Wizards and CEOs:
The Oz Factor

A story from John R. Kopicki, President and CEO, Muhlenberg Regional Medical Center

• emergence
• self-organization
• co-evolution
• phase transition
• clockware/swarmware
• generative relationships
• wicked questions
• multiple actions
  
  

The first thing you notice when you approach the entrance to Muhlenberg Medical Center is Jimmy. Jimmy, predictably and contagiously convivial, cradles the elbow of an elderly woman, gently guiding her to an awaiting cab. "So how are you feeling, beautiful?" he says flirtatiously and sincerely. She giggles girlishly and gives his hand a nudge with her elbow. You would never guess that Jimmy has worked at the hospital for 42 years. His mischievous eyes and quick wit suggests someone far younger than his years. His current position is official greeter for the medical center, which is in Plainfield, New Jersey. But he also assists those leaving the hospital–maneuvering wheelchairs and making sure people have a ride home–all of which has made for more speedy and facile discharges. The hospital could operate without Jimmy; some might think him to be a luxury; but he so impresses everybody that comes through the door— making people welcome, setting a friendly tone—that it overrides the fact that he is a non-measurable benefit. This says a lot about Muhlenberg–a medical center that values good relationships with its customers, right from the start.

The entrance to the medical center is a kind of solarium, with Ficus trees, a fountain with its inevitable coins, scattered pots of poinsettias. Inside the foyer, on the left, is a waiting area that resembles a living room. On the mantel of a false fireplace are photos that you might find at grandma’s house. Nearby stands an information table with hospital services on display. To the right of the living room is the extremely successful Express Admissions facility; and further on is the circular information desk—quiet, open, friendly. Nearby is a hallway of offices, one of which belongs to CEO and President of Muhlenberg, John Kopicki. In late 1997, Muhlenberg began the process of merging with the nearby Kennedy Hospital, to form the Solaris Health System–one of many such mergers provoked by the current turmoil in the health care industry. So, in addition to being head of Muhlenberg, John is also the Executive VP for Clinical Delivery Systems for Solaris.

When you step into the reception area to John’s office, you’ll be greeted by his assistant Lou Ciganenko, whose graciousness and efficiency leaves you knowing you are in good hands. Multi-colored Post-Its decorate the front edge of her desk, reminding John of an appointment tomorrow morning, a phone call to return by the end of the day. If you ask to see John, it’s unlikely he’ll be there. During this time of transition, he’s spending more and more time at Kennedy doing what he does best–building relationships. John doesn’t network; he takes seriously the task of developing trust through support, dialogue, and consensus building. Even though the Muhlenberg staff understands that they have to take charge as he forges new links with their new and more powerful partner, they miss him. The merger has everyone on edge—anxious about their jobs, excited about the possibilities, curious about the outcomes–and John’s presence is a comfort for many. But transitions are never easy, and this one is no exception. Muhlenberg is fortunate to have John navigating the turbulent waters of change–because he’s been there before.

Command and control

The time in question was not a merger, but not unlike a merger either. It, too, was a time of transition for Muhlenberg, one that John had not expected to be part of, because he was planning to leave the hospital. In 1990, after a brief spell as Muhlenberg’s COO, John had an opportunity to join a management culture that was closer to his own style, and so he handed in his resignation. It just so happened that, at this same time, Muhlenberg’s Board of Governors was coming to a major decision of its own: it felt the hospital needed a change of direction, a change of leadership. So, too, did the medical staff. As a result, two days before John was set to leave, the board asked him to stay and become the President and CEO. John accepted, knowing that what lay ahead would be one of the biggest challenges he had ever faced.

Fran Hulse, VP of Medical Affairs, who has worked at Muhlenberg since 1971, is one of the living memories of the center. She remembers the time prior to John’s appointment as CEO this way:

"It was a very uptight culture. People were extremely reserved and cautious about what they were going to say openly. The CEO’s view of management was very controlling–things had to work the way he said they would. Period. What tended to happen was that even senior people felt they couldn’t challenge him and expect to survive. Top management felt they had to be tightly on top of every single thing that happened, and had to okay everything. This created a climate that was anything but open as far as inviting feedback and comment—positive or negative. And negative had a lot of risk attached to it–if you spoke negatively about the wrong thing, you might just shorten your career at this institution. There was a pervasive sense of oppression, and as a result employees felt constrained and very reluctant to express their ideas and opinions openly. And the medical staff were frustrated. Their patience was wearing thin because the administration was giving lip service to medical staff issues, and doing nothing to address them."

