Transactional vs Transformational Leaders

When considering the difference between transactional vs. transformational leaders, the Rolling Stones had it (almost) right.  Unlike the song lyrics, you can get what you want.  With transactional leaders, if you tell them to do something, they will check the box and it will be done.  However, there are times when real value is in the leader who helps you not only get what you want, but also get what you need.

There is no question we operate in a complex industry and in a complex world.  The challenge in health care is in not making the complex complicated.  That’s where transactional leaders are all about checking off the boxes.  They are told to do something, they know how to do the work and will do it, as prescribed.  Box checked.

On the other hand, transformational leaders empower others, creating boxes for others to check off that they didn’t even realize were needed, at first, but relish the tangible results.  These leaders inspire the work through attributes that are not tangible, but if you focus on them, these attributes inform transactional leadership and help it from becoming more complicated.

Let’s say that the readmit rates at Mid-Size Rural Hospital “A” were far exceeding targets.  Patients and their families were frustrated with these poorer outcomes.  A transactional leader is told to reduce readmits by extending stay to ensure the patient is healthier at discharge, because hospital administration is just sure that the patients are leaving too soon.  Patient stays are mandated to extend an extra 24 hours and the entire hospital cadre focuses a tremendous amount of effort on entreating CMS to authorize the investment.  Averaging an extra night’s stay to achieve healthier outcomes is a small price to pay, right?  This situation underscores that transactional leaders struggle with the gap between thinking-its-done and actually getting-it-done.

In contrast, the transformational leader knows that releasing the patient too soon is just one aspect of the breakdown in Hospital A’s discharge process.  Other issues are also important, such as engaging the patient in managing disease conditions, along with warm transfers by talking directly to providers in the next care setting.  All of these solutions work together, creating a more successful outcome, along with producing more engaged patients and families.  And, of course, re-admit rates plummet.  See?  With transformational leaders, you get what you want and you get what you need.

Some health care administrators are looking for a miracle, but they also like things just the way they are, thank you very much. Many are struggling with the sea change in how health care is managed. Unfortunately, “just the way they’ve always done it” is frequently cumbersome and adds another box to check, just making it more complicated.

Rather than looking at the task with the mindset of “somebody’s making me do this,” question or reflect on the “why” of it, not just the functional roles of leadership. If you’re doing a retrospective annual review of your employees, for example, you can surely fill out the current forms and call the job “done”.  However, that is just a transactional function.  It’s yes-or-no.  End-of-story.  Then you address the next task which is the next box to check.

Instead of asking “how do I critique something that was just completed?” the transformational leader asks “how do I move something forward?”  So, in the situation of the annual review, the transformational leader looks at it as a prospective opportunity to ensure that in the year ahead, his or her staff understands how their work impacts the future success of the organization and how to accomplish complex work without making it complicated.  The transformational leader approaches any activity a future focus.

The work we do in health care is complex and messy.  There are a lot of people who view solutions or esteem success in neat, tidy rows.  They just line up blocks without thinking about their correlations.  They create silos but they are just sure that they’ve got it all figured out.  And, it makes things more complicated, not just complex.  To get to the heart of transformational change, you need identify core challenges and implement solutions that improve the functionality of the medical practice.

Next time the problem you yearn to solve rears its ugly head, fill the gap between think-it-done vs. get-it-done.  See the transactional issues before you as a symptom of this transformational divide.  And, yes, you can get what you want, by solving the problem, and also get what you need, by fostering sustainable success at the new business of health care.  What’s holding you back?  You can do this.

We can help.