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The Cycle of Vulnerability. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 323
New Relationships. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 334
Complexity Communication. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 339
Collective Mindfulness. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 343
Is There a Choice? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 348
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 349
Contents vii
Transforming Work and the Transforming Worker. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 490
Evolution and Revolution. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 492
The Learning Organization. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 493
Organizing for Transformation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 497
Dealing with the Lack of Time. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 502
The Leader as Revolutionary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 505
Innovation Coaching. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 508
Making Integration Work. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 512
Addressing Problems Head On. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 516
Eliminating Firefighting Altogether . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 518
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 521
viii Contents
P R E F A C E
It is difficult for us to believe that we are on the fifth edition of this textbook. When we
first wrote this text, health care was on the verge of many shifts and transformations. After
years of preparing for major transformation in health care where now deeply inside of those
transformations moving speedily and inexorably toward a significantly reconfigured healthcare
delivery system. Even political transitions and changes cannot stop the inexorable shift in
the very foundations of health transformation as we move further into the digital age. As we
update this fifth edition, we are still surprised and pleased that much of what is included in this
text remains relevant and essential to both guiding and thriving in the emerging healthcare
milieu. Because of our dedication to ensuring that the most current and relevant information
is contained in this text, we have committed to updating its contents every 2 years. And we
have maintained that commitment, working diligently to assure the most current and relevant
insights related to “quantum leadership” are contained within in a way that helps prepare and
inform contemporary leaders. The peculiarity of books on leadership is that they can never be
truly finished or even “current.” Leadership is essentially a never-ending work in progress—
an endless journey with facets and elements that add up to a broad and complex mosaic.
Embedded in the leadership role is a host of behavioral, relational, interactional, and structural
considerations that give form to the activity of leading. Research in each of these areas could line
the shelves of libraries for generations. We submit that no one person could comprehend all that
has been said and written about leadership or all the actions that have been done in its name.
Furthermore, as the world changes, new notions of how to advance the work of
organizations and people emerge, new patterns of behavior develop, and these demand some
level of explication and understanding. In fact, just like other segments of society, health care is
going through the drama and trauma of reconceptualizing its work and priorities to take into
account the new global reality, sustainable health reform, value-driven care and new payment
models, and the most recent advances in therapeutics and clinical technology. These advances
are already bearing fruit and radically altering both the quantity and quality of life. And the
changes yet to come will have an even greater impact than did those that have already occurred.
We hope this fifth edition has kept up with the changes and reflects the best thinking on the state
of the art of contemporary leadership.
An example of this is the ever-increasing digitalization and mobility of health services and the
increasing availability and complexity of “big data” and its growing utility in informing healthcare
decisions and actions. Accountability for choice and proper action are coming to rest more in the
hands of the “users,” of this data and other technology and healthcare leaders have the important
job of enabling providers to alter their practices accordingly and to prepare these users to assume
the accountability that is increasingly being appropriately transferred to them. Furthermore,
technology is making it not only possible but necessary to build evidence that clinical work is truly
making a difference in the lives of those we serve and in the health of our communities. Grounded
in evidence, innovation in clinical therapeutics, delivery models, and supporting infrastructures is
becoming a central role of the function of leadership in all health settings.
A leadership book like this one serves as a dynamic snapshot, if you will, of the leadership
role at a particular moment in time. In our attempt to identify and describe the correct behaviors
and strategies for the role, we focus on the issues that are most representative of the current era.
ix
One of the earmarks of our era, of course, is the accelerating rate of change in the substantive
reformatting of the delivery of health care. Another is the obvious challenges of ensuring
access, availability, and payment for health care for all Americans. Included are all the current
and emerging issues related to the value-based drivers influencing payment, not structuring
of payment, services, and therapeutics including drugs, durable equipment, and digital
therapeutic devices. All of these issues provide unique opportunities for more effective exercise
of contemporary leadership.
Healthcare leaders must push their organizations further into this fray. They must be able
not only to see into the darkness of the future but also to live comfortably inside the potential—
that risky, unsettled space between the present and the future. And because leaders cannot pull
people into a future that only they have conceived of, they must bring everyone to the table to
shape the future through collective dialogue and concerted action.
In this fifth edition, we try to conceptualize the newer complexity-based realities in
health care and use the emerging foundations as a template to prioritize leadership skills and
behaviors—those skills and behaviors that leaders need to use to ensure that their organizations
are guided accurately and effectively. Our strategy is first to provide a glimpse into the future
and then to present some of the implications of the maturing sciences of complexity and chaos,
thereby delineating the context of the leadership role as we all moved further into the 21st
century as leaders work to make sense of this continuously emergent sociotechnical world with
all its risks and opportunities.