When the medical staff heard of John’s resignation, they literally revolted. They called a special meeting among themselves, and passed a vote of no confidence in the administration. Once the sleeping giant woke, it wielded a lot of power. The medical staff started lobbying board members, pleading their case. The doctors felt that John understood their problems, and that he could work with them. John was the kind of person they felt they could trust, could relate to, who cared about what they said. The board listened, and offered John his greatest challenge.

Implicit in Fran’s account of Muhlenberg’s management culture, and common to all command and control cultures, is a story of disconnection. People disconnect from themselves–what they really think and feel—as a way of keeping their jobs and surviving the culture. They are disconnected from each other through silence, by not giving or receiving genuine feedback: that’s fertile ground for festering complaints. They are disconnected from their purpose, forgetting why they are there, becoming complacent and "just doing my work," because they are preoccupied with and living in an atmosphere of fear and suspicion. Command and control leadership generates disconnection; and disconnection empowers command and control leadership. A vicious circle.

Shifting worlds

Command and control style of management was not unique to Muhlenberg. Generally, it is more the rule, rather than the exception in modern American organizations. It is in the tradition of scientific management, with roots that go back to Frederick Taylor in the early decades of the century. It is a highly analytical, mechanistic view of the work place, and is based on linear thinking, hierarchical structures, and solutions imposed from the top down. Organizations are viewed as machines, and people as the working parts of the machine that need to be controlled for maximum efficiency. But with the shift from the industrial age to the information age, this approach has reached its limit. Certainty has given way to uncertainty in the business world, just as it has in the world of science.

In science, a mechanistic view of the natural world has given way to an appreciation of the world as being dynamic and complex, nonlinear and creative. Some realms of the world are mechanistic and predictable, of course, such as the orbiting of the planets. But most are not. Most are complex networks of interacting components that produce rich patterns that cannot be predicted from even the most detailed information about the components. Biologists, for instance, are beginning to embrace the new science of complexity theory as a means of understanding the complex dynamics of life at all scales, from the simplest ecosystem, such as a pond, right up to the global ecosystem: each scale rich in nonlinearity, unpredictability, and creativity. Taking their cue from complexity science, managers are beginning to recognize that business organizations are much more like organisms than machines. Each organization is a complex network of interacting components, and each is embedded in successively larger webs of interconnections, right up to the global economy, just like ecosystems. Nonlinearity and unpredictability therefore characterize the world of modern business, not comforting linearity and predictability.

Being a successful leader these days therefore requires a recognition that the world is not the way it used to be, or the way it used to be perceived. And no more so than in health care, where uncertainty and unpredictability can no longer be denied or dismissed, where leaders find themselves under extraordinary pressure to provide health care that is both cost effective and high quality. During this time of crisis and ambiguity, a top down approach to management comes up short. Leaders cannot command outcomes–the business environment is too complex, too fast changing. Faced with the reality that change cannot be stopped, leaders have to change how they think about change. Once, setting a goal and planning each step to achieve that end was regarded to be good change strategy, and sometimes worked well. Now, adaptability and flexibility are the hallmark of a robust organization, which calls upon different leadership skills.

Principles
Tune to the edge
Complexity lens

Leaders in the new environment need to understand how to tap into people’s creativity in the midst of chaos, rather than control their behavior. Leaders need to maintain a steadfast confidence that order, although unpredictable, will emerge, rather than feigning a certainty. Leaders need to embrace the complexity of the world, not fight to control it. As John Kopicki says, "If you’re an autocratic manager, you’re going to have a very difficult time operating in this chaotic environment. You just can’t tell people what to do and think they’re going to do it. It just doesn’t work that way anymore." Complexity theory gives managers guidance for how to navigate in today’s chaotic environment, how to unleash the creative and adaptive talents of their people, by relinquishing the control mode of traditional management. In other words, it shows managers how to make their organization more efficient and capable of appropriate change.

