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CHAPTER 1
Perception Versus Reality
It is very difficult to manage your way out of a situation that your behavior has gotten you into.
— Stephen Covey
Guide to Reader
This chapter forms a critical foundation for the leadership precepts in this book. It centers on the principle that leaders must be aware of how they are perceived and be willing to change behavior if a need to do so is indicated. Rooted in self-awareness, the ability to understand how you are perceived forms the underpinning for all highly effective leadership. Essentially, the message of this chapter — and this book — is that perception is more important than reality and one of the principal jobs of leaders is to discern how they are perceived.
Actions Louder Than Words
The CEO of a large academic medical center took great pride in being a visible leader within his organization and in personally championing key strategic initiatives with the frontline staff. The latest endeavor that he and his executive team were looking to achieve was a reduction of nosocomial infections by 50 percent in 12 months, with an ultimate goal of eliminating all preventable hospital-acquired infections within three years. The chairman of the board of trustees led a hospital-wide kickoff for the initiative with a great deal of fanfare, and the laudable goal was touted in a series of town hall meetings hosted by the CEO. An aggressive staff training and internal marketing campaign was developed and initiated. A key component of the implementation involved "patient safety rounds," which were designed to make senior leaders more visible in the organization, to engage frontline staff in a dialogue about the enhanced focus on infection prevention, and to track progress on unit-specific tactics and goals associated with the program. The CEO was particularly excited about this aspect of the initiative, as it centered on his self-perceived strengths of building effective relationships with staff and leveraging those relationships to create enthusiasm toward a strategic goal. He began performing his rounds daily with a great deal of fervor, and he felt he was gaining a great deal of support with the staff while increasing awareness of infection prevention. The CEO thus was surprised when the chief nursing officer requested a private meeting a few weeks later to discuss some complaints she had received about the patient safety rounds. She carefully began the discussion by telling the CEO that, although the staff greatly appreciated his visits and his enthusiasm toward the goal of creating a safer environment for patients, they were concerned that he had been witnessed several times entering and exiting patient rooms without performing proper hand hygiene. Moreover, his habit of shaking the hands or patting the backs of employees to make personal connections while rounding could actually be a detriment to the goals that he was holding them personally accountable to achieve. The feedback provided the CEO with a powerful reminder of the disconnect that existed between his internally held image of his activities and the very different perception he was creating with the frontline staff.
Be mindful: In the case of leaders, our actions form stronger impressions with those whom we lead than our words ever could. And remember the old adage: Perception is often more important than reality.
LEADERSHIP: THE MOST IMPORTANT REALITY WE HAVE IS HOW WE ARE PERCEIVED
In healthcare, leadership is, at its core, a business of building and maintaining positive relationships. And a leader's ability to develop effective relationships with peers, subordinates, and supervisors is greatly influenced by the perceptions people form during interactions. Just as a photograph can capture a moment in time and reinforce that moment in our memories, personal interactions with leaders in an organization can shape our perceptions of the leaders' personality, character, and ability to lead. These impressions can be lasting, and they have the potential to either enhance or destroy the careers of technically capable leaders.
Sadly, a gap often exists between how leaders perceive themselves and how they are viewed by those they have been invited to lead, and this gap tends to widen as executives take on more senior roles. Lombardo and Eichinger (2002) found that, when completing self-assessments in 360-degree performance reviews, leaders tended to rate themselves an average of .75 point higher on a five-point scale than their subordinates rated them. Lombardo and Eichinger also found that the most senior executives were increasingly likely to overrate themselves, particularly in the area of emotional intelligence. Furthermore, senior executives were found to be less likely to have reliable mechanisms for gaining feedback on their professional performance and potential areas for continued development.
Significant gaps can exist because of the distance, both real and perceived, between executives in an organization and the frontline staff. Despite trends toward a more relaxed work environment and the empowerment of employees, executives remain foreboding figures in the healthcare field. Consequently, executives are not often challenged by their employees and, even worse, are not openly criticized or offered suggestions for personal or professional improvement. Even when outspoken employees do challenge executives, those leaders often will retreat to the privacy and safety of their offices, and the duty of responding will be delegated to lower-ranking executives. In seeking shelter from the realities of the organization, executives can skew their perceptions of the needs and sentiments of employees and develop falsely positive impressions of their own performance as leader.
