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Listen in as our very own Mandel Global Leadership and Learning colleague Laurie Miller and Renee Kolonick, the Executive Director for Hospital and Regional Operations discuss using Structural Tension as a leadership tool to leverage the intellectual resources of a diverse team.

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Leveraging Intellectual Resources using Structural Tension

Podcast Transcript

Michelle Lampton:
Hello, and welcome to learning to Lead, a leadership development podcast from Cleveland Clinic. I'm Michelle Lampton. Today we're going to be hearing a conversation between one of our colleagues Laurie Miller and Renee Kolonick, the Executive Director for Hospital and Regional Operations. In it, they're going to be talking about a really valuable leadership tool called structural tension. Now, I have to be honest, I don't know much about this tool, so I invited Laurie to join me in our virtual studio to tell us more about what it is and what it looks like. So, Hi Laurie!

Laurie Miller:
Hey Michelle, it’s great to be hear with you.

Michelle Lampton:
It’s so good to have you with us today. So, I guess we are going to start with the obvious question. What is structural tension?

Laurie Miller:
So I think the important part about structural tension is the word tension. So it’s a tool that helps us get from one place to the other and really marshal all of the intellectual resources of everybody on the team to make that move.

We start off by looking at desired outcomes and we end up looking at what is the very first step I can take toward that. There’s a lot to consider in between, but that’s the beginning and the end.

Michelle Lampton:
That sounds like it would be really useful. So if I was a leader who wanted to use this tool what are some of the steps I would take? How would I bring it to my team and how would I use it with my team?

Laurie Miller:
So, one of things we might recommend is that you would send out the steps of structural tension to your team ahead of time before you use it, so that they can get some real crystalized ideas about. “This is what I think our desired outcome is. Another piece of it is, what are the strengths of the team? So that take some time to work on as well. So I think I would send that out ahead of time and then you have them go through in a pretty methodical way all of the five steps in structural tension. From, what is our ideal state? What are the strengths we have? What actions can we take? What’s our current reality? And then, what’s that first step we can take moving forward?

One of the things I find really useful about this is it helps teams who feel stagnant. It gives them hope to move forward.

Michelle Lampton:
So Laurie that’s fantastic and thank you so much for explaining it. Now, as I’ve said, I actually have never really used this tool before. I’m really unfamiliar with it. Is there a part of the tool that teams struggle with more than others? Is there any place I should be thinking about more carefully as a leader when I bring this to my team?

Laurie Miller:
Michelle that’s a great question, Yes there are some specific things to think about. If a team is feeling stagnant, and what we want them to do is move together in a certain direction, and we want them to help to decide that direction. We want to use structural tension. Pieces of it that are really useful are the conversation about ideal state, and strengths. Where we don’t want them to get bogged down is in the conversation around barriers. So we don’t allow people to spend much time on barriers. As we say, we don’t allow them to drop anchor there. We want them to drop anchor in what are our strengths we can leverage to move through the barriers?

Michelle Lampton:
That’s really helpful and I thank you so much for sharing that because I again am not familiar with this tool, and I feel like that’s really good for our listeners to know about as they approach this tool. So, let’s go ahead and listen in on your interview with Renee Kolonick to see how she uses structural tension in her role.

Laurie Miller:
We are welcoming today Renee Colonic to the Learning to Lead Podcast. We're so happy to have you here. Renee, I'm going to ask you to introduce yourself, your role and a little bit about your journey at the clinic, if you could share some things.

Renee Kolonick:
Thank you, Laurie. I am so happy to be here and joining the team here. I have been with the Cleveland Clinic now for 26 years. My current role is an Executive Director for Hospital and Regional Operations. So that just encompasses all of the family health centers and a lot of the ambulatory world and the medical office building as well as the medical operations and surge ops and pharmacy at the main campus. And so I love my job. I get to interact with a lot of people across the organization and try to do the best we can to help lead others and reach our goals with the organization.

Laurie Miller:
Thanks so much for now. I love that introduction. And so of course the podcast is titled Learning to Lead. So we're going to focus a little bit on, so what has supported you in your learning to lead?