Anticipating change requires the ability to predict and adapt to transformation and the crisis
that both stimulates it and represents the appropriate response. Leaders must now recognize the
ever-constant company of the serendipitous and the unplanned occurrences that are reflected in
a fast-paced and highly changing environment. Leaders must model and inculcate a predictive
and adaptive capacity into the life of their organizations and into the skills of the staff at every
place in the organization. Leadership competencies related to stimulating and guiding innovation
are no longer optional. There is simply no way that reforming and advancing health care can
unfold without a great deal of conflict. Most people assume that conflict in the workplace is bad
and should be avoided. Nothing could be further from the truth. Conflict is a normal element
of all interaction. Leaders must understand this and acquire the necessary skills to manage
conflict in a way that yields the benefits that it is capable of delivering. By handling conflict
appropriately, leaders also are better positioned to create a healing environment for providers as
well as consumers of health care and to undertake the healing of a wide variety of emotional and
spiritual injuries suffered by people as they struggle with the work of transforming the healthcare
system. Building a healthy environment by being fully present and demonstrating compassion
and accountability is a fundamental responsibility of the contemporary leader.
Not only is it necessary to handle conflict effectively, it is necessary to see organizations as
being in constant flux and subject to continuous change. Leaders now must both predict and
adapt to the patterns of change that affect their people and their organizations. This adaptive
and predictive capacity is no longer an option for good leaders if their organizations are going
to continue to thrive and change as new conditions and technology demand. Developing these
insights and the skill of predictive and adaptive capacity provides a good skill foundation to
ensure the organizations of the future continue to change and sustain themselves.
Over the previous two decades, a host of authors and researchers reminded us that leaders
must possess not just intellectual ability but also mindfulness and emotional competence.
After all, establishing and maintaining relationships are essential parts of leadership, and all
x Preface
relationships have an emotional component. To ensure that their relationships exhibit emotional
maturity, leaders need to understand themselves through mindful reflection expressed through
a high level of emotional competence in a way that touches the emotional center in themselves
and others. The value of personal mindfulness and emotional maturity for leadership is just
beginning to be understood.
Behavior does not exist in a vacuum, and thus the context within which people interact
and work together requires as much consideration as what they do. The enormous changes that
are occurring, some of them very traumatic, cause people to see themselves awash in a sea of
movement that does not make much sense. Staff members often fail to understand the direction
in which their leaders are taking them and begin to lose hope and any sense that their work is
meaningful. Leaders, in their actions, need to provide the foundations for hope and meaning
and value. They must first find these things for themselves and then translate them into a
language that others can comprehend and own.
Why are some leaders more successful than others at leading an organization through
transformational change? Why do some create an environment of hope and calm despite
difficult or even desperate circumstances? The answers can be found in the notion of personal
willingness. Willing leaders are the co-creators of change. They recognize that no one person or
situation can take away their personal peace, joy, or sense of competence. They transmit these
feelings to others in a way that encourages and enables them to embrace the new script and
share in the writing of it.
Whether we like it or not we now live in a value-driven age. As professionals, it is becoming
increasingly important to build an evidentiary foundation that provides a clear demonstration
of the relationship between the processes and the impact of our work. For too long, the focus of
professional work has been on the work itself: the quality of that work, the content of the work,
and how well the work was done. Increasingly, the challenges between appropriate resource use
and the outcomes of clinical work have raised the specter of incongruity and our often frequent
failure to advance the health status of those we serve. Value now calls for health professionals to
make a strong case for practice and establish a firm foundation that demonstrates a goodness of
fit between the action of clinical practice and the impact of advancing social health. And now,
this must be done within the context of equity-based provider teams committed to advancing
the health of those they serve in a cost-effective and price-sensitive environment. Evidentiary
dynamics is now a fundamental subset of both leadership and clinical work. Improvement
sciences and value-based practices and payment now require both technological and practice
frames that elicit best practices and advance the user experience. Ultimately, leaders have an
obligation to ensure that there is a tight relationship between the aggregated net health status
of the community and the resources used to obtain and sustain it.In the contemporary context
for health care, a capacity for innovation is no longer optional. Every leader now must operate
within an innovation mental model. Leaders now need to demonstrate an availability to the
inventive and the creative so much a part of our fast-paced sociotechnical existence. Innovation
is more than a process. It is increasingly evident that there is a science that drives it. As we
become more aware of the action of complexity and its consonance with the movement of
systems, the role of the emergent and transformational substrate of existence becomes more
definitive. It is the role of a leader to create both context and conditions that harness this energy
and facilitate the discourse, discovery, and application of this knowledge in advancing the quality
of life and our human experience. Creating the context for the dynamics of innovation is now a
central role of leadership capacity and is essential to the ability to be sustained and to thrive.
