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
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
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
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.