However, it is not an easy path for managers who find comfort in control–or at least in the illusion of control. It is not easy even for a leader whose innate management style resonates with the complexity approach and who is dedicated to making it work, as John’s story shows. But when it works, the dividends are great, and not just in material terms. This approach involves valuing people for themselves, as human beings. A culture emerges in the workplace, in which people feel that their efforts are recognized, and are therefore prepared to go the extra mile to meet extraordinary challenges. This is both a rewarding and powerful management practice, as John recognizes. "Sadly, we are living in a non-affirming society," he says. "People hunger for recognition, and when they receive it they are extremely motivated, and fulfilled."

A controlling style of management wasn’t John’s nature. True, he was trained in a traditional MBA program at The George Washington University, but he wasn’t interested in being a traditional manager. Rather, his leadership style is more intuitive, his reasons to lead more idealistic rather than egoistic. As the son of a funeral director, John learned early on to have a tremendous respect for people. Perhaps that is why he’s attracted to managing organizations that take care of people—like his father, he also services people in a time of need. When John became Muhlenberg’s CEO, he faced an enormous uncertainty–how his style of leadership would affect the existing culture. How could he shift a culture of command and control, where predictability reigned king, to a culture where there was an acceptance of uncertainty and change? How could he open up a closed system whose lines of communication had shut down? And how to bring people along in this transition, knowing that this was the organization’s only recourse for survival, given the harsh economic circumstances that lay ahead?

The science of complexity has a language and concepts for analyzing the transition of complex systems from one state to another, often called a phase transition. In Muhlenberg’s case, it was a shift in cultures, from the established command and control culture to a more flexible, adaptable culture that would flow from John’s different style of leadership. We could talk in complexity theory terms about how this transition was engendered–through changing the rules of behavior, with new emergent properties–but sometimes scientific theories don’t capture the richness of the experience. Instead we’ll turn to a classic folk story, The Wizard of Oz, which is rich with metaphors and archetypal characters, and offers many insights into organizational life. We’ll focus on the Wizard (as portrayed in the book, not the film), a character that lends itself to a deeper understanding of the world of the CEO in a command and control culture.

The Wizard of Oz

As you recall, Dorothy found herself in a strange land, and wanted to go home. She was told by the Good Witch of the North to see the almighty and powerful Wizard of Oz, who would surly be able to find a way to send her back to Kansas. Along the way she gathered three companions who also wanted help from Oz–the Scarecrow, the Tin Man, and the Lion. After many adventures, they found themselves in the audience of Oz, who, in a display of plumes of fire and a thundering voice, proceeded to terrify them and, instead of helping them, ordered them to kill the Wicked Witch of the West. Only when her broomstick was in his hand would he help them out, he proclaimed. Against all odds, Dorothy and her companions managed to do just that.

Dorothy was furious when, on her return to the Emerald City, the Wizard dissembled and failed to keep his promise. The Lion roared, to frighten the Wizard. The roar had more effect on Toto, Dorothy’s dog, who jumped in fright, and accidentally knocked down a screen, exposing a little old man with a bald head. "Who are you," they asked incredulously. "I am Oz, the Great and Terrible," he said in a trembling voice, "but don’t strike me–please don’t–and I’ll do anything you want me to do." Dorothy and her friends were shocked having believed him to be a great Head, a terrible Beast, a ball of Fire. "No, you are all wrong," said the little man meekly. "I have been making believe. I’m just a common man." And so we learn that among his tricks is ventriloquism, which enabled him to throw his voice onto the illusions he created.

This moment of personal conversion, when a man steps out from behind the screen of illusion, when apparitions of power are dispelled (by none other than a dog, which archetypally symbolizes intuition) and a common man is revealed, is perhaps every CEO’s dream and nightmare. But how did the Wizard find himself behind a screen of illusion in the first place? And why is it so frightening for him to reveal himself as a common man? The Wizard of Oz, as CEO, gives rich insight into the complex dynamics and collusion that occurs in a command and control culture.

Like Dorothy, Oz also landed in this strange land by accident, and like John, ending up where he never expected. Seeing Oz descend from the clouds in his balloon, the people of the strange land thought he must be a great Wizard. And, of course, he let them think that, tantalized by the privileges associated with power. Because the people were afraid of him and would do anything he wished, he ordered them to build a city and a Palace, "just to amuse myself and keep the good people busy." In this way, he became the CEO of Emerald City. He ruled with a fearsome hand, a true command and control type. But his story of leadership is not that simple, for Oz is an ambiguous, paradoxical character: he is both a perpetrator and a victim of control.

