Episode Overview

When it comes to making big decisions, strategic plans often overshadow the critical aspect of leadership culture. This episode of Value-Based Care Insights welcomes Keith Hadley, whose expertise lies in building healthy organizations and improving organizational decision-making through building high-performing teams. Discover the roots of misalignments in leadership teams and the significance of transparent communication in creating a unified voice to advance the culture of the organization.


  • Leadership growth is as vital as having a strategic plan.
  • Healthy organizations prioritize clarity and minimize confusion.
  • Stronger leadership alignment leads to faster and smarter decisions.





Lumina Headshots (6)
Daniel J. Marino

Managing Partner, Lumina Health Partners


Keith Hadley Circle

Keith Hadley

Principal Consultant, The Table Group; Founder, Keith Hadley Consulting 

Daniel J. Marino: 

Welcome to another episode of Value-Based Care Insights. I'm your host, Daniel Marino. As we've talked about on the program many times, as healthcare providers, as health systems, hospitals start to engage in their strategic plans, not only is it important to consider all of the elements that will drive the success for growth of the organization or alignment or partnerships, if you will. 

You also have to really give some consideration to development of the leadership team. And as we said, it's a growth piece. And where we see a lot of organizations struggle is they focus all this attention on the strategic plan, but don't focus a lot of attention on their own strategic growth, developing the leaders, thinking about how we need to change as a team becoming more cohesive because it's difficult sometimes as you're engaging in a lot of decisions or discussions, how to keep the team moving forward as the organization moves forward.  

Well, I am very pleased today to have a colleague, Keith Hadley join the conversation. 

Keith brings about 25 years of operational leadership and management experience to the consulting world and works with an organization called table group, which its principal is Patrick Lencioni. Keith, very happy to have you as part of the program today.

Keith Hadley:

Thank you, Dan. It's great to be here and excited for our conversation.

Daniel J. Marino: 

So Keith, before we jump into the topic, let's talk a little bit about you. You've got a fascinating background. How did you first get into developing leadership teams and aligning with Patrick?

Keith Hadley:

Yeah, well, I have a very predictable path. You know, I studied French and history in college because I think I wanted to teach at a high school or a college level but then very quickly realized that that wasn't my dream. But you know, but growing up, my family was all, you know, farmers, doctors, nurses, therapists, and educators. And so I had nobody in the business world.

Daniel J. Marino:

It’s fascinating how you sort of grew into it from this other area so how did you make the jump?

Keith Hadley:

Yeah. So, when right out of college, I got an internship with a small consulting firm that did international business development. It was at a time when, you know, NAFTA had just been signed. The wall had just come down and my boss said he hired me because he said as a history major, he figured I could write. 

And they needed, another foreign language on their team as they were expanding into Europe and beyond. But long story short, that small firm got bought by a big firm. And suddenly I found myself, you know, at a big firm doing business development, strategic planning, and feeling very out of sorts because I was the only one without a business degree and felt super unqualified to be there. 

But I worked there for eight years and loved it. And somewhere along that line, I discovered Pat's books. And, and it was like, opening up a whole new world of things that I felt like I should have been aware of when when I was doing that kind of client work.

Daniel J. Marino:

Well, and I've read many of his books. I think I've read all of them to tell you truth. And he just brings such a practical approach to a lot of, aspects of developing the development leaders and especially in healthcare, there are so many hospitals that are struggling with not only the financial performance of their organization, but meeting the needs of their communities. 

And, you know, as I mentioned in my opening remarks, organizations constantly and leadership teams constantly spend a lot of money on their strategies, which is good investing in new markets, new providers, new relationships, and new partnerships. Which is good, but I don't feel like they spend enough time developing their own teams. What do you see? where do you see some of that misalignment or some of the struggles?

Keith Hadley:

Yeah, I would even go further with it, you know, in my experience, my mother worked at Loyola University Medical Center. My brother went to med school there, and became a physician. My wife worked in home health care and in the nursing home environment, as well as in a different hospital in Chicagoland. 

