The Journal of Continuing Education in Nursing

Leadership and Development 

Advancing Lateral Leadership in Health Care

Michael R. Bleich, PhD, RN, NEA-BC, FNAP, FAAN

Abstract

Lateral leadership is a growing and recognized form of nonhierarchical leadership used in complexity science and systems thinking organizations. The definition and operational necessity for lateral leadership are discussed, and benefits and potential drawbacks in health care settings are presented. Lateral leadership is a strategy of growing necessity in an environment of innovation and change management. [J Contin Educ Nurs. 2019;50(9):389–391.]

Abstract

Lateral leadership is a growing and recognized form of nonhierarchical leadership used in complexity science and systems thinking organizations. The definition and operational necessity for lateral leadership are discussed, and benefits and potential drawbacks in health care settings are presented. Lateral leadership is a strategy of growing necessity in an environment of innovation and change management. [J Contin Educ Nurs. 2019;50(9):389–391.]

Like most organizations, health care is heavily oriented around hierarchical structures, a reality that may have served the past but is less likely to demonstrate the flexibility required in response to changing consumer demands. Professional development educators are tasked to increase the adaptability, agility, and flexibility of individuals who comprise the health care workforce. This acknowledgment, ironically, often comes from top-down leaders who request these traits in structures they have either created or maintained—structures that are rigid and fixed. Yet lateral leadership exists in organizations that are highly structured, where individuals expend large amounts of energy working around and through barriers, and in new organizations designed for fluidity. New market-entry health care competitors are more likely to design fluid organizations that respect lateral leadership, which portend a competitive advantage.

Many definitions of lateral leadership exist. Synthesizing key concepts, I define lateral leadership as a collaborative team of peers with differing attributes and professional backgrounds who band together for complex problem solving or creative innovation, experience this process as peers, respect and explore new relational opportunities spanning traditional boundaries, and agree among themselves who is most apt to keep the central aim focused through roles as facilitator, tie breaker, spokes-person, schedule keeper, and documenter. Lateral leadership, in this sense, is eye-to-eye leading, absent of a hierarchical figure, letting each team participant maximize the use of his or her abilities.

Forward-thinking leaders are taking down walls in their organizational structures, essentially flattening the layers between front-line providers and administrators. Rosen (2017) noted that static organizational structures, vertical reporting lines, arms-length relationships with other organizations, upward information flow, and downward decision making and directives are being abandoned.

These traditional structures are being replaced with multidirectional information exchange and the use of engaged experts to augment decision making. Influence, and not control, becomes the dominant mental model, and leadership development training is augmented by network development, empowerment, systems thinking over systematic thinking, and minimal specifications, giving teams the space to generate new ideas and solutions to chronic problems. These are the skills and abilities commonly aligned with complexity science principles. In lateral leadership, team members negotiate who facilitates the group, documents planning and implementation strategies, keeps efforts on schedule, breaks a tie in the event of an impasse, and represents the group's interests to key stakeholders. Each function is an act of leadership and talent optimization. Lateral leadership requires a more expansive way of thinking about organizations, the talent available in the organization, and trust building through actions taken.

Qualities in Lateral Leaders

In his work, Herbig (2018) advocated for lateral leadership, which confirms that in the formation of a team of lateral leaders, it sets in motion a dynamic that addresses the too-often disappointments of professionals in daily work settings: an absence of professional achievement and pride, advancement opportunities, and interpersonal relationships. Considerable noise and chaos exist in health care settings, as creativity and innovation to personalize patient care within ritualistic structures create tension among providers with spillover to provider–patient relationships. The lack of role respect and fluidity leads to distrust and a yearning to be part of an effective team. Herbig contended that people managers—those with supervisory functions—may not be in the best position to meet the personal motivation needs that lateral leadership teams can fulfill.

