Leadership in Practice

Leadership in Practice
Case Study: Leadership in Practice

While fictitious in nature, this is a typical case study for how leadership development looks when 360 feedback and executive coaching is used to develop a healthcare leader.
Kevin is the Chief Operating Officer (COO) of a tertiary-care hospital, one of many in a large chain in the Northeastern United States. At 48 years of age, he has moved into this position much more rapidly than anyone (including he himself) expected. An unplanned vacancy had occurred in the COO position only 6 months before, and the CEO and Board of Directors chose not to recruit externally. As the director of administration for the hospital in the previous 4 years, Kevin was considered the only qualified internal candidate and was offered the position.
As COO, Kevin is responsible for all day-to-day operations of the hospital. The directors of nursing, administration, human resources, government affairs, and quality now reports to him, but the doctors are part of a contracted medical group that is instead coordinated by the Medical Chief of Staff.
The CEO and the Board of Directors of the system view Kevin as a “high potential” leader who could one day become CEO. They also recognize that Kevin’s promotion might have been premature, but believe that with some further coaching and training, he could develop the needed skills to be a successful leader. To support and promote Kevin’s professional development, they have hired an outside consultant to serve as a leadership coach and mentor.
The executive coach was hired to work with Kevin for 6 months. The coach first began with an assessment of Kevin’s strengths and weaknesses through 360 feedback process. A survey of approximately 75 questions was sent electronically to those who worked most closely with Kevin—his boss, his direct reports, and his peers who also worked for Kevin’s boss. These raters completed the survey anonymously, and their scores were combined in the final report and analysis.
Kevin’s highest and lowest scores were then identified (see Table 2.2). The highest score a rater can provide is 5.0, the lowest score is 1.0.

Table 2.2 Kevin’s Highest and Lowest Scores
Highest Rated Items
Average Score (from all raters)
1. Ensures that the highest standards for ethical behavior are established and maintained (throughout the organization.
5.0
2. Genuinely listens to others
4.9
3. Demonstrates honest, ethical behavior in all personal and business transactions
4.9
4. Consistently treats people with respect and dignity
4.8
5. Is a role model for the organization’s values (leads by example)
4.8
6. Appreciates the value of diversity (avoids discrimination based upon race, gender, age, or background
4.6
7. Builds people’s confidence
4.6
8. Discourages destructive comments about people or groups
4.6
9. Consistently meets or exceeds customer expectations
4.5
10. Effectively recognizes team members for teamwork and team performance 4.4
Lowest-Rated Items

75. Creates and communicates a clear vision for his/her organization
2.4
74. is willing to take risks in letting others make decisions
2.5
73. Effectively anticipates future opportunities
2.5
72. Communicates a clear strategy on how to achieve the vision
2.7
71. Gives people the freedom they need to do their work
2.7
70. effectively involves co-workers in determining how to achieve the vision
2.9
69. Looks beyond “the way we do things now” in considering future opportunities
2.9
68. Trusts people enough to “let go” (avoids overcontrolling or micromanagement)
3.2
67. Clearly identifies priorities (focuses on the “vital few”)
3.3
66. Encourages active participation in strategy development and decision making 3.4

The executive coach also gave Kevin a Myers-Briggs Type Indicator (MBTI) assessment, a survey that Kevin completed himself. The results identified Kevin as fitting into 1 of 16 different personality types and helped him to better understand how he perceives, communicates, and functions in the workplace. The coach also reviewed any past performance reviews Kevin received from his supervisors, along with any other assessment he may have taken earlier in his career. Finally, the coach interview Kevin’s boss, the hospital CEO.
Following the assessment, the coach and Kevin met for a feedback debriefing. In this confidential meeting, which lasted for several hours, the coach presented a summary report that highlighted Kevin’s key strengths and areas for development.
In this meeting, Kevin learned the information laid out in Table 2.3.
Table 2.3 Feedback Debrief Summary Report
Strengths Supporting Data
Cares for people 360 items 2, 4, 6, 8, 10: MBTI reveals he is more of a “feeler” and an “extrovert”, i.e., he is able to tune in to others and empathize with them.
High Integrity 360 items 1, 3, 5: Performance review gives him a perfect score in “Integrity”

Executes—Gets the Job Done 360 item 9: Past performance review data; Boss’ interview: “It doesn’t matter what you give Kevin, he will always get the job done flawlessly”

Areas of Development Supporting Data
Lack of Vision 360 items 75, 73, 72, 70, 69, 66: MBTI reveals he is more of a “sensing” (works with immediate data, rather than thinking about future options) and “judging” (likes to move to closure, not leave things open for future possibility). Boss’ interview: “Kevin has his head down working, he does not seem to have or communicate a vision of where his organization is going”

Micromanagement 360 items 74, 71, 68: Boss’ interview: “Kevin’s direct reports indicate he is doing their jobs rather than letting them do their jobs. His standards are so high; he feels he is the only one who can do things correctly.”

Time Management 360 item 68: Past performance reviews say Kevin is such a nice guy, he never says no to any request. Boss’ interview: “Kevin has difficulty figuring out what to work on first. He is so busy doing everyone’s jobs, he just can’t keep up. He is not working at the level of COO, but at the level of those working under him.”