To be idealized by your people can be very seductive to a leader. To be idealized is to be adored/feared, but not seen–the paradox of enormous visibility as an image and simultaneously invisibility as a person. Oz’s high visibility was captured across the land in the myth of his omniscient powers. On the other hand, his invisibility was quite literal. Once the people built him the Palace, he shut himself up and would not see anybody. And he did this for reasons no one would have imagined—out of fear: fearful that the witches would discover that he was not more powerful than they, and fearful that they would surely destroy him. And he feared that if he went out of the Palace, his people would discover he was not the Wizard that they thought he was. As he says, "then they would be vexed with me for having deceived them. And so I have to stay shut up in the rooms all day, and it gets tiresome." In this way, Oz controls and is controlled by his position. And so we have the portrait of a leader who projects a power he does not feel, who is inaccessible out of fear of being found out, who is isolated and out of touch with his people, who lives a lonely life. And he is also someone who has become somewhat comfortable with the illusion, as Oz states: "I have fooled everyone so long that I thought I should never be found out."

But, not surprisingly, he is found out. And the discovery of his true identity exposes a collusion between Oz and his people. Both propagate his illusion of power. His people need him to be omniscient, which perpetuates a parental/child relationship. In every organization there are people who just want to be told what to do; who need to think there is someone more powerful than themselves, who wish for another to take care of everything. They endow powers on their leaders that the leader does not possess. And they project their own longing for power onto him. And, like Oz, there are leaders who allow it. Still, there is a vulnerability with this type of power, as Oz despairingly notes, "How can I help being a humbug when all these people make me do things that everybody knows can’t be done?"

Even when Oz acknowledges his failings and admits he can’t keep the promises he made to the foursome, they in a sense don’t allow him to stand on grounds of mutuality. He points out to them that they don’t really need what they are asking for. The Scarecrow doesn’t need brains; he needs experience. The Lion doesn’t need courage; he needs confidence. And the Tin Man, well, Oz can’t imagine why he would want a heart, when it can so easily be broken. But they insist that he bestow these traits to them anyway. And so he ceremoniously gives them what they already have. As a result, they enter a phase transition where two systems, two different realities paradoxically co-exist.

John recognized a similar paradoxical time in his own organization during the phase transition engendered by his leadership. "There are times when people will come to you and want that control decision. I mean, that’s the incredible thing about it. You’re all going along as a team, and then suddenly everybody will be looking at you, and you better not disappoint them. They want you to say, ‘By God, it’s going to be this way.’ Sometimes people say, ‘We’ve done this as far as we can. All we want is your final blessing.’ At that point they don’t want to hear me saying, ‘Well, geez, what do you want to do?’ They really want to have that final blessing from me, that final approval. I don’t understand it. It’s way beyond me."

Yes, it is way beyond John. It has more to do with the psychological residue of people used to being controlled than it has to do with John. When people work in an environment day in and day out where they are used to being told what to do, are rarely asked what they think, are used to perceiving themselves as weaker, used to a parental type relationship with the leaders, it has its effects. They develop a fear of freedom. Ingrained behavior doesn’t just disappear. It takes time, patience, and guidance. The transition from a command and control culture to a culture of change and adaptation requires a dual conversion, of the leader and of the organization. Both engage in a process of parting veils of illusion, and in particular, the illusion that the leader has complete control and has all the answers. It is finding a ground of mutuality, adult/adult relationship based on a common humanity. For Dorothy and Oz, that moment occurred when Dorothy, realizing his promises would not be kept, says to the Wizard, "I think you are a very bad man." "Oh, no, my dear;" said Oz, " I’m really a very good man; but I’m a very bad Wizard, I must admit."