Preface xi
Coaching people into the future they must live in requires special skills. Unlike in the
past, leaders cannot simply force people into a mold or into compliance with demands that
they played no part in setting. Allowing people to be investors, partners, and stakeholders in
their own processes is a talent necessary in the new leader. Leading workers out of a toxic and
perennially sick or stuck work environment is a part of this process. It requires the leader to
understand the characteristics of neurotic and pathological organizations and those behaviors
that prevent people and their organizations from embracing the changes they must adapt to in
order to thrive in the new world of health care.
Finally, leaders must focus on the energy and spirit within to be innovative and grow and
thereby act as models for others in their own search for meaning and value in what they do.
But the ability to exhibit creativity, self-understanding, and personal growth is not obtained
accidentally or without effort; it requires regular mental and spiritual exercise, including periods
of reflection, to refine it. In the future, leaders, to sustain their effectiveness in the leadership
role, will need to engage in reflective personal work and increase their level of creativity.
Like others of its kind, this book is always a work in progress. It is necessarily and forever
incomplete. There is already a host of good books on contemporary leadership, with more
arriving on the bookshelves every day. They too are incomplete. What individuals who want to
learn about leadership must do is see the myriad available resources on the topic as making up a
single dynamic and growing body of knowledge. Thus, if they want to improve their leadership
skills, they should use this book as one resource along with others, understanding at the same
time that the theories of leadership and their application will advance as more information
becomes available.
We hope that the contents of this fifth edition of Quantum Leadership stimulate reflection
and discussion. We believe that this book extrapolates, in a defensible manner, from current
research and practices newer ways of conceiving and exercising the leadership role. At this time,
leaders are challenged to take the next step in the journey toward better and more relevant
methods of leadership. Those whose lives they affect have a right to expect the best that the
leaders have to offer, especially as more is demanded of professionals than ever before. We hope
this fifth edition plays some small role in ensuring that those who provide healthcare services get
from their leaders what they have every right to expect and as a result the health of our nation is
advanced.
—Tim Porter-O’Grady and Kathy Malloch
xii Preface
A C K N O W L E D G M E N T S
We wish to acknowledge and thank our leadership colleague Jaynelle Stichler, DNSc, RN, FAAN,
for her excellent contribution of chapter-based case studies for each of the topical chapters
in this text. Dr. Stichler serves as an exemplar of nursing leadership and leadership practice
excellence, as clearly demonstrated in the quality of cases contained in this text.
This fifth edition of Quantum Leadership could not have been completed without the support of
a good number of people. First, I thank my coauthor, Kathy Malloch, who committed full time
and energy to this book and whose collaboration continually encourages me. I also acknowledge
the many colleagues in nursing and health care who were both the subject source and the
motivation for this book and have much to do with its content. Their encouragement kept us
focused on writing a text that is both relevant and useful. Finally, I thank Mark Ponder, for his
40 years of support and partnership, and for being a sign to me that caring, loving, and nursing
have nothing to do with gender.
—Tim Porter-O’Grady
The fifth edition of Quantum Leadership is the result of insights garnered from our many
dedicated readers, and for this we are grateful. We acknowledge and thank our colleagues for
their undying dedication to lifelong learning so they can influence and empower others to be the
best they can be.
Thank you, Tim, for your friendship and unquestionable support—you are one very special
person: a leader, a healer, a thinker, a visionary, and a great colleague. Finally, my greatest thanks
and recognition go to my husband, Bryan “Mallotchi,” my very best friend and confidant, always
encouraging me and tolerating my inconsistencies. Without his unconditional support, my work
as a leadership advocate and healer would not be nearly as meaningful.
—Kathy Malloch
xiii
C A SE ST U DY I N ST RU C T IO N S
The use of case studies in education provides a rich opportunity for students to employ situated
cognition in the application of new knowledge when analyzing the case situations in a low-stakes
environment. Case study analysis as a teaching method uses abstract conceptualization with
active participation and experimentation as the students reflect on each case scenario, applying
experiential knowledge learned from personal experience and the new cognitive knowledge
from content read in the textbook chapters (Kolb, Boyatzis, & Mainemelis, 2000).
In each chapter, two case studies related to the material are provided. These can be used to
facilitate classroom discussion or can be assigned for individual student learning beyond reading
the chapter content. Each case study presents real-life situations, complete with complexity,
structured controversy, extraneous and pertinent information, emotion, and decisions that need
to be made by weighing all possible options and using the new knowledge gained from reading
the chapter.
In reviewing each case, students should use critical thinking and problem-solving skills
to analyze the case. They can apply principles from the chapter content to identify possible
methods to resolve the case or to reflect on personal insights to enrich class discussion.
Students should be encouraged to (1) identify the stakeholders in each case; (2) describe
the case situation from the perspective of each stakeholder; (3) apply the chapter’s content as
a framework for analyzing the case; and (4) determine a course of action to resolve the case,
recognizing that there is not one correct answer or best way to resolve each case.
