Seven Inclusion Leadership Lessons in Historic Healthcare Reform – Article by Andres Tapia – Chief Diversity Officer for Hewitt Associates

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Seven Inclusion Leadership Lessons in Historic Healthcare Reform

Posted on March 21, 2010

by Andres T. Tapia –

This of course is a tricky blog post to write given the contentious and polarized debate that has ensued in the past year around healthcare reform. It’s tricky because while the politics and policy debates at the heart of what has transpired have dominated the airwaves and blogosphere, as a corporate and modern society anthropologist (which is a large part of what Chief Diversity Officers really are), what interests me is the cultural impact that greater diversity is having on the outcomes that emerge from the current mix of players. And this mix is particularly interesting because in its unprecedented diversity it’s changing the culture in profound ways, hence the subtitle of my book, The Inclusion Paradox: The Obama Era and the Transformation of Global Diversity.

So here I want to explore the lessons for leadershipin the 21st Century we can draw from President Barack Obama’s historic achievement after 100 fruitless years of leaders attempting health care reform of this magnitude. And while there are many definitions of leadership, here I am using C. Maxwell’s definition of leadership. Maxwell, a business leader is the author of various books on leadership including The 21 Irrefutable Laws of Leadership where he sums up his definition of leadership as “leadership is influence – nothing more, nothing less.” And for the sake of what? I would add: “to get things done.”

Make no mistake, regardless of whether one enthusiastically agrees or vehemently disagrees with the healthcare bill and whether it will achieve it’s stated objectives, as much as this is about healthcare, this also about leadership. What follows is an analysis of effective leadership, the ability to influence in order to get things done even in the midst of much division–but it is not intended to be about debating the particulars of the healthcare vote. Another caveat is that House Speaker Nancy Pelosi also played a vital role in winning the vote, but it is more difficult to draw broadbased leadership principles from her role to share here given the significantly more partisan role she plays.

What does it require to succeed at leading? Here are seven lessons I glean from President Obama’s approach. To make my points, I sometimes use excerpts from his words the night before the vote to those in the House of Representatives who are members of the party he leads:

Be values driven.Candidate and President Obama consistently operated from the following values:- a nation like the US needs to ensure it’s most vulnerable — in this case the sick — are protected not only healthwise but from economic ruin. (And the sick are not only those with ailments today, but it could be any one of us at any moment.)- out-of-control rising healthcare costs have to be managed to a sustainable level. And in his final push, President Obama kept coming back to these values as to the why of the effort.

“Maybe you’re thinking, Why did I ever get involved in politics in the first place? And maybe things can’t change after all. And when you do something courageous, it turns out sometimes you may be attacked. And sometimes the very people you thought you were trying to help may be angry at you and shout at you. And you say to yourself, maybe that thing that I started with has been lost. But you know what? Every once in a while, every once in a while a moment comes where you have a chance to vindicate all those best hopes that you had …And this is one of those moments. This is one of those times where you can honestly say to yourself, doggone it, this is exactly why I came here. This is why I got into politics. This is why I got into public service. This is why I’ve made those sacrifices…. and [why] I’m willing to stand up even when it’s hard, even when it’s tough.”

Application for us: As a leader, what are those moments for you? In the diversity and inclusion work in your organization, when the slog makes it feel all but impossible, what are the values you can go back to in order to remind you why you got into this work in the first place that can then give you the fortitude to stay the course?

Be in a long-term, sustainable mindset. Thinkers across the political spectrum agree that this was a politically high-risk goal to try to achieve. In the end President Obama explained why he did by quoting Lincoln: “I am not bound to win, but I’m bound to be true. I’m not bound to succeed, but I’m bound to live up to what light I have.” Then more specifically,

“Without serious reform efforts like this one people’s premiums are going to double over the next five or 10 years…folks are going to keep on getting letters from their insurance companies saying that their premium just went up 40 or 50 percent.”

Other long-term consequences that have been well documented: in the next 10-15 years another 15-20 million Americans could lose their health insurance because they won’t be able to afford it.

While some advisors and, of course, opponents were advising that he drop the effort or make the changes incrementally, leader Obama was driven by his belief that the current system was not sustainable and, while the short-term risks were very high politically, the long-term risks for the American economy and Americans were way too high. Politically, if he is right, then the long-term impact will also be beneficial to those with his point of view and beliefs.

Application for us: As diversity and inclusion leaders we know that the results we want to see are not within reach overnight. And it’s tempting to get the quick win with some visible hire at a senior level. And in the many times it works out, great. But how well are we managing the pipeline of talent, the entry and mid-level positions where it’s going to take 3 to 7 years to see the results of, but if done right, will create the most sustainable strategy for diversity in leadership rather than the current senior talent roulette we all play where we compete for the same talent as we rob Peter to pay Paul.

Have a heightened focus on results.This requires a great deal of pragmatism and ability to operationalize. Many a leader can extol great sounding strategies, but are they able to give up certain elements for the sake of influencing others to come along. President Obama has taken quite a bit of criticism from members of his own party for perhaps not being true to the totality of his convictions or not being a strong enough leader when he didn’t fall on the sword for certain cherished policy preferences by core members in his own party. His actions reveal a deep seated pragmatic approach of being willing to give up certain aspects of the plan (such as the public option) in order to gain support from enough and for enough to still have a piece of legislation that would bring about change. In this excerpt he implies, that often perfect adherence to theory, ideology, or philosophical stance can undermine any change from taking place.

