Leadership surveys @ TedBall.com over the past year reveal that both governance and managerial leaders seem to feel a sense of “pending chaos” about Ontario’s health system transformation. The first question people ask is: do the bosses really know what they are doing?

What we need most from our governance and managerial leaders in these uncertain times is resilience, confidence and optimism. I hope you find that most of my blogs try to model that — while telling most of the “whole truth”.

In Positive Organizational Scholarship, Sutcliffe and Vogus define resilience as “the ability to flourish and thrive amid adverse conditions when rigidity might be expected.” What we know from their research is that organizations with positive work relationships are more resilient – recovering more quickly from external threats and internal implosions. However, while positive relationships are a key to success, the research tells us that to succeed in a transformation, there must be alignment at the top.

The Balanced Scorecard Collaborative who have studied best practices since the early 1990’s say that the most common reason for strategy execution failure is a “lack of commitment/ alignment at the top” – that is, among the executive leadership of the organization; or, in the case of a Health Link, it would be the CEOs and senior staff of the partners. In the healthcare sector, this also requires the leadership to shift from reactive “crisis management”, to proactive strategy development, and to strategy implementation/strategy execution.

How can a CEO create such a fundamental shift in the thinking and behavior of their top management? How can middle managers “add-value” to those who actually delivery the services? Professional leadership coaches and change management scholars would emphatically say that it must start with a commitment by the CEO to model “change” and “learning” themselves.

Experience tells us that when a Board is encouraging their CEO to find innovative solutions, success rates skyrocket. When CEOs and managers tap into the collective intelligence of their organizations, there is a surge of innovative solutions to long-standing problems.

Brain research over the past few years has produced critically important information for people whose function is to provide leadership. We now know that the moment our brain registers ambiguity or confusion, it alters the chemicals in the part of our brain called the anterior cingulated cortex and makes us crave certainty.

David Rock in “Managing with the Brain in Mind” tells us that “not knowing what will happen next can be profoundly debilitating because it requires extra neural energy. This diminishes memory and undermines performance.” However, the key information for CEO’s and their change journey design team is that according to the research “mild uncertainty attracts interest and attention.” He points out that “new and challenging situations create a mild threat response, increasing levels of adrenalin and dopamine just enough to spark curiosity and energize people to solve problems.”

In my experience, leaders who create the perception that success is attainable — within the chaos — because the organization is smart and capable — always succeed. Also showing long-range plans (like an 18-36 month Transformation Journey Map, or a strategy execution process like the Strategy Management System’s 8-box model) tends to calm people because they then sense that there is actually a real commitment to the transformation process. In the past, many people have experienced hopeful boasts by their CEO, by the LHIN, or by the Minister — but then nothing much happened.

David Rock says “although it’s highly unlikely everything will go as planned, people function better because the project now seems less ambiguous.” However, it is about getting the right balance between ambiguity and certainty. In their study of how Japanese companies create the dynamics of innovation, Nonaka and Takeuchi say “ambiguity can prove useful at times as a source of a sense of alternate meanings and a fresh way of thinking about things.” They say: “new knowledge is born out of chaos.”

As in the balanced scorecard strategy development process, or in the patient experience design storyboarding process, or in the Health Link development process, organizational knowledge creation is a continuous and dynamic interaction between tacit and explicit knowledge.

We talk about the “Learning Organization” approach being top-down & bottom-up. However, in the full real-world roll-out, the process is very much a middle-up-down-sideways process.

The strategic decision to become a Learning Organization, or for a Health Link Partnership Group  to become an Intentional Learning Community, means that CEOs need to learn how they can lead and manage such an evolved and inter-connected organization. This can be a very different style of management than the current norm in the healthcare sector. CEOs who want to have a more leveraged impact need to learn more about how they can be developmental coaches and learning facilitators. They need to determine how they will personally model leaning, growth and change during the transformation journey.

Old ideas about “bosses” won’t work in our context. Today we need CEOs to be teachers, facilitators and role models. When everyone understands that the leaders are deeply committed to the struggle to become a “learning organization” that learns from its “best mistakes”, people always become less anxious, more open to exploring change… more open to learning.

That often means “learning-how-to-learn”. It requires an understanding of adult learning methodologies/ learning styles, and developing their own capacity to be developmental facilitators and coaches to others. So here, once again, is the need for a balanced perspective between a journey that is designed to support the development of all these essential “soft” skills – while putting in place the rigorous systems, structures and processes that will enable the organization to achieve these bottom-line results.

CEO’s and senior teams that are pathologically focused on the bottom-line results — but fail to address the “soft-side” to mobilize the humans — will fail, every time. However, some will continue to thrive on the basis of results-oriented language that is supported, at best, with incremental gains. All of the literature in this area indicates the critical importance of “the leader” in these major transformation efforts.

While external coaches and facilitators and internal senior managers and facilitators can very often “add value” to such a process, it is essential that the transformation process be led by the CEO. Others can help, but unless the CEO leads it, the gains will only be incremental, the pace will be very slow, and the changes are not likely to be sustainable.

The challenge for senior managers is how they will change their relationships with their direct reports. How do you stop being a “boss”, and start being a coach, guide, mentor and learning facilitator?

“Oooh! The soft, mushy, human stuff and the ‘vision thing’ again,” the cynics will say. But while many of our best performing healthcare organizations do have some fancy IT support, their transformation is succeeding because the people in the system think differently and act differently – in contrast to just “doing things differently”, but “thinking the same way.” What is most common among the top performing healthcare organizations is that they are transforming towards the learning organization model of staff empowerment and continuous improvement.

Organizations that produce superior results with Balanced Scorecards, best practice Accountability Agreements, and collective intelligence tools like Kaizen and Storyboarding, are those where the middle managers have transformed themselves from command and control in organizational silos, to a new emphasis on developmental facilitation for integrated, cross-functional high-performance teams. Gosh, even our Minister has transformed herself into a learning facilitator — instead of just being ministerial, and “announcing” her thoughts she comes to Longwood’s Breakfast with the Chiefs Program and facilitates.

This new skill for developmental facilitation is different from basic facilitation. However, experience tells us that middle managers will not transform until and unless their bosses have authentically transformed as well – and are themselves modeling the thinking and behavior that middle managers are expected to exhibit for front-line workers. The evidence tells us that the senior management team members behavior is the single most important factor that will drive change.

This is a major challenge for CEOs: how to develop the capacity of their senior and middle managers to be highly strategic and capable of leading and managing others through a transformative learning experience. While IDEAS from Utah may provide a few more tools, CEOs can’t contract out their role as teacher/knowledge facilitator to Queen’s Park. From the CEO’s perspective, since their own personal success is completely dependent upon the success of each of their direct reports, they clearly have a major stake in seeing that each of their senior managers will be successful at achieving the outcomes for which they are accountable.

After all, when the CEO’s direct reports are successful at achieving their outcomes, the CEO is, by definition, successful. And, when the CEO is successful at achieving a balance of outcomes – everybody wins. Does that sound like a place you would like to work?