The case studies can be assigned as reflective essays or they can be applied as a framework
that students can use to write a case from their own experience. They can present their cases to
the class or demonstrate knowledge and application of the chapter’s content in class discussion.
The case study analyses amplify the chapter content and engage students in applying the
principles to real organizational situations.
References
Kolb, D. A., Boyatzis, R. E., & Mainemelis, C. (2000). Experiential learning theory: Previous
research and new directions. In R. J. Sternberg & L. F. Zhang (Eds.), Perspectives on cognitive,
learning and thinking styles. Hillsdale, NJ: Erlbaum.
xiv
C H A P T E R O N E
Chapter Objectives
At the completion of this chapter, the reader will be able to
• Contrast the characteristics of the traditional leadership with those of complexity leadership.
• Enumerate the elements of quantum leadership and explain how quantum thinking has
influenced movement through the Age of Technology and throughout processes of continuous
health transformation.
• Assess the impact of quantum science and recent advances in technology on health care and
clinical practice.
• Describe the implications of digitally driven environments on the exercise of leadership in a time
of reformatting health care.
• Identify the different skill sets for leaders in contemporary complex organizations.
1
Chapter One A New Landscape for Leadership: Changing the Health Script in an Age of Value
2
Leading in a World of Constant Movement
growing digital architecture as work moves away from institutions altogether. The infrastruc-
ture of society is becoming less institutional and more information based, and the architecture
of our places of work, service, and business is changing dramatically. Information structures
are primarily relational and function collaterally and in multimodal ways, whereas most of our
business structures have historically functioned vertically. Leading in a complex multimodal
work culture is radically different from leading in a predominantly vertical or linear work
culture.
In the recent past, the Industrial Age, organizations were primarily fixed, finite, and
functional. Work in the Industrial Age was based on Newtonian principles, and from the
beginning of the 20th century, when Frederick Taylor laid down the foundations of scientific
management, to the late 1960s, business organizations were structured mechanistically and
hierarchically. Even the management theorists of the 1930s, 1940s, and 1950s did not radically
alter basic organizational design. Historically, the worker has mostly been considered a subset
of the work. Most training was gained on the job, and the apprenticeship model used for train-
ing was essentially hierarchical as well. The organization owned the work and set the rules.
Communication and decision making traveled up and down the corporate ladder: the higher
up the ladder, the greater a person’s authority and autonomy. At the bottom were the w orkers
who performed most of the functions—under the control of those who had moved “upward.”
Although attention was paid to both
the work and the worker, this attention
was barely reflected in the management Point to Ponder
structure and the application of leadership The worker is increasingly in control. The
in organizations. Leadership focused on knowledge necessary to get work done is now
the individual as leader and emphasized mostly in the hands of those who do the work.
behavioral characteristics as the driving Because the workplace is becoming more
centerpiece of leadership learning. Only dependent on knowledgeable workers, a major
recently is leadership being seen through a shift in power and control has occurred, and the
lens that focuses on factors external to the old structures are now in conflict with this new
person of the leader and providing differ- type of worker.
ent insights with regard to the requisites of
good leadership.
Much has changed in the life of the organization and the role of the leader. In the current
world of work, it is not the organization but the worker who owns the work. Over the last
two decades, the character of work has been changing—it has become increasingly techni-
cal and complex, now often called “knowledge work”—today individuals usually need to be
trained for jobs before they become eligible for them. Indeed, they are expected to arrive “on
the run” and start contributing from the outset. Further, organizations’ increased dependence
on knowledge workers has created a new power equation, shifting the locus of control from
the organization to the worker and the work.
In the Industrial Age, leadership meant being a good manager, guiding one’s subordinates
like a good parent, and directing their activities in the interests of the organization (Murphy &
Riggio, 2003). The critical skills were those required for planning, organizing, leading, imple-
menting, controlling, and evaluating (note the acronym constructed from these six words:
POLICE). The ability to function well and undertake well-defined processes has traditionally
been the basis of every role. Good performance and a sense of responsibility were highly
valued, strongly encouraged, and heavily rewarded.
3
Chapter One A New Landscape for Leadership: Changing the Health Script in an Age of Value
It was also expected that the workers’ behavior would demonstrate compliance with the
expectations of the workplace. Organizational leaders used vertical communication and com-
mand strategies exclusively to ensure that the workplace stayed focused and orderly and that
the work was performed efficiently. They also refined hierarchical mechanisms and fostered
congruence of workplace behavior in whatever way they could.
In this industrial context, the first contemporary notions of leadership developed. A whole
host of approaches to understanding leadership in complex systems and acting as a leader in
these settings emerged during the past century, and each one reflected prevailing notions of
work and workplace organization (Exhibit 1-2). These various approaches helped to create the
current framework for leadership, both in the realms of action and decision making.
4
Leading in the Post-Digital Age
structure in minor ways and characterized by an increased degree of control over employees.