The distance between executives and employees only widens the perception gap because (1) it creates two differing perceptions of reality and (2) employees misunderstand, and possibly get offended by, executives' lack of insight into issues within the organization. The bottom line in this situation is that people believe what they perceive to be true, even if there may be valid evidence to the contrary (see the note on confirmation bias in this chapter's "Leadership Research and Theory Support" box). An executive may be able to produce objective financial results, but the results may be of little consequence if the executive fails to capture the hearts and minds of those who work for him.
Lack of organizational self-awareness can be significantly detrimental to long-term success. A study that followed a group of executives longitudinally over time to track their career progression found that leaders who rated themselves significantly more favorably than other rater groups did on core leadership competencies also failed to recognize potential career-stalling behaviors. Those leaders were also more likely to be terminated than peers who had a view of their own performance that was more aligned with other rating groups in the 360-degree evaluation (Lombardo and Eichinger 2003). Findings from the study are shown in Exhibit 1.1.
What does this mean? Simply put, the responsibility for recognizing and managing perception lies solely on the executive. Consider the following case examples:
• An executive in charge of an organization-wide strategic project spoke frequently with her team in both individual and group settings about her personal commitment to the initiative. When business conditions changed, however, she began to divert attention and budget funding away from the project without explaining the rationale to her team. In the absence of information from their leader, the team came to the conclusion that she was not supporting them adequately, and they worried that their continued participation in the project might derail their own careers in the organization. The project ground to a halt, and trust in the leader was irrevocably lost.
• A hospital CEO was active in a number of local community organizations. He believed that his community service was providing excellent visibility for his organization and that his involvement was fully supported by the board. After his resignation, however, the committee in charge of finding his replacement gave the executive search firm clear instructions that they wanted a CEO who would spend more time in the hospital and less time with the Chamber of Commerce, Rotary Club, and other groups.
• A dynamic new vice president was brought into an organization and quickly began trying to make a name for herself. She made rapid changes in staffing, leadership structure, and service offerings and did so somewhat unilaterally. Although she delivered financial gains for the company as a result of her restructuring, she failed to recognize that the historical organizational culture was one of collaboration and consensus building. Peers were so angered by her lack of communication and her "empire building" that she was eventually forced out of the organization.
• Because of a sustained downward trend in volumes and revenues, a hospital CEO announced in a series of town hall meetings that everyone needed to pitch in and "tighten their belts" and that there would be a salary freeze and a significant reduction in force to rebase expenses going forward. Shortly after the layoffs were completed, the local paper published a story on the sizable bonuses that the hospital executive team had been paid for improving the organization's financial performance. Obviously, the news created a great deal of negative sentiment among the staff.
These case examples are similar because they all revolve around half- truths and perceptions formed in the absence of effective communication on the part of the executives. To avoid situations of this type, leaders must understand the common causes of misperception, work to develop self-awareness, ensure that they have a process to recognize and change poor perceptions in the organization, and establish mechanisms to foster positive ongoing perceptions.
COMMON CAUSES OF POOR LEADERSHIP PERCEPTION
Employees can form misperceptions about their leaders based on a wide variety of factors. However, certain factors have proved to be common triggers and must be actively managed by executives looking to maintain a positive image within the organization. Leaders must be aware that they are always "on stage" and that their actions are being judged at every moment. The list of factors discussed here is far from exhaustive, but it highlights how certain words and symbols associated with positions of authority can easily be misconstrued. Such misunderstandings can call into question the motives and integrity of leaders who are not mindful of crafting their organizational identity.
Executive Compensation
The Great Recession of 2007–2009 brought renewed attention to the issue of executive compensation — a historically touchy subject and something that continues to draw a great deal of ire from frontline employees today. Stories about corporate CEOs taking large executive bonuses while their companies faltered contributed to the "Occupy Wall Street" movement, and revelations that Wal-Mart CEO Michael Duke made more in one hour than the average Wal-Mart employee earned in a year sparked national outrage (Gomstyn 2010). Compensation of healthcare leaders, though not at the level of Fortune 500 CEOs, has also been the focus of criticism during healthcare reform debates. Some states have placed caps on income levels for CEOs of not-for-profit providers. In addition, a new Securities and Exchange Commission (2015) rule requires publicly traded hospitals to publish the ratio of their CEOs' total compensation to the median employee compensation — a response to increasing public concern over the gap between CEO pay and employee pay.
