Succeeding by Succession

The Pittsburgh Steelers are always listed among the all-time great National Football League (NFL) franchises.  The team was founded in 1933, making it the 7th oldest team in the NFL and the oldest team in the American Football Conference.  They are tied with the New England Patriots for the most Super Bowl titles at six, and they have played a total of eight Super Bowl games (tied with the Denver Broncos, San Francisco 49ers, and the Dallas Cowboys for the second most number of appearances in the Super Bowl).  They have played in (16 times) and hosted (11 times) more conference championship games than any other team in the NFL.  Since 1969, they have had three head coaches (Hall of Fame Coach Chuck Noll from 1969-1991, Hall of Fame Coach Bill Cowher from 1992-2006, and current Coach Mike Tomlin from 2006 to present), which is absolutely amazing!  

Coach Tomlin is likely to be inducted into the Hall of Fame by the time he is done.  During his tenure, the Steelers have played in two Super Bowls (winning Super Bowl XLIII in 2008 and losing to the Green Bay Packers in Super Bowl XLV in 2010).  Coach Tomlin has an overall record of 183-107-2 as head coach (including an 8-11 record in the playoffs), and he has NEVER had a losing season.  

And yet, after the Steelers were defeated by the Baltimore Ravens in the Wild Card Round of this year's playoffs (ending their season with five straight losses), all the pundits are asking if it's time for both Tomlin and the Steelers to mutually part ways!  At least one sports journalist keeps mentioning that the Steelers haven't won a playoff game since Barack Obama was President!

Upon a closer look, Coach Tomlin has done an amazing job getting the most out of his players.  He's not had a good quarterback, arguably the most important position on the team, since Ben Roethlisberger retired at the end of the 2021 NFL season (Roethlisberger won't be eligible for the Hall of Fame until 2027).  The Steelers had 18 seasons with Roethlisberger as their quarterback, and since his retirement, they've gone through a string of less than stellar quarterbacks, including Kenny Pickett, Mitchell Trubisky, Mason Rudolph, Justin Fields, and Russell Wilson.  

There are two pathways to getting what is called a "franchise quarterback" (one who will win championships) - the NFL Draft and free agency.  The only legitimate way to secure a "franchise quarterback" via the NFL Draft is to get incredibly lucky at picking up a great quarterback that nobody thought would be great in the later rounds (think about Tom Brady who was selected 199th by the Patriots in the 2000 NFL Draft and more recently, Brock Purdy, who was drafted with the last pick by the 49ers in the 2022 NFL Draft) or pick someone at the top of the first round.  The only way to get a pick at the top of the round is to either "trade up" or have a really bad season.  You're never going to be picking at the top of the first round of the NFL Draft with a Coach Tomlin at the helm.  He's just too good at what he does.

All of this could perhaps have been avoided, if the Steelers had drafted a quarterback while Ben Roethlisberger was still playing.  Think about how the Green Bay Packers have done it - they drafted future Hall of Fame quarterback Aaron Rogers while Hall of Fame quarterback Brett Favre was still playing, and they drafted their current starting quarterback, Jordan Love, while Rogers was still playing.  In other words, the Steelers should have had a better succession plan.

Enough about sports.  What's important here is to recognize the importance of developing a succession plan.  It is the job of every leader to develop an orderly succession plan with multiple potential candidates to replace them at some point in the future.  It is the job of every organization to make sure that they have a succession plan for every executive position within the organization.  Unfortunately, the available research suggests that most organizations are like the Pittsburgh Steelers - they don't do succession planning well and so are ill-prepared for the departure of a key leader (see "The High Cost of Poor Succession Planning" and "Succession Planning: What the Research Says" in Harvard Business Review).  If you or your organization choose to learn anything from the Steelers, choose this - don't get caught without a solid succession plan for your key leaders!  Succeed by succession!