Letting go

Although control and command is contrary to John’s nature, giving up control is not an easy practice–even for him. He talked about it this way. "I think unconsciously, you always want to maintain your control. You really have to fight against that. It’s the toughest thing for senior management to do, to give it up. Even when you recognize that you have to just give it up–it’s hard to have that flexibility, to have that patience. You have to create a new discipline in yourself. For instance, I had to have the courage to let my VP, Mary Anne, go ahead and spend money for which she couldn’t demonstrate the payback. That doesn’t mean I’m frivolous; that means that I have to make hard choices when it’s impossible to know the outcome. At other times, when I’ve let go, ‘I’ll think, What the hell has this proven?’ But I never say it."

John’s struggle to let go of control is rooted in his MBA training at George Washington University, which inculcated the conventional management model that leaders are controllers. But for men generally, letting go is difficult, because traditional roles, and the definition of masculinity, demand that men be in control. Traditional roles put enormous pressure on men to perform, produce, to be the answer man–a very mechanistic orientation. Leadership would then naturally be associated with fixing problems, providing solutions, enabling what’s disabled, leveraging—also a mechanistic view. And because masculinity is heavily associated with autonomy, it is also about being the Lone Ranger, as John points out: "You know, CEO’s don’t talk to one another. Did you ever hear a group of CEO’s saying, ‘How’s everything going?’ ‘Are you fine?’ Never. At a meeting once, there were a couple of them saying, you know, ‘I’m so tired of making decisions. Being the CEO, it’s so hard.’ And what I’ve been able to do is say ‘Yes, it is chaotic; we’re out of control. The best we can do is rely on our instincts.’ And they seem to respond to that."

Tales
Unleashing potential






Bibliography
Pfeffer: Human Equation

Personally and professionally as hard as it is, this less directive, less controlling style of leadership enhances an organization’s performance, in many ways. For example, until recently, Muhlenberg was rated from the mid to lower range in patient satisfaction, according to the Press Ganey survey. The hospital’s management committee had recognized the importance of improving these ratings, but had failed to shift them. As John’s open, growth-nurturing style of management began to permeate Muhlenberg, extraordinary organizational achievements began to be made by recognizing that front line workers are the ones closest to the problem and are therefore likely to be able to reach solutions, such as reducing admission time from 24 hours to just one hour (see Unleashing People Potential). The same approach to the stubborn problem of patient satisfaction brought similarly dramatic improvement: within a year, the scores started to climb, and for the last two quarters of 1997, Muhlenberg’s ratings were well into the 90 percentile, superceded only by Hunterdon Medical Center, another medical center.

It is probably no coincidence that much of the management culture at Hunterdon embraces a complexity, bottom up, human-centered approach. As Jeffrey Pfeffer, of Stanford’s Graduate School of Business, demonstrates so cogently in his recent book The Human Equation, human-centered management practice consistently leads to enhanced organizational performance, including the financial bottom line. It can be seen through John’s experience at Muhlenberg. It is evident at Hunterdon. And it is manifest in surveys of more than a thousand business organizations in the United States and Europe. The fact that complexity-guided management theory leads to human-centered management practice leads to the most readily understood reason for why CEOs might want to throw over the (illusionary) certainty of control in favor of the uncertainty of lack of control: it is good business.

Faces of transition

The practice of letting go, (and it is a practice, since no one is perfect), initiates a different personal journey and a profound struggle between the common man and the Oz factor–between openness and secrecy, vulnerability and omniscience, honesty and illusion. It is this conversion within the CEO, and through his example, that guides the conversion in the culture. It is not so much about a different way of doing as it is about a different way of being.

When we examine the conversion of Oz (or CEO) from Wizard to man, what emerges as pivotal to this change is a different way of being in relation to one’s people. Similarly, when John and his people recounted powerful moments that impacted them and affected the existing culture, we see that it is John’s way of being with them that instigated the change. Specifically, there are four behaviors: Be open, be straight, be human, be in relationship. These behaviors proved to be very effective in convincing a skeptical culture that things could and would be different. These ways of being may sound simple, but as John and others will attest, although ultimately life is simpler, it’s hard to do.

Be open, not controlling

Why should a leader be open to his people? Because openness gives him access to information about the problems, solutions, the reality of the organization. Fran recounts an early event which illustrates the power of openness.

