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What Is Integral Leadership and How Will It Resolve the Medical Care Crisis?

The world needs integral leaders. Integral leaders align independent, even competing, organizations around a shared vision: creating a force capable of transformation – “making one from many for the service of all.”

We have previously highlighted the paradoxical situation where America has the best and most resourced hospitals, doctors, and medical schools in the world. And we also have the world’s highest patient dissatisfaction rate. How can that be? We are so good yet seem to miss the mark on our most important objective: patient well-being. From our research, we found South Carolina to be no different. We have quality medical care components in hospitals, doctors, payors and university/innovators, but patient well-being – the positive feeling patients experience during and after care when shared goals between a patient and doctor are pursued and met – is often missing.

The conclusion we have reached is that our medical care environment is out of balance. In conversations with health system leaders and doctors around the state, I sense both resolution and frustration. Many want to address the situation. They want to fix it, but on their own. But while their intent is noble, the situation is not an “individual component” problem. It is a balance problem. Again, the medical care environment is out of balance. To address the Medical Care Crisis, we must align the component leaders around a central vision – a vision that makes patient well-being the priority. How do we do this?

The answer is integral leadership.

In 2009, the Greenville Health System (GHS) decided to partner with the University of South Carolina to create a new, separately accredited allopathic medical school in Greenville. It would be North America’s 136th medical school. To accomplish this, there needed to be political alignment and cooperation among prominent university, hospital, governmental and physician faculty leaders – all of whom were very used to “being the boss.” Such alignment can obviously be a challenge. In fact, lack of political alignment is a commonly cited reason that new medical schools fail to take flight. Accordingly, the Liaison Committee on Medical Education (LCME), the accreditation agency responsible for accrediting medical education programs, devised an elegant process to help. The process involves naming an Institutional Self-Study Task Force (ISTF) comprised of representatives from all stakeholder institutions. A set of prescribed sub-committees are formed and charged to assess the combined assets that, when integrated, will become the new medical school. The ISTF is led by a Planning Dean who drives the process (called the ISTF Self-Study) and maintains political harmony among the committees (and the stakeholder institutions). If followed closely, the LCME accreditation process will yield a new medical school. If not followed, the project usually falls apart.

As it turns out, the LCME process is much more than a recipe for building a medical school. It is a “cookbook” for integral leadership. If the Planning Dean simply follows the instructions and does not “color outside the lines,” they will be acting as if they were integral leaders thus “creating one from many for the service of all.”

In 2010, I was assigned as Planning Dean for the new Greenville medical school and the process that led to LCME Preliminary Accreditation. I also later chaired the LCME Provisional and Full Accreditation processes using the same self-study procedure. Thus, working closely with Founding Dean Jerry Youkey over seven years, I experienced the LCME process three times. In 2010, my first run, I was very brash, clumsy and self-centered, possessing only rudimentary leadership skills in retrospect. Most certainly, I did not have the worldview of an integral leader. In fact, I stumbled and bumbled along, often being bailed out by the real integral leaders, Jerry Youkey, Mike Riordan (then GHS CEO) and Dr. Harris Pastides ( then and now the USC President). However, “painting within the lines,” I did learn the ways of integral leadership – leadership that aligns strong diverse and competing leaders around a central vision, creating an ecology of opposites where win-for-all principles yield global system advancement such as a medical school.

If the LCME Accreditation process – a process that uses Standard and Elements to guide a self-study can “cookbook” the creation of a new medical school using integral leadership principles, why can’t it be adapted to do the same for a medical care environment in need of balance? Instead of a medical school, global system advancement in this case might mean official recognition – perhaps even Excellence in Medical Care Designation. And what if the designating agency – same as the LCME for medical schools – was our Public Benefit Corporation, Integral Leaders in Health?

With this in mind, we’ve created a set of standards that when maintained, will balance (we believe) the medical care environment – an effort worthy of Excellence in Medical Care Designation. More importantly, we have outlined a “paint-by number” process like LCME Accreditation, that when followed, will resemble integral leadership. Over the next weeks we look forward to highlighting our standards for designation and describing the competencies we think will balance the medical care environment.

In the meantime…what is integral leadership? It is what it takes to solve the Medical Care Crisis.


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