Lessons of experience: key events and lessons learned of effective chief medical officers at freestanding children's hospitals.
|Author:||Nowill, Donald P.|
|Publication:||Name: Journal of Healthcare Management Publisher: American College of Healthcare Executives Audience: Trade Format: Magazine/Journal Subject: Business; Health care industry Copyright: COPYRIGHT 2011 American College of Healthcare Executives ISSN: 1096-9012|
|Issue:||Date: Jan-Feb, 2011 Source Volume: 56 Source Issue: 1|
|Topic:||Event Code: 200 Management dynamics Computer Subject: Company business management|
|Geographic:||Geographic Scope: United States Geographic Code: 1USA United States|
As the healthcare environment changes, physician executives who are effective leaders and agents of change are needed. Healthcare organizations that are successful at developing effective physician leaders will be at an advantage. This article examines how physician leaders develop on the job. Such knowledge and insight can be useful to healthcare systems looking to develop a new physician leadership development program or improve an existing one.
This study identified that learning from other people (e.g., mentors, role models, bosses) and key events involving hardships are valuable means in developing leadership acumen for chief medical officers (CMOs) at freestanding children's hospitals. Most of the hardships CMOs reported were a result of mistakes made when they were trying to institute change. CMOs reported a disproportionately low number of learning events from developmental job assignments. This finding may indicate a lost opportunity on the part of healthcare organizations in developing leaders.
The most frequent lessons learned pertained to handling relationships, interpersonal skills, and executive temperament. Skills in handling relationships and interpersonal skills were best learned through business mistakes made in dealing with others. Lessons in executive temperament, self confidence, and handling adversity were most often learned from role models and bosses.
These findings indicate that physician leadership development initiatives should intentionally and systematically incorporate job assignments, role models, and mentors.
As the healthcare environment changes, physician leadership responsibilities will likely need to be expanded and more physician leaders recruited (Zismer and Person 2008). Physician executives have the expertise and clinical knowledge to make significant contributions in the transformation of healthcare. However, their training as physicians ill prepares them to assume leadership roles, making it all the more important that aspiring physician leaders participate in formal leadership development programs. Understanding how physician leaders develop on the job can provide important insight for designing effective physician leadership development programs.
How do physician leaders develop leadership acumen? Schneller and colleagues (1997, 92) remarked that the "knowledge and skills associated with physician managerial tasks are not part of the typical medical school curriculum nor are aspiring physician executives exposed to career ladders to facilitate their transition into management." Stoller (2009) asserts that little attention is given to training physicians regarding leadership competencies. To develop leadership skills, physician leaders have turned to executive degree programs at schools of higher education and professional organizations. Some healthcare systems have started formal leadership development programs for physician executives. However, the powerful experiences and learning that occur on the job are often overlooked as a method for developing leadership competencies.
Arguably, learning from experience is the most effective method of development. Experience is the foundation for all learning (Dewey 1938). Leadership happens in the act of leading. Experience is the foundation for developing leaders. Workshops, certificate programs, and formal education are valuable; however, these instructional methods develop leader skills that are then, to some extent, deployed in the act of leading.
While it is obvious that physician executives learn on the job, little is known about how they develop leadership acumen while working. The purpose of this exploratory study was to discover the key developmental experiences and the lessons learned from those events that had the greatest impact on improving the leadership ability of CMOs in freestanding children's hospitals. The knowledge and insight gained from this study can be applied to designing effective physician leadership development programs or improving existing ones.
The thrust of research on leadership development from job experiences started in 1987 with the study Key Events in Executive Lives by Lindsey, Homes, and McCall, followed by McCall, Lombardo, and Morrison's 1988 book Lessons of Experience: How Successful Executives Develop on the Job. These researchers from the Center for Creative Leadership (CCL) studied the experiences that had the greatest effect on the careers of successful senior executives and the lessons they learned.
CCL research team findings revealed that the lessons executives learn on the job could have a profound effect on their career development and were related to a "broad spectrum of skills, abilities, attitudes, philosophies, perspectives, knowledge and values" (McCall 1988, 6). A study conducted by CCL researchers McCauley and Brutus (1998) highlighted that job assignments play a central role in managerial development; some job types are more developmental than others, and different kinds of developmental assignments are associated with different kinds of learning.