Kevin agreed that he is a person of high integrity and of solid execution, and was pleasantly surprised that people felt he treated them with such respect. Kevin was also very surprised that people felt he did not have much of a vision, and struggled with the feedback that he was “too nice to say no to anyone.” After further discussion with the coach, Kevin eventually came to terms with the less positive feedback, recognizing that this input was influenced by the perceptions of those around him, which may not be entirely on target.
In the next meeting, Kevin and his coach conducted action planning. In this session, Kevin first selected the area for development in which he planned to improve. After some thought and consideration, Kevin decided he needed to improve his ability to create and communicate a vision for his organization.
For his action plan, Kevin and his coach came up with a variety of action steps designed to help him create and communicate a vision. During this brainstorming session, Kevin, inspired by key questions posed by his coach, generated ideas based on his knowledge and experience with his job responsibilities. The coach also offered suggestions based on his experiences working with other leaders with similar areas needing development.
A sample action plan is provided for Kevin in Table 2.4.
Table 2.4 Action Plan Worksheet for Kevin
Area for Development:
Create and communicate a vision for his organization
Action Step Support Required Timeline Completed?
Create a Vision
Meet with CEO regarding her vision CEO meeting Within 2 weeks
Review industry journals for latest industry trends Obtain journals Within 2 weeks
Attend industry conference for ideas Funding for conference April 17-20
Draft vision statement; share with boss and others CEO support, review of others May 1
Action Step Support Required Timeline Completed?
Communicate the Vision
Make sure vision is clear, compelling, easy to remember Review with coach May 14
Host team offsite to unveil the vision Funds for offsite expenses May14/15 (tentative)
Internal website to promote vision Marketing/design team May 21
Distribute t-shirt with graphic promoting new vision to all staff Marketing/design team June 1
Begin each staff meeting with a review of vision Each month
Ensure each staff members’ goals directly relate to the organization vision During June performance reviews
Survey everyone in 6 months to see if they can remember vision Survey design team December

Preliminary Case Study Discussion Questions
1. What Kevin’s strengths as noted in the evaluation? Can you combine these strengths into a few main “themes”?
2. What are Kevin’s areas of development? What themes do you identify?
3. Given your analysis of these test results, would you choose to work for Kevin?

Once the action plan was created, Kevin could begin to accomplish his objectives. His first step was to meet with his boss to gain her acceptance of the action plan and to gather her ideas and those of other stakeholders. In the ongoing coaching phase, Kevin and his coach will meet approximately every 1-2 weeks by phone, video chat, or in person. During each meeting, the coach will review the action plan to see which key steps have been accomplished and which steps still remain incomplete. As is often the case, Kevin may find himself falling behind or possibly losing focus in his areas of development. Like a personal trainer, the coach will refocus him toward his objectives and help him stay on task. Barriers and obstacles that arise are also analyzed and addressed through the coaching process.
During ongoing coaching, Kevin has informed all who provided input about his plan so that they can be aware and supportive of his upcoming changes. He will also check in with them every other month to ask them whether or not they have noticed improvements. Research shows that the more often Kevin follows up with these key people; the more likely they are to notice improvement in his follow-up survey. The coach will also follow up with the ski colleagues independently to ask if they have also noticed any improvement. The coach will also check with Kevin’s supervisor, the CEO, and Kevin’s HR representative to gain their input on his improvement.
At the end of the coaching term, a results measurement, a brief follow-up survey, is sent to all the previous raters. Each person indicates whether or not he or she has observed improvement in Kevin’s ability to create and communicate a vision for the organization over the past 6 months. Once again, the follow-up survey is anonymous, with the answers being combined so that individual input cannot be identified. The results are then depicted in Table 2.5.
A total of 12 raters working with Kevin answered that anonymous survey. In question #1, 1 rater saw no change in his overall leadership effectiveness, but 11 saw improvement on a +1, +2, +3 level. In question #2, he also showed improvement in his area of development “creates and communicates a clear vision of his/her organization.” Of 12 raters, a total of 10 felt that he had improved in this area.
Table 2.5 Mini Survey For Kevin
1. Did Kevin become more (or less) effective as a leader over the past 6 months
-3
Less Effective -2 -1 0
No Change +1 +2 +3
More Effective
1 6 4 1
2. Over the past 6 months, did this leader become more (or less) effective in the following area for development: Creates and communicates a clear vision for his/her organization?
-3
Less Effective -2 -1 0
No Change +1 +2 +3
More Effective
2 7 2 1

Following successful improvement as demonstrated by the survey, coaching was effectively concluded. However, Kevin continues to check in with his key raters every 6 months to see if they are still clear on his vision. He also continues to practice each of his action steps as he moves forward with his responsibilities. The CEO and Board have noticed great improvements in his leadership capabilities and are now contemplating renewing coaching for an additional 6 months to help him address one of his other two development objectives.

Concluding Case Study Discussion Questions
1. What other action steps would you recommend for Kevin to consider in creating or communicating the vision?
2. If Kevin had not followed up regularly with those working with him regarding his developmental opportunities, do you think he would have improved as much as he did? Why or why not?
3. Would you promote Kevin now to CEO of his hospital? If so, why? If not now, why not?