Raitis tammikuu

The U.S. Surgeon General, Dr. Vivek Murthy (Dr. Murthy is the 19th and 21st Surgeon General, serving under Presidents Obama, Trump, and Biden) recently released an advisory declaring that there is no safe level of alcohol consumption.  The advisory called out in particular the risks associated with several types of cancer, especially breast cancer in women and cancers of the digestive tract in both men and women.  The advisory states, "The more alcohol consumed, the greater the risk of cancer. For certain cancers, like breast, mouth, and throat cancers, evidence shows that this risk may start to increase around one or fewer drinks per day."  The advisory further provides a number of recommendations to minimize the health risks associated with alcohol consumption, most notably the addition of a health warning label on all alcohol-containing beverages to now include cancer risk (similar to the warnings placed on all tobacco products a number of years ago).

Given the push to limit alcohol consumption, I thought it would be a good time to talk about "Dry January", a challenge to avoid all alcohol consumption for the entire month of January.  While the formal notion of "Dry January" first began with a campaign launched in 2014 by a charity in the United Kingdom known as Alcohol Change UK (notably "Dry January" is a registered trademark with Alcohol Change UK), the history of abstaining from alcohol during the first month of the year goes back much longer.  The government of Finland created "Raitis tammikuu" (literally meaning "Sober January") as part of a war effort to save money in 1942!  However, the campaign launched in the UK certainly did the most to popularize the challenge.  At least 175,000 people signed up to participate in "Dry January" on the Alcohol Change UK website in 2023, and 15% of adults in the U.S. (that's 260 million people) also pledged to abstain from alcohol during the month of January.

Last year, Alcohol Change UK reported that 88% of individuals who participated in the challenge saved money, 71% had better sleep and more energy, and 58% lost weight.  While most people believe that they will revert back to their old drinking habits at the completion of the challenge, there is some evidence to suggest that the making this small lifestyle change, even if only for a month, will have significant health benefits and an impact on healthy habits for several months afterwards.  

There are a number of websites with recommendations on how to be successful with the "Dry January" challenge.  For example, Harvard Medical School provides a list of recommendations ("Thinking of trying Dry January? Steps for success") on its health blog.  In addition, Alcohol Change UK created an app to assist with the challenge (see the link here).  The National Institute on Alcohol Abuse and Alcoholism says, "Remember, if you feel better when you are not drinking, or when you decrease your drinking, then your body is telling you something. Listen to your body."  All of these websites also provide a list of signs and symptoms for alcohol withdrawal syndrome, which can be serious - the Harvard Medical School blog post says, "If you suffer alcohol withdrawal symptoms at any time, you should seek immediate medical help."

The Surgeon General's report states loudly and clearly that all types of alcohol, including wine, can increase the risk of cancer.  One of the questions we had was about the purported benefits of drinking a glass of red wine - the so-called French Paradox, based on an observation that the people of France lower rates of coronary heart disease (CHD), including deaths, despite a high intake of dietary cholesterol and saturated fat.  Back in the 1980's and 1990's, we heard that at least some experts suggested that consumption (in small amounts) of red wine could reduce the risk of CHD.  Red wine contains an anti-oxidant known as resveratrol, a compound believed to have anti-hypertensive effects and potential protective properties because of the ways it relaxes blood vessels.  Unfortunately, if that was the explanation, an individual would have to consume about 500 to 2,700 liters of red wine, or 800 kilograms of red grapes, or 2,900 kilograms of dark chocolate — massive amounts that would not be considered healthy, or even possible - in order to get the 1 gram per day of resveratrol that some research suggests would result in such health benefits! 

