The Deeper Message Behind the Effort to Repeal the Affordable Care Act

Political Disclaimer: I have never been a registered member of either major political party, but my preferred candidate in the 2016 presidential election was John Kasich, Republican governor of Ohio. The Republican party in Washington today is beyond recognition to me. While my essay probably appears to be an attack on Republicans, that is simply a result of the fact that Republicans are exclusively behind the current, wholly partisan effort to repeal the Affordable Care Act. There is no way for me to criticize what I see as horrifically bad legislation and related outcomes without criticizing those who are exclusively responsible.

The House bill (H.R. 1628), the “American Health Care Act of 2017,” which passed the House in May, and the Senate reconciliation bill, the preposterously named “Better Care Reconciliation Act,” recently brought out of secret negotiations in the Senate, are about much more than access to health insurance and health care in the United States. These bills are talismans of what could be a very bleak future, as privileged Republicans in congress and the Whitehouse are sending the unambiguous message that, as a matter of principle, they believe that reducing taxes for the very wealthiest Americans is more important than it is for tens of millions of Americans to have access to health care at all. Let’s be clear: policy debates about the “free market” or mandates aside, the reconciliation bill, in it’s current form, would be an unmitigated disaster for the delivery of health care in the U.S. The current legislation is a moral failure, which, if enacted, would do more damage to the well being of tens of millions of Americans than any other legislation in memory. What is shocking is not the fact that some members of congress support legislation that would devastate millions of American families. What is shocking is that nearly all Republicans in both the House and Senate have either already voted in favor of the legislation or said they would. This is not some theoretical dinner table conversation about the relative pros and cons of government involvement in American health care. The bill, in its current form would completely deny health insurance to tens of millions of Americans who have it now and eviscerate coverage for many millions more. That is not political opinion. It is a hard fact of the proposed repeal legislation.

What could a back room conversation about the effort to repeal Obamacare inside the Republican caucus possibly sound like?

“Well, this bill will increase the number of uninsured to almost fifty million Americans and it’ll be hardest on the lower income and disabled, and a lot of folks will probably lose coverage for pre-existing conditions, and rural hospitals will close, and people struggling with opioid addiction will be out of luck, and bankruptcies will spike, and somewhere over 35,000 people will actually die due to loss of health insurance, but we’ll be able to transfer nearly four hundred billion dollars in tax breaks to our very wealthiest friends (goosebumps) and…this is the best part… we’ll really stick it to Obama out of pure spite! Heck, that’s worth several thousand deaths by itself!!”

It has not always been this way. Over the last 70 years or so, Republican legislators and presidents have supported the common good with everything from the interstate highway system (Eisenhower) to a progressive tax system to preserve social security (Reagan) to the Americans with Disabilities Act (G.H.W. Bush) to global AIDs funding and prescription drug benefits for the elderly (G.W. Bush). There was a time when “conservative” did not mean reactionary and certainly didn’t mean coldly trading the health care of tens of millions of citizens for hundreds of billions in tax breaks for the wealthiest Americans. To be clear, the ACA would eventually face critical funding challenges without modifications, but the current Republican plan is based on a tax mechanism that would make the funding situation much worse! The only way hundreds of billions of dollars can be shifted to wealthy companies and individuals, while cutting taxes earmarked for health care, is to eliminate coverage for upwards of 30,000,000 people and reduce coverage for many tens of millions more through 2026—and that is the core source of opposition and dissonance for so many Americans. It is also a frightening precedent as it demonstrates that the current Republican calculus has no moral “red lines” when it comes to human cost.

What we see in the current health care bills is not only a cavalier attitude by well-off, medically insured (Republican) congressmen, senators, and president toward the least empowered and most at-risk citizens (those who rely on Medicaid for access to health care), but both bills also redirect hundreds of billions of dollars in taxes from that same Medicaid program (which the Senate bill cuts by nearly $1,000,000,000,000—yes, trillion) to the nation’s most wealthy companies and individuals. Moreover, by removing subsidies and tax credits, the House bill and the Senate reconciliation, would also eliminate access to insurance, or usable insurance, to many millions more who do not qualify for Medicaid, but do qualify for financial support to purchase insurance on the ACA exchanges. In fact, based on existing non-partisan Congressional Budget Office (CBO) assessments, the only likely beneficiaries of the current legislation would be young, healthy individuals whose premiums would likely decrease (but who may also lose benefits). The worst off would be low income Americans in their 50s and 60s, and, distressingly, the CBO estimates that in excess of 15,000,000 people would lose health insurance in the first year alone under the Senate reconciliation! The very basic reality is that the proposed repeal of the ACA would have the greatest negative effect on the poor, the near-elderly and elderly, the disabled, and specific groups such as those suffering from opioid addiction and pre-existing conditions. If that were not bad enough, recent research by Harvard University found that roughly one in every 830 people without health insurance dies as a result. In other words, the predicted loss of insurance for approximately 28,000,000 Americans by 2026 would result in nearly 37,000 preventable deaths. It is no small irony that Republicans refer to themselves as the “pro-life” party.

Of equal importance, the CBO report also states that the current instability in some ACA markets is not a product of the law itself or of some structural problem in those markets, but rather of President Trump’s threats to end enforcement of requirements to procure insurance as well as threats to de-fund subsidies that support the cost of premiums. In other words, the president has found a way to cynically fulfill his prophecy about problems with Obamacare by creating those problems himself.