"Early on we started to bring management groups together informally, away from the hospital, to try to get to know each other more on a personal level. The first time we did it, there was a roomful of people, around 45 and we asked the questions: What are we doing wrong? What do you think? How can we make it work? Nobody said a word. Here we were putting out all these direct questions, and all you could feel was the silence and the tension in the room. By the third time we got together some of the barriers were coming down. It was incredible to see people relax a little bit. People had to build trust. They had to feel this wasn’t just more lip service. I think it was less about trusting us and more about how shell shocked they were. Because they had no reason not to trust us. It wasn’t until you saw the reactions of those people that you really appreciated how bad it must have been to work here."

To be open means to allow things to unfold. Allow it to be. Allow it to be silent. Being open means restraining the impulse to take control and make some thing be what you want it to be rather than allowing it to be. Being open means getting teams involved, drawing people out, getting them to sit down and solve problems–being open to them as problem solvers.

Be straight, not secretive

John made it clear in the beginning, that it was going to be different under his leadership And people had to decide if they could change–become team players, be experimental, be straight. Being straight builds trust in an organization–people know where they stand. When there’s trust in an organization, people are more efficient, take greater risks which spurs creativity.

Fran recalls John being straight with her:

"It makes me think about the fact that we were conditioned by the previous leadership to do business in a way that was kind of calculating. I mean, not that we were necessarily by our natures calculating and devious. But I think without even realizing it we were conditioned about a certain way of doing business, where you had to strategize things in the back room so that a certain thing would play out a certain way. But there were players that never had the whole picture of what was really going on. When you do business in a calculating way, you’re doing it and you don’t realize you’re doing it because it is what you do to keep things going and how you survive. And I think literally John cut through that right in the beginning. He used to do that with me and say, ‘You know, you don’t have to do that Fran. Just talk to them. Don’t worry about telling them. We’re not holding anything back here.’ He had to keep reminding us that we’re not going to keep secrets here. That we can’t do that anymore; it doesn’t get you anywhere."

Fran also remembers a powerful moment when John was straight with the organization:

"John came right out in the open on some real big issues with the staff. At employee meetings held periodically through the year, John would get up and tell people what was going on. ‘Here’s the story, guys,’ he’d say. ‘And you’ve got to know this because we can’t deal with this without you. I’m not keeping anything from you.’ People listened and they questioned. Several years ago we were in a financially bad position. We had cuts and it was looking bad. John had to tell them that he was going to have to freeze wages; no raises for that year. He had a full house, standing room only, people sitting in the aisles. He pulled out all the charts, presented all the finances, took them through it step by step. He explained why; he told them what we were going to do. He told them how great they’ve been. They applauded at the end of the meeting! We sat there and said, ‘Can you top that?’ Usually you get, ‘Nobody appreciates me.’ or ‘Why am I only getting 2%?’ They applauded!"

If you are straight and bring people along, what emerges is a sense of inclusion. The resilience of people is often underestimated. People can accept very difficult situations if they feel they are part of the process, even when this includes no raises or even leaving their jobs.

Be human, not omniscient

People want to care about their leaders. It gives them a sense of community. People who feel a sense of community speak of being more willing to adapt and be flexible. When people see their leaders as human, it’s easier to care for them. And when their leaders can be human, it gives people permission to be human. COO Phil Brown recounts a time with John:

"John and I talk about personal issues from time to time. For instance, John stopped in last night. He came in to talk about how he was feeling about a family matter and things that were going on. And that gave me an opportunity to say back to him about how I see him, about who he is. I mean, I could understand, given the difficulties and challenges he was facing at the time, if it had been played out as anger and bitterness at work. But in fact he did just the opposite, coming to me, telling me about his concerns strengthened our relationship. I said, I understand now some more about why you are so caring, and giving, and patient. I haven’t often had those types of relationships in work setting, where those kinds of conversations get going."

John recognizes that his own frailties actually work to bind him to his staff:

"This management team puts up with me when I go off the deep end. Everybody has got to go off the deep end sometime. Somewhere we’ve developed a tolerance where we don’t hold grudges. It’s also about the ability to have failure in an organization where people don’t jump all over you, blaming and screaming. This gives permission to change. I heard a CEO recently admit he was wrong. He said, ‘I pushed my people too hard. We failed. We didn’t understand this field, and we’re going to take some hits and lumps.’ I guarantee you they’re going to figure this out. He accepted blame. They’re going to come out of this okay. When the leader takes responsibility during a crisis he gives permission for the team to regroup. What normally happens in a crisis is the leadership is replaced or they blame someone else. How many times has a CEO of a company come in and said ‘I’ll take that responsibility?’ I don’t see that a lot."