The CMO is a physician leader who typically is a member of the senior management team. An important role for a CMO is effectively handling relationships and influencing others. There are several factors that challenge the effectiveness of physician leaders in achieving this. First, physicians are trained to be medical experts, not executives. They are ill prepared to assume leadership roles (Cummings 1988; Kurtz 1980; Ottensmeyer and Key 1994; Peters 1994; Sheff and Sagin 2004; Torrens 1980). The second challenge is that physician leaders are charged with leading autonomous constituents (physicians) that they, in most cases, have no formal authority over. The third challenge is that physician leaders are often placed in a difficult position as "boundary-spanners," bridging the business world and the medical world.
Smith (1990) surveyed a national sample of physician executives to explore their roles and behaviors, the current skill level associated with these roles and behaviors, and the need for development in these areas. Smith's study discovered that the role associated with interpersonal behaviors is the most important for physician executives, the role that physicians are most skilled at, and the role in which physicians need the most development. Smith's findings are consistent with the findings of Gill (1998), Gill and Kirschman (2002), Guthrie (1999), Kurtz (1980), Noren and Kindig (1998), and Peters (1994).
Physicians are skilled at learning from other people. An integral part of their socialization into medicine is a strong motivation to acquire the knowledge and skills of professional role models (Maudsley 2001). Wright, Wong, and Newill (1997) reported that 90 percent of medical students identified, on average, three to seven physicians as role models. Eighty-two percent of medical school deans ranked role modeling as the greatest influence on students' development of high professional standards (Maudsley 2001). Taylor, Taylor, and Stoller's (2009) research on the role and functions of role modeling and mentoring in developing physician leaders found role modeling a valued experience. Their participants described the significant influence of observational learning and watching leaders in action. In regard to mentoring, these researchers discovered that many of their participants preferred short-term strategic interactions with various individuals about specific professional issues rather than long-term mentoring relationships. Another survey of 110 physician leaders, educators, and medical students revealed that mentoring, coaching, and managerial job experiences are perceived as the best methods to develop leadership competencies (McKenna, Gartland, and Pugno 2004).
The conceptual framework of this study is grounded in experiential learning. This framework integrates CCL research on lessons of experience and experiential learning theories. The conceptual model's main purpose is to discover the most important key events and lessons learned by CMOs. Experiential learning is defined as (McGill and Weil 1989):
The key terms for the conceptual framework are provided in Exhibit 1, followed by a diagrammatic framework in Exhibit 2.
The study took place in 2008. Ten telephone interviews were conducted with CMOs of freestanding children's hospitals. A freestanding children's hospital is one that is geographically, financially, clinically, and administratively independent of adjacent medical institutions. The telephone interviews were approximately one hour in duration. Participants provided their curriculum vitae as a means to verify that they met the inclusion criteria of an effective CMO. This study's methodology replicated the qualitative interview portion of the earlier work of McCall, Lombardo, and Morrison (1988). The research question that the CMOs were asked to answer was the following:
* What happened?
* What did you learn from them?
Criterion-based purposive sampling was used to choose participants. CMOs from freestanding children's hospitals were selected because of the similarity of organizations that employ them, and a gatekeeper was willing to help recruit participants. Similarity of site was important to ensure that the recruitment of participants was from a pool of leaders that were effective physician executives. To reach the level of CMO in a freestanding children's hospital, an individual has, most likely, exhibited a high level of competence as a leader. Having a gatekeeper help recruit a difficult population to engage in research ensured that enough participants would be available to reach a saturation point in data content.
The inclusion criteria for "effective CMO" is all physician leaders from freestanding children's hospitals serving in the capacity of CMO, typically having the actual title of CMO, vice president of medical affairs, vice president of clinical affairs, or full-time chief of staff with five years of leadership experience. The survey pool of 44 hospitals came from the National Association of Children's Hospitals and Related Institutions members list of freestanding children's hospitals. The study was approved by Fielding Graduate University's Institutional Review Board.
Interviews were digitally recorded, transcribed, and mailed to participants for their review and approval. Theme saturation was achieved after nine interviews. After participants approved their transcripts, the author and two trained coders coded the transcripts using a detailed coding protocol and codebook.
