As we defined in our previous session, an adaptive leader is able to bring about meaningful and continual change in the face of uncertainty. Also we noted that change creates winners and losers. The danger arises because losers are usual in power and favor the status quo. And loss creates emotional stress or a disequilibrium. And most people naturally strive to reduce their emotional stress. Adaptive change can be thought of like a combustible engine. In order to generate force for movement there must be heat to expand the cylinder, drive the piston and move the automobile. With meaningful change there must be emotional stress or disequilibrium, the equivalent of engine heat. The cooling system controls the combustible engine heat and the adaptive leader controls disequilibrium. Here is a typical graph of the disequilibrium associated with an adaptive change. The grey area represents the productive zone of disequilibrium. If there is too much discord, the whole system can self-destruct. The upper limit of disequilibrium is called the threshold of tolerance. When disequilibrium is too low, it is unlikely that there is significant change going on. Therefore the experienced adaptive leader needs to learn how to maintain the conditions for change in the productive zone. As the two arrows show, there are two ways people try to reduce their disequilibrium. First they can discredit the adaptive leader by attacking his reputation or mischaracterizing his leadership in a negative way. By discrediting the leader of change, they can dramatically slow down or even prevent the adoption of a new way of doing things, reducing disequilibrium, note how the line drops down to zero. Second, they can claim to not have the time or energy to implement the new program. If there is no change, there is no disequilibrium. Both the adaptive leader and those who supervise the adaptive leader must be aware of these common tactics and manage them. Rather than focusing on personality or procrastination, leaders should focus on the ultimate goal and how achieving that goal will improve patient care. If the adaptive leader can appropriately manage disequilibrium, over the time, the new approach will become accepted and become the new status quo. And disequilibrium will dissipate to zero. The potential dangers depicted by the disequilibrium graph warn anyone who is considering leading an adaptive change to be sure to inform your superiors before implementing your change. Support from your superiors is a must. Warn them about the productive disequilibrium. Without their full support and understanding don't implement the change. Work with an improvement team, not alone. This will leave you far less vulnerable to attack. Use campaign methods whenever possible, and this will be the subject of our next class. To control disequilibrium ask guiding questions to increase understanding. Whenever possible have those who will be affected plan the change. Listen and show empathy, more about this later. Be aware of different factions and adjust your message to address what each group needs. For example, a rounding program was framed for nurses as a way to improve respect by, and communication with physicians. For physicians, it was framed as a way to save time, and for medical students as an approach that would improve teaching. Be patient, deliberate, and persistent. Remember Aesop's Fable of the race between the tortoise and the hare, shown on the left. The steady and focused tortoise, won the race over the impatient, and distracted hare. I have to remember this fable quite often. I've discovered a useful analogy when it comes to being an adaptive leader. Think of yourself as a beekeeper who is trying to harvest honey. Abrupt and sudden movements will get you stung, but slow, deliberate movements will allow you to harvest the honey from the beehive without being hurt. A little smoke, in other words, careful, empathetic listening to calm the bees, also helps. When trying to implement innovative change, it is important to keep in mind Roger's innovative diffusion curve. He discovered that in every population, there are five significant factions. And when it comes to the adoption of innovation, you want to focus on the first three. The innovators, the early adopters and the early majority. Whenever possible avoid the last two factions. The late majority and the laggards. When trying to implement an improvement reward the innovators and the early adapters and early majority. Whenever possible recruit them to the pilot program to ensure its success. Avoid those in the late majority and laggards because they will resist and slow implementation. These groups will only cooperate when a new way of doing things has been exhaustively proven to be a benefit, and then it must be mandated. There are a number of pitfalls or traps that adaptive leaders should avoid. Don't lose perspective. Single-mindedness can backfire. Be open to modifications in tactics. Opposing voices should be regarded like canaries in a coal mine and warn of danger. These opposing concerns need to be addressed. Don't become self-righteous. If you become too self-righteous, you can take away ownership from others helping to implement the change. Always pull those into the improvement project by persuasion. Don't become the chief purpose officer, restrain from continually reminding others of the goal. People will develop purpose fatigue and they will avoid you, and the project. Don't become a martyr. Avoid excessive disequilibrium, which can result in the loss of your position as a leader. Whenever possible, you want to inspire those you are leading. When giving presentations, vary your voice's volume and tone and vary the pace of your speech. Embrace emotions and show your feelings. Too often in healthcare, we ignore the emotions associated with illness and injury. But without emotions, there would be no sense of urgency that we all need to feel. Listen from the heart. By that I mean, listen with compassion and curiosity. Huge reflective statements such as, that must have been hard, I feel your pain. We will talk more about the importance of emotions and personal narrative next week. I hope after listening to my discussion of adaptive leadership, you now agree that without adaptive leaders, there will be no change. And the pain and suffering associated with preventable errors, as well as the excessive cost and inefficiencies associated with modern healthcare will continue. And I want you to be an adaptive leader. Thank you.