Leading with Your Upper Brain: How to Create the Behaviors That Unlock Performance Excellence

ACHE Management Series Editorial Board

Douglas E. Anderson, DHA, LFACHE, Chairman

SHELDR Consulting Group

Tyler A. Bauer

NorthShore University HealthSystem

CDR Janiese A. Cleckley, FACHE

Defense Health Agency

Kris M. Drake, FACHE

Ingham Community Health Centers

Guy J. Guarino Jr., FACHE

Catawba Valley Medical Center

Shanna Johnson, FACHE

Ascension St. John Hospital

Sylvia E. Lozano, FACHE

Alameda Health System

Faith Needleman

Samaritan Life Enhancing Care

Mitali Paul, FACHE

Houston Methodist Specialty Physicians Group

Jayson P. Pullman

Hawarden Regional Healthcare

CDR Lisa A. White, FACHE

Navy Medicine Professional Development Center

Nichole C. Wilson, FACHE

Community Health Network

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This publication is intended to provide accurate and authoritative information in regard to the subject matter covered. It is sold, or otherwise provided, with the understanding that the publisher is not engaged in rendering professional services. If professional advice or other expert assistance is required, the services of a competent professional should be sought.

The statements and opinions contained in this book are strictly those of the authors and do not represent the official positions of the American College of Healthcare Executives or the Foundation of the American College of Healthcare Executives.

Copyright © 2022 by the Foundation of the American College of Healthcare Executives. Printed in the United States of America. All rights reserved. This book or parts thereof may not be reproduced in any form without written permission of the publisher.

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Library of Congress Cataloging-in-Publication Data

Names: Frisina, Michael E., 1955– author. | Frisina, Robert W., author.

Title: Leading with your upper brain : how to create the behaviors that unlock performance excellence / Michael E. Frisina, Robert W. Frisina.

Description: Chicago, IL : Health Administration Press, [2022] | Series: HAP/ACHE management series | Includes bibliographical references and index. | Summary: This book applies key aspects of cutting-edge neuroscience research to illustrate how leaders’ behavior affects the performance ‘brain’ of their team members—and overall organizational performance— Provided by publisher.

Identifiers: LCCN 2021043440 (print) | LCCN 2021043441 (ebook) | ISBN 9781640553279 (paperback) | ISBN 9781640553248 (epub)

Subjects: LCSH: Cognitive neuroscience. | Human behavior.

Classification: LCC QP360.5 .F75 2022 (print) | LCC QP360.5 (ebook) | DDC 612.8/233—dc23

LC record available at https://lccn.loc.gov/2021043440

LC ebook record available at https://lccn.loc.gov/2021043441

The paper used in this publication meets the minimum requirements of American National Standard for Information Sciences—Permanence of Paper for Printed Library Materials, ANSI Z39.48-1984.∞™

Acquisitions editor: Jennette McClain; Manuscript editor: DeAnna Burghart; Project manager: Andrew Baumann; Layout: Integra

Found an error or a typo? We want to know! Please e-mail it to [email protected], mentioning the book’s title and putting Book Error in the subject line.

For photocopying and copyright information, please contact Copyright Clearance Center at www.copyright.com or at (978) 750-8400.

We dedicate this book to all the people who have contributed to making us better leaders and better human beings.

Contents

Foreword

Preface

Introduction

Part I     Effective Leadership

Chapter 1   The Effective Leadership Equation

Chapter 2   Self-Awareness

Chapter 3   Self-Management

Part II    Engagement

Chapter 4   The Engagement Equation

Chapter 5   Creating a Culture of Purpose and Performance

Chapter 6   Leadership Behaviors That Drive Engagement

Part III   Performance

Chapter 7   The Performance Equation

Chapter 8   The Technical Tyrant

Chapter 9   Behavior Capacity

Index

About the Authors

Foreword

MANY BELIEVE INTELLIGENCE and tactical prowess to be the core drivers of effective leadership, and research shows that these are important ingredients in the recipe for professional performance. A quick glance at our organizations’ strategic plans and priorities, hiring processes, performance management templates, and meeting agendas will affirm that notion. An overwhelming majority of our attention is on the whats that we do, and not nearly enough on the how and why.

Indeed, leaders are leading—humans, processes, organizations, and more. Once we advance past the role of individual contributor, it’s critical that we turn more of our energy and attention toward growing not just our technical skills but also our behavioral proficiency. Leaders with highly developed behavioral and emotional competence, who are intentionally and consistently leading from the upper brain, stand out like bright and welcoming lighthouses in our teams, our organizations, and our profession.

