re talking about leaders who are principled and they are trying to
develop that vision within their organization. Or as I’ve defined recovery, they are trying
to help people develop new purpose and meaning in their life as they grow beyond the catastrophe
of severe mental illness. Principled leaders are working towards recovery
and we are going to talk about the principles that guide them. Also, in terms of a preface,
what is my interest in this? Back in the early 90’s I wrote an article called, ‘The Decade
of Recovery,’ and I was referring to the fact that we should be emphasizing recovery as
much as we were emphasizing, as that time ‘The Decade of the Brain.’ And I questioned
why I wrote that and I thought about various organizations. I had a couple of questions
in my head at that time and they were these: Why do some service organizations pursue this
vision of recovery with diligence, while others seemed unaware of the fact that the wrong
people were recovering? Or why do some organizations flourish while others seem to calcify? Or
said another way, why do some organizations have direction and energy to transform their
services and some organizations don’t seem to have a clue? The answer, in part, for me was leadership.
I had a chance to go around the country and observe many leaders, talk to many leaders,
etc. It occurred to me over and over again that the leadership was making a difference
in terms of why some organizations were flourishing and why some weren’t. So, in 1993, I wrote
an article called, ‘The Programs That Work: Issues of Leadership,’ and that kind of started
me down this track of looking at leadership that’s quite some time ago. And since that
time I’ve interviewing dozens of leaders around the country and taping their interviews, leaders
who are trying to transform their particular organizations. I’ve been visiting and I continue
to visit and observe these organizations that are run by leaders that are trying to transform
their services. And also, I’ve been studying the literature and the for profits sector
of how leaders are acting in the for profits sector, based on those activities that I’m
giving this particular talk today. And out of which came the eight principles of leadership
and the accompanying tasks that I’ll be focusing on. So, I also want to start on some background
issues. Just some that I want to cover before I get into the leadership principles. First
of all, what do we mean by transformational leadership, which is a term that you hear
more and more now that combines the whole idea of transforming organizations into an
adjective, transformational leadership. By transformation I mean what SAMHSA (Substance
Abuse and Mental Health Services Administration) has focused a lot on transformation, what
is transformation, and, really, its drastic change. A quote from their leaders, Curry
and Power that says, ‘Transformation implies profound change. Not at the margins of the
system, but at its very core. In transformation, new sources of power emerge, new competencies
develop, we look for what we can do now that we couldn’t do before.’ So you can see it’s
a drastic, profound change. We’re not just talking about implementing a little program,
a new form or a new test in your organization but transforming the organization entirely.
And why do we have to do this? Why is the need so immense at this particular point in
time? Well, if you reflect back on the last century, for the most part until the very
end of the last century, no one was talking about recovery. There was no recovery vision. I’ll often quote the Diagnostic and Statistical
Manual of the America Psychiatric Association. Up until 1987 it said schizophrenia was characterized
by, ‘acute exacerbations with increasing deterioration between episodes.’ We had developed a system
that really believed that anybody with a severe mental illness was going to deteriorate over
time. So our vision, of course, at that time, was to stave off the deterioration and maybe
to reduce the symptoms, but it certainly wasn’t about how people could live, learn, work and
participate in their communities, develop new meaning and purpose in their life. That
was no where to be seen in the mental health system. And the values that leaders talked
about were segregation (to segregate the folks with severe mental illness), professional
authority (professionals knew best), and control (how do we control people with severe mental
illnesses?) We have to recognize that we had a system that was set up almost exact opposite
of recovery. So now when we talk about this, our new vision, we have to talk about completely
transforming the system, the programs, the units, the residence wherever you happen to
be working. Couple other background points: what do we
know about leadership in the public mental health sector? Not very much, especially relative
to the leadership in the for profit sector. How many books have leaders in the for profit
sector written? How many times were they credited with turning the organization around? Or rewarded
with astronomical salaries? When an organization does well in the for profit sector it always
seems credited, to me, to the leader. Contrast that with the public mental health
sector which, I think, hasn’t had much talk about leadership, but I think leadership is
much more difficult in the public mental health sector. It’s more complicated and it’s more
needed. I say that for good reason. It’s inherently more difficult because it’s not just shareholders
that the leaders in the public mental health sector have to worry about; it’s also tax
payers, the general public. We have a myriad of people with oversight responsibilities.
