Episode Overview

Today, the health care environment is ever-changing and leaders must wisely set the future strategic direction for their organizations. To that end, the strategic planning process needs to define the future goals of and opportunities for the organization – and also must address the leadership and culture requirements for success.

In this episode of Value Based Care Insights, Dan is joined by Clinical Psychologist and owner of DLM Pathways, Dr. Doug McKinley. The two discuss the essential ingredients to align the strategic planning with leadership development while incorporating four critical steps for strategic initiatives combined with the five key behaviors of a cohesive team.

Key points include:

  • Building a culture is not easy, especially when challenges arise. Before having to solve a cultural issue, implementing the five key behaviors in your organization can prevent and guide cultural issues.

  • Why do organizational strategies fail? Often it comes down to leadership. From a cultural perspective, leaders need to have self-accountability, while being honest and transparent with their team members. Leaders shouldn’t be afraid to be vulnerable.

  • A successful strategy is built on healthy adaptive leadership. Trust is the overarching factor in building and maintaining an agile organization.


Lumina Headshots (6)
Daniel J. Marino

Managing Partner, Lumina Health Partners


Lumina Headshots (5)
Doug McKinley

Lumina Health Partners



Daniel J. Marino: Welcome to another episode of Value-Based Care Insights. I'm your host, Daniel Marino. In today's episode, we're gonna spend some time talking about strategic planning. Through a lot of the work that we do with organizations, through hospitals, through physician leadership and so forth, we spend a lot of time helping these leaders understand what are their strategic goals, their strategic initiatives are, and how to align the organization around where they want to go, as future goals and so forth. Some of the organizations actually do a pretty good job of activating the strategic initiatives while others struggle. And I've often wondered, well, what's the differentiator? Why have some leaders struggled with activating their strategic plans while others have really succeeded? While having conversations with other folks, and really thinking about the activation successes, it's come down to one important element, and that's leadership. From what I've discovered is that as the strategic plan is being developed, it's equally important to continue to develop the leadership. I'm really pleased today to be joined by my colleague and friend, Dr. Doug McKinley. Doug is a clinical psychologist, who has a tremendous amount of experience in leadership development. As a matter of fact, he wrote a fantastic book, The Resiliency Quest, where he spent some time talking about the key elements in leadership and motivating physicians and driving a lot of the goals that we've talked about today. Doug, welcome to the program. Very happy to have you here. 


Doug McKinley: Thanks, Dan. Good to be here. 


Daniel J. Marino: So Doug, I know you've done quite a bit of work with leadership development, , helping to pull teams together, helping some of these leaders understand the key elements that are going to drive some of the success and some of the work that you've done. Maybe you could speak a little bit to some of the challenges that you've seen and why leadership development is so important for organizations, especially as they move forward with their strategies. 


Doug McKinley:  Yeah, thanks, Dan. I think some people don't prefer sports analogies, but I like them because they're kind of tidy. They're kind of like a season, like a strategic plan. And let me just say, if we were gonna put a team together and let's call it football, since we're in that season and we didn't plan for, players being injured, or we didn't plan for any adversity, , and we just say, We're just gonna have a great year, and we build a strategy, here's how we're gonna win, and we don't really think about the players and their resiliency and how they're gonna play together, it would be kind of silly, right? So I think the thing I run into is people even, I mean, Dan, you know this, sometimes they don't even really have a clear strategy, so that's point number one. Even if they do, it’s unlikely they’ve taken a time to think about who's going to be actually acting on that strategy and what the verbs are, what the success behaviors are that are gonna help us execute the strategy. So I think the biggest challenge I run into is people just don't think about leadership and team cohesiveness as a strategic anchors. They overlook it. 

Daniel J. Marino: I absolutely agree with you. When we work with organizations, and I've had the opportunity, , to work with many hospitals, health systems, physician groups around the country, helping their strategic plans, we focus on four things, Doug. We focus on kind of defining the why, what, and how you're gonna do it. We then focus on the value proposition that really speaks to the goal and what you want to get out of the strategic plan. Third, we really focus on what is gonna be required for success, that commitment. But the fourth element that we talk about is culture. Now, we don't go into the culture drivers, but we really assess whether the organization in its current state has what it takes to achieve the strategic goals, or is there an evolution that has to occur in its culture. So given those four elements that I talked about for strategic planning, in your opinion, how does leadership development need to complement the strategic planning process? 