To lead others effectively, we must first (and always) lead ourselves effectively. The best leaders have a keen understanding of their strengths and weaknesses and actively manage both, sharing their innate aptitudes confidently and generously while humbly and transparently acknowledging deficiencies, deferring to and collaborating with others whose lights shine where their own is lacking. These leaders are aware of their positive and negative tendencies and regulate themselves effectively in order to bring their best selves to each circumstance and model an example for others.

There’s an old saying: The grass is greener where you water it. In this terrific book, my friend Dr. Michael Frisina exhorts us to bridge the knowing–doing gap, intentionally applying the behavioral practices that will better form us as leaders, building our muscle memory in those neural processes that drive leadership and executive excellence. The heavy lifting of behavioral stewardship is nonnegotiable for those who hold, or aspire to, positions of influence, because being smart, credentialed, accomplished, and well educated isn’t always enough. Drink deeply of the wisdom, and experience the growth that results.

Laurie K. Baedke, FACHE, FACMPE

Preface

THE NEVERENDING QUESTION for all organizations is, how do we continue to get better at what we do? This question relates to individual, team, and organizational performance; another way of framing it is, what do we need to do to improve our performance? In healthcare, for example, the question revolves around improving patient safety, patient care quality, and patient experience. The question also affects the engagement of the interprofessional clinical healthcare team and the level of employee motivation and engagement among those who support the healthcare delivery system.

Performance is science based. Consequently, we can seek continuous performance improvement using a science-based approach to addressing two critical performance factors, as depicted in the following equation:

Performance = f(x) (technical capacity) × (behavior capacity)

For decades, performance experts have sought to help organizations improve performance by focusing solely on technical capacity. This approach has not been effective in driving significant continuous performance improvement over time. Our hope is that this book will shift the emphasis away from technical capacity and toward the behavior capacity coefficient of the performance equation. Leaders can use increased behavior capacity to leverage technical capacity that ultimately will drive performance and continuous performance improvement. The simple yet profound premise of this book is that effective leadership behaviors are the key that unlocks high levels of performance excellence.

Behavior is the independent variable of the performance equation. Behavior capacity consists of the thoughts, emotions, and actions of each individual. When coupled with their level of intellect and technical expertise, this behavior capacity drives performance. Behavior is the decisions we make and the actions we take that determine performance outcomes. Rational people have complete control of their thoughts, emotions, and actions. We call this personal responsibility and accountability for performance outcomes. Since behavior is both observable and measurable, we can take a science-based approach and use behavior as the determinate factor for continuous performance improvement. Leaders ignore behavior capacity and its direct link to outcomes at their own performance peril.

In this book, we will provide a systematic, programmatic, and integrated approach to continuous performance improvement by teaching leaders and their team members how to purposefully and intentionally create the behaviors that exist in high-performing teams. We will engage you in critically examining your current behaviors, which affect the performance outcomes of your work. We will challenge you to recognize and consider alternative behavior that will contribute to your performance improvement. Finally, we will explain how to create a science-based approach to performance management in your organization—a functional methodology for managing upper brain cognitive functions, which frame effective behaviors, which manifest into high performance outcomes.

The answer to the neverending question of how we get better is for leaders to overcome bad thinking that has relegated behavior and leadership to soft skills that have little relevance to the science of performance. We take a scientific approach based on how the brain actually works as a performance tool. We link behavioral development directly to expected performance outcomes in the form of key performance indicators. Doing so requires a radical shift in current human resource practices, focusing on behavior development as a continuous improvement process in its own right. The development of behavior capacity, for both the leader and team members, has to be aligned with key performance indicators. The behavior changes we recommend are measurable, allowing leaders to guide their team members to the performance outcomes they desire. This is what leading from your upper brain does—it helps you get better at what you do as a leader. It helps your teams perform at high levels of performance outcomes, as well.

Introduction

The illiterate of the twenty-first century will not be those who cannot read and write, but those who cannot learn, unlearn, and relearn!

—Alvin Toffler

A NUMBER OF YEARS AGO, at an American Hospital Association Leadership Summit in San Diego, author Jim Collins, of Good to Great, Built to Last, and Great by Choice fame, delivered a keynote address. Collins discussed his friendship with iconic management expert Peter Drucker, and described visiting Drucker’s personal library and seeing the books he had written—39 published works on management and society, and two novels—all lined up in chronological order on the library shelves. That is when Collins realized that two-thirds of Drucker’s books were published after the author turned 65. Drucker believed that you should never write about a topic until you had attained mastery of it. Evidently, Drucker considered mastery of a topic a lifelong learning process.