A lateral leadership team forms—often organically—when there is a complex problem or project designed to innovate a solution. Usually, the problem is chronic with a known history and past failed attempts to solve the problem. A lateral leadership team should be expected to expand the menu of solutions or strategies available when problem solving, minimize the unintended consequences when introducing a solution, and make robustly informed choices. Lateral leadership teams are, in a sense, leaderless in the top-down sense of organizations. Rather than a single leader who becomes the de facto fallback, each team member owns the problem and solution and is acknowledged by other team members for their leadership contribution. This acknowledgment comes when multiple members identify where in the system the problem emanates, analyze the upstream and downstream variables creating the problem, project the intended and unintended outcomes derived from the course of action, and project how other parts of the system will be influenced by their decision making. Each participant's leadership voice is needed to achieve this, thereby advancing each member's sense of purpose and camaraderie among the others, their unique professional abilities, and the eradication of the de facto single voice of an assigned hierarchical leader.

Lateral leaders challenge the status quo, realizing that policies, procedures, algorithms, and protocols emanating from hierarchical designs are suspect as part of the problem, show capacity for exploring problem-solving options via their expansive and nuanced experiences, collaboratively engage in creating a culture of inclusion, and remain curious, listening and inquiring with intention.

Does Lateral Leadership Work?

The idea of lateral leadership is not new, and it has proven to be helpful. In the world of innovation, lateral leadership is increasingly present in design thinking, whereas individuals surrender and challenge themselves to think creatively and without abandon to generate breakthroughs. It has worked in the past in informal situations, such as workarounds that take hold and become normalized. It has worked when unlikely alliances have formed to forge relationships with individuals representing differing values, interests, or assumptions, but a common goal.

Lateral leadership works best when applied beyond day-to-day decision making and problem solving. When a holistic approach is needed, lateral leadership is most able to identify how systems are embedded within other systems and how the parts will be affected. Lateral leadership is ideal for exploration, experimentation, and anticipation of individual, professional, organizational, or social consequences that may impede change—it can create movements, tap energy, and message for impact and action which requires keen communication, preparation, and implementation skills (Geiger, 2015). Lateral leadership involves building in the capacity for scalability. Ultimately, lateral leaders are important figures in normalizing the impact of change (NHS Education for Scotland, 2016).

Professional development educators employ lateral leadership principles in interprofessional training and development where roles and functions of varying disciplines are explored, and a spirit of interprofessional cooperation is fostered. Crucial conversations and conflict resolution skills training contribute to lateral leadership by approaching high-stakes communication. Appreciative inquiry emphasizes relationship sensitivities to lived experiences, teasing out the context for understanding an issue in depth. Many quality improvement, team training, ethical decision-making tools are adjunctive to lateral leadership. Although each serves an honorable contribution to lateral leadership, none are comprehensive in evolving organizational design to meet consumer demands. Lateral leadership deserves attention for its overarching reach as a framework to complement other approaches to leadership development.

As multigenerational health care professionals expand, their demand for workplace experiences that transcend traditional concepts of leadership will rise. Rosen (2017) reflected that authority and control over professionals in the form of organizational, financial, physical, or intellectual factors restrain joy and acknowledgment in the workplace. Adaptive human resource benefits that steer away from a one-size-fits-all mentality might better be replaced with structures that reward creativity and innovation, implementation and scalability, and relational excellence that is generated by lateral leadership options.

Summary

Although lateral leadership is not new, its theoretical development is expanding. It suggests a fluid dynamic necessary to withstand a range of possibilities as extreme as health care mergers and acquisitions, unit and service consolidations, to care continuum expansion. It is a skill set that executives need if they are committed to the goal of unleashing human capacity and responding to imminent competitors. These competitors are more likely to create structural designs to motivate and excite professional workers, many of whom are extremely well-educated and under-used in roles conscripted through the convention of hierarchy. Professional development educators can contribute to lateral leadership knowledge and practice.

References

Authors

Dr. Bleich is Senior Professor and Director, Virginia Commonwealth University School of Nursing, Langston Center for Innovation in Quality and Safety, and President and Chief Executive Officer, NursDynamics, Ballwin, Missouri.

The author has disclosed no potential conflicts of interest, financial or otherwise.

Address correspondence to Michael R. Bleich, PhD, RN, NEA-BC, FNAP, FAAN, Senior Professor and Director, Virginia Commonwealth University School of Nursing, Langston Center for Innovation in Quality and Safety, and President and Chief Executive Officer, NursDynamics, 221 Jasmin Park Court, Ballwin, MO 63021; e-mail: mbleich350@gmail.com.

10.3928/00220124-20190814-03

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