As Peter Drucker pointed out, the cornerstone of most 20th-century organizations was con-
trol, as indicated by the “line and box” approach to configuring the workplace (Edersheim &
Drucker, 2007) (see Figure 1-1).
Group Discussion
We are living on the cusp of the transition between two health systems, and life in this
contemporary Age of Health Reform differs substantially from life in the traditional ter-
tiary care system. The changes that are now occurring include changes in clinical work
and leadership. Brainstorm at least 10 changes that will occur in refining health reform
and advancing health transformation over this next decade and discuss their implica-
tions for leaders.
5
Chapter One A New Landscape for Leadership: Changing the Health Script in an Age of Value
people in a new way. Further, we now live with the knowledge that everything is linked and that
events in one part of the universe have some kind of impact on events in other parts. Our under-
standing of the linkages among all experiences is the basis for complexity science and has led to
changes in the conceptual foundations of the sciences and their social application (Exhibit 1-3).
Just as the understanding of convergence, relationships, and leading life at the interface or
intersections of networks and systems is important, this new understanding of networks as a
structural framework for behavior now calls leaders to conceptualize their role in the relation-
ships between structure, process, and people redefining the functional elements of leadership
and of work. Newer understanding of the operation of complex adaptive systems and the
resultant complex responsive processes serve to recalibrate the roles of leader and worker and
reconfigure the very foundations of organization, relationships, and impact.
Along with this new understanding, these changes have raised the level of conflict sur-
rounding basic issues, ranging from the existence and nature of God to ethical and social
norms. Claims that once seemed beyond question are now open to investigation, continuous
challenge, and new insights. New scientific discoveries have substantial religious, philosophi-
cal, scientific, and ethical implications and have caused social discomfort among those holding
more rigid beliefs (Volti, 2010).
It is into this equation that organizational leaders are now thrust. The problem is that they
too are experiencing the conflict endemic to the times. Most leaders have spent the majority of
their lives leading in Industrial Age models, just as everyone else has. They too are confronting
newer realities with beliefs and practices acquired in the past. They too are struggling to make
sense of the significant changes occurring globally. As an additional challenge to adapting to
these changes, they must also lead others to adapt successfully to a whole new approach to
understanding human organization, relationship, and behavior. Furthermore, the related dis-
coveries and innovations are occurring faster than the rate of adaptation. As soon as one change
is accommodated, another occurs, requiring a new or different response (Nickerson, 2010).
Group Discussion
Healthcare providers in this time of significant health transformation must be willing
to leave some things behind (because they will cease to have value) and to take on some
new things. List some of the practices, habits, rituals, or routines that need to be left
behind, and discuss symbolic acts or events that could be used to help let go of these
formally. What replaces some of these “old” practices?
6
Postdigital Leadership
Change Is
Quantum theory continues to teach us that change is not a thing or an event but rather a
dynamic that is constitutive of the universe. Change cannot be avoided because it is constant
and ever present, but we can influence its circumstances and consequences. In short, while
we cannot simply control it, we can give it direction. This notion of constant change reflects
foundations in quantum mechanics that suggest that matter is constantly moving in the uni-
verse and can even exist in more than one place at one time while taking different forms.
Quantumness is almost counterintuitive and reflects characteristics and dynamics of matter
and energy that do not fit any logical, ordered, structured understanding of them.
Schrödinger, a mid-20th-century physicist, used his famous “Schrödinger’s Box” thought
experiment to show two prevailing realities operating at any given time. He identified them
as “actual reality” and “potential reality.” Actual reality is that which currently occupies our
immediate attention. Potential reality, however, although still current and present, is not yet
experienced. Being still “potential,” reality is waiting for the right moment to become e xpressed
and visible thus becoming “actual.”
Potential reality is the realm in which
leadership takes form. The leader’s role is Point to Ponder
to engage with the unfolding reality, per- A stop sign can be used to illustrate potential
ceive it, even predict it, note its demands reality. When first seen, it notifies a driver to stop—
and implications, translate it for others, and but not immediately. The sign is a real object, a
finally guide others into actions to meet the reality, and it does require a real response. The
demands of a reality not yet quite present. driver’s preparation to stop is the first in the chain
This leader must be comfortable with the of actions; however, it is only when the driver
ambiguity of the “in between,” that is, living arrives at the stop sign that the act of actually
in two realities, in the space between that stopping becomes real. Seeing the sign and
which is ending and that which is emerg- preparing to stop is acting in consonance with
ing. Demonstrating this comfort with the “potential reality.” Actually stopping at the stop
journey provides a frame for leading others sign represents “actual reality.”
through the chaos and uncertainty of
constant change.
In this transformational time between two paradigms, the leader’s primary role is to live
fully in the realm of potential reality. The leader is not only an operational expert and prob-
lem solver but he or she is a good “signpost reader.” To be effective, the leader must antici-
pate the path of change and then spell it out for those who are moving their own activities,
knowingly or unknowingly, in the same direction as real change is taking form (Yang &
Shan, 2008).
