Taking Leadership to Doctors, Nursing Homes, Churches, and Communities

By: Larry Walker, November 2023; Context: Sperry Knowledge Systems Center.

Dr. Robert Terry

In 1980 Harlan Cleveland, the head of the Hubert H. Humphrey Institute at the University of Minnesota, invited Dr. Robert Terry to join the HHHI to develop a leadership development curriculum.  This would be the first such program in America.

Dr. Terry was an excellent choice.  First of all, he was a charismatic leader himself, a 6’5” giant of a man who dominated any room he entered.  Second, Dr. Terry was a serious researcher from the Chicago University.

Dr. Terry, founder of the Humber H. Humphrey Center for Reflective Leadership (University of Minnesota), spent much of his career researching the researchers. Which theory is ‘most right’? What may have been missed? If one school of leadership thought was ‘right’, were the others wrong? How could all of these competing theories co-exist?

What Dr. Terry found as he investigated the field was that there were six schools of leadership thought at that moment.  These were: 

  • Trait Theory
  • Behavioral Theory
  • Organizational Theory
  • Political Theory
  • Visionary Theory
  • Ethical Theory

Rather than picking one theory over the others, Dr. Terry integrated all six theories into a comprehensive Action Wheel.  The Action Wheel integrates over 100 years of leadership theory, research, and practice into a unified model of fundamental human needs, behaviors, and actions.

The key insight was that leadership is a subset of all human behavior, or human action. All leadership theory is the study of what it means to be human; what we want, need, or require to willingly follow and work with or for others. Expanding the domain in this way enabled the six schools of leadership theory to be integrated into six, co-equal dimensions that together describe all human action.

These six dimensions explore the following questions:

  • What is the current reality?  What is really going on?
  • What is important?  What values are involved?
  • What must be done about it?  Mission?
  • Who should do it? Who is in charge?
  • How will we do this? Architecture/design?
  • What do we need for execution/implementation?

Leadership is concerned with the top three items: Current reality, values involved, mission identified.  Management is then assigned and tasked to design and implement the solutions.  High Performance is enabled when these six dimensions are addressed in the above sequence.

An interesting example of following this problem solving process came from our review of President John Kennedy’s speech to launch the Moon Shot Project: 

  • He starts by indicating that Russia had beat the US into Space.
  • He states how important it was for US to lead the world into Space.
  • He defines our mission to be on the moon by 1969.
  • He gave the task to NASA.
  • NASA would do the research and design and implement the solution.
  • Billions of dollars would be needed to make this happen.

This request for ‘billions of dollars’ was not questioned as he had explained each of the Action Wheel dimensions so clearly, that this ambitious idea was immediately initiated.

The Action Wheel Leadership Group (AWL)

In 2008, Warren Hoffman and Judie Ramsey brought Dr. Terry’s intellectual property to AWL in partnership with Larry Walker, Tadd Walker (Larry’s son), and Ron Hultgren (who got his Ph.D in Dr. Terry’s work).  AWL’s goal was to bring these powerful concepts to the general public in terms they could understand.

Tadd collaborated with Ron to convert Dr. Terry’s academic language into understandable segments.  This became teachable curriculum which was first delivered to four cohorts of doctors and administrators from the Ridgeview Medical Center, an outstanding facility located in Waconia, MN.

The original three cohorts were conducted in 10 hour sessions once a month for nine months.  The fourth cohort switched to a more streamlined version done in six 4 hour sessions once a month for six months.

In addition to exploring the Action Wheel’s six dimensions, each individual in the cohort was required to execute a project where they demonstrated use of the Action Wheel.  These individual projects were presented to the cohort as a whole and invariably were the highlight of each program.  Some of these projects led to demonstrable change – a big success!  A couple of project examples:

  • One Black doctor wrestled with the challenge of how to communicate healthy life-styles to his Black male peers.  He came up with a solution that capitalized on the popularity of Black male barber shops.  The places where Black males gathered with their friends were their barber shops, so this doctor convinced the barbers to hand out flyers describing healthy life-styles and to encourage their customers to talk about what these flyers meant.  Eventually, he expanded this to three barber shops.
  • An orthopedic surgeon had wrestled with the idea of hiring a Personal Assistant for five years.  He used the Action Wheel to convince himself to proceed.  His surprising report to the cohort:
    • “I spent five years agonizing over whether or not to hire a personal assistant.  Using the Action Wheel convinced me to go ahead and do this.  I hired Nicole.  Just last week, I got to my office early and was surprised to find a patient waiting.  I invited him to my office and was surprised when he said, ‘Would it be okay if I wait for Nicole?.  Can you imagine the blow this was to my ego?!  Then I caught myself as I realized this was exactly why I hired Nicole!

From their success with Ridgeview, AWL moved on to provide the shorter program to medical clinics, nursing homes, churches, and communities.  The Action Wheel projects done by each of these cohorts continued to inspire participants.