And I think it's broader in healthcare that we don't develop leaders at all. And just the idea of organizational effectiveness, organizational leadership, for many has just been overlooked. And so it's got to start at the top. And that's all the work that we do at table group is we start with the CEO and the executive team really helping that team become cohesive and focused and clear and aligned, which is, probably just as much about behavioral alignment as it is intellectual alignment or strategic alignment. So that's where we put a heavy emphasis. And in almost every case, we're treading into new territory that these teams have really not explored. And I'm excited to talk about what some of those avenues are, but, you know, I've done this work at very large hospital systems. 

I've done it in small clinics. I've done it with healthcare, technology, creators, you know, diagnostics, you know, all across the board and we see the same issues and you're right, they're dealing with tremendous change, tremendous uncertainty, and we need to have teams that are ready and are equipped to deal with the kind of complexity and changes they're seeing. 

Daniel J. Marino:

Well and especially when you think how they really have to focus on the alignment with their physicians. They have to focus on meeting the needs of the patients. There's a lot of new regulatory challenges that come through. So maybe we can dive into this a little bit when you're working with the leadership team, particularly the CEO. How do you engage them in such a way that they start to understand that this development is really critical to their success? That they really have to focus on thinking differently, thinking outside the box, which could be a little bit humbling for the CEO, right? A lot of times they don't realize that they're the ones that have to change. So how do you, where do you start? How do you really move that along?

Keith Hadley:

Yeah, it all starts with making a very clear distinction between the two sides of the organization that need to be mastered. So we talk about the smart side of running an organization, and everybody resonates with that right away. Having good operations, good technology, good finance, good marketing, good programs, good safety, all of the, what we call the decision sciences and, and all of these teams resonate with that side because that's what they went to school for. That's what they studied.

Daniel J. Marino:

Sure. That's their training. 

Keith Hadley:

Yep. And, and it's absolutely critical. We don't minimize the importance of that at all. But the problem is it's only half the equation, but it tends to get 90% of leaders time and attention. The other side is the healthy side, which ironically, since we're talking to healthcare providers, they also resonate with this. 

But when you think about the healthy side, healthy organizations are known for having minimal confusion, minimal politics. And as a result have maximum levels or they've maximized their level of productivity and morale. And if you think about productivity and morale in the typical healthcare system today, it's at an all time low. 

Even though the work they're doing is so important and that the purpose of the organization is so obvious. And yet we have people frustrated. We have people confused. We have conflicting priorities, you know, limited resources against massive goals and objectives that have been established, incredible pressure for talent to retain our best talent. So these are stressed out environments. So we ask, you know, what are people confused about around here? And it's the same list. Goals, priorities, decision rights. you know, “what's my job?”  

Daniel J. Marino:

Yeah, you can see that alignment necessarily isn't there. The clarity isn't there. How much does communication transparency fit in the equation?

Particularly when you talk about the senior leaders and maybe then their junior leaders underneath that, is it that the goal hasn't been clearly defined or is it more so around the goal, the vision, etcetera, has not been communicated. 

Keith Hadley:

I think it's both. And I think one of the reasons leaders don't communicate clearly is because they really haven't gotten clear themselves, right? 

So if we haven't really put in the time to get crystal clear. It puts tremendous pressure on our messaging to come up with something that sounds good, but it really isn't communicating very clearly at all. And so, when we think about a healthy organization, that's minimize confusion. That means we have to maximize clarity. 

And it also means we have to maximize or minimize politics and politics in organizations can be very damaging and we're not talking about things like sabotage. We're thinking of things like the meeting before the meeting, the meeting after meeting, saying one thing in one room and another thing in a different room or changing what you're going to say based on who's in the room. 

And so the communication from the top gets very muddy, very quickly. Just one layer out from that executive team Let’s say team two levels. We talk about team one is the team at the top team two that's where you immediately get into functional leadership. And already at team two, we're getting slightly different versions of messages. 

And it's because we haven't put in the time to get clear at the top. And often we haven't put it in that time because we're dealing with some politics, some internal, you know, just some misalignment between functions at the top.  