And to be clear, there aren’t even good political reasons for Republicans in congress to pursue the current path. The proposed repeal of Obamacare is wildly unpopular. A significant majority of Americans from both parties are opposed to the current legislation and only 17% in recent polls support it. Even among Republicans, well less than half of voters support the current legislation to repeal the Affordable Care Act. While the polls do not explain in depth why so many Americans are against the current efforts in congress, it is not difficult to surmise that there is broad based fear about a future in which Republicans sacrifice the well being of millions of American families for a set of principles that benefits the most well off Americans at the expense of the most vulnerable. That is viscerally frightening to a substantial majority of Americans, including those who voted for Trump and Republican legislators in Congress.

In fact, the negative impact of the repeal of the ACA would be so severe to actual health outcomes, that the American Medical Association has claimed in a letter to Senate leadership, that passage of the bill in its current form would be a violation of the Hippocratic “do no harm” oath. They add in their letter that, “We believe that Congress should be working to increase the number of Americans with access to quality, affordable health insurance instead of pursuing policies that have the opposite effect.” Similarly, in response to the same CBO report, the US Conference of Catholic Bishops issued a statement in which they said, “…the loss of affordable access for millions of people is simply unacceptable… These are real families who need and deserve health care,” followed by, “We pray that the Senate will work in an open and unified way to keep the good aspects of current health care proposals, to add missing elements where needed, and to not place our sisters and brothers who struggle every day into so great a peril on so basic a right (emphasis added).” While fiscal restraint, freedom from mandates, and free markets are all defensible principles, the Republican disregard for the well being of many millions of Americans highlighted by the USCCB is a frankly jarring spectacle to witness.

Of course, providing anything close to universal health insurance coverage is dauntingly expensive and complicated, but the notion of denying basic access, while shifting resources from those most in need to those who are already the most well off, is simply immoral, and that has not been lost on most Americans. In fact, it would seem that the disagreement within the Republican party is between conservatives, and those who are more conservative, about how much pain to inflict on the American public.

Unless you believe that roughly 275 legislators in Washington are that cold hearted (or have that little political self-interest), the only other viable explanation is that the motivation to kill the Affordable Care Act is not about any principle at all, but rather about a deep, nearly pathological need by many Republicans to avenge eight years of the Obama presidency regardless of the human cost. Either way, it is disturbing to contemplate that a majority of members of Congress (and the president) would casually devastate many millions of American families for either reason. It makes them seem frankly unhinged, particularly since there is no critical need to change anything with the Affordable Care act right now. A bipartisan effort to improve the ACA could happen at any time.

To better understand historical context of government involvement in health care, the reason we have Medicare and Medicaid at all is because in the mid 1960s both parties of congress and the president at the time, Lyndon Johnson, recognized that the free market would not and could not support access to health care for those in poverty or near-poverty, by reason of disability, age, and unemployment. While there was certainly opposition to both programs, there was bipartisan support for the principle that even in capitalist systems, there is broad social value, if not moral compulsion, in creating a floor of services, medical and otherwise, funded by society as a whole. The Affordable Care Act (Obamacare) was an attempt, unwieldy but broadly successful, to bring access to medical care for about half of the nearly 50,000,000 Americans who did not have such access prior to 2010.

Of course, there are elements of the Affordable Care Act that are unsustainable in their current form and that would have to be modified at some point regardless. A compelling example is the notion of Medicaid as an “open-ended” (the government simply pays what it costs for each new enrollee) benefit whose cost continues to increase at rates in excess of inflation. While all health care costs have been increasing for decades at rates in excess of inflation, Medicaid (and Medicare) are almost wholly funded by taxpayer dollars. Without a change, those costs alone would eventually eat up virtually all discretionary federal tax receipts, which, of course, is not viable. However, there is a rational, compassionate place between adjusting Medicaid and Medicare expenditures and taxes on the one hand and wiping out access to health care for tens of millions of Americans on the other hand, while redistributing hundreds of billions of dollars from poor Americans back to wealthy ones!

As for mandates, no one likes to be told what to do. But to suggest, as Republicans in congress have, that the mandate to purchase health insurance, which is central to the ACA and any other sustainable insurance market, is somehow unique to Obamacare, is at best disingenuous, and at worst, out right dishonest. Our government issues mandates in every sector of our lives, including other forms of insurance! When was the last time you tried to get license plates for a car without having “mandated” liability insurance? Health care providers are mandated to have malpractice insurance. Every 18 year-old male in the U.S. is mandated to sign up for the selective service. Tens of millions of children are mandated to attend school and every day nearly 3,000,000 airline passengers are mandated to show a government ID, sacrifice their privacy, and pay “security fees” to get on a plane. Our daily lives are infused with mandates and the underlying rationale for all of them is that the common good in those cases outweighs individual choice. You cannot legally drive without purchasing auto insurance because of the undue burden that puts on others in society if you cause a wreck. The same argument applies to health insurance. If an individual does not have insurance, but ends up in the emergency room and intensive care after an accident, those who do have insurance will ultimately pay the bill through higher premiums and higher costs for their own health care.