The coding data was mapped onto coding grid forms. Frequency of responses was determined for each category by CMO and recorded on a summary coding form. The data from the summary coding forms were tabulated and recorded on a master study coding form.
The study incorporated six strategies to ensure the trustworthiness of the results. First, a proven research methodology was used (McCall, Lombardo, and Morrison 1988). Second, the findings are plausible and resonate with the same underlying patterns and themes derived from previous research (Lindsey, Homes, and McCall 1987; McCall, Lombardo, and Morrison 1988). Third, data findings, interpretations, and recommendations were supported by the data and are internally coherent. Fourth, two researchers were employed to code participant's transcripts, discuss data, and reach consensus on category classifications. Fifth, a pilot study was conducted to test methods and to train coders. Sixth, conformability was enhanced by having participants check the accuracy of their interview transcripts.
Of the 44 CMOs who were asked to participate in the study, 10 responded. Their credentials and experience in leadership positions were reviewed to ensure that they met inclusion criteria. This sample represents 20 percent of the CMOs working at freestanding children's hospitals in the United States. The demographic profile of the participants is included in Exhibit 3.
In total, 48 key events were identified, comprising 15 different categories, which were further sorted into four major key event groups. Exhibit 4 provides the definitions and frequency distribution for all key events by major category. The percentage of key events experienced by CMOs by major category is illustrated in Exhibit 5.
Learning from other people comprised 50 percent of all key events reported by CMOs. CMOs reported learning from individuals who, because of their position, what they stood for, or what they did, left a strong and lasting impression that made a difference in the way they lead. These individuals were role models, bosses, or mentors. The following personal narratives illustrate the power these individuals had on their development. In the first, a CMO tells how early in his career he learned how not to act by observing the behaviors of physicians who were negative role models.
In this next vignette a CMO describes an extremely tough boss. He learned about persevering in the face of adversity and developed self-confidence as a result of going through this experience.
In this last narrative a CMO conveys the importance a mentor had on his career direction.
Ten CMOs reported key events involving hardships. Eight CMOs (80 percent) reported learning from business failures and mistakes, the highest number of CMOs for any event subcategory. Most of the business failures reported by the CMOs involved implementing change initiatives and the mistakes made dealing with the people who were critical to the success of the project. Business failures and mistakes were the best teacher for CMOs in learning how to work with people. In the following vignette, a CMO acknowledged that he learned the value of involving individuals who are going to be affected by a change.
Assignments tend to be developmental when an individual is faced with ill-structured situations or novel circumstances that they are motivated to solve. CMOs in this study reported only two developmental assignments that made a difference in the way they lead. This represents 4.2 percent of all key events in this study. The two events CMOs reported learning valuable lessons from included "fix-it" and "change in scope" assignments.
The lessons of experience for these CMOs were about handling relationships, executive temperament, setting and implementing agendas, basic values, and personal awareness. The best teacher of relationship management skills was business failures and mistakes. Ten CMOs discussed 73 lessons, comprising 21 different subcategories. These subcategories were classified into five major learning groups. Exhibit 6 displays the lesson descriptions, categories, and subcategories and the number of lessons learned by CMOs in this study. The percentage of lessons learned by major category is provided in Exhibit 7.
For the subcategory "learning they had personal limits," 20 percent of the CMOs reported that they did not know how to work in teams and didn't realize this until they were part of the executive management team (EMT). Here is an extract from one CMOs personal narrative:
The second vignette comes from a different CMO:
Understanding how physician leaders develop on the job can provide important knowledge and insight in designing effective physician leadership development programs. This study explored the developmental experiences and the lessons learned that had the greatest effect on the leadership ability of CMOs in freestanding children's hospitals. These findings may be useful for healthcare leaders who are interested in establishing a new physician leadership development program or improving an existing one.
This study found that role models and mentors played an important part in the leadership development of CMOs. Other studies have established that observational learning from role models is a common method for physicians (Maudsley 2001; Taylor, Taylor, and Stoller 2009; Wright, Wong, and Newill 1997). In addition, learning from other people is perceived by physicians as the most effective way to develop leadership competencies (McKenna, Gartland, and Pugno 2004). Five of the CMOs (50 percent) in this study discussed the importance of mentors in their development. Two of these CMOs attribute the influence of a mentor on their decision to change their career from medicine to administration. I recommend that physician leadership development programs incorporate the use of mentors and role models.