Daniel J. Marino:

Yeah, if you're just tuning in, I'm Daniel Marino. You're listening to value-based care insights. 

I'm talking today with Keith Hadley around developing strong leadership, cohesive teams, aligning that with strategic plans. So Keith, when you think about those key elements. That really drive a cohesive team, aligning them to align with their strategies, manage some of the challenges that they have so forth. What are some of those key elements that you focus on with the teams? 

Keith Hadley:

Yeah. So we talk about four disciplines and the first discipline and they're truly discipline. Like physical health is a function of disciplines. You got to eat right. You got to exercise, get good sleep. It's not that we don't know that we just don't do it as a discipline. 

So organizational health discip lines, by the way, we asked that one of my colleagues was at Mayo clinic and ask, you know, a room of about a hundred physicians, like, you know, Hey, how many of you in the last 24 hours have like done all three of those and like, not a single hand stayed up. So, you know, when we're talking even to physicians, they realize that physical health is harder than it looks. 

So organizational health, though, is four disciplines. It's really simple, but it's just really hard to do. So the first discipline is about building a cohesive team. And that's, you know, a cohesive team is one in which we can trust each other enough to have really honest, good conversations leading to stronger decisions that we can hold each other accountable to all focused on the shared results of the organization. 

And that's Pat launch he only wrote about that in his book, the five dysfunctions of a team, trust, conflict, commitment, accountability, results. That's the first discipline and. Dan, you know how hard it is to stay cohesive and aligned with just one other person. I think of like a marriage, just staying cohesive. 

You have good days and bad days, and now you have maybe a team of eight or 10 people. And to try to help that team stay and maintain their cohesion is hard. So it's active work.  

Second discipline is all around creating clarity. So the organization needs answers to six critical questions and every time we've done this work in hospitals or in healthcare systems, everybody has an answer. 

That's not the problem. And the answers are right. That's not the problem. You know, everybody at that table is too well informed to have wrong answers. The problem is they just don't have the same answer. And so six critical questions, Pat wrote about that in the book, the advantage and it's, why do we exist? How do we behave? That's our core values and our core purpose, clarity.

Daniel J. Marino:

Right, so that of the team becomes really critical to drive into that cohesiveness as well as in your decision making, I would assume. 

Keith Hadley:

Totally, totally. So we need to be clear to top two. Why do we exist as an organization? How do we behave for most hospitals and healthcare providers? That's a pretty easy set of statements, but even as easy as this to understand, you know, we need the same answer.  

The next two get pretty tricky though. What do we actually do? And how will we succeed? And this gets into the choices that we make around what's included in the scope of our work. 

And there's a lot of changes happening there. Are we going to do local community clinics? Are we going to do research? You know, all kinds of, you know, we call that our business definition. We have to make choices. And then how will we succeed? That gets into our strategy. How are we going to differentiate ourselves? What's going to be the pattern of decision making that we teach people to make sure that we're strategically aligned and consistent?  

And then the last two questions are really hard to get the same answers on. And that's what's most important right now. 

We call that our rally cry and who's doing what? So it's a lot of work to get totally clear, focused and aligned. From a team and then the 3rd and 4th disciplines are we got to over communicate the heck out of it and we have to reinforce it through all of our human systems, which I don't want to minimize the importance of those disciplines. 

We could talk more about those.  

Daniel J. Marino:

No, that's critical. So when you think of where in healthcare leadership is going and talk a little bit about the growing physician leader that is occurring right now in the hospital or the health system, or even the medical group for that matter. 

More and more physicians are assuming leadership roles. Sometimes what we see is the, I don't want to say the interest, but the strategic focus is slightly different where you may have a CEO that's not a physician leader. You'll have the chief medical officer, which is, maybe a few other clinical folks who are on that leadership team. 

How much does that the background, the training of the leaders, I'm thinking more so the physician leaders versus the administrative leaders. How much does that come into play to really design where they want to go or even breaking down some of these barriers to align around a cohesive team. 

