Leslie: In the September 2009 column we began a discussion about the challenges for leadership in anxious times. Having just returned from the American Health Information Management Association's (AHIMA's) 81st Annual Convention and Exhibit in Grapevine, TX, I realize how timely this topic is for our readers. At the convention one speaker after another spoke about the extraordinary challenges facing HIM professionals today--from the American Recovery and Reinvestment Act (ARRA) with its incentives for adoption of electronic health records (EHRs) and the promulgation of new privacy regulations, to the implementation of ICD-10--every presenter was talking about change and transition.

Patty: I was impressed not only by the enormity of the changes coming at us, but also by the thoughtfulness that speakers brought to the discussion. The need to recognize the human impact of change was a common theme. I was reminded once again of the concepts that you and Katharine Baker write about in Leading a Business in Anxious Times: A Systems Approach to Becoming More Effective in the Workplace. Katharine is joining our dialogue again this month.

Katharine: As we discussed last month, our approach, Systems-Based Leadership, offers readers a new way to think about organizations under stress. We delved into the concepts of anxiety and the organization as an emotional system; today I would like to explore how individuals who are emotionally mature (or what we call "highly differentiated") can be leaders regardless of their actual position or job description in the organization.

Leslie: This is an important concept for HIM professionals because it demonstrates leadership as a reciprocal process that transcends the formal organization chart. In essence, when a key individual engages others in an emotionally mature way, those others in the workplace become calmer and perform more effectively.

Patty: Please tell us what you mean by an emotionally mature way? What does that kind of leadership look like?

Katharine: Emotionally mature leaders are first self-aware. They recognize when they are anxious and can contain their anxiety, rather than reactively spreading it to others. They are clear about their responsibilities and the responsibilities of others so they set appropriate boundaries, neither over-functioning for others nor underfunctioning.

Leslie: Emotionally mature people make decisions based on facts, not feelings. Thus in a difficult situation they can see more options, evaluate them and compare their relative merits and benefits. They can keep thinking clearly even under severe stress.  

Katharine: That's right, and even in the presence of anxious others, emotionally mature individuals state their position and take action without attacking or becoming defensive. Using a systems approach, an emotionally mature leader is aware of the wider relationship system and how people who are concerned about a particular issue interact with each other. The emotionally mature leader remains as neutral as possible as she works through the issue both individually and possibly in group discussions.

Leslie: Let's imagine that the HIM director in a community hospital wants to get out in front of the ARRA revisions to the HIPAA privacy and security rule by conducting a series of educational sessions for all clinical and administrative departments over the next few months. The hospital's chief risk management officer wants to hire an outside company to do the training and put the cost in next year's budget. The HIM director feels a sense of urgency about providing the training sooner rather than later. She tells the risk management officer and her own boss, the VP of Operations, that she and her staff have an outline and training materials they could use to conduct the education sessions immediately. The training would get done sooner and save the hospital money by avoiding the outside speaker fees. Not persuaded, the risk manager suggests training be done another way and does not support the HIM director's plan. The HIM director's boss defers to the risk manager on the issue. The HIM director wonders if her boss lacks confidence in her ability or is intimidated by the risk manager who reports directly to the CEO. Frustrating, isn't it?

Katharine: I am sure that the HIM director in this situation would be frustrated. So let's look at how she might address this situation if she were using systems-based leadership and functioning as an emotionally mature leader.  First, I would expect the HIM director to recognize she is caught in a triangle, an important concept we describe in our book. A triangle is the smallest unit of an emotional system and is the way anxiety is transmitted and managed. When anxiety in the system is high, triangles emerge. Triangles have two insiders and an outsider. The person in the outside position is generally the most uncomfortable and automatically seeks to win over one of the insiders, pushing the other to the outside of the triangle. By observing the triangle and assessing her position in it, the emotionally mature leader can develop a strategy for leadership around the issue.

Leslie: Okay. Let's look at the triangle in my example. The risk management officer starts in the outside position, possibly sensing the HIM director and her boss are the insiders in the triangle. It seems like the risk management officer has convinced the VP of Operations, either through intimidation, or by appealing to her as an equal in the formal organization chart, to reject the HIM director's idea. The leadership challenge for the HIM director is to help the risk management officer and the VP of Operations calm down enough to see the logic and the value of her training plan.  

Katharine: That's right. This might be accomplished through one-on-one meetings in which the HIM director would probe further to determine the root cause of their concerns. Do they doubt the HIM director's or her staff's expertise? If so, the director could ask what it would take to demonstrate to each of them that she and her staff are well suited to do the training. Is the risk management officer worried about what others will think if she is not involved in implementing the training? She might ask the risk management officer if she wants to be engaged as a partner in the training. Is the VP of Operations overly protective of the HIM director? Does the VP have concerns about the time it will take away from the director's other duties, and those of her staff? Spending time identifying and addressing their concerns while staying well connected to all sides of the triangle, is one way to calm anxious colleagues, to get them thinking instead of reacting, enabling them to make better decisions in the best interest of the organization. From an emotional maturity perspective, it may be as simple as treating the other person less like an outsider and more like a valued colleague.

Patty: Your case study examples always bring the theory alive for me. I can see how important it is to assess if you are insider or outsider in the triangle and to reflect on your part in the triangle. I think being nonjudgmental of the individuals in the triangle helps one see more objectively what might be happening at the emotional level. Seeing more objectively helps a leader meet individuals in the triangle where they are at and move towards solutions together.

Leslie: Being aware of the triangle and your part in it is the first step toward managing your own anxiety and focusing on solutions. Reflecting on the part you are playing also helps you be less focused on others. This can be a very freeing experience especially since you really can't change others, but you can change yourself.

Patty: Thank you for discussing this short vignette with us today. I know your book is filled with examples from all types of business settings, and that regardless of the size or type of business organization, the concepts about emotional process are universal. For our readers interested in learning more about the book, please visit www.leadingabusinessinanxioustimes.com.

Leslie: As HIM professionals navigate the emotional turbulence that always accompanies transformative change, we are confident that systems-based leadership can help them add a new dimension to their leadership skills.

Leslie Ann Fox is chief executive officer and Patty Thierry Sheridan is president, Care Communications Inc., Chicago. They invite readers to send their thoughts and opinions on this column to lfox@care-communications.com or ptsheridan@care-communications.com.