Healthcare leaders must be sensitive to the fact that their compensation packages are often much higher than those of frontline staff. And even though a competitive compensation strategy is critical to retaining top- level leadership talent, the methods of determining those compensation levels (market surveys, board-level recommendations) are often poorly understood by the rank and file of the organization. Likewise, much of the work an executive does occurs out of the line of sight of the staff, and staff might not always fully appreciate the strategic decisions executives make to ensure the long-term sustainability of the organization. Leaders must understand this dynamic, be keenly aware not to flaunt the "trappings of success," and remember that they are being scrutinized. Actions as seemingly innocuous as decorating your office lavishly or having a hallway discussion about purchasing a new sports car can serve to create a rift — the best leaders understand this innate tension and actively work to manage it.
Perquisites
Another common source of negative perception involves perquisites, or perks — the tangible representations of the value the company has placed on its leader. Company cars (or car allowances), reserved parking spaces, social club memberships, and posh executive dining areas are among the perks seen in some areas of healthcare. Even the simplest of catered business lunches in the hospital administrative suite cause some eyebrows to rise. Highly visible perks, although desirable and almost expected with senior-level positions in an organization, can host a litany of problems, including the following:
• Bitterness over imbalance of power. Leaders need to understand that there are likely employees within the organization who feel they work harder than, are at least as well qualified as, and are equally deserving of success as their executives. The visibility of perks can serve as a discernible trigger to this subset of employees and lead to insubordination and low employee morale.
• Financial and quality ramifications. Once a few employees get infected with the wrong perception, that same way of thinking can spread to a larger group of employees quickly and easily. Results of this viral spread may include lower staff productivity, slipping of key quality and operational metrics, and negative long-term effects on the bottom line.
Perks are an important part of a competitive compensation package and are often necessary for the recruitment of talented candidates. However, leaders must recognize and manage the way employees perceive these perks. Leaders should exercise care in taking advantage of perks that might be considered inappropriate given the unique culture of the organization or the specific conditions at the time. For instance, a CEO driving an expensive sports car into a reserved parking space might cause significant strain on staff relations, especially if it occurs during a time when the hospital is struggling financially and focusing on expense and job cutting.
Leadership Visibility
One of the most common criticisms of leaders in healthcare is that they are rarely seen in the operations of the hospital. No matter how often a leader rounds or walks through the facility, some employees still would like to see her more often. Most healthcare organizations operate on a 24-hours-a-day, 7-days-a-week cycle, so even if an executive spends a great deal of time getting to know the staff on the day shift, the night shift might feel alienated. This dynamic only becomes more pronounced as leaders move up in an organization or move to organizations of greater size and scale. The simple truth is that most employees in a healthcare setting are caregivers by nature, and relationships play an important role in their sense of job satisfaction. If employees do not feel they have an effective working relationship with their direct supervisor, and if they do not feel connected to their senior leaders, the likelihood of them seeking employment elsewhere will be significantly higher.
Less-visible executives often develop both real and perceived distances from frontline employees, are perceived as aloof or uncaring, and have a weak grasp of the day-to-day issues in the organization. Regardless of competing priorities, it is imperative that leaders at all levels carve out specific time on a regular basis to spend in the operations; to speak with staff about the direction of the organization, key goals, and metrics the staff can influence; and to actively seek feedback about how leaders can help staff perform their jobs more effectively. Senior executives should round not only during the day shift but also periodically during evenings and weekends (ideally these responsibilities can be distributed to each executive team member on a rotating basis). Other methods to enhance leadership visibility may include regular town hall meetings and informal breakfast sessions with employees celebrating their anniversary months with the organization.
(Continues…)
Excerpted from "The Healthcare Leader's Guide to Actions, Awareness, and Perception"
by .
Copyright © 2016 Foundation of the American College of Healthcare Executives.
Excerpted by permission of Health Administration Press.
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