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Describe the leadership style in an organization in which you were a member. How would you characterize the leadership style? Did it work?
Radiology at Beebe was theory X for my first 10 years. Techs and support staff did what they were told and did not deviate from protocol.
The last 8 years have progressed to theory Y. They collect data on employees and sometimes use it for improvement and usually use it to deny or minimize raises at annual evaluations.
Ouichi’s Theory Z with workplace empowerment is still far away.
I believe that as a leader, I have to be able to sense which leadership style a caregiver needs. Co workers without much intelligence can function in a theory x world and at least have a job. People that want to work, do well in a theory y world. People that want to work and can think, do well in a theory z world. Unfortunately we are not in a one size fits all world.
As instructor maybe I should be the first to reply. In the OR, my leadership style was very authoritarian. I was very nice and respectful, and all the OR crew liked me a lot. Still, I had a what may be called, a nice my way or the highway approach. In a self assessment it was pretty Theory X. Problem was, I had one case when I was in the Army of a retained sponge. The OR nurse did a double count and missed it twice. What part did my authoritarian leadership style have in maybe preventing her from speaking up if she was even a little unsure?
The goal of most hospital mangers is to keep their job and their income. This means maximizing hospital revenues.
The goal of the patient is to get as healthy as possible as soon as possible.
These two goals are rarely aligned.
As a physician, my duty is to the patient first and to the hospital second.
How do I lead a dysfunctional organization that does not want to be lead?
You have hit the nail on the head. The very first thing I would do is initiate a practice improvement program. You do not need management to do this. You begin with a small project, small team, do something easy yet meaningful and when you realize improvement, make sure your results are seen by all. The methodology for this will come in session 3 of this program. Your colleagues will be attracted to success and the program will grow. That is something that will directly affect patients and align well with your mission. At the same time I would demand that every meeting be conducted using proper meeting dynamics. Change the meetings from top down to democratic. Use proper business methodology as your backup, and if your managers are unaware of the proper way to run a meeting buy them the HBR pamphlets on “Running Meeting” and “Leading Teams”.
I have been in an organization that embraced Deming’s idea of Quality Leadership. Attempts were made to improve processes and involve all staff so as to enhance engagement and performance. However, the organizational structure negatively impacted the leadership activities as there was a siloed disconnect between the leadership team and the operations team. The result was frustration and a slower pace of change, as attempts for departmental improvement via staff input, autonomy and decision-making were partially thwarted by the operational bureaucracy. Thus, in this particular example, influence, communication and persistence, by the leadership team, were needed to continue to work towards the realization of the mission, vision and overall strategy. Leadership cannot occur in vacuum and in large organizations, the process is complex and challenging.
I think it important to put both X and Y into their historical perspective. Mr Ford lived in a time when elementary education was not very common which led to many of the practices of the time. But it also led to the union violence that reacted to the X way of doing things. Y arose when education was more common and helped greatly.
However, life continues and medical staffs are some of the most highly educated and the individual pusuits, “lack of social interactions” brought about by the electronic devices is about to turn the Y concepts in a signifacantly different direction.
Thus, the need for engagement. The future will find leaders must be able to draw out their folks encouraging them to be involved. Look at the falling numbers in professional societies and medical societies and the drift to away from “parent” organizations like the AMA toward very specific groups like the echocardiogram organization with small but interest-aligned specialists.
I think the Y era is ending in favor of the isolationist era. Open for debate…
Vince Carr
I think I must be doing something right. Although I at first thought my more
authoritarian, I think it is probably more of a hybrid of authoritarian and Theory Y.
I do give my employees a lot of say and input into things. I do seem to be
good at employee retention and have little turnover etc. I do solicit input etc and
reward with praise, etc as well as monetary. As a solo practitioner I think my
“authoritarian” bent is that I am ultimately the one on the hook for the majority of
the decisions..
Just to be a Devil’s advocate here I want to throw in this food for thought. There was a large scale “theory Y” experiment in history , The October revolution in the Russian Empire in 1917 ( that is when Soviet Union was created), because people wanted to make decisions and govern themselves, it worked for 10 -15 years, but then because of fatigue, or chaos, or to not having the skills , or simply wanting a strong leader , it produced Joseph Stalin who was one of the most autocratic leaders in history ,so make sure that you team is ready for theory Y, do not throw them into all the decision making, it is sort of like leadership a learned skill.
The fellowship training in thoracic surgery was a form of Theory X that I will term “individually authoritarian”. Each surgeon had a specific routine- which vessel was grafted first, where proximal anastomoses were placed on the aorta, where and how the suture was started and where it ended, how many knots were required, etc.. It was incumbent upon the fellow to learn each of these idiosyncrasies and pass it along to the incoming/upcoming fellows. Failure to do so was not an option.
I believe it was a successful system, One learned attention to detail, which was critical in these cases. One learned many ways to perform the same procedures. This allows you to have a Plan B/C should the case present an unusual condition. One also had the opportunity to use the “best” of each teacher to establish their own sequence and idiosyncrasies.
Thanks for the comment Ray.
I look at it like this. As a surgeon there is a best practice process. Eliminating variation in the process is essential to the best outcomes. Your team needs to stay on track and follow the process to the letter, and that is your observation.
Good leaders then examine the process in a theory Y manner. All of the participants feel empowered to add their thoughts about how the process could work better. Even suggest a practice improvement project and create data driven improvement. If the process changes as a result, it then is implemented and you’re elimination of variation from the new process continues.
Hopefully that makes sense.
I think Theory X is a easy fall back, the lazy way out and makes leaders feel in control- even if the ship is sinking. Theory Y requires a good bit of effort on the part of leadership- having a clear mission, being transparent and empowering your team. Not just lip service but actually valuing the opinions/implementing the ideas of those who know the process best. A great example of the better results with theory X vs Y comes from aviation safety. Korean pilots tend to have more accidents than American pilots because in the Korean aviation culture, questioning authority is scorned while it is invited/felt to be the norm in American aviation.
My fellowship was Theory X. It worked for the director. In hindsight, it discouraged questions (lack of acceptance to new technique etc.) and did little to foster self confidence in the fellow. Some fellow sought additional training as they left feeling unprepared.
I like the idea of theory Y. Everyone in the organization can engage and improve, strong team work. I might be wrong but theory X sounds like military order, at least from where I came from. No need for discussion, just follow orders. I don’t think they assume people are stupid though. Do I miss the point/off topic here or this does not apply ? But if I’m on the right track here, I guess we still have a place that needs theory X?? Can we find something in the middle between X and Y or we always have to choose one?
I agree it does sound like the military except when dealing with small units like the squad level of Marines and Navy SEALS, Quality Leadership is in full view. The members of those teams are given a general framework to accomplish a task and then they are left with the ability to plan and then alter the plan as they see fit. It is a, giving back control to the people carrying out the assignment, that is the core of modern leadership.
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