Evolution
As organizations grow, their leadership development often lags behind. It makes sense. Leaders don’t produce goods and services when they’re leading, so they seem expensive. And finding good, competent leaders, or training them, is hard. But a failure to develop a leadership infrastructure is a serious error that can cripple a growing organization.
Back when most healthcare was delivered in solo or small group practices, leadership was simple. There were only one or two bosses, and they knew everyone who worked under them. They could witness and oversee everything that went on in the office. It was like a single-celled organism--and amoeba. Everything was contained within one cell membrane, and everyone was in direct communication with everyone else.
A larger group practice is more of a simple multicellular organism--like a flatworm. Its greater size and complexity allows the practice to react more effectively to changes in its environment. It can exploit resources and develop some capabilities that the single-celled solo office couldn’t. Of course, greater complexity requires some new systems, and some specialization of cells. Still, everything is pretty close together and pretty direct. The nervous system is more or less a brain and a chord. Digestion is a short tube. Most communication between cells can take place by diffusion. Everyone is still in communication and relationship with everyone else.
But what happens when the organization gets bigger--a lot bigger? Three hundred, four hundred--maybe a thousand employees. Now it becomes a complex, multicellular organism--like a human being. The greater size means the organization can be much more resilient. It can not only react more effectively to changes in its environment, it can actively change the environment to suit its needs. But with all those advantages come some serious challenges. How does one part of the organization communicate with another? How do you coordinate multiple parts doing different things at the same time? How do you work towards a clear goal and purpose, with all the disparate parts cooperating and creating a sum that’s greater than the whole? The answer is leadership.
The network of leaders in any organization create the systems needed to hold the whole enterprise together. They form the nervous system that allows communication from front line workers to senior decision-makers, and back again. They are the circulatory system that makes sure every part of the organization gets the resources it needs to function properly. They are the endocrine system that regulates the work environment and keeps it stable and optimized for all the different kinds of work that are being done. They are the skeleton that creates a strong connection from one part of the organization to the other, so it can support the weight of its rapid growth.
There’s a reason there aren’t six-foot-long amoebas or 200-pound flatworms. It’s the same reason you can’t organize a large healthcare organization as if it were a small group practice. When a growing organization is faced with financial and logistical challenges, it’s tempting to see leadership development as optional, but it’s about as optional as our blood vessels, our nerves, our glands and our bones.