Doug McKinley: Well, first of all, it needs to, right?  It needs to be considered. So if we're gonna do that, and again, if you don't assess culture and the vehicle through which you're gonna drive your strategy, it's just a big mistake. So I think they need to be complementary. A lot of times when I listen, especially when I watch you lead a strategic session, Dan and I look around the room and I think there's no way this team could pull that off. I love what you're coming up with, but I'm looking at the players and first of all, we don't even have clarity or agreement. I think an undervalued competency. Getting to an agreement as a leadership team and as a cross-functional team is really hard. You can't just assert it. 


Daniel J. Marino: I agree. You know, we-


Doug McKinley: <laugh> good. You've got an agreement. Good. 


Daniel J. Marino: We've spent some time talking about that. And I think, you know, the basis of the agreement is trust. You're a huge proponent of that. You've talked about that, where there has to be, innate trust in the leadership team. From there, you know, you kind of speak to accountability and driving results and frankly, that commitment is critical in that strategic planning process. Oftentimes what I see, to your point, is that's really overlooked. I don't think the leaders really look at that. Maybe it's because they don't wanna put themselves out there and they don't wanna be vulnerable. But I think as we start to think about the successes of these plans, you can't activate them properly to the success that you want if you don't take those things into consideration. 


Doug McKinley: Yeah. They say that culture eats strategy for lunch or something like that, I forget, is that what the phrase is? 


Daniel J. Marino: Yep. <laugh> culture eats strategy for lunch every day. Something like that. 


Doug McKinley: Yeah. So if that were really true, if people really believed that, then this conversation wouldn't be so novel. I just don't know if people have really agreed on that or not. It's a nice posture and it's a nice marketing message. And the times when I would get in and really start rolling up my sleeves, working on culture, people really wanna get to the tactics to solve the problems. They don't talk about culture. So it's a big challenge. I get it. If you're a results-oriented organization, you just want to drive for results, you want to get things done. And my suggestion is to just have to take time to pull back a little bit and stand back and look at how you're working together. 


Doug McKinley: The first four things that you have, the four things that I'm trained in, be a part of the CAPA Pro, you know, table group Len program, is that we have to have team cohesiveness, then we gotta build clarity, which is the strategic plan. Then we have to commute, overcommunicate that plan, and then fourthly we need to reinforce it and hardwire it into our behavior. So that team cohesiveness is, again, people. Not just because we're a team, we're gonna work well together. And that's where these five behaviors become critical. And I think that's one of the things you wanted me to just touch on, Dan.


Daniel J. Marino: I feel like the five behaviors are sometimes they're taken for granted. Speaking to many of the leaders, you get so wrapped up in the day-to-day activities, there's a lot of pressure on these leaders today, right? So we do a lot more crisis management and a lot of our daily activities than we do a lot of planning the day. Understanding these behaviors that are critical in driving success, everything starts from the top, right? These leaders have to provide a good example to their middle managers, to their staff. I've heard you speak about these behaviors, Why don't, why don't you spend a couple of minutes going over 'em? I think that would be really helpful.


Doug McKinley: Yeah. The author originally outlined them as dysfunctions. He basically said that the five dysfunction of a team is the inability to have trust. And if you have no trust, then you're clearly not going to have healthy conflict. And if there's no healthy conflict, then how are you going to agree on commitment, which is the third behavior. Well, accountability is the fourth dysfunction. What are we holding people accountable to if we don't have those four things and those three things in place? And then the last behavior is your results. So trust, conflict, commitment, accountability, and results, and the results. You know, I could be very productive. It's like a sports team analogy. Again, Dan, I could be a great athlete and our team could suck. Right? The results have to be that we win together as a team. Not that I'm building my stat and we work at health care and it's easy for really great clinicians, nurses, doctors, all of 'em, to feel like, “Hey, I'm, I'm doing my thing. I've got my surgical field in and I'm really good,” And forget that they're part of a huge ecosystem. Yeah. So the results have to be focused on organizational wins, not personal wins. 


Daniel J. Marino: We obviously did a lot of work in supporting the mental health care system during covid. And I saw many of the leaders, in the response to Covid took a very top-down approach, right? Like of an approach to figuring out how they wanted to respond to Covid, and manage some of the interactions with doctors and patients through telehealth. One of them basically said, “You know, we're going to do telehealth and we're gonna implement it in the next couple of weeks.” It was a very authoritative type of style of leadership that many organizations put in place. And frankly, I think it was needed, right? Many of the staff and employees, of course, looked to the leaders to provide that level of direction. And I think many of the leaders did a great job responding. 