Republican histrionics aside—no, the Affordable Care Act, is not a “disaster;” Hurricane Katrina was a disaster—the fundamental problem with the Affordable Care Act, despite its flaws, is not the law itself, and the problem certainly wasn’t the noble goal of creating access to healthcare for tens of millions of uninsured Americans. The problem is that it was bolted onto an underlying health care system with deep structural flaws, many of which the ACA attempts to address symptomatically rather than causally. If the Republicans in congress and our president were acting in anything approaching good faith, they would be engaged in a bipartisan effort to create lasting, structural solutions to our health care system, even if that means material compromises for both political parties. In comparison, although the ACA was ultimately passed along partisan lines, the initial discussions on the bill were largely bipartisan, including a presidential address to Congress and Whitehouse strategy sessions involving members of both parties. The reason that is not happening now is because the current Republican repeal legislation has absolutely nothing to do with improving the healthcare system. Their motivation is either to create a healthcare system based on free market principles and privilege, regardless of human cost, or their neurotic obsession with poking Obama in the eye, or both. The very name of the Senate reconciliation bill itself, the “Better Care Reconciliation Act,” is laughable on its face. It may be cheaper for some and it may allow others to avoid buying health insurance at all, but in no way does it improve care for anyone.

Let’s be clear that as a society, we either believe that access to some meaningful level of health care is a guaranteed right (as we have done with primary and secondary education), and make collective sacrifices to achieve that goal, or we believe that access to health care is a privilege enjoyed only by those with the financial means to afford it. It’s that simple. Most Americans have said they believe health care is a right. Republicans in Washington, through their repeal legislation, have declared the opposite, and will likely lose the moral and political battle over time.

Let’s also be clear that no broadly effective health care solution, ACA or otherwise, will work long term, in any way approaching “affordable,” without acknowledging a combination of undeniable truths.

Some of those truths are:

  • Almost all Americans will have to contribute some level of their own personal financial resources to their own health care.
  • Not every American can have access to every medical service, test, treatment, etc., or have such access precisely when they want it. There must be some management of care.
  • Covering nearly all Americans will require that some form of government sponsored insurance be part of the solution (Medicaid, Medicare, VA, etc.)
  • Covering nearly all Americans will require substantial tax receipts, most of which will come from wealthy Americans and businesses, because they pay most of the taxes collected in the U.S.
  • Covering nearly all Americans will require healthy people to pay into insurance pools, which will subsidize less healthy people.
  • Some individuals will have to pay for some benefits they never use.
  • Some form of centralized negotiation of cost will be necessary for public programs the same way it exists now for privately insured programs (the federal government already does this with the VA health system)

In short, the current Republican effort to repeal the ACA has absolutely nothing to do with improving health care outcomes or the health care system. As confirmed by the non-partisan Congressional Budget Office, it would objectively wipe out access to health care for over fifteen million people in the first year of implementation alone! The Republican effort is about legislating the principle that health care is a privilege only for those who can afford it, while decreasing tax obligations on the wealthiest Americans. Heaven help us if that becomes the driving moral principle for all Republican policy while they have a congressional majority and hold the presidency.

Organizational Culture vs. Macro Culture: How to Lead in Multi-Cultural or Even “Foreign” Environments

Many of my posts and articles address the critical nature of culture within organizations, and for good reason. Many of the biggest leadership challenges today are actually more about culture (beliefs, values and behavior) than about operations or strategy.

But what role does macro culture (the culture outside the organization) have on the micro-culture inside the organization and on related leadership challenges? It turns out it’s a really big deal.

In my case, I have been very fortunate to have travelled to 37 different nations and lived in six different countries around the world. Although I carry an American passport, my world-view is the product of life and work in dozens of different macro cultures, with particularly extensive experience in those of Latin America, Europe, and the Middle East. As part of my experience, I have served as a Chief Executive Officer of large, complex organizations outside the United States and have learned powerful lessons as a result.

So, back to the original question: What role does macro culture play on the internal cultures of organizations within those macro cultures and, importantly, what are the implications for leadership in those contexts?

It would be impossible to fully answer such questions in a single article, but there are some high level takeaways I can address here.

Let me start with what was nearly the biggest mistake of my professional life. I was the new CEO of a parent company in Latin America that had four subsidiaries within the overall structure, three in Latin America and one in Florida, on the U.S. mainland. I had the advantage of speaking Spanish and of extensive experience living in other Hispanic countries, but I had never run an organization outside the U.S. at that point.

The holding company had American ownership and I was hired in the U.S., with the implicit assumption that I would impart American business practices in the Latin American operations. In fact, early on in my tenure, I determined that my objective was to make my new company the “best American operation possible.” Huge mistake.

Macro cultures have evolved over centuries (or millennia) and many generations. They dramatically impact values around things like time, incentives, respect, relationships, gender roles, hierarchies, and even religion among others. These values are reflected in behavior and language, among other manifestations, and while people may learn to say what they think a boss wants to hear, if they are being asked to do things that conflict with their cultural values, there will be no sustained commitment at all and lots of down stream dissonance and confusion.