Renee Kolonick:
I have been really very fortunate to have mentors and coaches surrounding me that have really focused on growth and development. And part of that growth and development has been not only encouraging academic learning, but also encouraging learning through different experience, learning through challenging boundaries and barriers. A lot of the things that GLLI has offered clinic caregivers has been an enormous part of my learning to lead, not only at a local level, but more of an enterprise level. And allowing me to think strategically and really moving towards enterprise goals and removing barriers.

Laurie Miller:
That's wonderful. Renee, are there any things, particularly any tools or anything particularly from the Cleveland Clinic leadership experience that you've supported so much that really stick with you and helping you to think strategically?

Renee Kolonick:
Yeah, I think there are many, but if I were to pick one that I think I use more than others, I would say that it would be the structural tension tool. The structural tension tool is something that is pretty much used in everyday life for me. It gives me the ability to understand where I'm at today, where I need to be tomorrow and helps me think about the strengths that I have to move forward. What barriers might come my way and what kind of actions and behaviors I need to put into place to get over that, and then allows me to come up with next steps in order to reach those goals.

Laurie Miller:
That sounds like a really orderly kind of way to think through an issue or a concern or a change.

Renee Kolonick:
Yeah, it definitely is. That's a little bit of my personality order, so that I can make sure that I'm thorough and thoughtful around things. And honestly, the tool has been so versatile that there really isn't a reason not to use it. I mean, you can use it for things as easy as you get a daily call that says, "Hey, something's not working at this location. I need some help." And so you can quickly talk through, "Okay, well, what does it look like now? What do you want it to look like? What do you have at your hands that can help you get there? What are some of the barriers that are preventing you from making that work? And how can I help you either remove them completely or go around them?" And then let's talk about how we're going to follow up on next steps.

And so those are pretty simple. That happen every day. All the way to the complex. We've got an organizational concern about space across the organization. We don't have necessarily the financials to go out and build all kinds of new space in the environment. And so how do we leverage what we have and utilize what we have the most efficiently? And so using structural tension and that kind of complex organizational situation has really helped me be thoughtful, be thorough. It's really a tool that is built on collaboration. So this is just not a, "I have a problem and I am going to solve it tool." This is, "How do you incorporate all of the appropriate people that are required to get to the success you're looking for?"

So it brings the organization and kind of thoughtfulness of it allows you to bring in the people who are your stakeholders and who are the ones who are going to help you be successful. And kind of align on what the ideal state is and agree to where you are from a current state and then help leverage those strengths and what you're going to do around the barriers to get to the action plan.

Laurie Miller:
So, Renee, I heard you mentioned two ways that you use it. And I know you're a coach. So one of them sounded like you're sharing that with other people in a coaching kind of conversation, as well as looking at results and how to build the organization. Those are two really different kind of goals in mind. Can you talk about the different ways that you use structural tension in coaching versus heading to a large result like you mentioned?

Renee Kolonick:
Yeah. I definitely think that from a coaching perspective, that this is the tool that has really made driving those conversations easier to manage. And I'll give an example of performance evaluations. It's a little bit of a different coaching environment. It's making sure that the person that you're evaluating is aware of where they currently are. It's giving them very clear expectation of where you want them to be, and then talking about the strengths, but you know they have to get there. And then if the evaluation isn't all blowing, and there's some opportunity for the caregiver, then you're going to talk about some of the barriers that you see. But you're going to be really specific around what kind of behaviors and what kind of actions that, that person can put in place to overcome those barriers. And then you'll walk out of that evaluation with very clear next steps for that employee to tackle.

So that the next time you're having a conversation around what their performance looks like, you have something that you've agreed upon in that meeting to kind of follow up with. And then it's not this kind of fuzzy line where somebody is trying to figure out how do I get better? How do I drive to meet expectations? It's a really clear and thoughtful conversation around what that looks like. It explains the gaps clearly, it explains the strengths and opportunities clearly and gives a successful outcome and what it might look like. So, that's more on the coaching side. On the enterprise side, it's really around collaboration and it's really around making sure that everybody that's driving whatever goal you're looking for is on the same page. Because where structural tension won't work is if you are not aligned in where you think the future should be.