The type of lifelong learning demonstrated by Drucker is not a trivial pursuit. In the age of the knowledge-based worker, adaptability and continuous learning define the course of your career. Current reality does not permit us to treat learning as an occasional indulgence. To become an effective leader and stay relevant, you must commit to your own lifelong learning process. Think of all the jobs and establishments that did not survive the last thirty years (Sadani 2020). Here is a short list to consider:

Projectionist

Photocopy center

Cybercafes

Video cassette parlors

Video game centers

In another thirty years, travel agents, librarians, retail cashiers, legal secretaries, telemarketers, postal workers, social media managers, and real estate agents may similarly disappear.

Not only are occupations continually going away, but new jobs are also continually emerging. In 2018, talent management experts Tomas Chamorro-Premuzic and Josh Bersin found that half of the most in-demand skills did not exist five years before. As a result of this rapid and continual change, employers now put a premium on intellectual curiosity and the desire and ability to quickly grow and adapt one’s skill set.

The leadership development world does not lack suggestions on how to create a learning culture. Here is a sample of science-based recommendations:

Reward continuous learning.

Nurture critical thinking.

Make it safe for people to speak out and challenge authority.

Give meaningful and constructive feedback.

Lead by example.

Hire curious people and develop them in the technical areas of their roles.

All these recommendations are behavior based as well as science based. None has anything to do with technical skill, process, strategy, talent, or intellect. Executing these recommendations successfully requires leaders who are behaviorally smart—leaders whose behaviors motivate their team members to higher levels of performance while managing constant change and continuously increasing complexity. Effective leaders are committed to lifelong learning. They are constantly reinventing themselves. They have the ability to connect and ignite the part of their brain that drives continuous growth, development, and performance.

Effective leadership requires the ability to change and innovate (Morris 2015). Consequently, we are advocating for effective leaders to engage in a lifelong learning process that transcends formal learning and encompasses a dream, a curiosity, a passionate desire, and a clear, future-oriented view of an ever-changing world. This type of learning must be purposeful, continuous, and developed over a long period of time. It requires, as Aristotle indicated, dedication to the constant formation and daily practice of good habits. It also requires what we will teach you in this book—learning to lead with your upper brain.

BECOMING SMART ABOUT BEHAVIOR AS A LEADER

You do not become an effective leader without engaging in some kind of leadership development. As CEOs, senior operational leaders, human resource and organizational professionals, you have to understand that highly effective leaders are a rare commodity. Your recruitment and retention strategy requires some leadership development methodologies. But not all leadership development models fulfill their promises of producing the next generation of emerging, effective leaders. To that end, we want you to focus on three key objectives in this book:

Developing a systematic, integrated, and science-based approach to performance excellence using the model constructed in this book.

Identifying the cause-and-effect relationships between effective leadership, workforce engagement, and high levels of organizational performance outcomes.

Discovering how performance is a function of technical skills and behavioral capacity, and how behavioral skills drive technical skills to higher levels of performance.

Performance requires more than your skill, talent, and intellect. Performance requires that you have a highly developed sense of behavior awareness and function as an effective leader. You need to be able to manage in the context of process (technical skills) and of people (behavioral skills). The behavioral skill set is a combination of a leader’s ability to manage their thinking, emotions, and behavior. Inability to manage in the context of people using highly developed behavioral skills affects a leader’s ability to manage and execute in the context of process. Your technical skill capability will rise no higher than your behavioral skills capacity. When you are aware of your behavior as a leader you enhance your technical skills, resulting in performance at the highest levels.

Your development as a leader, and the development of others as leaders, requires a leadership development methodology and a model that you can use to build your behavioral skill capacity. As a CEO seeking to hire a new chief operating officer, you would likely receive over a hundred resumes from people totally qualified in the job’s technical skills. How would you evaluate the top candidates’ behavioral skills?

Typically, people get hired because of their technical skills. Professionals rarely lose their jobs because they stop being technically smart. They lose their jobs because they consistently display disruptive behaviors that derail their careers. Becker’s CEO Report E-Newsletter provides continuous examples of senior-level professionals who have lost their jobs or received disciplinary actions based on behavioral skill lapses, not technical skill lapses (Ellison 2021).

LEADERSHIP DEVELOPMENT AS A STRATEGIC OBJECTIVE

A successful leadership development program aligns company strategy with an understanding of the essential leadership behaviors needed to execute that strategy. We often confuse effective leadership with mere execution of strategy and achievement of results. In reality, effective leadership is the ability to inspire others to execute strategy at a high level of performance based on the behavior impact of the leader. No matter what else leaders do to affect the performance of their teams—communicating vision, creating strategy, providing adequate resources—the ultimate success of leaders and their teams is predicated on individual and collective leadership behavior. The foundational premise of this book is that individual leader behavior is the single most important predictor of how a team performs.