Not surprisingly, I initially found myself frustrated with some things that didn’t match my expectations. One example was what I felt was a lack of urgency around time commitments. Another example (funny now) was what I thought to be “inappropriate” use of organizational email systems for personal, all-staff emails. However, I also discovered deep value for human relationships, for loyalty, for family, for enthusiastic social life, and an almost limitless patience in the face of frustrating bureaucratic challenges. And as for time, yes, it really was perceived differently, but it turns out that the relationship with time was, at its core, far more healthy than what I had been socialized to believe in typical American organizations.

Thankfully, before I had a chance to seriously damage my professional relationships or to create unsustainable stress in the organization, I came to the realization that my objective had to be to create the “best Puerto Rican operation possible,” which still provided opportunities to inculcate best practices in the organization (which we did with things like shared services, customer service, planning, financial controls, and accountability among others), but those efforts had to exist in concert with the overriding external cultural values that so thoroughly permeated the organization—and I absolutely had to choose my battles. There were a few cases in which I challenged organizational norms because I just didn’t believe they were justifiable, culturally or otherwise. But I only did so if I was really confident (and had confirmed with others from the local culture) that I was probably right. One example was the notion that we just couldn’t provide great customer service because that didn’t exist in the external culture. I didn’t buy it and launched a comprehensive effort to change the reality, which we did.

Another example comes from the Arabian Gulf area of the Middle East. Compared to American norms, professional interactions are incredibly formal in the Arab world and there is a long, historical tradition of being deferential to those at the top of hierarchies. Even long time lateral colleagues often address each other as “Mr.” or “Dr.” so and so, particularly in the presence of others. Being from the West, but also being someone who believes that formal hierarchy can get in the way of open communications, dissemination of ideas, teamwork, etc., this was a challenge for me. At first I created occasional dissonance by simply being too informal. While still more informal than most of my colleagues, I have learned to be more protocol driven, particularly in the presence of others. My motivation for that, in addition to simply being respectful of the local norms, is to avoid the appearance that I do not honor the professional status of my colleagues. It is a work in progress, but a critical key to success when navigating new cultural environments is to earn the benefit of the doubt by listening, learning, and being as gracious as possible.

Having said that, sometimes there are cultural “non-negotiables” that must be understood and respected. The Middle East, for example, is broadly Islamic and unlike the West, there is often little or no distinction between Islamic values in the workplace, private life, government, etc. While most Muslim majority countries are very respectful of other religions, there is an expectation that Muslims and non-Muslims alike honor certain Islamic values. A very good workplace example is that some female Muslim employees choose to limit their interactions with male colleagues. For example, some have made the choice not to shake hands with male colleagues or to share an elevator alone with a male colleague, etc. While this may sound extreme from some Western perspectives, in practice, it is very workable. It is also an example of something that should not be questioned or challenged. Sometimes the macro culture imposes norms on organizational culture that are “sacred” and simply to be respected. An example in Western contexts is the recognition that managers absolutely should not use their positional authority to pressure subordinates into compromising relationships. Unfortunately it still happens, but the cultural norm does not support such behavior and, in most cases, such behavior is actually illegal.

The fact is that is all organizations exist within the context of some set of macro-cultural values and assumptions, which permeate organizations through the people in them. This is true whether a leader finds him or herself in a “foreign” land or in the community where he or she grew up. The point is that leaders must be cognizant of those cultural influences and must be prepared to honor them even when they are not held by the leader him or herself.

Fortunately, there are certain values and behaviors that tend to transcend most macro cultural contexts that leaders can rely on when engaging the people in organizations they are leading.

In my experience the most important aptitude for a leader in such situations is inter and intra-personal intelligence and the most important behaviors are to listen and observe more than talk and act. For better or worse, leaders who are imperceptive and lacking in self-awareness are simply ill-prepared to be effective in culturally complex environments. It’s not that such environments are unforgiving to mistakes in protocol; they’re actually quite tolerant with “beginners.” They are, however, unforgiving to “outsiders” who insist on ignoring or disrespecting norms that are important to people in the organization. As an example, I have a very productive and respectful relationship with a female employee in my HR department, whom I initially embarrassed in front of others by trying to shake her hand. I later apologized to her personally, but more importantly, I learned from the experience and changed my behavior so that I do not extend my hand first to any female, Muslim employee or colleague. If they extend their hand to me, then I know it is appropriate to shake their hand. Simple.

A related, very important personal trait for leaders in such situations is to be unpretentious about their own cultural norms. People instinctively know that anyone who is new in a given cultural context will need some time to climb a learning curve. It has been my experience that, regardless of macro culture, there is an appreciation for leaders who are authentic and unpretentious. People don’t expect perfection, but they genuinely appreciate a leader who knows that he or she doesn’t know everything—and understands that some local values and customs may not only be of great social importance, but are highly functional and valuable as well.

In short, it has been my experience that when navigating new cultural environments, leaders are much better served by “soft skills” than by technical skills, regardless of how valuable those technical skills may be to an organization. MBA programs almost never talk about “kindness” or “patience” or “sensitivity” as leadership traits at all, let alone highly valuable leadership traits. That is unfortunate, because the “on the ground” reality is that those traits have high transactional value in essentially any organizational context, but they are effectively required in culturally complex environments in which a leader has little experience or understanding.

Success Is as Much about Managing Expectations as It Is about Results

Interestingly, we humans have a very strong psychology connected to our expectations. We are remarkably willing to see most outcomes as positive if they exceed our expectations—even if the outcomes are frankly not very good. This is an important realization for senior managers and leaders.

