Beware Your Leadership Shadow


Last week, at the 2nd annual Lean Healthcare Transformation Summit, I moderated the CEO Panel discussion that featured four excellent Lean leaders: Jim FitzPatrick of Mercy Medical Center (North Iowa), Scott Armstrong (Group Health), Alan Gleghorn (Christie Clinic), and Dr. Gary Kaplan (Virginia Mason).

The CEOs shared a lot of insights, but one theme that came up was the idea, introduced by FitzPatrick, of a leader's long shadow and how you have to be careful with where it lands.

During his introductory statement, FitzPatrick told a story from his hospital. I'm paraphrasing from memory, so some of the details might not be totally correct. FitzPatrick has been at this hospital 25+ years with at least 10 as CEO. He recalled how he was walking through the cafeteria and an employee said, proudly:

“We're finally serving peas again after 18 years.”

FitzPatrick asked why that was and the woman said:

“Don't you remember the time you said you hate peas?”

My corny transition comment, as referenced to yesterday, was “I think Jim's key message is to give peas a chance.” Well, it got a laugh. Always good at serious minded healthcare improvement events!

FitzPatrick clearly didn't mean for his statement to be interpreted as “don't you dare ever serve peas around here.” But it happened. People often misinterpret a leader the way a Myers-Briggs “introvert” might mistakenly take action on something an “extrovert” blurts out. In the Myers-Briggs framework, introverts tend to think through everything before they say it, while extroverts to think out loud. The introvert takes action on something the extrovert leader says… assuming (sometimes incorrectly) that if the extrovert said it, it must have been a directive statement (“don't serve peas”) instead of just an expression of personal preference. So there could be more involved than simple employee/leader dynamics.

I'm paraphrasing FitzPatrick's takeaway, but he learned to be much more mindful of his “leadership shadow” and how people might interpret things.

Gary Kaplan chimed in with stories of how what the CEO does gets seen and widely interpreted. He used examples such as “If I'm carrying coffee with me, then clearly it's OK for everyone to eat or drink in patient areas.” and “If I'm checking email during meetings, clearly that's OK.”

So he's mindful of leading by example – even if you think you're not being watched, somebody is seeing what you're doing and they're drawing conclusions from that.

Good reminders to be mindful of that shadow we cast…

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Mark Graban
Mark Graban is an internationally-recognized consultant, author, and professional speaker, and podcaster with experience in healthcare, manufacturing, and startups. Mark's new book is The Mistakes That Make Us: Cultivating a Culture of Learning and Innovation. He is also the author of Measures of Success: React Less, Lead Better, Improve More, the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, and the anthology Practicing Lean. Mark is also a Senior Advisor to the technology company KaiNexus.


  1. I agree that the leader casts a long shadow. That’s why I don’t get some “bottom-up” philosophers who believe any change- lean, TQM, systems improvement, etc. etc- should bubble up from the masses. That’s a revolt. It’s the job of the leaders to create the vision and battle cry then to put into motion the steps that can make that happen. The only way to do that successfully is for the top to get everyone on board with the direction by walking the talk and holding themselves and others accountable to it. It’s great to see a leader opening willing to point out his own flaws in this regard. I’m sure that helps his followers as well admit their mistakes and improve.

    I find many “leaders” who really struggle with the whole accountability thing- either holding themselves accountable, or, even more frequently, consistently holding those who report to them accountable. (Maybe because they don’t like to admit their own mistakes so are hesitant to point them out in others?) That’s a big part of leadership and something ONLY the leader can do.

    • I agree with you, Oneida, that Lean or improvement in general can’t be all “bottom up.” I was just at ThedaCare the past few days, a leading lean healthcare system. They clearly have a strategy and vision that’s set by senior leadership and it’s cascaded down through the organization with some “catch ball” discussion and revision with different levels of management. But basically vision flows top down. And then improvement ideas generally flow bottom up, but things are prioritized against the organization’s vision and true north.

      As John Shook, CEO of LEI says, Lean is neither top-down nor bottom-up. It’s more complicated than that.

      • Exactly! It’s more complicated than being a magic pill. Lean is a tool- a great tool but not the only tool either. It can be combined with other tools and, preferable, within a true culture of improvement that transcends purist methodologies for the best results of all.


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