Be in relationship

A control culture sees people as opponents and relationships as hierarchical. A changing culture sees people as part of a web of connections and relationships as connections to build. So much of what John accomplishes and inspires stems from his way of being in relationship to others, which engenders a sense of mutuality and respect. It even reframes the meaning of charisma and power.

People associate charisma with being slick, razzle dazzle, a powerful attractiveness, interesting. Much like the all and powerful Oz. John’s charisma, on the other hand, is not a screen of projection, like Oz, that lights up the place. Instead, it arises from his sincerity and honesty as a person, and the way he deals with people. Charisma with him is an emergent property–it comes through in his relationship to others. As Fran states, "If anything, you would say he’s not that comfortable a public speaker. But then you find that out and it becomes his strength because he’s real; he’s not a phoney. It works in a completely different way."

Similarly, when power is in the context of a mutual relationship it is power with another rather than in the command and control approach of power over another. If there are two phrases that capture the spirit of this culture of change and mutuality at Muhlenberg, at all levels, it’s "just, try it" and "work with me." It is John’s way of being in relationship to people that defines him as a leader, not his position.

A culture of change and care

A culture of change, adaptation, and action did emerge at Muhlenberg, as John hoped it would. And care. Care for the patients, as exemplified by Jimmy’s warm and reassuring greeting at the front door, so important to people who are sick and often disoriented. It’s no coincidence that patient-satisfaction scores have gone way up. "I’m very proud of that," John says. And care for the people who work there, too. Mary Anne Keyes, VP of Patient Care, says she has the best team she has ever had. "It’s an incredible experience to come in every day, to believe in what you’re doing with people, to enjoy the relationships–that’s worth a lot." That’s just what John wants to hear. "If we can’t come here every day being happy, there’s no reason to come here at all," he says.

But no one should imagine the process—this transition from a one culture to another—is quick and easy. It demands dedication, constant vigilance, constant practice–and a lot of patience. "You have to keep trying," says John, "and you have to be prepared to get things wrong, because you will. You have to be prepared to fail at things." But, slowly, the culture starts to shift–a little here, a little there, building toward a critical mass. At that point, what was previously dominant in the culture–that is, the residue of command and control–is rapidly eclipsed by the newly emergent culture, a culture of change and care. The phase transition is upon you, unplanned, unanticipated. "It just happened," remembers Dr. Bob Bayly, "as opposed to if we had tried to sit down and design it."

Nor should it be assumed that this flexible, adaptable management practice is for everyone. It is no surprise that several senior managers left soon after John became CEO—some voluntarily, and some otherwise–because they had no stomach for even the prospect of a very different form of management. They were what John calls "culture casualties." And even now, seven years on, there are those who don’t fully embrace the new culture, which demands cooperation and teamwork in order to be successful.

Complexity theorists know that complex systems–such as business organizations–are very sensitive, very responsive. If positive influences are present, the system can become highly creative–new ideas flow to overcome problems or exploit opportunities. Equally, if negative influences are present, the system can become inhibited–politicking replaces openness, for instance. As Raymond Robinson of nuclear medicine observed, "Things feed off each other. One person does it, so another person does it. Where hatred can be infectious, so can good emotions like care be infectious." There’s an important lesson here for managers who pursue principles of complexity theory: just as you can’t sit back and hope for good things to emerge out of chaos, so, too, you have to be tough with people in the organization if they threaten the health of the culture. Culture casualties are inevitable.

Now that the culture at Muhlenberg has found some stability within itself, and people are more adept at riding the roller coaster of change, they are embarking on a merger with Kennedy Hospital, where initially the management practice appears to be different. Two different cultures face each other, with unease on both sides. "I think everyone’s anxiety level here [at Muhlenberg] is high," says John. "But people have consistently said, ‘Let’s just get on with it. Let’s find out how it turns out.’ It’s kind of an acceptance of life and what is going on in the world. It’s incredible." And what about John himself? He continues to do what he does best, investing himself in a whole new set of relationships. What will his way of being, his style of management bring to this new transition? Not even a Wizard could know.

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