In this vein, the comic strip character Calvin, from Calvin and Hobbes, employed a very effective modus operandi with his parents. He purposely strove to be mediocre, average, even below average at times. Even as a little kid, he knew that by doing so he could impress his parents any time he wanted simply by being better than mediocre.

The same psychology exists in professional organizations. There is an art and a science to creating expectations that you are usually able to exceed. As an example, Southwest Airlines has brilliantly mastered something that the legacy carriers (American, Delta, etc.) are truly miserable at doing: managing flight delays. Any delay is bad, right? The airline has failed to deliver on the contract. However, at Southwest, when there is a delay, the gate agents will announce a delay time that is almost always longer than the actual delay! I don’t know what formula they use, but if they say the flight will be delayed for 35 minutes, it is usually delayed for less time, say 25 minutes. The customer suddenly thinks their flying experience has greatly improved and the airline has delivered, even when the flight is late!

As managers and leaders, to a great extent, our own success is similarly tied to our ability to manage expectations as much as it is connected to our performance. Let’s be clear that this is not about being “Calvin” from the comic strip. There are big downsides to consistently managing expectations downward. However, whether we are managing expectations to those above, beside, or below us in the organization, there is significant value in carefully finding a balance between what might be optimistically achieved vs. what is likely to be achieved. Relatedly, have a look at this post to see the big downsides of telling your boss or bosses what you think they want to hear vs. what you believe is true.

If five things all have to go right to achieve a goal, a budget, or any other outcome, and you lead people to believe you will succeed, then you are putting an exceptional amount of risk into the expectation. Likewise, if you commit to an extraordinarily high target of some kind, even if you experience excellent performance and come close, you will have “failed” to deliver. Using the airline example, people hate legacy carriers because they say a delay will be 35 minutes and it almost always turns out to be much more than that. It’s less about the number than it is about the fact that the expectation wasn’t achieved.

On the other hand, if you say that you are confident that you or your team will achieve something in the future because you are already at the target, then you are being disingenuous. Moreover, you cannot “lowball” expectations forever. The expectations you set have to be credible.

In short, there is no “upside” in building overly optimistic expectations. You may get some brief kudos for making people think you will deliver huge results, but if you don’t deliver, then you have two problems—you didn’t succeed and you lose credibility. You are better off generating expectations that show meaningful performance, but that are more likely to be achieved than not. At least as importantly, you want to have some un-committed “operational levers” in your back pocket, which is discussed in another post.

You Rarely Communicate as Well as You Think You Do

Good communication is much harder than we often think it is. Because our days are filled with dialog (meetings, email, phone, texts, etc.) we sometimes mistake the quantity of our communication with the quality of our communication. Within the constraints of time, it would probably be harder to communicate more than we do, but it certainly wouldn’t be difficult to communicate more effectively than we do. We also confuse one-way dissemination of information with communication, which is why it is so common for people in organizations to complain that they have no voice, even though they are being inundated with information.

Where do we start? Not surprisingly the most likely cause of poor communication is a failure to listen. We are often motivated to “get our message out,” so we carefully craft an email or call a meeting and hit people with the message, but we don’t dedicate an equal amount of time and effort to evaluate to how the message is received, understood, etc. and to then listen to what people think about it.

I’m also convinced that another cause of ineffective communication is the failure to use the correct medium for the message. We have so many ways to communicate today: email, webinars, phones, texting, instant messaging apps, and face-to-face opportunities. Each of these methods is a very different medium with their own pros and cons in a given situation. The fact is, for a variety of reasons, we often simply choose the wrong medium for the situation. The most common mistake is usually based on either a desire to save time or, ironically, to avoid actually communicating with someone else. Writing a quick email, or worse, sending an instant message of some kind about a subject that is complex or controversial is asking for trouble, yet it happens regularly. And worse, sometimes people use email, not to actually communicate, but to document that a message was sent. There are times when that may be necessary, but if one avoids a difficult face to face conversation or phone call which is more likely to result in actual communication, and instead, sends an email as a “CYA” action, the person is not only contributing to a communication problem, but is also often acting in an unprofessional manner. One of the markers of leadership is doing things that are right or effective even when they are hard and that certainly applies to communication.

In short, if we listen more than we talk and choose the right medium for the message, we’ll communicate better without having to communicate more!

Less is More: Leading with Fewer Executive Competencies in an Ever More Complex Operating Environment

I have addressed the challenges of leadership in complex and volatile operating environments in previous posts and I have pointed to the kinds of skills and traits that are more likely to serve leaders in contemporary environments, including a model of strategic leadership. The reality, however, is that there is no way that any one leader can possess, let alone have expertise in, the multitude of competencies that are often described in the literature today. As an example, a recent report from the Aspen Institute identified no less than 18 competencies required of the contemporary university president!

In fact, as organizations and the environments they operate in become more complicated and the pace of change more accelerated, it may be that executives are better served by narrowing the things they have to be really good at and get right, rather than trying to do it all.

In an ideal world, a senior leader would have great finance chops, be a world-class communicator (internal and external), have deep operational and planning skills, be an excellent people manager with great empathy, intuition, and interpersonal intelligence, and be a visionary as well. On the other hand, if such leaders do exist, there are certainly far fewer of them than there are leadership positions.