The French Paradox is still widely debated.  However, if we are going to pay attention to epidemiological studies linking wine consumption with lower risks of CHD, we also have to pay attention to the more rigorous studies linking alcohol consumption with an increased risk of cancer.  The bottom line is that alcoholic beverages, even wine, should be limited to at most one drink per day (and the Surgeon General's report suggests that we should even limit our consumption further than that amount).  Novelist and wine aficionada Boris Fishman discusses some of the benefits to wine consumption (albeit limited) in New York Times editorial released in response to the Surgeon General's advisory.  My wife and I enjoy drinking the typical "glass of wine with dinner", but we decided to jump on the bandwagon and take the "Dry January" challenge this year.  Balancing all of the potential benefits and potential risks, I suspect my wife and I will go back to drinking our wine again after the month of January.  But for now, we will push on and abstain for the rest of the month.

Vroom Vroom!

I've always strongly believed in the concept of situational leadership, which is the idea that there is not one universal leadership style that works for every situation.  Rather, effective leaders adapt their style to the context of the particular situation (see my posts "What style of leadership works best? It depends upon the problem at hand...", "Connecting the dots...", "Tame the chaos", and "The place where we feel we belong" for more on this topic).  It is a well-accepted truism that when it comes to leadership, a one-size fits all approach just doesn't work.

While situational leadership as a theory/model was originally described by Paul Hersey and Ken Blanchard in the 1970's while working on their classic textbook Management of Organizational Behavior, the concept of adapting your leadership style to the specific needs of the situation has certainly been described by other management and organizational behavior experts.  For example, contingency theory, developed in the 1950's is very similar to situational leadership theory and emphasizes that there is no one best way to organize and lead a team, group, or corporation or make decisions.  Rather, the best approach is contingent (dependent) upon the specific needs of the situation. 

Robert Blake and Jane Mouton  developed their managerial grid model (also known as the Blake Mouton Grid) in the late 1960's (more on that model in an upcoming post).  William James Reddin developed the 3D Theory (also a subject for a future post), which he first outlined in his 1983 PhD thesis, Managerial Effectiveness and Style: Individual or Situation.  Reddin stated, "Any managerial style has a situation to it, and many situations inappropriate to it..." 

More recently, Daniel Goleman described six different leadership styles in his article, "Leadership That Gets Results" that was published in the March/April 2000 issue of the Harvard Business Review.  These six leadership styles included coercive leadership, authoritative leadership, pacesetting leadership, affiliative leadership, democratic leadership, and coaching leadership.  Importantly, Goleman concluded that "being a great leader means recognizing that different circumstances may call for different approaches." 

In today's post, I want to discuss the Vroom-Yetton-Jago Model which was first developed in 1973 by Victor Vroom and Phillip Yetton, with later contributions by Arthur Jago in the late 1980's.  Again, the underlying assumption of this model is that there is no single universal approach to leadership, and the optimal leadership approach is determined by the specific context or situation at hand.  Vroom and his colleagues described a number of different leadership styles, ranging from autocratic (the leader makes decisions on his or her own) to collaborative (the leader reaches consensus with the other members of his or her team).  They developed a series of yes/no questions - seven in total - that would help a leader navigate through a complex decision tree, which would determine the leadership approach that would work best in a particular situation:

1. Is the quality of the decision important?

2. Is team commitment to the decision important?

3. Do you have enough information to make the decision on your own?

4. Is the problem well-structured?

5. If you made the decision yourself, would the team support it?

6. Does the team share organizational goals?

7. Is conflict amongst the team over the decision likely?

Here is the decision tree that Vroom and his colleagues developed:

Here were the five different leadership styles that Vroom and his colleagues proposed:

Autocratic Type 1 (A1): The leader makes his/her own decisions using information that is readily available at the time.  This style is completely autocratic.

Autocratic Type 2 (A2): The leader collects required information from followers, then makes a decision alone.  The problem or decision may not be fed back to the followers, and their involvement is simply to pass along and provide information to the leader.

Consultative Type 1 (C1): The leader seeks ideas and suggestions on how to solve a problem from followers individually, but still makes a decision alone.  The leader's decision may or may not be influenced by the followers' input.

