LeadingAge Magazine · May/June 2013 • Volume 03 • Number 03
Aging-services providers have been riding a wave of change in recent years, with more to come as demographics, restructured funding models, ongoing economic stress and changing expectations by consumers change the field. In such an environment, providers who don’t adapt cannot thrive, and leadership models that address the need for adaptation head-on have value.

Mary Jo Lewis, M.D., is a geriatrician, medical director and executive coach who led a “learning circle” at the recent PEAK Leadership Summit in Washington, D.C. She has spent the last 10 years working with universities, hospitals and other organizations on leadership development to enhance the capacities of leaders serving in a range of disciplines.

In addressing ways to thrive in the midst of change, Lewis draws on the work of management consultants Ronald Heifetz and Donald Laurie, who introduced the concept of “adaptive change” that leaders must handle. Their approach was spelled out in a well-known Harvard Business Review article, “The Work of Leadership.” They rejected the model of a leader as “shepherd,” one who protects his employees or followers from harsh realities. The role of a leader, they argued, is to ensure that followers face painful realities and learn to leave their comfort zones in order to solve vexing problems, an approach that is more conducive to the long-term success of an organization.

Lewis believes leaders must adapt to circumstances and take calculated risks while staying anchored in their organization’s vision and mission. The approach is built around Heifetz and Laurie’s “six principles for leading adaptive work”:

1. Get on the balcony
2. Identify the adaptive challenge
3. Regulate distress
4. Maintain disciplined attention
5. Give the work back to people
6. Protect voices of leadership from below

“When we teach this,” Lewis says, “we usually do it in teams. We’ve found you can enter in through any of those principles. The ‘on the balcony’ piece is key. It’s that sense of seeing the big picture and being in the action.”

LeadingAge talked with Lewis about adaptive change and the ways leaders can best help their organizations learn to face challenging, changing environments.


LeadingAge: How you were attracted to leadership work?

Mary Jo Lewis:
I moved from full-time clinical work into half-clinical, half-administrative [work] in 1997 for a health system. That experience formalized my understanding of how leading in teams, with diverse backgrounds in disciplines and discourses, helped us make progress on leadership problems.

A couple years after that, in 1999, I was selected to be in a program at the University of St. Thomas business school—a program for MDs learning to lead. The most compelling thing about it was that it was leadership instead of management, and how one brings oneself to the work in addition to those skills, like accounting and finance, that are more technical in nature.


LeadingAge: What sorts of organizations/clients do you work with and what do you do for them?

Mary Jo Lewis:
I teach in the St. Thomas program, and I’ve been teaching an undergrad leadership course at Concordia College, and I teach for the School of Public Health at the University of Minnesota, an online course. I [also] do coaching for MDs and administrators, people in mid-career, generally. I do spiritual direction here in Fargo.

Spiritual direction is similar to executive coaching, but it’s for people looking for a deeper relationship with their spirituality. The way I connect [the spiritual] part with executive coaching and leadership is by asking, “How do we bring ourselves to this work, whether in health care or other areas?” What is the deeper purpose and meaning of our work … our call?


LeadingAge: What adaptive challenges do you see facing LeadingAge members?

Mary Jo Lewis:
The ways we work together with seniors in all facets of social living are adaptive, complex problems. Whether it’s in housing, health care, mental health, etc., [these are] all are adaptive complex issues in that there is not one best answer to any of those problems. Looking at any of them is about getting an understanding of who the stakeholders are. In the field of aging in particular it’s kind of a microcosm of all the societal adaptive problems we face. It comes to a head, in a sense, in the field of aging and senior issues.


LeadingAge: In your presentation you talked about the differences between “technical” and “adaptive” work. Could you explain how they differ in the context of the work LeadingAge members do?

Mary Jo Lewis: In the geriatric health care setting we know how to vaccinate against flu; we have the ability to figure out what strains of the virus will be prevalent this year. That’s a technical thing. An adaptive challenge would be looking at end-of-life issues for an individual. At that point, who is involved in understanding the end of life, and what does it mean to be at the end of life? What does end of life mean for that individual’s family and friends?