We have the courts, we have advocates, we have the general public, and we have citizen
boards. So, the public mental health leader has a
lot to contend with to have competing pressures. Just look at some of the pressures today.
We have pressure for quality services in an era of cost-cutting. Make the services better,
but do it with less money. We have consumer choices overriding value, yet you still hear
talk and laws about patient commitment. How do you handle those competing pressures? Most
of all, we have the status quo versus change. It’s always a competing pressure. A couple of other points: Leadership, any
leader I’m not talking about the CEO all the time, I’m talking about the leader of any
organization; the self-help groups, residences, leader of a ward or a unit. I’m talking about
leadership at all levels. So, I guess I will define leadership. I put a couple of definitions
here in sequence. Packard said in 1962 said leadership was, ‘the art of getting others
to do something you are convinced should be done.’ That sounds a little manipulative.
I call that the Tom Saywer leadership. Will’s kind of took that and went a little bit further.
In 1994, he said, ‘the leader is one who mobilizes others towards a goal that is shared by leaders
and followers.’ So, Will’s introduced the concept of followers’ shared goals. And then
Nanus in the nineties also talked about the organizational element. A leader worked in
an organization with identifiable boundaries and resources. When we talk here about public
mental health leadership, we are talking about a leader who mobilizes others in a particular
organization towards a goal of goals shared by the leaders and followers. That’s kind
of the definition I’m working off here. You can also define leaders by what they aren’t. Nanus particularly always contrasted leaders
with managers and they did it very artfully. They also did it someone pejoratively somewhat
towards managers. You’ll hear that in some of the distinctions they make between leaders
and managers. We don’t look at managers pejoratively, that’s where many of our leaders come from.
In many of our small organizations, leaders are managers as well. But here’s how they
kind of tried to make the distinction. I think it’s an interesting one, if somewhat negative
towards managers. They say, ‘Managers administer, leaders innovate.’
‘Managers are copies, leaders are originals.’ ‘Managers focus on systems and structures,
leaders focus on people.’ ‘Managers rely on control, leaders inspire trust.’ ‘Managers
have short-range views, leaders have long-range perspectives.’ ‘Managers ask how and when,
leaders ask what and why?’ This is one you kind of hear in other places, ‘Managers have
their eyes on the bottom line, leaders have their eyes on the horizon.’ ‘Managers imitate,
leaders originate.’ ‘Managers accept the status quo, leaders challenge it.’ ‘Managers are
classic foot soldiers, leaders are their own people.’ And lastly this is another one you
hear on occasion, ‘Managers do things right, leaders do the right thing.’ So, as you can
see it’s not very nice about managers. But I think you get the idea if we focus on just
the leadership end of it and what leaders are trying to do and managers are certainly
able to do those things well. A couple of other background issues; can leadership
be taught? Well, if it can’t I could home now and shut off the cameras because, obviously
I am here, presenting today with the belief that leadership can be taught. How do leaders
often learn? One is trial and error. You are thrust into a leadership position and you
learn by trial and error. Unfortunately leaders error are often other people’s trials. That’s
not a great way to learn, but that’s often we learn to be leaders. Also you can observe
other leaders if you have the opportunity to observe other leaders in your organizations.
Hopefully they are effective leaders, because if they aren’t you aren’t going to learn too
much. Lastly, you can learn as a leader through what we’re trying to do here today, and that’s
through education, through training you can learn from leaders comments; what they’re
saying, what they say worked for them. You can also learn from one another, leaders in
a particular system you can read, reflect, and discuss on people’s leadership styles. What we’re going to do today, is that we are
going to learn from leader’s comments in our public mental health system. Hopefully you’ll
have a chance to reflect and discuss amongst yourselves afterwards and carry this forward.
I’m going to give these principles and these tasks so you can reflect and discuss on them.
I’m going to talk about eight principles and the accompanying tasks that go with those
eight principles. I want to tell you the origin of where we came up with these eight principles.