Consultative Type 2 (C2): The leader meets with the followers as a group and seeks their collective input, but still makes a decision alone.  The leader's decision may or may not be influenced by the followers' input, but at least the followers have an opportunity to express their opinions and share their ideas with the group.

Group-based Type 2 (G2): The leader meets with the followers as a group and seeks their collective input.  The leader accepts any decision by the group and does not try to force his or her idea on the group.  The ultimate decision is made by consensus.

I suspect that no one in their right mind would actually go through the exercise of answering all seven questions as they work through the decision tree, particularly when a decision needs to be made quickly.  That's not the point here though.  While there are certainly advantages and disadvantages to using this model, I think the key point is that there is likely to be a situation or decision that lends itself very well to a specific leadership approach, even what Vroom and his colleagues call an autocratic approach.  The seven questions can provide leaders with a rough idea of which style fits which particular situation the best.

I think William Reddin and Daniel Goleman perhaps said it best.  Reddin said, "Any managerial style has a situation to it, and many situations inappropriate to it..." Goleman added, "Being a great leader means recognizing that different circumstances may call for different approaches." Incidentally, rumor has it that Victor Vroom once had a boat that he named "A1".  In other words, he was the captain of his boat and on his boat, he called the shots!

Resolutions

Today, January 10th, is unofficially known as "Quitter's Day" - yes, it really is a thing!  "Quitter's Day" typically occurs on the second Friday after New Year's Day and is the day when most people have decided to quit on their resolutions for the new year.  Apparently the tradition of setting New Year's resolutions started during ancient times, though the concept of a "Quitter's Day" is much more recent.  According to research conducted by Strava in 2019, around 80% of individuals on their platform had abandoned their resolutions by the second week of January.  More recent research suggests that the vast majority of individuals give up on their resolution within a month.

The word resolution when used in this particular context is defined as a firm decision to do or not do something.  Most people that I know come up with at least one resolution for the New Year, either committing to doing more of something or less of something.  Most resolutions involve exercise, dieting and weight loss, or trying to break some bad habit.  There are numerous articles on how not to break your New Year's resolution (here's a great one on Medium), so I am not going to add anything new here in today's post.  To be 100% honest, I don't make a resolution every new year.  Rather, I come up with my own personal list of annual goals.

I've found that setting personal and professional goals for myself is a much more fruitful exercise than coming up with a resolution that I will likely fail on anyway.  To be clear, the great thing about a New Year's resolution is that it is usually simple, clear, concise, and focused.  Some experts would argue that setting 5-10 personal and professional goals is too many, but it works for me.

This year I tried to focus on goals that would help my mind, my body, and my spirit.  I focused on intellectual, physical, and spiritual growth and development.  Three of my goals are physical in nature (and yes, one involves weight loss), four are intellectual in nature and involve new priorities for learning, and three are spiritual in nature and relate to developing new friendships and improving the ones that I already have.  

I try to use the SMART goal framework.  For example, all of my goals are all time-bound, in that they are things that I want to accomplish by the end of the year.  I've found that when it comes to goal-setting, it's a marathon and not a sprint.  I suspect that part of the reason why individuals give up on their resolutions is because they try to do everything all at once in the first few weeks of the new year.  It's also important to push yourself a little, so all of my goals are what we would call "stretch goals".  Importantly, however, I don't set the bar so high that it's almost impossible to reach.  For example, I did NOT set a goal to run next year's Chicago Marathon in under three hours!

Only time will tell if I achieve my personal goals.  However, I feel pretty good about them.  I'm not necessarily trying to completely re-invent myself, which is why I think a lot of people give up on their New Year's resolution.  For those of you who find yourself abandoning your one resolution for the year on Quitter's Day (or even later in the month), try setting annual goals instead! 

"Health care workforce challenges persist..."

