It is in this fifth and final set of insights provided by both Sandstrom, coupled with those offered by McKenna and Pugno, that we find leadership in action. It is here where “the rubber hits the road.” It is one thing to promote differences of perspectives and practices, while also extolling the value of community. It is quite another thing to deploy these differences when taking action and to sustain community while confronting the swirling world of VUCA-Plus.
On behalf of this major leadership task, Sandstrom provides the tools of responsibility and accountability, while McKenna and Pugno provides a detailed list regarding the setting of a stage for action (“commitment’) (e.g. inviting others to participate, explicitly describing how attainment of both collective and personal goals can be achieved. They also provide a list of competencies needed to make decisions (e.g. establish criteria for determining priorities, establish processes for implementing and monitoring decisions). I would rearrange and expand their list of decision-making competencies by noting that problem-solving is often required before a decision can be made. Some of McKenna and Pugno’s competencies on this list (e.g. analyzing information, generating and investigating options) relate to the process of solving a problem.
More broadly, I would suggest that effective leadership-in-action moves beyond the competencies of communication and the management of conflict that were identified regarding the fourth set of leadership competencies. We find the need for effective problem-solving and decision-making skills if actions are to be taken that promote differences and foster community. Elsewhere (Bergquist, 2003), I have proposed that empowerment should be the focus of any attempt to promote differences and community. The empowerment pyramid, in turn, is comprised of these four components of effective relationships: communication, conflict-management, problem-solving and decision-making.
McKenna and Pugno add to my empowerment pyramid by including a list of competencies related to taking action. They rightfully introduce competencies related to the management of conflict (e.g. resolve conflicts by identifying common ground, explore and test new approaches to tackle occasional and ongoing challenges). It is important to acknowledge that empowerment is a recursive process. Issues regarding conflict (and communication) re-emerge when action is finally being taken. There is often also a return to the stage of problem-solving—for we often learn much more about a problem when we have actually tried to solve it.
A recursive process is particularly predictable when leadership is addressed to the very challenging goals articulated by Sandstrom with regard to promoting and enhancing differences while also sustaining a sense of community. This challenge is particularly strong and prevalent in contemporary healthcare systems. While most of these systems were relatively homogeneous during the 20th Century with their broad-based support for traditional allopathic medicine, there is not an appropriate diversification of viewpoints regarding the validity of alternative modes of prevention and treatment.
There are also now much more diverse populations to be served and newly emerging perspectives and practices to be incorporated. VUCA-Plus conditions produce a demand for this diversity—thus requiring that physician leaders be skillful in their engagement with this diversity and with the requirement that the health care community they serve be preserved–and hopefully be more fully enhanced by the introduction of new perspectives, practices, and participants.