In a 2021 report on performance, Gallup found that 70 percent of a team’s engagement is influenced by their manager (Ratanjee 2021). Furthermore, the traditional command-and-control management style does not work for today’s workforce, which expects the manager to be more of a coach than a boss. Gallup’s study of more than 550 job roles and 360 unique job competencies found that leaders who create successful, high-performing teams in thriving organizations display the following behavior skills:

Building relationships. Successful leaders establish connections with others to build trust, share ideas, and accomplish work.

Developing people. They help others become more effective through strengths development, clear expectations, encouragement, and coaching.

Driving change. They set goals for change and lead purposeful efforts to adapt work that aligns with the stated vision.

Inspiring others.They leverage positivity, vision, confidence, and recognition to influence performance and motivate workers to meet their challenges.

Thinking critically. They seek information, critically evaluate the information, apply the knowledge gained, and solve problems.

Communicating clearly. They listen, share information concisely and with purpose, and are open to hearing opinions.

Creating accountability. They identify the consequences of actions and hold themselves and others responsible for performance.

Effective leadership development requires putting people through a set of planned scenarios that require the learners to apply effective behaviors that will drive performance excellence. For example, by learning and applying the techniques of behavior-based interviewing, you acquire the skills you need to hire the most talented people available for any job vacancy in the organization.

To create an effective leadership development program, you need three essential elements:

You need a mechanism for identifying your future leaders based on current performance. More importantly, you need to identify criteria for measuring future potential for performance in positions of increasing responsibility.

You need to determine the leadership patterns that are most appropriate for the organization, taking into account the purpose and the complexity of the organization. In most cases, you will need a combination of the four leadership behavior patterns in order to align all your strategic objectives with key results. We will discuss these patterns in great detail throughout the book.

You also need a comprehensive development plan for leaders at all levels of the organization, including senior leadership. Every leader in the organization needs their own personal development plan, with suggestions and specific action steps for improving their effectiveness as leaders and driving performance outcomes.

We have experienced a great deal of cynicism from senior leaders who resist investing the time and money into the leadership development program we recommend. These leaders have run the gamut of other programs and assessment tools, hoping for a silver bullet to leadership effectiveness but finding only unfulfilled promises. Each new effort and new program seems to meet with the same lack of momentum and result in the same long-term struggles to sustain leadership growth, development, and performance outcomes.

We sense that frustration and readily acknowledge it. Nonetheless, the consequences of failing to create effective leaders in your organization can be disastrous. The data show that high-performing and extremely talented people do not quit their jobs; rather, they quit their ineffective leader, manager, or boss. A study by the American Psychological Association found that 75 percent of Americans say their boss is the most stressful part of their workday. Another Gallup study found that one in two employees have left a job to get away from their manager at some point in their career (Abbajay 2018).

Effective leaders are essential in every organization that wants to hire and retain exceptional talent and release that talent throughout the organization to produce high levels of performance excellence. Our primary reason for writing this book is to assist you in creating an integrated and systematic structure to develop effective leadership behaviors in your organization, which in turn will drive performance.

One part of the human brain, what we call the upper brain, is the catalyst for performance behavior. Effective leadership is the result of a cause-and-effect relationship between performance behaviors that reside in the upper brain (growth and performance) and blocking behaviors that reside in the lower brain (fear and survival). Awareness and management of the tension between these two competing operating systems provides the spark to energize, engage, and enhance performance throughout the organization.

A universal truth in the life cycle of high-performance organizations is that individual breakthroughs drive organizational breakthroughs. Reducing the variability of leadership performance is critical to successfully aligning your strategy with key performance objectives and achieving the performance results you desire as a leader. Effective leadership behavior is the means to a greater end, particularly in healthcare—safe practices, high-quality care measures, and positive patient care experiences that create high levels of service satisfaction. You can get everything else right regarding the technical skill elements of performance—recruiting and retaining top talent, having the most innovative strategy and robust financial margins—but if you lack effective leadership behavior, you will never obtain the high level of performance you are technically capable of achieving.

So, the question is not whether you should have a systematic and programmatic approach to leadership development, but whether you will have an approach that gives you a return on investment in creating effective leaders and driving organizational performance. Garland and colleagues (2021, 73) tell us that healthcare leaders need