I hate to start off a new year with bad news, but the NEJM Catalyst just released a new Insights Report "Health Care Workforce Challenges Persist as a Legacy of COVID-19".  It's a good read, as well as a sobering one.  The Insights team surveyed 691 members of the NEJM Catalyst Insights Council, which is a group of physicians, clinical leaders, and health care executives working in health care organizations in 292 different countries around the world.  These senior leaders reported that the top two challenges that their organizations will face in the new year are (1) staffing shortages and (2) clinical burnout.  

Just over half (53%) of the senior leaders surveyed reported that staffing shortages have actually worsened since the COVID-19 pandemic, which is not a reassuring trend.  Frederick P. Cerise, MD, MPH, currently President and Chief Executive Officer at Parkland Health & Hospital System in Dallas, Texas, said, "Our staffing challenges are dramatically different from the height of the pandemic to now.  It's no longer the desperation of filling shifts.  But pressure is still there."

Recruiting physicians and other clinicians remains a significant concern, with 83% of senior leaders reporting that recruiting physicians and nurses is difficult, very difficult, or extremely difficult.  Recruiting challenges have, in fact, worsened since the last Insights Council survey in November, 2022.  These challenges are particularly impacting pediatric subspecialties, as fewer medical students are choosing pediatric residency training programs.  Similarly, fewer anesthesiology, radiology, and surgical residents are choosing pediatric subspecialty fellowship programs.

Retention is almost as difficult as recruitment, and again these challenges have increased since the November, 2022 survey.  Part of the issue here is the ongoing crisis of clinician burnout.  Nearly half of the respondents reported experiencing signs of burnout related to work-related stress.  

Finally, 45% of Insights Council members reported that trust in leadership/hospital administration has worsened in the last 2 years.  Dr. Cerise said, "The erosion of trust was going on before the pandemic, and almost half of respondents say it worsened in the past 2 years."  Staff shortages and burnout certainly contribute to the lack of trust, but so too have ongoing financial challenges with the consequent need to emphasize productivity, the lack of autonomy that many clinicians perceive, and ongoing administrative hassles that clinicians encounter every day as they try to provide the best care for their patients.

The results of the NEJM Catalyst Insights survey probably shouldn't surprise too many of leaders in health care.  I hope you agree that the findings are important.  What is clear is that we have an obligation to work hard to address some of the findings in this survey, at least those that are under our direct control. 

Do coaches matter?

The NFL regular season officially ended yesterday, which means that today is what has become unofficially known as "Black Monday".  I recently posted about "Black Monday" (see "Black Monday is coming soon...") and focused particularly on the situation with the New England Patriots and their now former head coach, Jerod Mayo.  At least at the time of this writing, five NFL teams have cut ties with their head coaches.  Jerod Mayo was one of those coaches who lost his job, and there will likely be more to come, if not today then later in the week.  

There's at least some evidence to suggest that better coaches and managers help sports team perform at their best, at least when it comes to wins and losses.  For example, one study using data collected from the NFL, NHL, NBA, MLB, and college football and basketball suggested that coaching explains somewhere between 20-30 percent of the variation in a team's success.  So, I guess it makes sense for some of the low-performing teams to move on and try to change coaches.  But let's also be realistic - it's not easy to lead any sports team or organization through a turn-around situation, nor is the new coach, manager, or leader always successful.

At least one of the arguments is that the best coaches get the most production and performance out of each individual player on the team.  Is that true though?  Does better coaching lead to better individual performance?  If you were a professional athlete, would you take a small pay-cut to go play for a legendary head coach or manager? 

Interestingly enough, Lawrence Kahn published a study several years ago that looked at individual players performed under successful managers.  Kahn used a manager's salary as a measure of "manager quality", which makes some intuitive sense, as the more successful a manager is in terms of wins and losses, the higher he is likely to be paid.  Kahn found that (1) higher quality managers lead to higher team winning percentages and (2) players tend to perform better, relative to their prior years of performance, under better managers.  Kahn wrote that "when a high-quality new manager takes over a team, the average starting player's performance relative to his lifetime statistics (accumulated under other managers) is greater than when a low-quality manager takes over the team."  