  • The partners in one medical clinic were in serious disagreement with one another about being bought out by a larger medical system.  As we led them through the Action Wheel process, they realized there was a serious disagreement about values.  After multiple discussions around values, three of the doctors decided to leave.  This was a loss for the clinic, but it also immediately eliminated the tense disagreement which was impacting the work of all of the partners.
  • The Head of Maintenance, a recent immigrant, at a nursing home asked us to review and comment on the draft plan for his project.  His idea was to write a tough job description for each of his people to force them to do better work.  We counseled him that ordering people in how do their jobs was usually counter productive.  He listened and went off to finish his project.  To our joy and surprise, here is what he shared with the cohort:
    • “Cleanliness is essential in our facility.  It is important that we keep this place clean and welcoming.  While part of this job is my responsibility, it is also important that every staff member treat cleanliness as important as my staff does.  So – when anyone sees paper on the floor bend down, pick it up, and put it in the trash where it belongs!  Thank you”
  • The leader of the nursing home kitchen was highly regarded, and his kitchen was seen as a highlight of the nursing home operation.  As an individual, however, he was burning out, dragged down by the responsibility of delivering three quality meals a day to over 200 residents.  He applied the Action Wheel to his situation and realized he had a quality staff that would rejoice at sharing more of his burden with them.  He proceeded to delegate numerous aspects of what he had been doing – and – the pressure was eliminated.
  • A member of a community cohort provided services to Seniors.  Her project proceeded to form a network of over 100 professionals working with Seniors in various organizations.  The network began to share what services were available from each service organization and also began to encourage all the professionals to refer their clients to other organizations when their needs were outside the boundary of that organization.  The professionals also began quarterly meetings to mingle with their peers and become better and better informed as to what community services existed.

While our condensed program was a much simpler sale than our intensive 9-month program, it was still difficult.  AWL needed another revenue stream.  We finally realized that we could commercialize the three leadership dimensions by using them for client interventions.  The idea was that these leadership dimensions were invaluable wherever there were organizations wondering how to tame one or more issues that were important to them.

Our first approach was to package three half-day sessions with the client.

This was one session for each dimension with the final output being recommended actions to address the client’s issue.

  • Session One explored ‘what was really going on’?  That is to say what factors related to the issue being addressed.
  • Session Two explored ‘what were the values of the individuals involved ?’
  • Session Three explored ‘what actions could we take to address this issue?’  These actions were then packaged as recommended actions for the client.

We found these interventions to be very successful with clients very pleased with our recommendations. 

As we did more interventions, we found ways to streamline the process further.  The fastest process we did was:

  • Sessions One & Two done in advance by email and then summarized offline.
  • Session Three was then done with a large group which reviewed the summaries from the two email sessions and then explored ‘what actions could be taken to address the issue?’

Here are interventions which achieved significant results for clients

  • A small, local medical clinic was becoming dysfunctional (doctors disagreeing loudly with one another – in front of patients!)  In the first session the clinic people identified a central issue: their neighborhood primarily brought male patients to the clinic, and these men preferred to be treated by male doctors.  Some of the male doctors had retired, replaced by female doctors.  The remaining male doctors were overwhelmed by the sheer number of patients referred to them.  In the second session, we discovered that one of the female doctors felt as if she was treated as inferior. In the third session, it was clear that the clinic had to provide more male doctors to meet patient preferences.  During these discussions, the female doctor realized she was not a good fit for that clinic and resigned.  The dysfunction disappeared.
  • We delivered our short program to a Church and in the middle of our delivery process were asked for an intervention as well.  This involved resolving leadership issues between the Church Staff and their Leadership Advisory Group, volunteers who reviewed what was going on and made recommendations.  The Advisory Group was large and hard to schedule into Sessions, so the first two sessions were conducted by email to obtain the current reality and what was important.  The summaries of those inputs were then shared in a live session with the larger group which broke into subgroups to identify potential actions.  Each member of the group was then given 3 votes to indicate which potential actions they preferred.  This process grouped items into broad categories: items securing a majority of votes, items receiving a few votes, and some items who received almost no votes.  This grouping made selecting the actions to take forward straightforward.  After being this transparent in about their future action plans, the Church member contributions went up 50%!

Adaptive Action

During its 10 years of operation, AWL was continuously challenged to shorten and improve the Action Wheel program.  There was a constant search to find better and better terminology.  After 5 years, Tadd and Larry had their ‘aha’ moment – what they were doing with their client interventions was incremental action, and a good term for this was ‘adaptive action’.  

They were about to launch a robust marketing program based on adaptive action when they discovered a colleague they had collaborated with, Glenda Eoyang, had just published a book titled “Adaptive Action” based on her related work in complex adaptive systems!

Glenda not only scooped the name for incremental, meaningful leadership action, she also beautifully named the three leadership dimensions:

  • Adaptive Action
    • What – what is really going on?
    • So What – what is important, values?
    • Now What – what do about it, mission?

This beautiful wording captures the essence of incremental, meaningful leadership action.  This naming structure makes it easy to introduce to audiences at all levels.

This simple, clear problem solving process applies to any problem from simple to complex.  The more we used it, the clearer its effectiveness became.  This process of starting with small, incremental actions quickly enables action toward any and all issues.  We highly recommend it.

Later we came across two other fields which often used this same process:

  • People who strive to be good and active listeners.
  • Journalists who deliver succinct, clear news about ongoing situations.

AWL became inactive when Covid 19 banned in-person sessions. 

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