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A finding of this study that is consistent with the literature is that interpersonal and relationship management skills are important competencies for an effective physician leader. Unfortunately, many CMOs learned their lessons in handling relationships after they had made the mistake of misjudgment of the importance of other people to the success of a project.
Development from mistakes is a hard road to take. Physician leadership development programs should incorporate job assignments as a way to develop relationship management and political acumen competencies.
CMOs in this study did not report job assignments as playing a major role in developing their leadership acumen. Two CMOs reported that they did not know how to be team players until they reached the level and challenges of being on the executive management team. Their personal narratives may provide some support that these leaders were not challenged in their prior roles as team members, limiting their ability to develop requisite competencies as they advanced in their careers. Based on these findings, I recommend that physician leadership development programs incorporate the use of job assignments in a conscious and systematic way. Findings from this study would suggest that job assignments that develop relationship management and team skills would be particularly helpful.
Healthcare executives looking to establish a new or to improve an established leadership development program for physicians in their organization are encouraged to consider the results of this study. For the findings to be beneficial one should consider the organization's commitment to developing physician leaders and the aspirations of these individuals.
Role models, mentors, and job assignments need to be integrated consciously and systematically into a formal program that is part of the organization's culture and business strategy. Leadership development is a long-term endeavor that must be embedded in the organization's culture and allowed to demonstrate results over time. On an individual level, development comes from within, from an individual's desire to succeed. McCall, Lombardo, and Morrison (1988) found that the extraordinary characteristics of executives in their study included their ability to create opportunities for growth and their courageousness to look inside themselves and come to grips with their imperfections and extract something worthwhile from their experiences.
In using job assignments as a method of development, organizational leaders will need to establish a means for identifying developmental assignments and what a person may learn from them. In addition, procedures need to be in place to ensure that aspiring physician leaders have opportunities to participate in developmental assignments without sacrificing crucial day-to-day responsibilities. Taking physician leaders out of their customary roles and placing them in developmental assignments will require some short-term sacrifices. However, the long-term payoffs will outweigh the short-term sacrifices, as mastering challenging assignments early in one's career is an indication of later management success (McCall, Lombardo, and Morrison 1988).
Responsibility is a central element in developing leadership skills from job assignments.
Exposure is not enough; what matters is what one is doing while being exposed. Individuals must take an active, meaningful role, preferably a leadership role. The arrangement of developmental assignments needs to follow the principle of continuity of experience. Continuity of experience states, "Every experience builds on another and modifies in some way the quality of those experiences which come after" (Dewey 1938, 35). Developmental assignments need to be arranged in such a manner that a prior experience paves the way for a more complex one, allowing an individual to develop more sophisticated and integrative ways of thinking and doing to handle increasingly more complex situations.
The use of challenging job assignments in developing a physician leader's relationship management and political acumen skills throughout a career may progress as follows:
1. Leading a team that is responsible for a new service
2. Managing a continuous quality improvement project
3. Leading a project team that is charged with solving a problem or gaining consensus on new processes, technology, or budgets
4. Heading a new initiative in the community or professional organization
5. Taking on a boundary-spanning responsibility previously managed by one's boss
6. Putting together a coalition of peers from multiple specialties to lobby the organization for new technology
The first three assignments are designed to develop skills in building and maintaining positive relationships, influencing others within one's group, and handling conflict. The last three assignments are geared toward developing political acumen. These are experiences in which the physician leader is working external to the institution or across organizational boundaries and is required to influence others without hierarchical power and with attenuation of status. Potential leadership development outcomes from these assignments include understanding and negotiating across political boundaries, effectively influencing others in different situations, and creating action and commitment by forging relationships.
Using an organizational coach or mentor may help maximize learning potential from challenging job assignments. Lessons learned are not always inherently clear. Extracting wisdom from ambiguous situations and applying it to future challenges requires critical reflection. Having a person serve as a sounding board who can challenge assumptions and expose blind spots can have a profound effect on helping construct meaning from experiences and integrating new understandings with existing knowledge. In addition, having coaching support when one is struggling with a challenging and stressful job assignment can enhance self-efficacy (Moen and Allgood 2009) and facilitate growth and development.