What to do? As I approach 30 years of work in a broad variety of organizations and 20 plus years in fairly senior management and leadership roles, it is becoming clear that it is better for a leader to have fewer of the most critical skills and traits, but to excel in those areas, rather than to try to be expert in an impossible number of competencies.

From my experience, as it relates to contemporary organizations and environments, the three most critical skills for executive level leaders today are strategic planning/implementation (and a strategic focus), change management, and people management. The most important knowledge requirements are organizational dynamics and human behavior. And the most important traits are intuition, self-awareness, tolerance for ambiguity, and interpersonal intelligence.

Of course most leaders will possess some technical expertise based on previous experience, and that expertise can bring value, but what makes a really good COO or CEO is not their knowledge of accounting or marketing or technology, etc. What makes them truly valuable is their ability to make many other people successful by driving to a shared vision, maximizing teamwork, providing strategic insight, managing change, marshaling resources, engendering confidence, taking risks, etc. None of that comes from technical expertise. In fact, although helpful, even operational expertise is less important than strategy and change management in today’s environment for senior leaders.

Of course, a related key to success for senior managers and leaders is that they ensure that other people in the organization have the expertise that they might be lacking and that the organization itself is configured for success. The executive may not be a finance expert, for example, but someone on his team better be. Likewise, the organization must be staffed and configured in ways that are amenable to change, innovation, risk-taking, etc. The same applies to any other technical area of importance in the organization.

In short, the ever-increasing complexity of leadership challenges combined with the increasing rate of change, is outpacing the capacity of even the most capable leaders to effectively address all of the competencies that are now being ascribed to contemporary leaders. As such, this may truly be a case where less is more. Being really effective in a few key areas will likely bring much more value than being mediocre in an impossibly large number of areas. Strategy, vision, and change and people management can be the basis of highly effective leadership in even the most complex, ambiguous, and uncertain environments.

Make Sure Your Daily Work Involves at Least Some Tasks and Projects You Really Like Doing (and Includes Some Time for Yourself)

We would all like to wake up each day fired up and ready to get out the door to work. However, even those of us fortunate enough to love our jobs have some days that are more tedious and less rewarding than others. That is unavoidable. What I’ve learned, however, is that we have more control than we think we do over both the enjoyment and reward we experience each day at the office or job site.

One way to influence both how well we do and the extent to which we enjoy what we’re doing is to organize our work such that we are engaged every day in some tasks and projects that we genuinely enjoy doing. I tend to be a “list” person, although it is possible to organize one’s work using a daily calendar or other tool. Whatever tool you use, it is worth the time early each day to review what you intend to accomplish before the day is over. You might break the tasks down by how critical they are or time sensitive they are, etc. Some things, such as standing meetings, will be “routine,” while other items will be unique to the day in question. Regardless, our decisions about how to spend our day should be dictated by two things. First, what is the cost or benefit of completing (or not completing) task “x” vs. task “y,” and, of all the things I might do today, which ones would I particularly like doing. Although there are exceptions, it is possible to build tasks into almost every day that provide a sense of reward, accomplishment, etc.

A very important related strategy that I learned fairly late in my management career is to block out times in the calendar that are not dedicated to any particular task or meeting. Whether I do it myself of have an assistant do it, I actually block 30 and 60 minutes times in my calendar simply labeled “blocked.” This ensures that not every minute of my day and week are obligated to someone else. I use these times to meditate, make phone calls, take a walk or work on something that I haven’t had enough time for. The key is that I own that time. My assistant and I both know that these blocks of time can also be “borrowed” if something urgent comes up, but we are both disciplined about keeping them protected as much as possible.

Finding a way to engage in work that we find enjoyable, as well as walling off time for ourselves, is important beyond meeting our own needs for stimulation and reward at work. It is important because the more engaged and energetic we are at the office (the more we like our jobs), the more effective we will be in managing others as well.

Treating People Well Pays Dividends over the Long Run…And It’s the Right Thing to Do

Every day we are presented with opportunities to interact with the people in our professional lives. This includes subordinates and supervisors, colleagues, vendors, business partners, etc. Over time, all of these interactions add up to things like reputation, management style, and personality. This “body of work” is also how people judge things like honesty, integrity, kindness, character and many other traits.

We generally do not think about this at the time of each interaction. Likewise, it is not possible to behave exactly how we want to in every situation. Sometimes a lack of time or stress or multiple demands get in the way of how we would prefer to act. However, on balance, we determine who we are via how we behave. Over time, the sum total of our interactions paint a pretty clear picture for those around us. This is as much about values as it is about leadership, which is not surprising since personal values influence how leaders see the world and thus the same values influence the decisions they make, including how they treat people around them. In fact, leadership without values is a frankly dangerous proposition.

The unfortunate truth is that there are people in the professional world who have enjoyed “success” (usually financial), even though they have hurt people in the process, sometimes quite purposefully. On the other hand, when we talk about legacy as I have in other posts, being a rich “son of a bitch” who trampled other peoples lives is something that even the rich SOB probably does not aspire to. Another way to think about this is the old axiom about what you want on your tombstone. When our time here on earth is all over none of us wants our legacy to be that we were a jerk. On the contrary, since we can’t take anything with us, material success at the expense of other people is worse than a hollow victory—it’s a moral failure. This also applies to how we treat those with less leverage or power than we have in any given interaction. Kwame Anthony Appiah, in a recent Ethicist column in the NY Times Magazine, was responding to a reader question about how an employee was being terminated when he noted, “It’s particularly important to respect your ethical obligations to employees when they have no legal recourse.” This is a critical point. He is saying that leadership decisions (and how we treat people) must come from an ethically defensible place especially when we have the leverage to do whatever we want.