Keith Hadley:

Yeah, it can be critical, but here's the problem that we see. On an executive team, the leaders need to decide which  team is their number one team, what's their first team. So if that physician has been selected to represent the interests or the needs of a particular constituency within the system, then they are there like a member of Congress advocating for their primary team, which is outside of that executive team. 

On the other hand, if they're there representing the system, representing the entire organization and making that executive team, their number one team, then it's great to have them at the table because they can be a good strategic advisor. They can bring all that context and perspective, but they need to bring that as with where their primary loyalty or their primary drive is the shared collective result of the organization. 

And then we like to say that. Physicians would represent the executive team out to their constituency, not the other way around, or they're representing that constituency on the executive team.

Daniel J. Marino:

Right. But I also feel like you have to land on that vision, right? So that whole team, that leadership team does have to agree on where we're going to go. 

Right. I think that has to be the first step. And then maybe you might have a couple of different paths to get there. But if you don't have that North star, right, I think you're really challenged in terms of where to go. And then it's a matter of perceptions that come into play, which I would think would definitely tear the team apart.

Keith Hadley:

Right. And I would change one word that you said. You said they need to agree on where we're going. And I would say they don't need to agree. They need to commit. And so the, the CEO, their job is to be the decision maker, to build enough trust on the team, to get all the issues and perspectives on the table. 

Yes. From all the different functions, all the expertise that people are bringing, but often executive teams aren't going to agree. The goal is not consensus. The goal is clarity. So we need to agree on, Hey, what's our North star? Where’s our vision for the future? Or what's our strategy or how are we going to make these trade offs and the allocation of limited resources? 

And we need to debate it with good, honest debate. And then we need to decide. And often that the leader, you know, that's their job is to decide. My dad was a high school principal and I learned a lot of lessons from his leadership. And one of the things I'll never forget that he said is, the hardest part about being the principal at the high school, is that the only decisions he gets to make are the impossible ones.  

So if you're the CEO of a system. They recognize like, hey, I only get to decide when it's impossible. And I'll tell you what's impossible is that when you have a team of highly trained, highly skilled, well meaning leaders around the table and they do not agree, your job is to get all the issues on the table, listen to the various points of view, and then make a decision and then ask the team for, and expect their commitment. And that's really where that team one comes into play is that we need to be able to represent that decision out there at our team, team two, team three   four levels so that we can speak with one voice focused on one thing. And I think that's what breaks down most in executive teams is that people show up expecting it to be like Congress they leave with. You know, not having gotten their way, they leave with a lackluster, you know, lukewarm commitment, no matter how hard they try, they communicate through their nonverbals, their lackluster support. 

And now two, three, four layers out, you see these little gaps emerging between functions and people are left to fight as Pat says, bloody unwinnable battles between functions because their leaders are not clear. Their leaders are not aligned.  

Daniel J. Marino:

Yeah, it breaks down the organization. If you don't have that commitment and that alignment, I agree with you wholeheartedly. 

How much does agility come into play when within the leadership team,  

particularly aligning with the strategy? How agile do you have to be, you know, when do you need to pivot, if you will? 

Keith Hadley:

Yeah. The military has this great rule of thumb. It's called 70%. and it's when you get about 70% of the information that you think you need, it's probably time to make a decision. 

So before you have agility, you have decisiveness. And the idea being that as a leadership team, we need to make some decisions and let's make faster, better decisions by being clear and aligned. If we're making a fast high quality decision. We have to build in our ability to pivot and be agile. Meaning some of the decisions that we make, we're going to very quickly realize, Oh, that maybe wasn't the right decision. 

We need to come back to the table and make a new decision. And so agility comes in with, from a qualitative perspective, with things like humility. You know, leaders who are humble enough to say, like, hey, my job is to make a decision here, but I'm not always going to make the right decision. And hopefully these are decisions that if they're the wrong ones, we can walk back and make a new decision. 

And then they need to have the cadence or the rhythm to know that, like, on a daily weekly basis, we're checking in with people to know, like. Are you seeing signs that we should pivot. 