Physicians are accustomed to observational learning from role models. Healthcare leaders can do several things to integrate role models in the development of physician executives.
1. Identify the role models in leadership positions that emulate the competencies, values, and characteristics that you would want developing physician leaders to acquire.
2. Increase the exposure and work interactions of developing physician leaders with these role models.
3. Have physician leaders reflect on the positive and negative role models they have encountered. Have them describe what behaviors they would like to emulate and what behaviors they wish to avoid.
4. Incorporate those behaviors as part of the physician leader's development plan.
This study is delimited to the population of CMOs at freestanding children's hospitals. This may limit the degree to which the results can be generalized or transferred to other healthcare settings and other types of healthcare leaders. Another limitation of this study was a result of using a semistructured interview format. Semistructured interviewing methods limit the investigator to answering only the research question, preventing exploration of why CMOs reported a low level of learning events from job assignments.
Effective leaders continue to develop their range of skills and competencies throughout their careers. Much of their development occurs on the job. Healthcare organizations that can consciously and systematically harness job experiences as a method of development will be at an advantage in developing, engaging, and retaining the talent they need to prosper in the future.
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Jody Graham, FACHE, chief operating officer, Children's Memorial Hermann Hospital, Houston, Texas
In this interesting article, the author focuses on a relatively new breed of hospital administrator--the chief medical officer (CMO). The view is further magnified by focusing on CMOs in children's hospitals. In most adult hospitals, CMOs have become the drivers of the quality strategy and implementation. Their territory has been established by federal regulations, CMS reimbursement strategies, and The Joint Commission. In children's hospitals, however, quality standards and indicators are relatively underdeveloped, and CMOs, at least temporarily, have more flexibility in building the quality agendas of their hospitals. As such, children's hospital CMOs might be viewed as pioneers compared to their counterparts in adult institutions. Nevertheless, the article concentrates on two factors well-established as keys to success: mentoring and experience.
The author's case is built on a survey sent to a group of children's hospitals and analyzes the responses of ten CMOs in those hospitals to learn what factors are most important in achieving success as a CMO in a children's hospital. The article's exhibits document the factors that are most important based on these responses. A review of the author's conclusions confirms the common view that good mentoring and work experience are critical success factors for CMOs (or executive leaders in any industry).
One of the most intense challenges for hospital administrators is to capture the medical staff's full engagement and commitment. Traditionally, physicians have regarded quality improvement as firmly in the domain of hospital administrators, probably because physicians' incomes have not been tied to the success of quality improvement efforts. Physicians will likely devote far more attention to improving quality outcomes in the next decade, incentivized by new structures that tie quality to pay. If so, CMOs of children's hospitals will have little experience to draw on, and mentors will not necessarily know how to advise their mentees because quality standards and indicators are underdeveloped as compared with adult hospitals. CMOs must possess creativity, initiative, and leadership, or their efforts may be unsuccessful. Familiarity with the history, culture, and tradition of a medical staff might emerge as equally important as experience and mentoring to CMOs' success. Indeed, medical staff's actions and reactions are often political, and local factors will he material to how staff responds to quality improvement efforts. Experiences gained at one hospital might be worth little in dealing with challenges at another. In such a scenario, in filling GMO positions it might be wiser to look to less-experienced local leaders than to experienced candidates outside the organization.
In conclusion, the author has confirmed that recognized indicators of success such as mentoring and experience are valued factors in the current children's hospital paradigm. In the present healthcare environment, these indicators have never been more necessary. A further interesting analysis might be what the future successful CMOs of children's hospitals will bring to the table and how to prepare up-and-coming CMOs for that future now.
Donald P. Nowill, PhD, MBA, MHA, principal, The Professional Development Group, Greenwich, Connecticut; faculty member, Albertus Magnus College and Capella University
the process whereby people individually and in association with others, engage in direct encounter, then purposefully reflect upon, validate, transform, give personal meaning to and seek to integrate their different ways of knowing. Experiential learning therefore enables the discovery of possibilities that may not be evident from direct experience alone (248).