“Now, is this bill perfect? Of course not. Will this solve every single problem in our healthcare system right away? No. There are all kinds of ideas that many of you have that aren’t included in this legislation. I know that there has been discussion, for example, of how we’re going to deal with regional disparities and I know that there was a meeting with Secretary Sebelius to assure that we can continue to try to make sure that we’ve got a system that gives people the best bang for their buck. So this is not — there are all kinds of things that many of you would like to see that isn’t in this legislation. There are some things I’d like to see that’s not in this legislation. But is this the single most important step that we have taken on health care since Medicare? Absolutely. Is this the most important piece of domestic legislation in terms of giving a break to hardworking middle class families out there since Medicare? Absolutely. Is this a vast improvement over the status quo? Absolutely.”

Application for us: In the diversity and inclusion space, where does our idealism get in the way of good enough? Where is it that we can — given budget constraints, leaders that still don’t get it, middle managers that are hard to move on this issue — create pragmatic and tangible enough results that when all added up begin to turn the tide? What are the list of things we are are already doing, that are the successes we are already achieving, that despite how far we may feel we may be from the desired state, still add up to a significantly better environment and set of opportunities than if nothing had been done at all?
Tap into the transformative force of inclusion. After today 32 million who have not had coverage will be included in the giant pool of the insured and they too can benefit from the entire system pooling the risk so the healthy and the sick can help protect one another. And among the un-insured who will now be covered we have had a crosssection of the US — white and people of color, low income and middle class. It also includes young people, a generation that has been the most affected by job losses, with their unemployement rate at over double the national average who now through age 26 will be covered by their parents’ insurance. This is a major inclusion play.

“But even before this crisis, each and every one of us knew that there were millions of people across America who were living their own quiet crises. Maybe because they had a child who had a preexisting condition and no matter how desperate they were, no matter what insurance company they called, they couldn’t get coverage for that child. Maybe it was somebody who had been forced into early retirement, in their 50s not yet eligible for Medicare, and they couldn’t find a job and they couldn’t find health insurance, despite the fact that they had some sort of chronic condition that had to be tended because somewhere deep in your heart you said to yourself, I believe in an America in which we don’t just look out for ourselves, that we don’t just tell people you’re on your own, that we are proud of our individualism, we are proud of our liberty, but we also have a sense of neighborliness and a sense of community and we are willing to look out for one another and help people who are vulnerable and help people who are down on their luck and give them a pathway to success and give them a ladder into the middle class. That’s why you decided to run.”

Application for us: the greater the diversity that comes into your organization’s doors, and the more benefits policies or advancement processes continue to exclude them, the more the pressure will build to challenge a system that perpetuates marginalization. The message is simple and compelling. When we don’t include all in the benefits of being part of the overall society or organizations, the cost is not just to the marginalized but the dislocations caused by keeping so many out start to spill out into the entire organization.

The bottom up is as important as the top down. Like he did in his campaign not only did Barack Obama work top down through the House and Senate leadership including attempting to do so with the Republicans, he also directly reached out to normal citizens through dozens of healthcare town halls, several healthcare rallies in the final weeks before the bill’s passage, through Tweets and through email. He led the effort to mobilize hundreds of thousands to express their support. To be sure, so did the opposition– and the grassroots, bottom-up energy on both sides has been a significant part of the debate as difficult and painful as the debate got. Leadership, both sides of the debate realized, require tending to and giving voice to the bottom up. And it does make a difference on results. Application for us: As a diversity and inclusion leader, how much are you tapping your affinity groups to not just have them be social gatherings but to be forces for change? How are you giving voice to their marginal voices so that their experience in the organization can be heard and their unique insights into what would create greater inclusion can be translated into policies and culture change? How much does their unique perspective into diverse ways of thinking is being captured in terms of enhancing their company’s products and services in order to grow their markets as they pursue tapping the growing diverse marketplace?

Be relentless. From his critics on the left to the right there is one thing they agree on and that is that President Obama showed resilience in living up to what he said were his agenda priorities. In a short-term focused society this is quite remarkable. A year of painful, and protracted debates in congressional chambers and on the streets, even after a big political setback like the result of the Massachusetts election to replace the deceased Senator Edward Kennedy that broke the Democrat’s filibuster proof majority, when most commentators were saying healthcare reform was DOA, the president continued soldiering on. Part of being relentless is not just to persevere but also to keep adapting one’s approach as one discovers what is not working and trying something new again and again until it works. And given the withering criticism, the sagging poll numbers, President Obama’s relentlessness driven by his convictions (and some say his will to survive politically) kept pressing on and calling those on his political side to stand fast.

Application for us: As a D&I leader where it that you continue to show relentlessness? where is it that you feel your stamina is flagging? What do you need to not give up on? How do you draw from your values, from the results achieved so far by others before you and due to your own work to persevere?

Be inspirational. It’s not about being inspirational for inspiration’s sake, but the truer, more profound way to inspire is to effectively perform the other six principles here. Nothing is more inspiring that hearing a leader have a vision and then be successful at bringing about change. It’s easy to pinpoint what is wrong, ten thousand times more difficult to implement a solution. But to be able to bring about change where in 100 years other presidents have not able to, is in the end, what counts when it comes to leadership.

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