In the end, we are better off and those around us are better off if we have consistently treated people well and fairly; if we have taken the time to listen; if we keep our ego in check; if we take an interest in their issues and their success. We are better off for two reasons. First, treating people around us well and fairly tends to motivate them and engender commitment, which makes us more successful. Second, and probably more importantly, if you have genuinely treated the folks around you well and you have done that over time, those same people will be supporters when you need it most. Those same people will go the extra mile precisely when you need them too.

And it’s the right thing to do.

Treat Your Subordinates Every Bit as Well as You Treat Your Colleagues and Your Superordinates—And Don’t Blindly Defer to Your Bosses

There is no doubt that we all live in a world of hierarchies. No matter what your position socially, professionally, or economically, there is almost inevitably someone “below” you and “above” you in the hierarchy in question at any given time. And to be clear, this dynamic happens regardless of our personal beliefs or desires relative to the social order in question. This is true because humans have an almost insatiable appetite to rank and order virtually any group or structure involving other human beings.

In any hierarchy it is generally accepted that we treat those above us with “respect” or at least with some kind of deference. After all, part of the rationale for hierarchies in the first place is to create privilege for those higher up the ladder. We do this with our language, dedication of time, and other behaviors such as how we prioritize our interactions and commitments. To be clear, there is a difference between understanding that we are ultimately accountable to a supervisor, executive, board member etc. vs. mindlessly deferring to the requests and agendas of those above us in a hierarchy. In fact, we can be respectful while also being assertive when some other use of our time and efforts will bring more value to all involved. And in some cases, “chain of command” is, in fact, critical, such as in combat, but that rarely applies to contemporary organizations.

Interestingly, it is less expected that we treat our lateral colleagues and subordinates with the same deference. Although the product of entrenched social norms, this is a mistake for your effectiveness as a leader. It is a mistake for at least two fairly significant reasons. The first is that this kind of behavior also subordinates the ideas and contributions made by colleagues and subordinates. The last thing you want as a leader is to make decisions or implement policies, etc. without the value of the best ideas or correct priorities because subordinates deferred to less effective ideas or solutions simply because they came from folks higher up the organizational ladder. The second reason it is a mistake to treat lateral colleagues and subordinates with less deference and respect than your superordinates is because if they believe they are obligated to engage in the same behavior, they will prioritize your requests and needs above their own or those of their lateral colleagues and subordinates. When that happens, you have everyone in the hierarchy prioritizing their efforts not by what is best for the organization or customers or other stakeholders, but by what they think their bosses want.

We have all fallen victim to this and it is one of the bigger dysfunctions in organizations today. An example is when you are working on a very important, even critical project or customer need, and you stop doing it, or worse, reschedule a meeting or planning session or negotiation involving other people, so that you can respond to a request from a superior that may have a fraction of the importance or value of what you are working on. This hurts you, the organization, and ironically, even the boss! And when your subordinates do it, it hurts you as well! One of the most devastating examples of blindly subordinating oneself to those “above” us has historically resulted in the loss of hundreds or potentially thousands of lives. In the old days, the captains in aircraft cockpits were second only to God. Co-pilots and flight engineers did not dare challenge captains or even point out mistakes. Because of this, many airplanes crashed at the hands of the captain even when one or more other crew members knew that they were in danger. This problem became so severe that the airline industry was forced to implement a completely new method of operations in cockpits called “crew resource management,” which was designed to remove blind deference to authority. While captains are still in charge, flight deck crews now operate as equal partners in the completion of safe flights, and among other changes, this has resulted in the safest form of transportation in the world.

So, despite the fact that it is often dysfunctional, why do managers often blindly prioritize and subordinate themselves to those above them while expecting the same from their subordinates? Sometimes it is an ego driven attempt to “remind” subordinates of their place in the hierarchy—another thing humans are regrettably quite good at. Unfortunately, that is like reminding a man with no hair on his head that he is bald. The reality is fairly self-evident. Sometimes, we are simply less thoughtful because the conventional wisdom is that we don’t have to care as much about folks below us in the chain of command. Sometimes we feel that if we’re going to “kowtow” to those above us, someone better kowtow to us. Unfortunately, we are hurting ourselves when we blindly defer to those above us, and when we expect the same behavior from those below us.

On the other hand, a manager who shows as much deference to lateral colleagues and subordinates as to superiors is not only leading in a more rational way, he or she is also demonstrating a sense of security and self-confidence that ironically engenders greater authority and respect than one gets by “demanding” it. Moreover, he or she is modeling precisely the kind of behavior that will make the broader team more collaborative and effective.

So, when dealing with superordinates, have the courage to use your intelligence and judgment to say and do what is best for the organization—and best for your bosses. And when interacting with subordinates, park the ego at the door, listen, and treat them how you want to be treated, not how the hierarchy suggests that you treat them.

