Warren Bennis has described leadership as "the capacity to translate vision into reality." A compelling vision meets several tests. It is clear. It is directional. It describes how the organization will deliver differentiated value. It creates stretch. And it is in service to the organization's purpose. In other words, it's packed with purposeful meaning. A vision needs to be specific enough to be directional. It is, after all, a picture painted with words. You should be able to close your eyes and see it. The first obligation of a vision statement is clarity, not emotion. Its purpose is not to inspire; it is to orchestrate people and pull them toward a future worthy of their aspirations.
The following vision dates to 400 B.C. It is described as the First Aphorism and is attributed to Hippocrates. It articulates the meaning of a physician's calling. And it defines an obligation to do right and to lead others to cooperate in doing right. It is a vision of a purposeful meaning in motion:
Life is short, and the Art is long; the occasion fleeting, experience fallacious, and judgment difficult. The physician must not only be prepared to do what is right himself, but also to make the patient, the attendants and the externals cooperate.
Hippocrates' vision endured. Its themes of responsibility and cooperation echo throughout what became the enduring vision for Mayo Clinic more than 2,000 years later. In the words of founder William J. Mayo:
The sum total of medical knowledge is now so great … that it would be futile for any one man … to assume that he has even a working knowledge of any part of the whole. … The best interest of the patient is the only interest to be considered. … It has become necessary to develop medicine as a cooperative science; the clinician, the specialist, and the laboratory workers uniting for the good of the patient, each assisting in elucidation of the problem at hand, and each dependent upon the other for support.
The two most important questions a CEO needs to answer for an organization are "What do we aspire to become?" and "What will we do in order to become our aspirations?" But as Max DePree, former CEO of Herman Miller, once observed: "Management has a lot to do with answers. Leadership is a function of questions. And the first question for a leader always is: 'Who do we intend to be?' not 'What are we going to do?'" Will Mayo answered that question with a commitment to a "union of forces" for whom "the best interest of the patient" came first.
Too many leaders ask for a show of hands when they try to define the future of their organization. But that runs in the face of what it means to lead — to see a place worth going, to decide to go there, then to get others to want to go, too. As Floyd D. Loop, M.D., former CEO of the Cleveland Clinic, observed, "Knowing where the organization is going is the one task the leader cannot delegate." Yet, a leader's aspirations need to resonate with the folks whose commitment will be needed to transform them into reality. The challenge is to convey a future worth becoming and a path worth traveling. All of this may require some convincing. Being convincing doesn't require inspiration. It requires clarity, consistency and persistence.
According to professors Linda Smircich and Gareth Morgan, "Leaders emerge because of their role in framing experience in a way that provides a viable basis for action, e.g., by mobilizing meaning; articulating and defining what has previously remained implicit or unsaid; by inventing images and meanings that provide a focus for new attention; and by consolidating, confronting, or changing prevailing wisdom."
Purposeful meaning has direction. Getting from here to there requires some specificity. Ambiguity fosters anxiety. Vision needs to move beyond abstraction. And it takes more than a slogan. Tell me we aspire to become great, and I'll struggle with what that means. Tell me we aspire to become the best rural hospital in America, and I begin to get a better sense of things. Tell me more about what the best rural hospital in America will look like, how it will act, how it will make people feel, and you move beyond abstraction to meaning with a purpose. Now, show me a path. Most organizations are hungry for a way through the fog, for a trail that tethers the present with a future worth becoming.
Words, no matter how well chosen or crafted, are subject to interpretation. They beg the question, "What do you mean?" It is the job of the CEO and the executive team to answer that question. Some might argue that if a vision is sufficiently clear, it ought not to need explanation. But vision is a leadership tool. By definition, it requires illumination by leaders. Clear, consistent and persistent explanation can help. So can stories well told. It is the stories that provide the vehicles for inspiration.
