The Missing "Something"

Updated: Nov 12, 2021

I am an avid reader of Longwoods, and I love the work that Matthew Hart does and the newsletter he consistently puts out every Tuesday. Nine years ago, when I moved out west from Toronto I was sad that the “Breakfast with the Chiefs” was no longer available to me…I guess the silver lining of Covid is that those in-person talks are now more accessible!


So this Tuesday when I opened up the newsletter I was excited to see a new opinion piece from Janet Davidson. I had the privilege to work with Janet in 2009 or so, and I recall admiring her candor, ability to read situations, strategic thinking and straight-talk. She commanded a presence...but she also was kind. I was early in my career and she never turned down my requests for advice, mentorship and guidance. She truly paved the way for many women in leadership roles in Ontario and Canada!


I sat down to read her piece, and I was struck by a recurring theme that is constantly emerging these days: “We have some absolutely stellar institutions and organizations with outstanding leaders providing world-class care and service, first-class researchers and scientists, dedicated and committed care providers, hardworking and caring volunteers and lots of funding. Why isn’t it all coming together?


Something is missing. Doreen talks about the “missing ingredient” being more evident during the pandemic in her May blog. Janet also notes how the pandemic has exposed our collective Canadian healthcare warts – our lack of funding, attention and desire to change the health and living conditions of the elderly, the vulnerable and racialized communities.


Changing conditions for those disadvantaged means moving from a medical system towards a health system, but: Something always seems to interfere with our ability to effectively apply what we know to be true about how to improve and sustain better health. We seem to be stuck in the original paradigm of medicare.”


Indeed “something” is missing to make this change. I believe the “something” is a combination of skills, mindsets and ways of interacting that effectively form the “grease” for change. It is the intangible element of culture. In healthcare, we have allowed culture to be created, in part, by accident. We have neglected our people at the expense of our system outcomes. We have adopted a technical leadership model that is driven by individual expertise when what we need is an adaptive approach driven by collective wisdom.


What is an adaptive approach? An adaptive approach is a thoughtful way to deal with challenging issues. It recognizes that even if we know the right thing to do (i.e. how to improve and sustain better healthcare system), doing it is challenging (i.e. we are stuck in the original paradigm). Any problem has elements where solutions are known, tried and true. This is often found in the existing culture, and culture is sticky…most cultures will try to maintain the status quo.


Changing a health system means we will come up against issues we have never seen before, we will need solutions that have never been tested, and we will not be in a place to assure a successful outcome. Leading in the unknown requires a different set of skills: the ability to pause and not jump to action, to seek to understand perspectives, ideas and what people think, and the ability to collectively make sense of what is being learned. Only then can you consider what might be actionable.


This is a model of leadership we are entirely uncomfortable with in healthcare (and in my experience, in many other professionals like lawyers, accountants and engineers). We prefer to rely on expertise, knowledge and quick action. We look for certainty. We hate risk. This means we hold tight to the status quo.


Let’s go back to the “something” that is missing: it is the “underbelly of culture” and we need to purposefully build it in ways that support, value and demonstrate adaptive leadership. That means:

  • We invest in the skills of communication so that everyone can listen, respond and ask questions in a way that creates psychologically safe environments and surfaces people’s thinking

  • We focus on how we lead our teams and design our meetings so that people will share perspectives

  • We work with others to get to “what is right”, not who is right, which means leading ourselves without ego

These are not just “nice to haves”, they are essential elements to building culture. They are also not things that “you have or you don’t”. These are specific skills that can be taught, learned and incorporated. They are not unattainable.


This is what we do at Thought Architects. We make these seemingly invisible skills visible, real and attainable. We help shape the underbelly of culture, and it starts with you.


Join us in this Radically Human Revolution. Download your version of our Manifesto, join us in our upcoming Campfire Chat for adaptivity in action, look for our sessions in the New Year to have a Coffee Chat with a couple of our Architects for a good conversation, join one of our workshops or sign up on our waitlist for the coaching skills training. Better yet, contact us to create your culture. Our new schedule for 2022 is coming out in December, so stay tuned!




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