So if you and I are talking about something and we want to drive in enterprise projects, and I've got an idea of what ideal looks like, and you have an idea of what ideal looks like. And it doesn't align, we're in trouble. We're not going to get very far because success metrics are going to look different. What we think our strengths and what we think are barriers are going to look different. So when you have enterprise issues, goals, opportunities, and you use structural tension as a tool that allows you to bring people in, you're bringing all your stakeholders and you're collaborating on what you think current state is. You're collaborating on what you believe ideal state is. And if you can get to an alignment on those two things, then it should be really easy then to come up with what strengths do we have, what's the low hanging fruit. What are like knock it out of the park ideas, actions, behaviors that we can put in place, no problem.

And then have some thoughtful conversation around what barriers are in place? What's going to potentially prevent us from being successful? Is it removable? If yes, great. Is it not removable? Then how do we still hit that goal by going around it, recognizing it's there, understanding its impact and importance, but still figuring out how to get to goals. And then what are the two or three things that we can work on together to create an action like plan? What does those success metrics look like? And how do we drive forward from there? And I've been really impressed by, I think that this is a tool that the organization has used very heavily because I've been really impressed with the knowledge that a lot of folks across the enterprise have already on it. And when you have folks that understand the structural tension model and you're working in collaborating with them on something that's familiar with them, it really just drives execution in a timely matter.

It allows you to be more efficient, effective, and come up with a plan that's going to work the first time around.

Laurie Miller:
Can you share an example of a time when you got a really big surprise from people you were using that with, or it went in a direction that you weren't anticipating?

Renee Kolonick:
I'm going to actually share a very recent as of yesterday example. So we met with the team. We have a significant amount of leaders that we have been working on a major project for the organization. And some of the data that has been helping us drive to the desired organizational goal was not fully bought in with the members of the team who were going to have to implement the change locally. And so we decided to kind of create a structural tension retreat for lack of a better word. And we brought the team together and said, "Before we just go and roll this out across the enterprise, we need to make sure that the data that our data guys are providing us in the organization can actually work on paper." And so we know our current state with what we're working on right now is this. And we know our ideal state is creating a 20%, 30% improvement in the metric.

And we know that the data that our data team has provided us at least on paper says we can get there. And so let's go ahead and go through an exercise where we try to actually take those numbers and put it to work operationally, to see if we in this controlled environment could hit the target. And walking in there, the team did not think we were going to be able to do that. And we went through this systematic approach. We all are agreeing here's where we are today. We're all agreeing here's where we want to be tomorrow. We are all agreeing that we're going to pretend that this data is right and we're going to go ahead and we're going to stick people in these slots and see if this works. And at the end of a one hour session, the numbers that the data team came up with directionally aligned with what the team was able to produce.

And so we came up with action steps and ideas on how our next step is going to be, let's put it into pilot and a couple. Instead of just putting it into paper and making it work on paper, let's put it into practice and see if we can find some providers who can make this work for us, both on that primary care side, on a surgical specialty side, on a medical specialty side, let's get it done. And then once we've proved to ourselves that those pilots can work, then we'll go ahead and we'll take it broadly across the organization. And it was good for a couple of different groups in the room. It was good for the data team who came in person to help listen and learn the other side, the implementation side of their work. And so they were super excited to see that it worked.

And then the director team, so we're going to have to operationalize this in their buildings. He sat there and said, "Oh, when I first looked at the data, I did not believe that this was going to be it, but working through this exercise helped." The other main key thing out of it was we found boundaries. And so part of our next step is to go ahead and take those boundaries, those barriers, and figure out how to overcome them. Most of which are not removable. We've identified like this is probably not going to be removed, but how can we go around it and still get to goal? How can we meet the enterprise targets? And we all in that room decided that those barriers were pretty standard and that they weren't going anywhere. And that the behaviors and processes that we said we would put in place to eliminate them would be our best first step in meeting goals.