They’re not just out of my head, believe me. Since 1993, I’ve had the chance to observe
leaders. Purposely trying to watch leaders, what they’re doing, what principles, actions,
etc. they are using. Also, who’s reading the literature in the for profit sector, which
I told you. And then I selected leaders to interview. I selected leaders to interview
and taped their interviews. I did this based on what followers were saying about them,
what their bosses were saying them, what their peers were saying about them in terms of their
own abilities to transform a system. Where they effectively trying to transform their
particular organization? Then I identified about ten principles and then I sent these
principles to these leaders and said, ‘I want you to comment on these principles. Comment
on several of the principles which you think are most important, add some principles and
give some examples on how your leadership was guided by these principles.’ I taped those
interviews and listened to the tapes and, not transcribed them, but certainly picked
out the major points that the leaders are making; some quotes and examples. Right now I settled on eight principles based
on their comments. We eliminated some, added some others, etc. Based on the comments, so
far, (I say so far because we are continuing this effort) so far, we’ve eight principles
and accompanying tasks as delineated by public mental health leaders. We’re going to focus
on those eight principles now, the goal being to just familiarize yourselves with some of
the principles and tasks so that you can later discuss or comment on them. The strategy is
to review each principle and talk about a particular leader and how they are guided
by some of these principles and some of the tasks they talked about in the interviews. One thing I have to do when I talk about these
leaders and how they are examples of these particular principles, I have to stick closely
to my notes. I said to them, in order to get them to go on tape, I said I would use their
names, but I wouldn’t misrepresent them and I wouldn’t misquote them. Because this is
on tape, I want to make sure I don’t do that. So, I’m going to stick closely to my notes,
which have quotes in them and describe the system and organization. Principle 1 – Leaders Communicate A Shared
Vision Almost all leaders I interviewed talked about
this particular principle. I’m going to pull a couple of them just to give examples. The
first one I want to give is Len Stein. Now many of you in the mental health field are
aware of Len Stein. He’s an excellent example of this transformational leadership principle.
Dr. Stein is considered by many to be the father of community treatment. He and his
colleagues are best known for creating, originating, research what has come to be known as the
ACT Program for mental health, which is being replicated all across the country, maybe all
across the world. Less well-known is Les’s breadth and passion that guided him. What
guided him was that he was convinced in the late 1970s, that treating people with severe
mental illnesses in the community could not only bypass the side-effects of institutionalization,
but could open up opportunities for learning and personal growth that a hospital setting
couldn’t provide. What Len and his colleagues did was to take
an entire hospital ward, its staff and patients, out into the community. They treated people
with very severe mental illnesses in the community and they were not then, referred to the hospital
ward, they were referred to the community. They were referred to this kind of ‘hospital
without walls’ within the community. As Len said, at the time if there had been any events
like a suicide or a homicide, certainly the program would have closed and Len’s reputation
would have been closed out too. Fortunately, that didn’t happen and this program has been
replicated in a number of places. I want to give you an anecdote of that indicates
how passionately Len believed in this vision of treating people in the community. Once
people began receiving services in the community, Len maintained that they must be able to contact
their providers quickly, remember that their providers were part of the community too,
they were in the hospital wards. Accordingly, he asked all the therapists to make their
phone numbers available to people living in the community. Their refusal resulted in Len
giving therapists a choice; either turn in their phone numbers or turn in their resignation.
It isn’t a choice when you think about it. I think this anecdote is an indication how
strongly a vision, the vision of community treatment at the time, can guide one’s actions
and was a key moment in the transformational process for Len. If you look at the actions,
the tasks, under the eight principles of leadership in your handout, I would say Len, in the second
one (I really should number these, I used bullets). The leader constantly communicates
the vision. In Len’s talk, the points he was making, as we continued the talk in the tape,
he was making the point that the leader’s able to persuade others of the potency of
the vision. You can see he used some strong ways to persuade others, including losing
your job, which is a fairly strong way to get your mind made up. The leader uses the
vision to shape the future. These are things that came out of my discussion with Len and
added to these principles. More on this particular principle, I want
to talk about Kim Ingram. When I interviewed Kim she was the director of the Thomas Fiddle
Mental Health Rehabilitation Center. It was a fancy name for the state hospital in Thomasville,
Alabama. The organization had recently converted their program into a rehabilitation-type of
hospital. It was first accredited by the Joint Commission four years before I interviewed
her. The year before I interviewed her, she said they were accredited with commendation.
They had improved their yearly discharges over a four year period from 54 to 105 to
150 to 171, respectively. When I visited there was a lot of exciting
things going on in Thomasville. Kim talked about some of these principles and particularly
principle one. She used her vision to shape the programs they were creating and eliminating.
