Relational Leadership™: The "Who" - not "What" - of Primary Care Transformation


In our last post of 2015, PCP President and Founder Andrew Morris-Singer sends us off with a call for leaders that focus on the “who” not the “what” of change in the health care system.

Saul Alinsky, a founder of modern community organizing, once wrote of his activist contemporaries, “They have no illusions about [the problems of] the system, but plenty of illusions about how to change [the system].” It pains me to say this, but one could argue this is also true in contemporary efforts to transform healthcare. We’re all quite aware of the challenges of physician-centric, fee-for-service delivery models that lack transparency or accountability. Yet research shows that collective efforts to shift from this system through changes in policy, reimbursement, procedure and education are failing up to 75% of the time. What’s more, our profession seems to be running out of steam, likely a product of both the inherent dysfunction of the system and the unintentional consequences of sub-optimally planned quality improvement strategies. Bottom line: our change-making mojo seems to be missing something. Specifically, a focus on the who of change; the people whose individual and collective behavior will need to shift to achieve our grand healthcare visions. Many changes in healthcare – like meaningful use, team-based care, continuous quality improvement, etc. – involve people. These aren’t robots that just need a blueprint to follow. They’re humans, with motivations, interests, fears, and egos. If we just focus on the technical aspects of these changes, without taking the human factors into account, we’ll fail to inspire change, and just might do irreversible damage to the people. They might stay in practice, and continue to go through the motions of practice, but their internal professional drive will have suffered irreparably. Recent studies of physician burnout and suicidal ideation in the setting of healthcare reform suggest a rapidly depleting supply of hope and optimism. This needs to be taken seriously.

Primary Care Progress’ Relational Leadership™ Model

But we can pull out of this free fall if we commit to developing our Relational Leadership™, a people-oriented approach to change making. If you’ve been tuned in to PCP, you’ve likely heard us talk about this approach to change making. It runs counter to the prevailing leadership model in healthcare, replacing a traditionally authoritative, individualistic and proscriptive approach to change with an approach that is more collaborative, engaging, and nurturing. Ultimately, we think it’s the missing link in healthcare leadership, as do an increasing number of researchers, thought leaders, and decision makers on the frontlines of healthcare transformation.

And that puts PCP, and those of you who are actively developing your own Relational Leadership™ capacities with us, in a unique position. Through experiences as student hotspotters, running powerful campaigns in the PCP Team Cohorts, and building interdependent, interprofessional, and collaborative teams, our Team Leaders have already developed a foundational set of leadership practices that more institutions are starting to value as they attempt internal reforms.

PCP leaders can use their skills to help foster interdependency, collaboration, and more effective care coordination on interprofessional clinical teams, and they can help predict and manage the normal stages of team development – forming, storming, norming, performing, and transforming. Their strategic storytelling can generate the motivation and drive absent in so many teams’ technically focused improvement efforts. They can also model a more authentic, respectful, and engaging approach to patient and community engagement. Finally, they can teach those working for big changes in policy and institutional procedure a more strategic approach to building and leveraging power. PCP leaders are developing a set of skills and a mindset that will make them invaluable to reform efforts.

And at Primary Care Progress, we’re committed to supporting the professional development of our leaders – connecting them with like-minded others engaged in the same work and being a guide at their side as they undergo this highly rewarding professional growth.

A Look Ahead

So what does 2016 have in store? Amazing things, especially with our new executive director, Jennifer Nadelson, behind the wheel. We plan to expand our collaboration with the AAMC and the Camden Coalition to further spread interprofessional student hotspotting, an amazing program in which interprofessional teams of students learn the essentials of caring for complex patients while developing their Relational Leadership™ skills. Our Team Cohorts will also expand to help learn leadership, advocacy, and teaming skills while advancing concrete campaigns in their communities to revitalize primary care. PCP will also develop a menu of campaigns that our Teams can run, showcasing the successful work of other chapters that have paved the way. Finally, we’ll partner with practices at the vanguard of primary care delivery innovation to develop a Relational Leadership™ laboratory.

2015 was great for PCP. And 2016 is going to be even better! As the dialogue continues to shift from traditional care models to new ones, from individuals to teams, and from technical improvement strategies to more relational ones, success in primary care is increasingly being defined on our terms. There will be challenges as we continue to grow and we will learn from them. But the stars are aligned for PCP. With each new member, campaign and collaboration our movement becomes stronger and our communal voices louder. You are the primary care rock stars and change makers this country so desperately needs. And from what we are seeing from you lately, you are rising to the challenge – and beyond.

Andrew Morris-Singer

Dr. Morris-Singer, board certified in internal medicine, is President and Founder of Primary Care Progress, as well as a practicing clinician, medical educator, and leadership consultant. With nearly twenty years of experience in advocacy, he regularly writes and speaks on current trends in primary care, community organizing strategies to advance primary care reform, and the emerging model of Relational Leadership™.

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