I will be the first to admit that what happens in the sporting world doesn't always transfer over to the non-sports world.  However, I do think that the best leaders often get the most out of their teams.  As John Quincy Adams once said, "If your actions inspire others to dream more, learn more, do more and become more, you are a leader."  At the end of the day, regardless of the organizational context (sports, military, politics, business, health care), it pays to invest in hiring and developing great leaders.  

The three primary colors of leadership

Last September I wrote a post on whether it's good to be a leader, a manager, or both (see "Leader, Manager, or Both?").  I concluded with the statement that in order to be the most effective, an executive needed to be a good leader AND a good manager ("It's not an or question, it's an and one.").  Similarly, in a post from May, 2023, I claimed that at any given time, a leader may need to assume the role of player, manager, or coach (see "Player, Manager, Coach").  The management literature is replete with definitions of leadership - someone a lot smarter and wiser than I am once claimed that there are almost as many definitions of leadership as there are persons who have attempted to define it.  

I think it is very hard to come up with a perfect definition of leadership, so instead I usually fall back and describe what is meant by leadership with a quote.  The ancient Chinese philosopher Lao Tzu said, "A leader is best when people barely know he exists, when his work is done, his aim fulfilled, they will say: we did it ourselves."  Former U.S. Senator (and NBA Hall of Famer) Bill Bradley said, "Leadership is unlocking people's potential to become better."  And finally, going back to the leadership versus management theme, management consultant and leadership guru Peter Drucker said, "Management is doing things right; leadership is doing the right things."

There are perhaps just as many descriptions of different styles of leadership.  However, in my opinion they all boil down to three archetypes, first described by Kurt Lewin, Ronald Lippitt, and Ralph White, based upon leadership experiments that they conducted at the University of Iowa in the 1930's.  What may surprise you is that their study subjects were not corporate executives, military generals, or government leaders, but rather ten-year-old boys who were formed into different hobby clubs.  Each club was led by an individual who was instructed to use one of three styles of leadership - autocratic (authoritarian), democratic, or laissez-faire:

Autocratic (Authoritarian): The leader makes decisions unilaterally, without much input from team members. The leader has control over all decisions and expects subordinates to follow orders without question.

Democratic (Participative): The leader involves team members in decision-making. There is a focus on collaboration and discussion, with the leader considering the opinions and suggestions of others before making a final decision.

Laissez-Faire Leadership (Delegative): The leader takes a hands-off approach and gives team members the freedom to make their own decisions. The leader provides minimal guidance, and employees are trusted to complete tasks independently.

The three leadership styles were experimentally manipulated so that Lewin and his colleagues could determine their impact on the other individuals in the club.  Clubs with democratic leaders generally showed higher levels of creativity, satisfaction, and productivity compared to the other two styles.  Although the clubs led by autocratic leaders initially appeared to be more effective, that specific style of leadership often resulted in resentment and decreased motivation among the members of the club.  Finally, the clubs led by laissez-faire leaders tended to perform the worst.  Of interest, the individuals in the clubs with autocratic leaders often became aggressive towards each other (can anyone say Lord of the Flies?).  

At the end of the day, Lewin's leadership experiments laid the foundation for subsequent research on different styles of leadership and the development of different models of leadership.  In the next few posts, I'd like to explore some of these different models of leadership.  I think you will agree with me that, in regards to the different theories on leadership, there are two principal and consistent themes.  First, all of the different leadership styles essentially are based upon the three styles first described by Kurt Lewin and his colleagues.  They are akin to the primary colors, which can be mixed and matched to generate all of the other colors.  Second, there is no universally accepted "best" style of leadership that works for every situation.  Instead, the most effective leaders need to rely upon all three styles, depending on the specific needs or context of the situation.