Postdigital Leadership
Age changes do not occur quickly. Such massive change generally occur over 2 or 3 decades.
The challenge is not to become “stuck” in the no-man’s-land between an extinguishing life
script and an emerging one. The dynamics of a substantive change are moving in concert to
create the underpinnings for a comprehensive transition (Bridges, 2002) from one way of
living to another. This has occurred several times in human history. From the Middle Ages
through the Age of Enlightenment and the Industrial Age and up to the current era, which we
7
Chapter One A New Landscape for Leadership: Changing the Health Script in an Age of Value
might dub the Digital Age (or the Information Age), historic indicators have presaged major
shifts in human experience (Figure 1-2).
There is an important difference, though, between previous shifts and the one that is
presently occurring. In hindsight, the significance of previous shifts quickly became clear,
even if it was rarely apparent during the critical transition points. Today, however, the period
between predicting future changes and confronting their unfolding is too brief to allow plans
to be made to accommodate them. Indeed, today’s network leaders act as agents of change,
but, like everyone else, they must also undergo the changes themselves virtually at the same
time as they perceive them. Wholly new leadership skills are required to manage in this kind
of a world.
Think for a moment about some of the ways in which the script of life is being rewritten for
all of us:
• Social media is now a primary communication and business tool, and it is fundamentally
altering how business is done.
• Fiber optics, in conjunction with satellite technology, has wirelessly connected the world
into a seamless communications network in which information can be transmitted
instantly from any place on the globe to any other place.
• Genetics, genomics, organ printing, and micro-manipulation are demonstrating that
the micronization of life processes can alter their trajectory and influence how life is
experienced.
• Information has thus become highly portable, and, given the developments in shipping
and delivery, everyone has access to almost anything they want or need from anywhere in
the world. From decades of collecting and storing massive amounts of digital information,
8
Endless Change
the current challenge is to be able to manage and utilize that data in a way that advances
the utility of it and its impact on human decision making and action.
• Technology has enabled communication and interaction to become increasingly more
portable as chips have become smaller and digital devices have become packed with
technology and applications in lighter, smaller, multifunctional portable hardware.
• Each person has control over any relationship, personal or business, and can personalize
any interaction within any context at any time and in any way he or she desires.
• Miniaturization has made it possible for people to be mobile and still remain connected
to everything and everyone. Furthermore, it has made innovations in service,
communication, information, wearable technology, and health care faster, easier, and less
expensive to implement than ever before.
• Globalization has created a world community and removed traditional boundaries
between people, be they political, social, or physical. The recognition of the mobility of
human experience and of work has created a new virtual and global landscape for human
action and relationships.
These are just a very small sample of the transformations that are occurring. And these trans-
formations are only the beginning of much more emergent substantive changes. Even so, they
have a major impact on our understanding, on the way we live and relate, and, of course, on
the way we work.
Imagine the lives of our great-grandparents or even our grandparents and how different our
lives are from theirs as a result of these technologies (keep in mind, for example, there were
no cell phones before 1986). Then, consider the possibility that the children of current teenag-
ers might never write or read as we have, interact and play as we have, relate to each other or
travel in the same way we have. And remember, this generation is currently ushering in a new
way of living and working as the baby boom generation continues to retire.
In short, our Age is a transitional generation—the last generation of the Industrial Age and
the generation moving quickly and further into the Digital Age. Current generations are in
essence the bridge between two ways of experiencing the world (compare digital immigrants
to digital natives). What we do now lays the groundwork for a future that will look nothing
like the world most of us have known.
Group Discussion
List dramatic discoveries and inventions that occurred during the past century and
compare the way life changed as a consequence with the way life changed during the
preceding millennium. Then, discuss the technological changes occurring in the first
decades of the 21st century that affect the future of health reform and care delivery.
Endless Change
It is important that leaders be aware of the transformative work that continually redefines their
role. The Digital Age now calls for leaders to perceive their role differently and to express it in
ways that best fit the characteristics of emerging sociotechnical culture (Figure 1-3).
9
Chapter One A New Landscape for Leadership: Changing the Health Script in an Age of Value
The role of today’s leaders is to encourage this transformation. Indeed, they must make a
commitment to the journey and work hard to incorporate the changes in their lives in a very
personal way. In other words, rather than simply suggesting that everyone and everything
must change, they must lead by example. They must serve as witnesses to the changes and
show others how to adapt to the changes by demonstrating that adaptation in their
own lives.
