A collaboration with partner Mo Kasti 

accelerate blueAmerican companies spend almost $14 billion annually on leadership training seminars. Yet, according to Gallup and others, the level of employee engagement has improved very little over the last 15 years. The cost of the current level of low engagement is estimated to be almost $450 billion per year in American companies.

In healthcare, recent Gallup studies of more than 6,000 physicians in the United States show that only 10% of physicians are fully engaged with their hospitals, while 42% are actively disengaged.

The cost of poor engagement to hospital systems can be measured not just in ROI and profit or loss, but in the metrics that reflect quality of care, including patient experience, referrals, patient safety, readmissions, hospital-acquired infections, etc.  In healthcare, the cost of low engagement is very high.

A Quicker Path to Engagement

The reasons for low levels of engagement in healthcare organizations are many and largely due to the unprecedented pressure to transform an entire industry in a relatively short period of time. Healthcare administrators and clinicians really are trying to ‘redesign the aircraft while it is flying,’ only they have to do it while caring for a planeload of very sick passengers. Engaging healthcare workers in the process of transformation is understandably a challenge, but there is a way to score some quick wins.

One strategy of engagement and leadership training that often is overlooked is identifying and developing the key influencers who possess some natural leadership qualities. Usually they are the people doing most of the work. These natural leaders exert a form of leadership that affects attitudes, engagement, morale, openness to new ideas, a culture of high connection and caring as well as the ability to leverage all of the creativity that exists in a work area. They understand the need for change, they are often the first to see threats or opportunities and have the zeal to implement ideas.

How to Identify High Potential “Natural” Leaders

otential leaders predisposed with natural ability are all around us and easy to see if we look for people who:

  • Help make the daily business of the organization hum.
  • Naturally make the right things matter most.
  • Create strong authentic connections built on trust.
  • Exude positive attitude and trigger the best instincts of others.
  • Are early adopters because they are ahead of the norm

These influencers are not a separate group of consultants, new hires, or task force appointees. They are individuals who bring energy, commitment, and genuine enthusiasm to their daily tasks.

Why do we call them “natural” leaders? Because their influence on others is a form of leadership. They lead by example. They are not afraid. They play to help everyone succeed. By their very presence, they influence others in a good direction. These attributes are not always obvious, especially in a low-engagement culture. But it is there as potential that can be mined and leveraged. With proper training and development, these influencers can develop strong abilities to self-motivate and inspire that same passion in others.

Finding these people, bringing them together in clusters, supporting them as they deepen their own learnings, and teaching them to enlarge their influence is a powerful way to ensure that high engagement is occurring in a way that it is aligned with the best that formal leaders can bring to their task.

How to Develop High-Potential Natural Leaders

Natural leaders, along with formal leaders, can create an emergent high-performance culture and spread that culture throughout the organization. Once you identify them, share your vision, ask for their help, and demonstrate your trust and confidence by investing in their development.

Natural influencers can become highly effective leaders through education and training that helps them see their own natural abilities and gives them the opportunity to learn and collaborate with like-minded colleagues. And, to turn the flying aircraft metaphor on its head, practicing engagement and developing leadership skills is done best with applied learning through real-life improvement projects. So your influencers and future leaders can learn and exercise their engagement muscle while also actively making clinical, operational, and/or cultural improvements.

The benefits and outcomes of investing in these natural leaders will be perpetuated for many years to come as they engage others by forming clusters of influence, equipped with the power of their leadership skills.

How to Deploy Leaders

To deploy these leaders, think of your institution as one organization with two structures, as illustrated below.


Your leaders can and will come from all ranks of the organization’s hierarchy. Their effectiveness depends on building networks around initiatives and letting the leaders exert positive influence engaging and inspiring others.

A Powerful Combination

Virtually all truly successful change efforts include some combination of training, developing, and encouraging formal leaders, while at the same time developing and supporting the attributes of natural leadership among those who are not formal leaders and then deploying them in ways to maximize their impact on others.

Without a focused engagement and leadership development strategy, change efforts tend to snap back because the pervading culture overwhelms initiatives focused on transformation. But when the right people are engaged, developed, and effectively deployed, transformation not only continues to move forward, it does so at an accelerated pace.

lew-frees-150x150Lew Frees, PhD, is the President of Harmony Inc.  He has more than 30 years’ experience guiding transformational change in organizations from Fortune 500 companies to small businesses, including many healthcare organizations.  Lew’s most recent work is based on his forthcoming book: “Align: Leading from the Inside Out,” in which he describes a multidimensional change process that significantly increases the level of engagement by leveraging the natural leadership that exists throughout an organization.

Mo KastiMo Kasti is the CEO and founder of CTI and its Physician Leadership Institute, dedicated to accelerating clinical transformation through leadership and innovation.  An energetic and creative innovator with more than 25 years of experience in healthcare and leadership, Mo is an expert in transforming physicians, leaders, and organizations. Mo’s recent book, “Physician Leadership: The RX for Healthcare Transformation.”  has received high praise from executives across the healthcare industry. Mo has spoken on healthcare leadership topics to hundreds of physician and C-Suite audiences.