Leading From Within: A Few Notes From A CEO Of A Small Hospice

Leadership concept with gears

Leading from within requires working with many different people and processes, and effectively communicating.

This post comes to us from guest author Tom Johnson-Medland. Tom is the CEO of Lighthouse Hospice in Cherry Hill, NJ.

There are a myriad of applications for leadership in today’s business economy. There are external platforms to lead from and internal platforms to lead from.

Consultants tend to bring a unique set of skills to a business in helping lead them through regulatory, compliance, quality and business work flow issues. They lead from an external position by taking people along from where they are to where they need to go. They do this in larger and more broad sweeping strokes. They are leaders from the outside.

Leaders from the outside can hone the skill of an organization’s leaders by bringing new data and expanded knowledge areas to a situation and staff along with new solutions and resources as well. The greatest challenges that those who lead from the outside face are gaining buy-in and credibility from the already established roles, routines, and expectations of the leaders from within. It is quite common for this form of leadership to lose traction and or momentum, as once the external leader is removed from the position of mentoring and coaching, things tend to seek the least common denominator again.

C-suite leaders are internal leaders – they lead from the inside. They lead from a position among the daily grind and routine. In many ways this takes more grit to perform because you do not have the luxury of walking away from the problems in a limited time span; you are married to the work, the people, and the resources – and you are accountable for making that all come together with profitability (or if you are a non-profit, delivering on mission and making an impact relative to resources) as an overall output.

Leading from the inside has its own set of challenges. Leaders in an organization have to fight to maintain the drive, to stay fresh, and constantly be about the task of increasing their knowledge base and skill set for remediating and integrating situations and employees. The internal leader has to work with limited resources and they do not have the luxury of staying out of “the trenches” (like a consultant or external leader) on a daily basis. The internal leader stands toe to toe and shoulder to shoulder with the very people that may need to be refocused, realigned, and reequipped. This has its own challenges when it comes to buy-in, consensus building, and credibility.

As the CEO of a small for-profit hospice in Cherry Hill, NJ (around 63 employees and 45 volunteers), one of the first things I realized about leading from within was that it took a mass amount of time to analyze situations and processes, rally resources, and then implement them throughout the organization by communicating, communicating, communicating. The CEO needs to be the one who looks at the big picture and accesses the specific assets for the rest of the C-suite leaders (and consequently the whole organization). Big view vision; little view focus.

It could not all be done by the CEO; as a matter of fact, it has to be done with and through the senior leaders – the C-suiters. This meant that I had to align the Directors of our organization strategically and tactically so that they could then align their workforce in similar fashion. And, it meant that I had to engage each leader from where they were as a leader.

Some lead in one fashion and others in another. This same disparity of leading styles is what makes an organization agile and robust. But, having difference is never an easy proposition. The world would be better (or so it seems) if everyone did things the same way. Actually not.

All the while the CEO needs to test the strength of the communication (the neural pathways of the business), test the soundness of the processes, test the growth of the full leadership team, and test the quality of what the organization produces. As we say in Project Management, there needs to be ITTO – Inputs, Tools, Techniques, and Outputs. Growing them in an increasing evolution of talent is best measured by the quality and the depth of the execution.

I spend most of my time facilitating communication across the silos of the organization, realigning different programs within the company, reframing and redefining the work, and keeping people pointed toward a common and united goal of quality care (end-of-life care) and growth. This sort of seemingly random application of principles is solidified and hardwired into the company when the leaders at all levels begin to match these competencies to routine and schedulable tasks in a company. I have routinized educational development, updating of Best Practices and Policies and Procedures, rewriting evaluations and metrics on a regular basis throughout each year. Each month has a specific over-site focus that I work on some the company infrastructure grows to support growth of outputs.

I often thought that that was easy and simple (at least when I was the CIO). It is not. The CEO and other leaders in an organization may have all the strategy and all of the tactics they need (all the infrastructure) – in hand – but they have to get the whole of the workforce in line with those strategies and tactics and able to perform those tasks consistently using the skills and gifts that they were hired for – which are most likely at odds with other leaders in the organization. It is methodical to be sure.

The leaders in the healthcare industry (and others) have to model an openness to ideas and knowledge, a clarity of purpose and focus, a tireless devotion to execution, a creativity in finding solutions, a heightened ability to communicate to all types of hearers and learners, a fluid sense of accountability and grace, and all of this within a dwindling landscape of resource and dollar.

It is a constant checking and rechecking. I like to think of the work of leading as consistent with the image of a bargeman navigating his/her barge through a narrow canal. The leader is always about figuring out how close this barge is to the rocks, the shoals, and the edges of the canal. They are always checking for how deep the water is. But that seems to be the true test of leadership.

So, if I were to fashion this into a sharply focused, actionable competency for leaders who lead from within an organization, I would have to say a leader needs a superior vantage point from which they may gather information and assessments (keen listening posts and observation points), needs to be able to translate their findings so that everyone along the organizational chart can understand where they are, where they are going and how they will get there (exceptionally agile communication) by integrating all of the resources at your disposal (people, finances, skills) to make the organization healthy (quality) and sustainable (growth). And then, you have to be able to engage the external world with these same sorts of competencies so that you can drive the industry your company represents in a fashion consistent with what you know to be true about the industry and what you are expecting to take place over time.

We do this by engaging a handful of good people with this model and then asking them to do the same. You have got to be able to do this with and for some senior leaders so they can do the same for their handful of good people. It takes time and tenacity – and you’ve got to want to serve others to help them get there. As we say in Project Management it is taking a whole bunch of good work and getting it done with a whole lot of good people.

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