In the initial stage of this transforma-
tion, leaders must be able to show that the
Point to Ponder unfolding changes represent a critical shift
The behavior of leaders must exemplify their and must, through their passion for move-
commitment to sustain their own journey and to ment, inspire responses from others. This is
coordinate and facilitate the efforts of others to not the time for complacency but for truth
build a desired future. telling and transparent conversations. In
short, it is a time to inform people how the
changes make a substantial difference in
their lives and in their work. Advancing people’s awareness of this requires a level of honesty
and directness once thought to be confrontational.
In the case of health care, the major reforms under way will lead to the end of the
hospital-based sickness-oriented model of service delivery (tertiary-driven care). Our technol-
ogies and emerging clinical dynamics enable us to treat illnesses at an earlier stage and r educe
the need for costly surgical interventions. As a consequence, not only physicians but also
nurses and other health professionals must make substantial changes in the way they practice
their professions and provide services. The refinement of value-driven approaches that focus
on early engagement, attaining the highest level of personal health, prevention rather than
10
Another Random Scribd Document
with Unrelated Content
Gelegenheit bekämen, die Eigenthümlichkeit des Lebens auf den
Hochschulen kennen zu lernen, auf der andern Seite aber das
peinliche Gefühl bei ihnen vermieden werde, einem Ganzen
anzugehören, über dessen Wohl ihnen keine entscheidende Stimme
zustehe, und so das Gesetz der möglichsten Gleichheit der Rechte
nicht gekränkt werde.
A n m e r k u n g . K. für Heidelberg bemerkte, daß er um des
Allgemeinen willen von der Wahlfähigkeit zum Vorsteheramte für
sogen. Füchse abstehe, wenn die anderen Hochschulen sich zur
Stimmfähigkeit für Alle verstehen wollten.
Und es geschehe dies besonders der Einheit des Gesetzes willen.
3) Wurde der Wunsch geäußert, daß bei der Aufnahme alle
Abstimmung durch bloßes Ja oder Nein wegfallen möge, sondern
laut und mit Anführung der etwanigen Gründe gegen den
Aufzunehmenden gestimmt werde, wobei auf §. 9. und 10.
verwiesen wurde. — Rostock behielt sich hiebei Berathung mit ihrer
Burschenschaft vor.
4) Wurde als zum Wesen der Burschenschaft gehörig anerkannt,
daß kein Zweikampf zwischen den einzelnen Burschenschaften, als
solchen, statt finden dürfe, sondern jeder unter ihnen obwaltende
Streit schiedsrichterlich ausgeglichen werden müsse.
5) Wurde festgesetzt, es solle in dieser Versammlung der
Abgeordneten noch kein förmliches Cartel, oder eine
Verfassungsurkunde der großen allgemeinen Deutschen
Burschenschaft verfaßt, sondern blos einige Grundgesetze derselben
vorläufig entworfen werden, damit die Abgeordneten sie zur
Berathung ihrer Burschenschaft mitnehmen könnten. Die
vollständige Ausarbeitung müsse bis zur Versammlung am 18.
Oktober ausgesetzt bleiben.
6) Sollte auch an die Hochschulen, welche keine Abgeordnete
hierher gesandt, der Entwurf dieser Gesetze, die 19 Puncte zugleich
mit einer Schrift, welche die Ansichten der Abgeordneten von dem
Wesen der Burschenschaft näher ausspräche, so wie auch eine
Aufforderung, dem hier gebilligten Grundsätzen beizutreten,
übersandt werden.
A n m e r k u n g . Berlin behielt sich vor, zu dieser Aufforderung
nur dann mitzuwirken, wenn ihr Verein als Burschenschaft anerkannt
würde.
F. d. U.
Protocoll,
gehalten Nachmittags am 1. April.
Göthe hat noch oft in späten Jahren herzlich über diese seine
Verwechslung mit Schiller gelacht.
Das Rednertalent, welches außer in England so wenig cultivirt
wird, wurde in Jena wenigstens oft in Uebung gesetzt. Wenn die
Bruder Studios rudelweise Abends durch die Gassen schlenderten
und einen ihrer Freunde noch in seinem erleuchteten Zimmer zu
Hause fanden, so wurde demselben gar häufig ein Vivat gebracht,
dem das Verlangen einer »S t a n d r e d e« folgte.
Der Gefeierte mußte nun sein Fenster öffnen den Raum mit
einigen Lichtern erhellen und in der häufigen Ermanglung dieser, die
schwerfällige Studierlampe auf die Fensterbank postiren, dann aber
eine Rede halten, welche oft an die Neapolitanischen Improvisatoren
erinnerte. — Vorzüglich stark war in solchem aus dem
Steggreifreden der Meklenburger W. — Seinem Nachbar, einem
Professor, waren vierzehn Tage vorher die Fenster eingeworfen.