So I'm super excited about that. I can't wait for the work. I wish I could tell you right now what it looks like in the future, because I can't, but I can't wait to see what that looks like. It's going to be a completely new day for exam room utilization across the enterprise, and really making sure that we're utilizing our existing space in the very best way that we can.

Laurie Miller:
As we present tools to leaders like yourself, Renee, we hope that they bring them greater ease. So I'm wondering have these tools brought you greater ease. Leadership is a really large job and for every leader. So we hope that this helps your day easier, your plans execute more quickly and that there's more fulfillment for you as well. Are there connections there that you can talk about?

Renee Kolonick:
Absolutely. So I have three senior directors that I work with very closely. And when you use tools like this daily and you use them consistently in almost every thought process that you have, the team starts to feel and see what routine looks like. So when you first start rolling it out, you might have to do a little bit more work teaching and prepping the team for what's expected and how this is going to work. And it might take a little bit more time, but what utilizing this tool has done for my team. And now that we've been using it for quite some time, is they already know the process. They come in, they know what to expect. They know the order in which we're going to go in. They understand that we have to think about behaviors. We have to think about process.

We have to think about environment. And so it allows us to get through things quicker because it is such an organized methodology that it creates timing and it creates structure that allows you to get rid of all of the waste. And so it's more of an effective, efficient way. And what I have found with the team, so they all know what works for me. Like I'm a huge fan and advocate of it. But what gets me really excited is when I go to their meetings and I see them using those same tools to do the same things. And it's very organized and structured and it gets them to where they want to be in a timely fashion so that we're not talking about the same thing for two, three weeks in a row. And that we're actually getting to action and getting things done.

So that's probably where I get my most proud moments from is when I see the team actually taking these teams and finding just as much value in them as I do.

Laurie Miller:
That's really great. It's been amazing, your contribution to the enterprise is huge. Renee, is there anything else that I haven't asked that you'd like to share.

Renee Kolonick:
Yeah, I would just say that GLLI has so much out there to offer and I have been very fortunate to have taken advantage of quite a bit of it and will continue to do so moving forward. I think you have to open your brain to be willing to try something new. I think you have to allow yourself to try the tools, not one, but for a period of time to show yourself what kind of value will this add to your life? How much time will it save you? How much clear will it make you come across? How will it help you in a first tile situation? Like we talked about early, from coaching to enterprise goals transformation. So when you come up with these tools and you find them, it's like you found a bar of gold. I mean, it really does create so much time saving.

And from a performance improvement perspective with this tool specifically, it allows you to structure it in a way that it takes that uncomfortable feeling away from actually providing constructive criticism or feedback. So, this is just one of many tools, I would really encourage any listener out there to take a look at what there is to offer. Allow yourself the time to develop personally, your development is just as much important as anybody else's development. And if you don't focus on it yourself, how can you expect anybody else to do so? So, give yourself an hour, a quarter. Give yourself an hour a month and go out there and see what's on GLLI and learn the tools because you might find a gold nugget.

Michelle Lampton:
And that's our episode. Thanks again, Laurie, for joining us today and for being such a valuable resource for all our leaders.

Laurie Miller:
Michelle, it was a huge pleasure, thank you!

Michelle Lampton:
And another thank you to Renee Kolonick for sharing her stories and how she has applies structural tension with her team. Caregivers, if you want to learn more about both structural tension, head over to Connect Today - we have several resources to support you should you want to use this tool in your leadership practice.

That's it for us at GLLI - stay curious and keep learning!

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Learning to Lead

This podcast is designed for Cleveland Clinic caregivers looking to develop their leadership skills both personally and professionally. Listen in with leadership experts on the topics that matter most, and what makes our culture what it is at Cleveland Clinic. We'll hear from aspiring leaders to seasoned experts on hard lessons learned, best practices, and how to grow and develop. No matter where you are in your journey, this podcast is for you.
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