The vision guided what the institution wanted to become. Initially, when she and the groups
spent time articulating the values and vision of the organization Kim did not think it would
be particularly useful. As she says, quote, ‘I’ve been proven wrong on a daily basis.’
Now she thinks that defining the vision and values is one of the most critical things
that the staff can do. She says, ‘This guides everything that we
have done. It allows us to make decisions. Everything we do from buying equipment, to
hiring staff, to programming is made relevant to the vision and the mission. When we’re
making decisions, we ask constantly, ‘Is this the key thing that moves us toward accomplishing
the mission.” They have to live the vision, according to them. She uses the vision to
check to see if their actions align with the vision. ‘She cannot say one thing and do something
differently.’ As they were transitioning from what she called, ‘a tightly controlled, highly
structured, custodial type of organization,’ that would be one in the twentieth century
without any recovery vision, ‘to a rehabilitation focused organization, they struggled with
the way in their old lexicon to control patients.’ For example, she gives us an example, they
had a levels program, which, essentially, there are patients that get privileges based
on their behavior. The staff would define what behavior they wanted, patients would
perform that good behavior and they would get privileges, increasing privileges the
better their behavior. She realized that this was a staff vision and not the vision of the
service recipients. It was in this system that was inconsistent with the notion of self-determination
and the levels program was ended. This was a program that they felt very good about at
one time. The levels program winded up with division and said it wasn’t working; it wasn’t
relevant to the vision. Kim, in terms of principle one, I think, the vision of the leader is
shared, as much as she didn’t like them initially and about half way down where it says, ‘The
leader identifies the relevance of the vision to the organization’s consumers.’ She made
sure she involved the consumers in the particular vision. One more in principle one and that is Cynthia
Barker. Cynthia Barker was recovering from the symptoms of mental illness while she continued
to advocate services for people with severe mental illnesses. When she was interviewed,
she directed Project Phoenix, what she calls Mobile Drop-In Center, which takes people
by vans from whatever location to places in the community where they which to go. This
project uses a van and others use their own transportation resources to attend the events.
This was what Cynthia was very concerned about; there was no drop-in center, per say, they
would drop in the community. Any community activities that they would choose to go to,
there was no drop-in center. It was there that I saw the first mobile drop-in center.
As a matter of fact, when I was there, that morning Cynthia said, ‘Why don’t you come
out to lunch with us?’ I agreed and we went out to a restaurant for lunch and there were
30 consumers there, dropping in. So that’s how they were so efficient at doing this. But, this was her vision to use community
activities and settings in as normal a way as possible. She repeatedly reminded the folks
that the program’s
van must look like a passenger van and not an agency van. She refused to use the mental
health center’s 15-passenger white van. Instead the grant she wrote was to fund a 7-passenger
minivan, that she made sure was painted burgundy that was important. She was vigilant in insuring
that potency of the vision in not letting the program slip into segregated activities.
The minivan would pull up and people would get out, just like a family. She leads a life
compatible with that vision; she decided to give up her disability check. But, if we look
at the first principle of leadership I think you could say Cyndi, if you look at the second
point, ‘The leader constantly communicates the vision.’ Over and over she kept saying
they weren’t going to end up looking like a group of psychiatric patients going to an
event at a drop-in center. We’re going to use the community. The next point, ‘The leader
clearly communicates the vision.’ She certainly did that. And down near the bottom, ‘The leader
lives a life compatible with the vision.’ She certainly did that as well. So, there
are some examples of leaders who are trying to live by this particular principle and picked
this principle out. Remember, I gave them just these principles, I didn’t give them
any of the accompanying tasks, I just gave them the principle. A number of leaders commented
on that first principle. Let’s turn to the second principle, ‘Leaders
centralize by missions and decentralize by operations.’ The person I want to use as the
example here is Richard Surls and he was, perhaps, one of the most visible city and
state mental health directors from the late 1970s all the way to the early 1990s. I interviewed
Richard just after he left his position as Commissioner of Mental Health in the state
of New York, prior to that he had directed mental health services in Vermont and Philadelphia.
In each setting he brought direction and energy to the mental health organization. When Richard
came in as your new commissioner, director and you’re in the organization, you knew that
thing were about to change. He talked about a number of these principles.