Während er sich nun für die ihm wiederfahrene Ehre auf das
Allerwärmste bedankte, beklagte er seinen gelehrten Nachbar, der
nicht das Glück habe in einer so guten Meinung bei den Herrn
Studenten zu stehen wie er, und ermahnte die Herren Akademiker,
sich künftig nie wieder solche Excesse gegen Professoren zu
Schulden kommen zu lassen. Die Art und Weise wie er abwechselnd
den lustigen Schalk, dann wieder den ehrenwerthen Philister
sprechen ließ, war in der That ungemein humoristisch.
Die Collegien in Heidelberg fingen in wenigen Tagen wieder an.
Mit dem Bewußtsein meine Burschenpflicht erfüllt zu haben, trat ich
meine Rückreise über Erfurt und Göttingen an, wo ich in einer Nacht
ein Paar Studenten, welche im Rausch »Bursch heraus« gerufen
hatten, dadurch der Arrestation entriß und vor öffentlicher
Relegation schützte, daß ich (vielleicht die einzige Lüge meines
Lebens) mich für den Sohn eines Hannoverschen Ministers ausgab,
und den nachgiebigen Pedellen meine hohe Protection versprach.
In Göttingen war ich verdammt, den Tod meines liebsten
Jugendfreundes, Christian Kirchhof aus Uetersen zu erfahren,
welcher zu Charkow in Südrußland, einige Tage vor seiner Rückkehr
in die Heimath, nachdem er als Hauslehrer sich bei einem Grafen
d ’ O l o n n e die erforderlichen Studienkosten verdient hatte, durch
ein Nervenfieber weggerafft war. Sein Tod ergriff mich fürchterlich.
Schlaflos und weinend langte ich nach einigen Tagen wieder in
Heidelberg an. — Christian hat das Versprechen, mir nach dem Tode
zu erscheinen, nicht gehalten.
[4] »Als ich zuerst von dir gebeten wurde, das gefährliche
Geschäft einer Disputation mit Dir zu unternehmen, wollte ich
mich zuerst nicht auf den ungleichen Kampf einlassen, und hätte
es gewißlich nicht gewagt, wenn mich nicht Deine erprobte
Freundschaft gegen mich zu diesem Unternehmen angetrieben
hätte. Du bist mein Freund mein Landsmann, ich fürchte daher
nichts. Aber reden muß ich vor bedeutenden Männern, deren
große und göttliche Gelehrsamkeit mir zeigt, wie kühn ich bin.
Vergebt daher gelehrte Männer! wenn ich Euren Ohren, die so
zart sind, hier bei Anhörung von übel klingenden lateinischen
Phrasen, Zwang anthue.«
[5] In Jena waren im Jahre 1818 nur zwei hübsche Mädchen,
von denen die Eine zu stark, die Andere zu mager war.
[6] Es waren dies drei Studenten, welche den Feldzug
mitgemacht hatten, und mit dem Erinnerungszeichen daran
geschmückt, vor die Barriere traten, wo sie als ehrliche und
wahrhafte Burschen rehabilitirt wurden. Unser Präsident trug aber
auch das eiserne Kreutz. —
[7] Die Polen hatten diesen Schlesier durch schändliche
Mißhandlungen so erbittert, daß er nur den Namen »furioso«
trug. Er sprach immer nur von einem Polen vergleichend. »Ein
Pole oder ein Schurke« u. dgl. m. Bei einer solchen Phrase erhob
sich dann allemal der sanfte Deputirte L. und foderte eine
Ehrenerklärung für die Polinnen, da seine Mutter eine solche sei,
welche Furioso allemal wenn auch ungern ertheilte.
[8] Diese neunzehn Punkte sind leider nicht mehr in meinem
Besitz — Um das Sitzungsprotocoll in seiner ganzen
Vollkommenheit zu geben, habe ich die Verhandlungen über jene
Puncte hier indessen nicht auslassen zu dürfen geglaubt.
[9] In der Heidelberger Burschenschaft war das Fuchswesen
ganz aufgehoben, der Student im ersten Halbjahre hatte gleiche
Rechte mit den älteren Burschen.
[10] Wie wenig Verstecktes wie so gar nichts Revolutionäres
lag damals in den Deutschen Burschenschaften! Wie hätte sich
der junge Deutsche Pegasus zügeln und reiten lassen, wenn
einige unvorsichtige Stallknechte ihn nicht durch Verketzerungen
zu hartmaulig gemacht hätten.
[11] Ein löblicher Vorschlag, nicht wahr?
[12] Das war freilich ein sehr einfältiger Beschluß, gegen den
ich vor allen Dingen protestirte. Ich rief stets, »wir haben ja
nichts zu verheimlichen, laßt uns die Protocolle sogleich allen
Regierungen vorlegen. Ein Geheimniß für 100 ist ohnehin ein
Unsinn.« Allein ich wurde nicht gehört und ich bedauere es nur,
daß meine Protestation damals nicht mit zu Protocoll genommen
ist. Ich könnte indessen den Beweis durch Zeugen führen, wenn
dies überall der Mühe werth wäre.
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