Daniel J. Marino: I also found the year after Covid that it's been very difficult for the organization to give back to more of a decentralized sort of management style, where you're able to delegate some activities there and ensure that there's some level of accountability. And I don't know if it's because the leadership certainly has some bruises and certainly some recent thinking that occurred within covid. But some of the things that you've mentioned, you know, driving commitment, accountability, building that trust, I believe many of them want to, but it's been very hard for them to get back to where they were from a management style pre covid in this post covid environment. Any thoughts on that? 


Doug McKinley: Yeah, I think it's very simple. It's because they didn't trust the people to help them do it. We call this heroic leadership, Dan. That's what happened during Covid is the companies that organizations were not healthy already. They had to enlist heroes. They had to bring in superpowers to pull off this heroic measure. And they saved the day. Then you go back and everybody felt like, you know, well, I guess I'm not that important cuz the person with the cape flew in and saved the day. There are some amazing people out there that did do heroic things, but that's not a healthy organization that's a top-down or specialized thing. They've lost the trust of their players. The people all wanna feel appreciated and valued for their strengths. And when you go into heroic leadership moves, like what some organizations did during covid, then you're basically putting people on the bench, and they feel discouraged. It was a mistake if they did that. And now it's not a matter of going back to the way it was. It's a matter of actually creating a healthy organization so that they can actually allow people to use their beautiful gifts. So yeah, it's a real challenge. 


Daniel J. Marino: Yep. You're absolutely right. If you're just joining us if you're just tuning in, I’m Daniel Marino, and you're listening to Value-Based Care Insights, I am here today with Dr. Doug McKinley. We are talking about the need to align leadership development with strategic planning and the successes and challenges around that. So Doug, when you think about organizations on building that trust factor, what are some of the key things that you see or that you're working with some of the leaders on to build a level of trust? It kind of gets me back to one comment that I've heard you make 20 times, I've had the opportunity to work with you on different engagements. You've mentioned that healthy adaptive leadership creates effective strategy. So when, when you, when you think through that comment, when you think through that quote, trust has to be an underlying factor, right? Sure. So what are some of those key things that you begin to work on with leaders that help them kind of advance or pull together that trust factor? 


Doug McKinley: Well, I think the keyword in that quote is adaptive, right? Let's just say today's a Wednesday and we go out and we plan our day. If it's like most operational things, it never goes as we plan. And so for me to, to be so rigid in how I wanna get things done, it's gotta go my way, it has to go perfectly. If I'm not adaptive, then how am I gonna enlist trust and vulnerability amongst the team where we can actually juggle, those tender moments? So I think the first key to building trust is we need leaders that are willing to be vulnerable and admit, “Hey, this isn't going as we planned. We need to pivot right now. And I need to tell you, I'm not sure where we're going. I'm not even sure what our next move is, but I'm glad you're with me, and let's do this together.” As opposed to what I think heroic leaders do is they hide that and then just drive expectations without enlisting their team. So trust is a currency, and it's alive, it's dynamic. It flows like a current like money does the value of something. And you have to value it. Trust is a currency. You have to value it and not break that trust by demanding or yelling, being disappointed in people when things don't go as planned, because they often don't. 


Daniel J. Marino: I love that trust is a currency. I absolutely love that. And you know, when we work with organizations, with leaders on developing their strategic plans, their strategic initiatives, it's really that, right? Nobody hits the crystal ball. You don't know exactly what's gonna happen a right year, two or three years, right? So it's a little scary. But you've got the only thing you have that supports that is trust. And you need to have trust. But one of the key things that I think that, as you've alluded to, as you talk about that adaptability, it's really around being agile. And, you know, and I've heard you talk about this before, being a highly impactful agile leader and the competencies that go into that. And you know, what I've seen is I kind of think about the different health systems and those CEOs that have been successful. Some of the key attributes that I found is they're not afraid to be vulnerable. They're not afraid to admit a mistake. They provide strong direction to their team. They really focus on developing that trust with their immediate team, but also with the junior managers as well as the employees. How does being an agile leader, or maybe the agile leadership competencies that are so important, how does that figure in?


Doug McKinley: Well, it starts with trust, right? I think self-leadership is another undervalued competency. Am I clear about who I am and what I'm doing and why I'm doing it so that when I am engaged with my teammates, they're clear about who I am? I think self-leadership is one of the key things if you're clear about who you are, then you can show up in a way that allows the people around you to feel comfortable with you. And the first thing you gotta do is if you're wrong, you gotta say, “You know what? I'm wrong.” Right? I don't hear that very often. I don't know about you, it's, you know what, I was wrong. I was wrong about you. I was wrong about the strategy. I overvalued the market trends and you know, I'm sorry, I got us off track. What do you guys think? Right? 