I wanted to use him as an example of principle two, ‘Leaders centralize by mission and decentralize
by operations.’ Richard’s take on principle two, when he talked about how he used it,
included giving responsibility to operational staff to try new initiatives. And his direction
to them was this, ‘I’ll support you as long as you are right.’ As he described it, what
he was saying was, that he wasn’t going to tell them exactly what to do, but it has to
be consistent with the mission. So, people had a lot of flexibility to do certain things
as long as they were consistent with the mission. This paralyzed some people because they’re
used to having a little more detail. Some of them wanted to be told exactly how to do
it, but this was the way he tried to run his particular organization. If you look at principle
two, some of the tasks under there, the first one, ‘The leader uses the mission to focus
the entire organization and how the organization can benefit its consumers.’ That was the focus
he constantly talked about the mission and focused his leadership on it. Skipping down one, ‘The leader gives responsibility
and authority to the operational staff.’ He did that and some of them didn’t like, but
apparently, the majority of them did. The next one, ‘The leader encourages staff to
process relevant information themselves.’ They get the information, they know the mission,
they do the operation. Skipping down a couple more, ‘The leader manages at more macro than
a micro level.’ This certainly wasn’t micro-management; some people may do better in that, the effective
leaders I talked to seemed to be managing more at a macro-level than a micro-level.
The second from the bottom, ‘The leader insures his staff understands that all operations
outcomes are critical to the organization’s mission.’ Everyone in the organization knew
their particular operation had to line up with the mission. Principle three, ‘Leaders create an organizational
culture that identifies and tries to live by key values.’ In the interests of time,
I’m going to go back to Kim. I have so much material here, I’m going back to Kim Ingram
so I don’t have to repeat her background again. Kim (Director of Thomasville State Hospital)
said they were guided by three key values for both residents and staff. These values
were choice, empowerment, feeling successful and satisfied; those were their key values
around which everything revolved. As these values were put forward, some staff left because
they were in disagreement with the values. Choices had been a very difficult value to
implement in the new patient facility, but nevertheless it did anchor their decision
making. Getting all staff to believe that people were capable of choices for themselves
was very difficult. Kim told a story of a voluntary patient who
wanted to leave on foot on a Sunday and hitchhike to Mobile and then on to Georgia. Kim called
in the clinical director to speak with the patient, but of course, the patient was a
volunteer patient who was doing quite well and he was judged not to meet the criteria
for involuntary commitment. So, consistent with this self-determination value, the patient
was not prevented from leaving. They talked to him about not leaving, about waiting until
Monday. They talked to him about getting some help from them, but the patient didn’t want
any of that. He left and he returned the same day. Kim stated that he is now working even
harder on his rehabilitation plans and his eventual recovery. She quotes the patient
as saying, ‘I made a bad choice,’ but he made a choice. They lived with that particular
value. If you look at some of the tasks that Kim related to that value, the leader is clear
about what values influence the organization’s decision-making. Next one, ‘The leader uses the organizations
values as anchors and guidelines for decisions.’ Skip down one, ‘The leader acknowledges when
organizational values conflict.’
Self-determination and choice sometimes conflicts with other values. ‘The leader insures that
the organization’s values are the same for everyone in the organization, regardless of
role.’ It makes not difference between patients and staff. Principle four, ‘Leaders create an organizational
structure that empowers their employees.’ Bob Williams is a good example of this. Some
of you I know are listening on the web right now know Bob. Bob was interviewed when he
was the Superintendent of Florida’s State Hospital. He and his staff had instituted
a person-centered rehabilitation program, ‘To enable persons who have experience persistent
mental illness, to manage their systems and help them acquire the skills and supports
necessary to return to the community and be successful and satisfied in an environment
of their choice.’ That was their vision. But with respect to principle four, Bob said
that he saw staff as assets, as a resource to empower. When he arrived he developed a
list of 50 people within the organization that had significant leadership potential,
but were not typically in leadership positions at that time. Bob went to this list when physicians
opened up, ‘We didn’t get too hung up on credentials.’ In essence, he looked at certain characteristics
of people, such as their ability to relate to residents as individuals, a willingness
to work hard and a desire to lead. He mentions again, ‘Their degree was one of the least
important criteria.’ It was this group that Bob invested all of his training resources.