When you think about your career as a physician executive, certain key events or episodes probably stand out in your mind--things that led to a lasting change in you as a leader. Please tell me, with as much detail as possible, about three experiences that made a difference in the way you lead now.
I have identified negative role models that I have learned from. Physicians who grew up right after the Second World War had a deity complex. They may have been able to create change, but they did not engage the hearts and minds of the people they were leading. I was able to witness that and knew I didn't want to follow in their footsteps.
I had a superior, who, if he ever got mad at someone, they were toast. No one ever survived the kind of shunning that he would initiate. I saw people whose careers were just wrecked because there was something that they did at some time that struck him badly. He intimidated everybody. However, the people that were not destroyed by it did very well. He got people to do extraordinary things. I am probably a lot more resilient because it was like being forged in a fire. It gave me strength. I had to carry extra loads, but boy was I toughened up by that. I was emulating him and that led me to do extraordinary things during that period. He literally put me in a position to be a world leader in my field.
My most important experience was very early in my career. I had a mentor in medical school, Dr. Smith. He was an enormous influence on me. I was doing the straight medical track. He validated the importance of the administrative side of medicine, that it was a legitimate role. My experience with Dr. Smith set my life on the course it is now. This was the first time I thought about a career as a physician executive. Dr. Smith made me see that it was a valid pursuit for a career. This was never talked about in medical school.
What I have learned is that if I am going to do something that I believe is the right thing to do, I would be better served by always doing something "with" the people as opposed to "to" the people. I learned it is better to try to get people to change with you as opposed to doing things around them.
I had been practicing for 19 years, doing a mixture of management and clinical practice before I joined the EMT. As a result of being on the EMT and having a coaching experience with an organizational psychologist I discovered that a lot of my behaviors as a physician were not effective as an executive. I learned that I was not collaborative. I was introspective. I worked alone and I did not really participate in discussions. I had taken a lot of classes, business classes and all that, but never realized how my personality and training as a doctor affected my performance as a leader.
The other thing that I had to learn and I am still learning as a physician executive is that because physicians function in an expert culture, where we are judged by our personal effectiveness, it is very difficult for us to ask for help. We do not know how to be team players very well. I do not know how you would teach that, it is almost something you have to learn on the job, but it is something that many physicians are not inherently very skilled at.
EXHIBIT 1 Conceptual Framework Key Terms Term Definition Noticing The term "noticing" is used to denote those aspects of the event that an individual chooses to focus on. In most cases, an individual will focus on those aspects of the event that she believes will help her achieve success, as she defines it, and in areas that create the highest level of cognitive-affective dissonance. Experiencing The term "experiencing" is used to denote the interplay of those aspects of the event that the individual has noticed and the internal processes of the individual. Reflection Reflection refers to those processes in which learners engage to recapture, notice, and re-evaluate their experience, to work with their experience to turn it into learning. Knowing "Knowing" is the term in this conceptual framework used to emphasize that the outcome of reflecting is knowledge. Possible Outcomes Outcomes are lessons learned. This represents the artifacts of gaining new knowledge in the form of a broad spectrum of skills, abilities, attitudes, philosophies, perspectives, knowledge, and values. Key Events A key event is an important episode in a leaders work life that develops her ability to lead. Job Assignments Assignments include starting from scratch, fixing or stabilizing a failing operation, participating in special task forces, taking on a large increase in the scope of responsibilities, and switching roles from line operations to a corporate staff position. Hardships Hardships include experiencing business failures and mistakes, being demoted or transitioned into an unacceptable job, confronting a subordinate with serious performance problems, taking on a new career, and personal traumas such as divorce, illness, or death of a loved one. Dealing with Other Dealing with other people includes learning from People role models with exceptionally good or bad attributes and observing behaviors of individuals that demonstrate leadership and corporate values. Dealing with Other Other events include such activities as formal Events coursework, nonmanagerial job experiences, first-time supervisory events, and experiences outside of work. EXHIBIT 3 Demographic Profile Characteristics Average Range Gender Male 8 males, 2 females Age 58 years 45-66 years Years as CMO 9 years 8-11 years Management Experience 22 years 19-28 years EXHIBIT 4 Event Categories and Subcategories: Definitions and Events Reported by CMOs Rank Order Key Events Frequency Learning from Other People 24 * Values playing out--these events denote the value-laden insights gained by CMOs. 12 * Role models--the superiors who CMOs interacted with or observed during their careers. 