Film director David Lean was one of the century's best makers of meaning. In his epic film Lawrence of Arabia, T.E. Lawrence engages in a pointed conversation with Prince Faisal, who describes the past glory of the Arabs: "You know, Lieutenant, in the Arab city of Cordoba were two miles of public lighting in the streets when London was a village." To this, Lawrence responds, "Yes, you were great." And, after a fateful pause he adds, "Time to be great again." With this exchange, Lawrence imparts meaning to an emergent purpose that was beginning to coalesce a band of warring tribes into a force to be reckoned with. In Bridge on the River Kwai, the building of the bridge becomes the embodiment of meaning. In Doctor Zhivago it is the enduring love for Lara that lends purposeful meaning.
Will Mayo and his brother, Charlie, avoided using "I" when they spoke of their clinic. Instead they would say "we" or "my brother and I." The world's greatest leaders, those who cultivated and realized purposeful meaning, succeeded at conveying the aspirations of "we" when they said "I." When Lawrence commented that the best of the Arabs "won't come for the money, they'll come for me." "Me" was this bigger thing that had become the Arab cause. And when he described writing his will across the stars, it was an Arab sky he saw. Think of Winston Churchill. When he said "I," England heard "we." He so came to epitomize the meaning of his defiant nation that when he returned from political exile to his old command as First Lord of the Admiralty, all the ships of the British Navy at sea flashed one to another a simple and hopeful signal, "Winston is back." Which was another way of saying, "We are back."
Meaning can emerge. But if it's going to be purposeful, it will require intentional leadership. Intentional leadership is characterized by consistency over time and place. The same message is articulated and demonstrated by leaders throughout the organization at all levels over time. The former president of the University of Notre Dame, the Rev. Theodore Hesburgh, drove this point home: "The very essence of leadership is [that] you have a vision. It's got to be a vision you articulate clearly and forcefully on every occasion. You can't blow an uncertain trumpet." Integrity describes a state of consistency in message and behavior. Purposeful meaning requires integrity.
When I met with Ron Peterson, the president of Johns Hopkins Hospital & Health System, years ago, he spoke of the importance of the original intentions set forth by the institution's founding father, Baltimore businessman Johns Hopkins. Hopkins' vision was the creation of a single institution that combined a hospital with a university-based medical school. This laid the groundwork for a revolution in which the practice of medicine would be integrated with research and teaching. That was the founder's vision. It remains Hopkins' vision today. And it has molded every respected academic medical center in America. But it was still subject to interpretation: What does Hopkins' tripartite purpose mean? Peterson didn't emphasize "research" when I interviewed him. He emphasized "discovery" as the distinguishing essence of Hopkins.
Discovery is a very different thing from research. Discovery gave rise to the "bench to bedside" tradition that has been a critical part of what it means to be Hopkins. There is an openness that comes with a commitment to discovery. A willingness to look beyond. It was out of this founding vision that William Osler originated the residency training program that brought the education of physicians fully to the bedside. William Halsted followed Osler's lead and established the first surgical residency program in the United States. And William Welch saw that living conditions characterized by poor sanitation and contaminated water were killing people by the hundreds of thousands and so founded the first school of public health. In a 2005 interview on C-SPAN, Peterson was still on message. Once again, he underscored the importance of the founder's vision. And he described a Hopkins that still stood for discovery.
Few models of human behavior are as well known as Maslow's hierarchy of needs. It is typically portrayed as a pyramid with human needs arrayed in five layers. At its base are physiological needs; on top of that are safety, love and belonging, and esteem; and finally at the top of the pyramid, self-actualization. The gist of the hierarchy is that individuals are not motivated to higher levels until lower-level motivations are substantially realized. Self-actualization is another way of saying meaning, or in Maslow's interpretation, "what a man can be, he must be." Organizations are made of individuals. Extending Maslow's thinking leads to "what an organization can be, it must be."
Aspirations can be conveyed as numbers — for example, market share or margin. Or they can be embedded in a tale well-told. Organizations are well-suited to stories: The team that stumbled, crashed, got up and soared again. The bickering hoard that found a common cause and became one. The runt of the litter that became a champion. Which would you prefer to hear? Aspirations as margin, or aspirations as victory march?