Another example: My Mom is living alone in a home in South Dakota, 10-12 hours away from her kids. We’re all, along with her, trying to balance her independence and our ability to be there to help her. The technical part is that we can go there and see what housing is available, what services are available, but the idea of where to move and when and why is the adaptive challenge.

Regarding changing the characteristics of an organization, the CEO doesn’t really have the whole answer. What the CEO needs to do is, in a way that balances comfort and challenge, create what Heifetz calls a holding environment, a network of relationships. It’s understanding what is the vision of our organization? What parts of what we stand for are core to what we need to do in the future? And what do we need to let go of, and how do we come together to explore those ideas?

The leader needs to have a sense of building a community of practice to help formulate what part of this vision is pertinent. It requires living with a little more ambiguity than we’re comfortable with. The old organizational charts may not even fit. The CEO says, “I want to give some of this problem back to the people,” though everyone thinks he should have the answer. You’re not abdicating responsibility, but it does require a little more agility and flexibility. Saying “I don’t know” is really difficult, and that’s where emotional intelligence and self-knowledge are so important.

That’s where I see most of the big societal or organizational systemic challenges coming together with individual leaders’ adaptive work in knowing themselves. People don’t want to hear that; it’s not comforting. They’d rather read something that says, “Here are 10 steps to be sure your organization is on a sustainable path.”


LeadingAge: Do adaptive challenges play out differently in mission-driven, human service work like ours as compared to commercial business settings?

Mary Jo Lewis: In a lot of ways it’s very similar [in both]. Whether you are not-for-profit or for-profit, you still have to provide a service or product and you’re working with people and financing it. So in that sense the technical issues of how you do it differ, because a for-profit wants to generate profits and a not-for-profit has to balance margin and mission. The margin/mission polarity is a good one to look at in any work we do, even in how we sustain our family. Unless we’re independently wealthy, we have to balance family life and making a living. The adaptive work of all types of organizations has deep similarities but we come at them from different mindsets and perspectives. We can be blinded to different things.


LeadingAge: In your presentation you added some personal elements to the adaptive leadership concepts, for instance your discussion of the Mobius strip (inner life and outer life), and “resiliency through sanctuary.” Could you expand on those concepts?

Mary Jo Lewis: Doing adaptive work is really hard. You have to be able to stand in the midst of ambiguity and not give up. [You] have to have perseverance, know who you are, and know how you exhibit stress. Having places you can go to rejuvenate, having people who can help you understand that, is important. The Mobius strip is a wonderful image of how adaptive work tends to be “both-and” rather than “either-or” kinds of challenges. What we’re trying to balance with my Mom is safety and independence. It’s also true that my inner self is also who I am on the outside if I have integrity, if I am who I believe myself to be. In working through ambiguity, I have to have that strength of character, understanding of self, in order to do that.

Balancing or managing interdependent values (like safety and independence) require that the stakeholders (family and senior and service providers) have the holding environment (that safe place) to explore the both-and questions. It often feels unsafe to hold both interdependent values at the same time … that’s where leading within an adaptive frame can help people stay in that ambiguous tension long enough to make progress on the challenge.

I think of the Mobius strip as a great image … a framework for the ambiguity. It shows the interconnectedness, the interdependence of the two values we are trying to balance or manage.

[As for] resiliency through sanctuary, in order to have that resiliency, to stay in that ambiguous adaptive work, having places and times of sanctuary is important. In the CEO’s busy day can you take five minutes here and there, you can take a couple of weeks a year to get away. It can be meditation, a walk in the woods, etc.

The Heifetz model of adaptive leadership is a wonderful framework and it’s not rocket science. It’s about relationships, how we interact with each other in making progress on challenging work. In a sense it seems complicated because the ideas are embedded in it. But we do this all the time, and it’s about learning to do it in an intentional way instead of by happenstance.

The ways we lead, either though formal authority or informally, are fascinating to me. In any field leadership is key to how we make progress together.