5 * Mentor--a person who takes a special interest in your development and plays an important role in your career. 5 * Peer--a person who is equal to another in abilities, qualifications, age, background, and social status. 1 * Coach--a professional one-to-one relationship with an individual, usually a consulting or organizational psychologist, with the purpose of improved 1 organizational performance and personal effectiveness. Hardships 11 * Business failures and mistakes--stories of 8 shortcomings that derailed goals. * Personal trauma--crises that may involve divorce, 2 illness, or death. * Subordinate performance problems--dealing with subordinate performance issues. 1 Other Significant Events 11 * Purely personal--a range of experiences that happened outside the workplace that contributed to a CMO's 4 development. * Early work--events that took place early in the 2 managers' careers. * First supervisory position--denotes first supervisory 2 events. * Coursework--refers to formal training. 1 * Feedback--job-related advice. 1 * Teaching--formal teaching roles, such as teaching medical students, residents, and fellows. 1 Developmental Assignments 2 * Fix-it--encompasses the work of turning around a failing or dysfunctional operation. 1 * Scope--individual assumes an increase in responsibility; the change is both broader and different 1 from what the individual has done before. EXHIBIT 5 Percentage of Key Events Reported by CMOs, by Major Key Event Category Other People 50% Hardships 23% Other Significant 23% Events Developmental 4% Assignments Note: Table made from bar graph. EXHIBIT 6 Lesson Categories and Subcategories: Definitions and Lessons Reported by CMOs Lessons Frequency Handling Relationships 21 Influencing without authority--getting cooperation in 6 non-authority relations. Understanding others--dealing with people other than one's peers, bosses, and subordinates. Lessons learned in this area required CMOs to understand the perspectives of 5 other people. Dealing with conflict--learning that conflict is endemic; one can deal with conflict by reducing, resolving, or 3 avoiding it. Political situations--realizing that organizations are political systems and learning how to function within 2 them. Developing people--learning that part of dealing with subordinates is developing them. 2 Directing and motivating--realizing that staffing, managing, and directing are required in building a working organization with roles for delegation, sharing 2 responsibility, building competence, team building, and leadership. Working with executives--in various contexts, learning how to present ideas to executives and the importance of 1 impressing and not antagonizing them. Executive Temperament 20 Self-confidence--having trust in one's own competence (e.g., in one's skills, ability, judgment, intuition) and faith in one's ability to take risks, handle tough 9 situations, and be successful. Handling adversity--developing ways to accomplish one's goals in the face of obstacles, recognizing that difficult situations are often not out of one's control, 3 and taking action on them. Coping with situations beyond your control--facing those situations about which one can do nothing, including those that involve luck, others' performance, and 3 unrealistic expectations. Coping with ambiguity--discovering that one has the capacity to manage in an ambiguous situation. 2 Learning to be tough--developing the strength to do what must be done in the service of the organization. 2 Using/abusing power--recognizing the dilemma that use of power may either help or hinder the attainment of desired 1 results. Setting and Implementing Agendas 14 Strategic thinking--being able to see organizations as systems; being able to gain a broader perspective. 6 Management models--obtaining "formal" management theories or processes learned during the course of a career. 4 Problem solving--finding alternatives; learning the art of problem solving, transcending habitual ways of 4 thinking about problems. Basic Values 10 Human values--being sensitive to human needs, making statements of warmth and caring and of insights of human 6 nature. Management values--making statements of ideal values and practices and undesirable practices; recognizing principles that guide appropriate, ethical behavior. 4 Personal Awareness 8 Personal limits--recognizing that personal limits and weaknesses in managing often stem from lack of time 6 and/or expertise to accomplish alone the variety of tasks necessary to be successful. What I like to do--realizing that one has found something one likes, that is exciting and worth doing on its own merit, or something one dislikes and will seek to avoid. 1 Work/life balance--examining, re--evaluating, and prioritizing; balancing work and personal life. 1
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