Daniel J. Marino: Yeah you just don't hear that very often. 


Doug McKinley: That's adaptive. It's being honest to the moment. “Yes, last month we said we were gonna go here, it's not working.” Let's just admit it. It was my idea. Instead, what I usually see is people say, “Well, I don't know who came up with that idea, but that was wrong.” And then we judge and shame each other. Now the trust currency bank account has gone down and Brene Brown says that vulnerability is the precursor for innovation. If you really wanna have an adaptive, innovative strategy that can be flexible in the marketplace, you have to be vulnerable with each other. And that comes through being honest and building trust with one another. I know it sounds squishy, but it's not, it's actually real business savvy to build trust bank accounts with your team. 


Daniel J. Marino: Yeah, I agree. We're faced with many challenges, right? Those characteristics around strategic planning and strategic initiatives and leadership development are so critical, Doug, to driving the success of organizations. 


Doug McKinley: Yeah. It's interesting, let's say you have a great leadership team, and I know you and I both worked with them, you have to assume that somebody on that team might leave, right? Right. They're going to get recruited somewhere else. If you don't have an ecosystem where trust and vulnerability is valued, you're not gonna be able to pivot when that happens. You know, if you're a conductor and you're first chair violinist, you know, your best solo artist leaves you, you don't not have the concert. You have people in place, you have a bench strength, you have a system, an ecosystem where people want to step up and be a part of leadership. And so this isn't about building the perfect team. That's what I tell people. It's all the time. You're not trying to find exactly the right people with the right chemistry. It's practicing these five behaviors in a healthy way and people can come and go off the team and we all can work together. That's a big distinction. 


Daniel J. Marino: Big distinction. But I think the organization is a journey, right? I mean, you don't just flip the switch and or buy a program or read a book and put these things in place. It is a journey, right? As organizations go through this. So, in closing, Doug, for a lot of our listeners today, any pieces of advice, any words of wisdom other than, you know, this the conversation we had and a lot of wisdom and a lot of great, great insight here. Any final thoughts you might wanna share? 


Doug McKinley: Yeah, Patrick led gave a nice term recently that I'm gonna share with your audience. He called it organizational health insurance. <laugh>, he said, “We're heading into a tough time. We just came out of a tough time and now we're likely going into a recession. “ And I really think you need to sit down with your, if you're listening to this and you're on a leadership team, sit down with your leadership team and just, just look at what are the key indicators of what it looks like to be. A lot of teams wanna be smart and not healthy, right? I'm sure most of the people on your team, including your listeners are smart. But is it a healthy environment for where people can actually plant their gifts and really invest and do great things together? So I would say sit down and build an organizational, health insurance plan, which is building a cohesive team and get clear about who it is and what we're trying to accomplish. The strategy's great, but I really believe in culture and team and a healthy organization. I don't know if it is each strategy for lunch, but it's equally as important. Take a minute and think about it. That's all I'm asking people 


Daniel J. Marino: Yeah. You need to really have both of those elements and it is so important because, you know, having one and not the other, you won't be successful. So I agree. Well, Doug, this was great. I wanna thank you for your time. I know you're very busy. Real quick, if anybody wants to get ahold of you, any thoughts on how they can reach out?


Doug McKinley: Yeah, my website is www.dougmckinley.com. It's pretty easy, <laugh>. So you could, you could find me there. I have a podcast like you, Dan, it's called Leadership Currency Podcast. So you could find that through the website, www.dougmckinley.com. Thank you.


Daniel J. Marino: It's a great podcast. I love listening to great topics. For our listeners today, thank you for joining in. I hope you enjoyed the conversation as much as I did. Until the next insight, I am Daniel Marino, bringing 30 minutes of value into your day. Take care.












About Value-Based Care Insights Podcast

Value-Based Care Insights is a podcast that explores how to optimize the performance of programs to meet the demands of an increasingly value-based care payment environment. Hosted by Daniel J. Marino, the VBCI podcast highlights recognized experts in the field and within Lumina Health Partners

Daniel J. Marino

Podcast episode by Daniel J. Marino

Daniel specializes in shaping strategic initiatives for health care organizations and senior health care leaders in key areas that include population health management, clinical integration, physician alignment, and health information technology.