He told them, ‘I told them up front they were the critical ingredients if the program was
going to be successful. They had my personal support.’ He estimated at least three quarters
of them did very well. If you look at principle four in terms of some of the things that Bob
mentioned to me, the leaders see staff as investments and assets rather than costs. The next one, ‘The leader delegates power
and authority to employees.’ Skipping down a couple, ‘The leader recognizes staff who
are acting in an empowered way.’ Next one, ‘The leader encourages staff to start their
own opportunities, to stretch.’ ‘The leader eliminates organizational tradition that limits
empowerment.’ Of course he mentions several times over, credentials. Many looked at them
as an impediment getting into particular leadership positions. Five, Six, Seven and Eight. Principle five,
‘Leaders believe that human technology can translate vision into reality.’ By human technology
I mean the techniques and strategies that sciences show help people to change. Dennis
Rice in Massachusetts, Director of Alternatives Unlimited, was a great example of this. He
ran a residential education and vocational program for people with serious mental illnesses
and also people with mental retardation. Dennis was one of the leaders who was most serious
about training people in human technology. They were struggling early on, they had youth
therapy and that type of intervention group. This was not working according to Dennis.
So, they recommitted themselves to training people skills and strategies and techniques.
Not in knowledge, but in skills and techniques. He hired three full-time trainers which most
organizations his size don’t have. And then he felt that he could take any innovation
that came down the pike and train people on it because they knew how to train in order
to translate this innovative concepts into skills. ‘We integrated and reprioritized our
training effort for staff and service recipients. Staff meetings became study groups, house
meetings could then include skill teaching.’ Dennis certainly had created an organizational
culture that recognized the value of human technology. He believed that staff training
must focus on skills as much as facts and concepts and he insured that the organization’s
training plan was linked to the organization’s mission. So often leaders have this training
program and mission that don’t relate; they are usually training people on concepts they
find interesting, but that don’t really relate to the mission. He’s a good example of principle
five. In the interests of time, I’m going to use him for principle six so I don’t have
to describe Dennis again. Principle six, ‘Leaders relate, constructively,
to employees.’ Dennis believed you couldn’t communicate enough. Listening to people about
their issues was a critical part of communication. He said, ‘The leader communicates, communicates,
communicates. You can’t communicate enough and, frankly, I find this very annoying. The
patience one has to have to communicate the vision, values, mission is a full-time job
even though the leader has other things to do.’ He mentioned that the leader is constantly
communicating this big picture, while the staff talks about the details, the nitty-gritty.
He constantly had to connect the big picture to the nitty-gritty. He says, ‘We believe
that the quality of an organization is reflected in the importance it places in all of its
members and this includes the staff. The staff needs to be successful if the clients are
going to be successful.’ We’re all the way up to principle seven and
you are bearing with me well. Principle seven, ‘Leaders access and use information to make
change a constant ingredient of the organization.’ Pam Wolmack is a great example of that. I
visited Pam’s agency. She was interviewed when she was the executive director of the
Mental Health Cooperative, which was a case management operative in Nashville, Tennessee.
At that time the agency provided case management, clinic services, crisis intervention services,
there was 840 people in using case management (over which 1300 used the clinic services),
the crisis intervention services was a mobile crisis service and that was used by everyone
in the county. They had over 170 staff, 70 case managers, 5 physicians, 5 nurses, etc. Pam pegged principle seven as one of the principles
that made the most sense to her. She said the old adage, ‘When you are through changing,
you are through,’ applies to her. Pam sees information as the organization’s capital
that makes the change more effective. The organization data comes from what people say
is needed, or descriptions of data that the agency collects. She says data as coming from
the consumer or coming from the database. They have key monitors that they monitor weekly.
For example, they look at how many minutes a case manager is in face-to-face contact
with consumers, they look at hospitalization rates, where they’re living, the medications
they’re taking, etc. They collect and collect information in this particular agency and
they make changes on it. They find that some teams have too many difficult clients and
they change that, they find some teams are underperforming in terms of their face-to-face
time and they found that they needed to use their computer center in a better way. Another example from Pam is that they had
a hospital and they found that people were not using it. They didn’t want to go to the
hospital
if they could avoid it, meaning they didn’t like the emergency service. Also, the data
they were collecting showed that people who did use the hospital were just there for two
days. So they didn’t seem like they really needed the hospital. So they developed a respite
program using local hotels. They would get a hotel and the person would stay there during
the time of crisis with the consumer who would provide support and assistance. As Pam puts
it, ‘Our whole goal is to remove any barrier the consumer has to getting services here
or to live their life. ‘Is this a barrier or a help,’ we ask. We just start lopping
off the barriers.’ Pam used the information to frame problems in a new, unique way. It
wasn’t, ‘How do we get them to use the hospital better,’ but ‘Let’s come up with a new program.