Daniel J. Marino:

In our industry you're seeing that constantly. I mean, we did a strategic plan in the beginning of the year for an organization and they had a direction they wanted to go with some of their payer strategy, particularly for Medical advantage. Well, lo and behold, in the beginning of March, CMS released some new regulations, right? Now it was technical in nature, but it affected the strategic plan and the growth that they wanted to have. And to a certain extent, some of the leaders were a little bit upset about that, right? Because they had a direction, they weren't sure where to go. But what we tried to say was, you know, you need to be agile. That's part of you as a leader is understanding how things are changing and feeling comfortable to pivot. But I think one point that you made, which is critical is you have to be able to communicate that to you know, yout next set of leaders, right? To agee and so forth. 

Keith Hadley:

Yeah. I think a lot of leaders make a pivotal mistake and the mistake they make is that we have to be consistent. We don't have to be consistent. Because the world isn't consistent, but we have to be as clear. I worked with a client once that we worked in the context of an offsite to determine what is their rally car, their thematic goal. 

They announced it at their all hands meeting. And then the next week, something changed. And I was talking to the leader and he's like, Oh, but we just announced that last thematic goal. Like we can't announce a new one. And I was like, no, this is the perfect time to announce the new one. Cause you have everybody's attention. 

You know, just get right back out there and say, Hey guys, Hey, last Friday, we said this. Here's what changed. Here's the new direction. Yeah. Here's the new priority.

Daniel J. Marino:

For a lot of folks, they probably are, you know, they watch the industry and I think for the leadership team to quickly be able to pivot and pivot in a comfortable way is refreshing and reassuring to tell you the truth. 

Keith Hadley:

Yeah. That's why you know, my background is strategic planning, but I am not a fan of the formal strategic planning, especially if it has like the five year or 10 year aspect. I mean, we like to have a really simple focused approach and say, hey, let's look three years down the road. 

Like if three years, there's a mountain peak, let's call that Everest. We're trying to get there. What's the base camp I need to get to now? Like, let's think in terms of, you know, quarterly or six months increments. In light of where we want to get to in three years, but knowing that every quarter we need to review this thing. 

So whenever I see a strategic plan, I always ask like, who's the audience? Is this something you need to present to the board? Is this something you're trying to teach your director level vice president level folks that they can make better decisions? Like let's, let's keep our plans agile and flexible. 

Not our North star. We need that North star. That's our vision, but. The reality, it's just like climbing up a mountain. Yeah, we're just trying to get to base camp, we reassess the weather, the terrain, our supplies, the health of the team. And then we get to the next camp and we reassess. 


Daniel J. Marino:

Okay. This has been fantastic. I know, a lot of our listeners definitely interested in all aspects of developing leaders and certainly alignment with leadership teams and strategy and so forth. If our listeners want to hear a little bit more, how can they get in touch with you? Or what are the resources that you have available?

Keith Hadley:

Yeah. So there's, you know, if you're a podcast listener, Pat Lencioni has an amazing podcast. It's an award winning, it's called, At the Table with Patrick Lencioni, and he's also rolled out recently a new tool called the working genius, which is a terrific tool about productivity, the six activities that we have to go through to get any work done, and that's at the working genius podcast. 

And then one of my colleagues, James Felton and I are doing a podcast called the Organizational Health Advantage with Keith Hadley and James Felton. And that's available on any of the podcast forums. And, if you're interested in learning more about organizational health, of course, we just invite you to go to tablegroup.com. If you want to learn a little bit more about me, keithhadley.com.

Daniel J. Marino:

Keith. That's great. Well, again, this is a topic near and dear to my heart. We work with many organizations on their strategic development and the leadership aspect of it is just absolutely critical. But I want to thank you for your time today.

This has been fantastic. I really appreciate it. We'd love to have you back again to maybe deep dive in one or two of these topics. I think, you know, particularly around the four aspects that you had described the four disciplines. I think you touched on some great information, but thanks again for your time. This has been wonderful. 

Keith Hadley:

Thank you, Dan. I really appreciate your time.  

Daniel J. Marino:

And I want to thank our listeners today for tuning in until our next insight. I am Daniel Marino bringing you 30 minutes of value to 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.