Determine the Best Candidate to Be Your ‘Right Hand Man/Woman’ and Nurture that Relationship

No matter how talented or insightful you are, you will do better work if there is someone close to you to whom you can delegate certain tasks, from whom you can solicit a second opinion or advice, and whom you can trust in a tough spot to “watch your back” or help you get a tough task completed. Part of this relationship is “operational” and part of it is personal. I don’t mean personal in the context of a personal vs. professional relationship. I mean personal in the sense that part of what you gain in the relationship comes from the connection you develop with the individual as a person. These are the kinds of relationships that foster things such as loyalty and trust and they can be invaluable in terms of your own success.

One of the reasons that such relationships are helpful is that sometimes we face issues or challenges as leaders that are “messy” because they involve delicate and/or political or cultural issues that do not have clear answers or even objectively agreeable interpretations. In those situations we often benefit by being able to discuss such issues in very frank ways that we would not or could not in more public settings. Having someone with whom we can be vulnerable or “politically incorrect” as we work our way to defensible decisions can be invaluable. The reality, particularly in today’s very dynamic and often ambiguous operating environments, is that effective leadership requires that we choose not between right and wrong decisions or courses of action, but between what we believe is the most viable of several potential decisions or courses of action. It is therefore extremely helpful to have a trusted advisor with whom we can openly and candidly evaluate all options.

Additionally, a nice benefit of nurturing this kind of relationship is that you also help the “right hand man/woman” develop important skills, knowledge and confidence toward his or her own personal and professional growth, so it is a win-win!

Saying What You Think Your Bosses Want to Hear Rather Than What You Actually Believe: Short Term Win, Long Term Problem

Over my career, I have witnessed a surprising number of situations in which other senior managers and leaders have said things to their bosses, boards, investors, owners, etc. that were simply not defensible and almost certainly unlikely to actually happen. This can occur in just about any context, but the most common examples in my experience have been related to financial performance. I have personally been swept up in such a dynamic myself.

So, what’s going on here? At the most simple level, those same bosses, boards, investors, owners, etc. often make unrealistic demands, often as a result of commitments they have made. I’ve seen senior executives in publicly traded companies make growth commitments to shareholders, for example, that roll down hill in the organization, resulting in layers of commitments, none of which have any basis in reality, and at worst, incentivize poor or even ethically questionable operational decisions. I’ve seen similar dynamics in private equity owned organizations as well. Although less common in not-for-profit entities, it absolutely happens in those organizations as well.

At another level, organizations often reward managers who are perceived to be “aggressive” operators, who will commit to high levels of performance. They are seen as “winners” with the right attitude who are willing to really stretch themselves and their teams to achieve extremely aggressive goals. This is complicated stuff because these kinds of managers often do deliver outsized results (even if they don’t hit the super-sized targets). This behavior often comes with a host of potential problems, however, such as short-term thinking, team burnout, susceptibility to less-than-stellar practices, etc.

In the worst cases, managers often make commitments that they simply know are not achievable under any normal set of circumstances. I’ve seen otherwise smart, competent people load budgets with revenue generating activities that don’t actually exist in reality or pump up promised bottom lines with expense reductions or flow-through margins that they know are not operationally possible. Sometimes folks are banking on a miracle, but generally, otherwise decent people do these things because they believe they will pay a price for being more realistic and/or more honest—that they will be seen as having a poor attitude or not willing to take the risk of stretching their goals. To be clear, there is a difference between accepting the challenge of achieving high goals within the realm of reality (which can be motivating and rewarding) vs. making commitments to goals that are unachievable within the context of existing operational and market realities, ethical considerations, etc.

Over time, my observation is that these kinds of dilemmas are much more likely in organizations in which the most senior executives/owners/investors have profit or ROI expectations that are in excess of “normal” or “reasonable.” I have seen organizations actually break, and ultimately destroy, incredibly robust, profitable businesses in search of an additional 100 basis points (one percent) of profitability when the business was already returning nearly 35% margins. One might call this greed, or it may just be driven by expectations that were sold to others, but regardless of the source of the motivation, the most damaging outcomes tend to be at the expense of sustainability, quality, and social responsibility over the long term. Another negative outcome tends to be employee/manager turnover, both voluntary, since most folks cannot or choose not to perform under the conditions related to the drive for unachievable sales/revenue/growth/profits year in and year out, and involuntary, because people get terminated for ultimately failing to meet unrealistic expectations!

In the end, an organization’s approach to growth or profitability tends to be deep in the DNA. Some are very short-term oriented with relentless focus on profitability or near term equity. Others are more focused on longer-term sustainability with more stable growth and profitability over time. I mention this because for managers and leaders who find themselves in organizations where their own motivations and beliefs do not align well with those to whom they are accountable, the organization is frankly not likely to change. If one finds him or her self in a situation in which he or she feels compelled to make commitments, for example, that do not feel “honest,” the solution is more likely to be found in another organization with better aligned values. This is not unequivocally true, but likely. And in the end, if you consistently say things that you believe others want to hear rather than what you actually believe, there are two outcomes over time that are both bad options. One is that you endure growing internal dissonance. The second is that you are ultimately penalized for failing to meet expectations that you did not believe were possible to begin with. Life is pretty short to endure either of those outcomes for very long!