Come up with one in terms of the needs of the client, not the needs of the hospital.’ Further down on the same principle, ‘The leader
uses information to anticipate the future,’ and ‘The leader thrives on change.’ Nobody
does that more than Pam. She initiates change rather than manages change. She recognized
that maintaining the status quo actually moved the organization backward. She recognized
that when you’re doing things well, it’s time to do more things. At the bottom, ‘While the
leader knows that planning for change is good, the leader’s plans may not always be appropriate.’
She was always changing her plans. All right the last principle, (I’m going to
use Bob Williams here) ‘Leaders build an organization out of exemplary performers.’ Particularly
around the last comment here, ‘The leader publicly recognizes the outstanding contributions
of exemplars in the organization.’ Bob identified a number of exemplars, but I won’t get into
them now. He had a culture that recognized people’s accomplishments and appreciate them
so. When you walk down the hall with Bob, ‘Here’s Joe Such and such. He’s developed
such and such, he’s doing a great job.’ He’s constant. I was at a dinner with him and he
brought in the catering staff for a round of applause. He was constantly building exemplars
as well as recognizing exemplars. I’ve gone through the eight principles, but
just a summary reflection for me on these principles. In all the principles many of
these people differ greatly. Obviously they differ in gender, age, credentials, things
like that, but they also differ in personality. They differ in terms of how charismatic they
are; some are, some aren’t. But charisma wasn’t the issue here. They were similar in commitment
to certain principles of leadership, what I call ‘The Developing Science of Leadership.’
I’ll conclude with a caveat here. A quote from myself, ‘Leadership remains an art as
well as a science. Some of the tools of leadership are not simply the tools of science, some
are the tools of the self.’ I thank you very much and I am going to open it up for questions.
If anybody has any questions in the audience, we’ll try a couple of questions.>>Man: The one thing I’m wondering about
is when change did not go well. It sounds as though change is something we definitely
want to strive for, but it does not always go well. I was wondering if any of the leaders
that you spoke to changed or learned from a change that did not go as they hoped it
would.>>I think Pam Wolmack gave a number of examples
when she tried something and it didn’t seem to work and she would go back quickly because
they were collecting data. I think the key is that they were collecting data from their
collection system as well as from the consumers. As soon as they saw it wasn’t working, they
went back to the drawing board and tried to come up with something else. But it’s a good
point, there were a number of time when your plans just don’t work and an allegiance to
plans is not always a good thing if you’re about change.>>Woman #1: There’s this school of thought
that suggests that leaders who stay in a position for more than three years become stale and
ineffective. What’s your response to that?>>I don’t think so. I think leaders can grow,
if they’re trying new things and building new programs. Some leaders try the same thing
over and over again. These were not the leaders that I were recommended to meet. Really those
were the leaders who were trying to transform their organization, so it wasn’t like they
were continually just managing or leading program Y and that was it. I think the key
again was the change and the effort to constantly trying to build a new organization and not
just living with the status quo. Nobody said they had a great organization. It was always,
‘What more can we do?’>>Woman #2: Do you think that there’s much
of a difference in the kind of leaders in an organization depending on where the organization
is? For example, a new fledgling program or organization that just started versus one
that [has been established.] It seems like your focus has been on transformation and
change. Do you have any comments on that?>>That’s interesting. I did, and I wasn’t
able to give the examples on that, but I did meet with a lot of organizations that were
just brand new and developing. The principles seem to be the same. They picked from the
list of ten or twelve and didn’t seem to have any trouble or be different from the other
leaders. One leader I didn’t talk about that I interviewed was Mike Hogan, who came in
to a situation where the vision was already there, the organization was there, they were
going on a path that was very transformational, it was up to him to maintain it. Yet many
of the same principle and tasks remained the same. I think I’m getting the sign that the comment
period is over. I just want to thank you folks; the ones that came, the folks that are watching
live, and lastly, the folks that are watching the archive of this webcast. Good luck in
your leadership. It is an exciting area to study and think about and discover. We certainly
need better leaders in this century because the system we have right now needs to be totally
transformed. Thank you very much.

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