From The Field M A R C H 2 2 , 2 0 1 6 Adaptive Leadership: The Next Requirement for Sustainable Community Health Improvements? JANDEL ALLEN-DAVIS, M.D. Vice President, Government, External Relations and Research, Kaiser Permanente Colorado T he scenario is familiar to funders. A significant grant policy, politics, and culture and it becomes even more difficult is given to a coalition of nonprofits working with to assess what works. community leaders to address a thorny issue in health, The approach used to address issues, measure success over education, workforce development, or the environment. The time, and both celebrate and communicate results requires grantees have met all the requirements of the grant with navigating a number of cultures within cultures at the fidelity. Then evaluation proves more difficult than envisioned, foundation, agency, and community level. When this is done and it is not clear that the investment has resulted in meaningful well, all boats rise. When it is done poorly, significant damage or sustained change: while many stakeholders have been can ensue: loss of trust, wasted resources (time, talent, and reached, the impacts are negligible at best. As the end of the treasure), and potentially avoidable delays in effecting change. funding cycle looms, the foundation, the accountable agencies, A useful concept that illuminates the underlying problem is and the community are concerned about future funding. Do introduced by Ron Heifetz in his book Leadership on the Line. we need more time? Was the investment large enough? Maybe Heifetz emphasizes the importance of understanding the we should have anticipated that surprise. difference between technical and adaptive challenges. A In the end, the foundation provides continuation funding at technical challenge is one wherein the solution is well a significantly reduced level and the project moves along, described and largely agreed upon. Grantmaking processes are albeit slowly. The foundation, feeling somewhat conflicted an example of this. Adaptive challenges are different and aptly about continuing funding versus withdrawing support describe the complex, current environment in which funders altogether, silently wonders about its ability to effectively and work. efficiently drive meaningful change. Foundations face both technical and adaptive leadership THE PROBLEM IS NOT TECHNICAL challenges in their efforts to improve health status, and adaptive challenges far outnumber the technical ones. Meeting communities where they are in the quest to identify According to Heifetz, organizational leaders frequently apply and implement work that may improve health is complex and technical solutions to adaptive challenges, which makes our complicated, as the issues facing communities are not simple. efforts at change all but impossible, wastes time, and dispirits Therefore, funders have an obligation to go beyond providing teams. programmatic or operational funding. They must play a larger role if they are to contribute to meaningful and sustained How do you recognize an adaptive challenge? change and responsibly steward the resources in their trust. Traditional approaches to accomplish this have involved • The challenge is complex. working in health and health care domains such as ensuring • Answers are not known. that communities have access to healthy food and opportunities to participate in physical activity. Funding serves as the • Implementation requires learning. primary means of driving these improvements. However, • No single entity has authority to impose the solution making the transition from simply measuring reach to on other stakeholders. measuring impact is difficult. Moreover, the social determinants • There is a gap between the way things are and the of health require understanding how education, violence, desired state. race/ethnicity, economic mobility, and a host of other factors indirectly and directly affect community health status. Add in • There are multiple perspectives on the issue. • Behaviors and attitudes need to change. have accountability for results are present from the beginning of program development, including the evaluators, • Old ways need to change, creating a sense of loss. policymakers, and others. • People with the problems are key to solving the problems. • Hold all parties accountable, including yourself. The • Resistance is triggered in stakeholders. responsibility to be good stewards of resources is a primary responsibility of funders. At Kaiser Permanente, much of Foundations have both tangible and intangible assets to this resource comes from families and others who pay for address community issues, while assisting participants in health care services, so we must be able to stand behind the creating their own solutions. Whether they are established work we fund. anchor institutions or emerging ones, they have at their disposal financial resources, strong reputations, multisector • The most important role that foundations can play is respect, deep and multidimensional relationships, and access to that of capacity building. If communities are part of the the best research and evaluation regarding effectiveness. This solution to their problems, we must ensure that investments capital can be leveraged to drive convergence, facilitate are not viewed as unlimited by recipients. Opportunities to conversation, and build capacity; in short, to solve the “teach people to fish” while “providing fish” improve the odds that lasting change will ensue. Holding regular adaptive challenges facing communities. But a different education and learning sessions for community members approach to leading is required, which both funders and their and key nonprofit agencies accomplishes this and more. boards must understand and embrace…and this is not easy. Developing and using an adaptive leadership framework • Maintain flexibility and be willing to diverge from the provides useful tools that might help funders apportion their grant plan as surprises emerge. Given the complexity resources wisely in service to improving community health. involved in solving community health problems, adaptive Since the publication of Leadership on the Line, Heifetz and leadership appreciates that setbacks and the unanticipated others have described ways in which foundations and human are the norm. We should only accept that “change takes services agencies are accomplishing this. In Leading Boldly, time” when we can confidently state that slowing down to Heifetz proposes both imaginative and even controversial reassess the situation is critical to achieving the goal rather approaches to drive change and suggests that foundations are than an admission of failure. in a unique position to drive significant change by leveraging • Conflict is. Be ready for it and be ready to serve in the adaptive leadership skills. In exercising adaptive leadership, role of mediator. Our resources, reputation, respect, foundations stretch well beyond technical grantmaking research, and relationships place us in a very unique role. activities to help communities identify the problems they No other entity is in a position to serve in this capacity. seek to solve, work through stakeholder conflict, identify conflicting and competing priorities, enhance local leadership Improving community health is a multigenerational endeavor. effectiveness, and wield influence in circles over which they However, we should challenge the notion that this must take have neither formal nor informal authority. The good news is as long as we think by leading with an adaptive frame of that this capacity can be learned. reference. Doing so requires flexibility, courage, imagination, resourcefulness, and humility. I would encourage all of us to ADAPTIVE LEADERSHIP IN ACTION: become ardent students of Heifetz and begin conversations in IMPLICATIONS FOR THE FIELD the boardroom and at the leadership-team levels within our The first requirement of adaptive leadership is to determine organizations…and watch the magic happen! which type of challenge we are confronting, a technical problem or an adaptive one. Once that has been done, the real work begins. • Lead from the balcony instead of the dance floor. This SOURCES allows foundations to see the big picture. Approach communities as asset based, and therefore in the best Heifetz, Ronald A., Kania, John V., and Kramer, Mark R. position to solve their own problems with the right type of “Leading Boldly.” Stanford Social Innovation Review. Winter assistance. Maintaining perspective is a delicate dance and 2004: 21-31. requires that foundations provide the right amount of assistance, knowledge, and pressure. Deep listening at Heifetz, Ronald A., and Marty Linsky. Leadership on the Line: the outset, meeting communities where they are, and Staying Alive Through the Dangers of Leading. Boston: Harvard understanding how work gets done increases local Business School Publishing, 2002. commitment. This approach requires providing appropriate assistance as communities wrestle with setbacks and Views from the Field is offered by GIH as a forum for challenges. It also involves ensuring that all the parties who health grantmakers to share insights and experiences. If you are interested in participating, please contact Osula Rushing at 202.452.8331 or orushing@gih.org.