Daniel H. Pink, in his book A Whole New Mind, suggests, "We are our stories. We compress years of experience, thought and emotion into a few compact narratives that we convey to others and tell to ourselves … . When facts become so widely available and instantly accessible, each one becomes less valuable. What begins to matter more is the ability to place these facts in context and to deliver them with emotional impact. And that is the essence of the aptitude of story — context enriched by emotion … . To paraphrase E. M. Forster's famous observation, a fact is 'The queen died and the king died.' A story is 'The queen died and the king died of a broken heart.'"
Hospitals are places rich in drama, sacrifice and occasional heroism. They are filled with stories, stories filled with meaning. Unfortunately, you'd never know it by spending time around the executive suites and boardrooms of many hospitals. The stories remain untold because no one is actively listening for them or seeking them out. To get a sense of this missed opportunity, think about the stories of human drama unfolding every day in a hospital. Now compare that with what happens in celebrated organizations such as Apple and Southwest Airlines.
One way to get the stories that imbue a vision with meaning is to ask for them. This can be an intentional and productive part of a strategic planning process. The CEO and other leaders can, in town hall meetings and other venues, introduce a vision along with their explanation of what it means, then ask employees, physicians and others to share inspiring stories that breathe meaning into the vision. Not only does this exercise help the leadership team get stories, it engages the organization in the kind of dialogue that generates understanding, ownership and commitment.
According to professors Leonard Berry and Neeli Bendapudi, storytelling is an important tool at Mayo Clinic, and "storytelling continues in the workplace because, once people are away from the classroom, the idea of putting the patient first can seem distant and sometimes even unrealistic, given the stress and unpredictability of day-to-day work." Among the Mayo Clinic stories that Berry and Bendapudi highlight is this one:
A patient walked into the emergency room with severe shortness of breath. When she learned she had a bacterial infection and would need immediate surgery, she said she had a sick dog in her illegally parked truck. The nurse told her he would move the truck and take care of the dog, but when he went outside, he found it was a semi, which he didn't have a license to drive.
He obtained permission from a shopping center to park the truck there for a few days, and another nurse, a former trucker, drove it there. He brought the dog to a vet, then took it home while the patient healed. When he was asked why he went to such trouble, the nurse said, "At Mayo Clinic, the patient's needs come first."
Making meaning in a hospital or health system entails meeting challenges not faced within most business organizations. Many of these challenges are embodied in the role of physicians. Because of their training, experience and history, physicians are a unique tribe. And they are made of tribes within tribes with specialties defining distinct professional cultures. The differences between the administrative tribe and the physician tribe are substantial and unfortunately often have been characterized by a high degree of distrust and conflict.
In 2009, professors C. Marlena Fiol and Edward J. O'Connor wrote what, in my opinion, is one of the more significant health administration books published in the last decade. In Separately Together — A New Path to Healthy Hospital-Physician Relations, they suggest that efforts to generate a shared vision among groups characterized by mistrust are usually bound for failure. For such division to be overcome, each group must recognize the distinctive and unique contributions of the other — their distinctive value in the health care system.
Of course, at their core, hospitals and physicians are about patients. It is their differences and conflicts that keep them from locking elbows around the meaning they share. Instead of defaulting to the prevailing tendency to make the other "wrong," what is desirable, Fiol and O'Connor suggest, is a "separate togetherness" in which "each must be the captain of its own ship and the ships must be aligned on their journey toward a shared destination." So the ships sail separately but toward a common vision.
Sustainable organizations are purposeful. Their vitality depends, in no small measure, on their ability to generate meaning. Meaning clarifies, fortifies and animates purpose. Fundamental to effective leadership is an ability to fill an organization with meaning consistent with its purpose. Leaders who fail in this may leave their organizations aimless and dispirited, while leaders who succeed will help lift them to futures worth stretching for.
Dan Beckham is president of The Beckham Company, a strategic consulting firm based in Bluffton, S.C. He is also a regular contributor to H&HN Daily.