Most people have good intentions, especially in health care. Caregivers and leaders both want to do what is best for their patients. However, in high-intensity settings, leaders often don’t stop to think about the impact of actions they use to achieve their good intentions.
I’ll use the emergency department as an example, because in this environment things can go from calm to chaotic in seconds. ED physicians and nurses striving to give timely, efficient service to patients are often at the mercy of other departments, such as the laboratory and radiology.
If you are the medical director of the ED, you must be able to work effectively with the head of radiology. During the day, when radiology is staffed, you may not be allowed to read your own X-rays and then suddenly, when radiology signs out at 5:00 p.m., you magically become qualified. So even though the people in radiology and the ED all have good intentions of providing quality health care, they also have their own agendas and issues. Often, money and pressure to perform financially are the real culprits.
Interaction between radiology and the ED is an example of a frustration source that can create a gulf between the intentions and the impact of leaders. Blowups can happen between leaders or staff of departments at these flashpoints, and the impact can be detrimental to the overall organization goal of quality care for the patient.
After such a blowup, a leader needs to have a reflective internal conversation over four points-the issue from the leader’s perspective, the issue from the other side’s perspective, the leader’s intentions, and the impact of the actions that were taken to achieve those intentions.
Leaders need to look at what happened first from their own perspectives. They should ask themselves, “What really happened here?” The answer might be, “We were inundated with patients, and radiology was taking more than an hour to read X-rays, so we couldn’t move the patients.”
The next portion of this conversation is, “What is their story?” The other side might say, “We want to do a good job and be thorough because we know how mistakes happen.”
Then the conversation goes to, “What were my intentions?” The leader might say, “My intention in telling this person, ‘Get your butt down here right now and help me out’ was to improve the level of patient care at the time.” However, regardless of good intentions, the impact of that action was to anger the other individual, which is often detrimental.
The next time the same issues again are coming to a head, that emergency department leader needs to have that conversation, but in the present and future tense. “What are my intentions, and what will be the impact of my actions?”
Recognized best practices in avoiding wrong-site, wrong-person surgery, include having the surgical team take a “time out” before the surgery to discuss what they are trying to accomplish and how they intend to accomplish it-intentions and impact. Leaders also need to take that “time out,” but internally. They have to slow down and take advantage of that moment of thought and reason to get things moving faster later.
Soliciting honest feedback from people around them-including supervisors, peers, and direct reports-can help leaders create a balance between intentions and impact. These 360-degree surveys assess the leader’s behavior on the job against a set of competencies required for success. The resulting multiple responses, including the self-assessment, provide valuable insight and feedback on how others view the leader’s actual performance.
Various personal styles and how those styles are communicated can cause a clash of perceptions. In one case, the perception of the people around one executive I worked with was that he was far too demanding. His self-perception, however, was that he was decisive. The client, after taking the widely-used Myers-Briggs Type Indicator assessment, turns out to be an ENTJ-a common type among organizational leaders.
I informed the client that an ENTJ can often be perceived as demanding, and yet these people are very logical, intuitive and decisive, and most of the time they do have the right answers. However, it’s the way they communicate that totally shuts everything down. Their intention is to get things moving, make a decision and get on with it. The impact is often that they’re perceived as arrogant and demanding.
Consider stepping back and soliciting 360-degree feedback. We can’t read minds or tell the future, so we can’t always know what impact our actions will have, no matter how good our intentions. However, a little “time out” taken to reflect on our intentions and how we plan to bring them about can have a positive impact on our workplaces and leadership effectiveness.