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FOLLOWERSHIP: A Leadership Outcome Measure

Although followership is a topic that is infrequently addressed, it is an essential part of successful leadership. If leaders do not have followers, their ability to influence and create change is limited. In this era of outcome measures and results, the degree to which leaders can successfully create followers who are aligned with the mission or issue demonstrates their success at making a difference.

Oftentimes we think only about the leader roles and behaviors that help create successful engagement. In so doing we miss the follower in that equation. Developing committed followers is the purpose of leadership, first and foremost. If the leader cannot manage that relationship in a way that builds follower trust, empathy and confidence, the relationship falters. The leader has no committed followers. The leader struggles with attaining his/her goals.

Change is present in every industry and organization. Healthcare faces enormous impact from the external environment which is causing huge shifts internally. With the changes anticipated from healthcare reform, hospitals and healthcare organizations will need to work more differently than they ever have before. It will mean fundamental changes both in structure and process. In order to be successful, leaders must develop followers who understand their role in the success of the organization, foster their engagement and provide them an opportunity to help structure their workplace. If followers are just “inflicted” with changes, their willingness to engage will fall short, as will the transition and desired outcomes.

Followership is a complex process. Working with organizations as a consultant and operational leader, I often see them forget about the alignment of goals among all levels, such as when they focus on staff satisfaction rather than engagement. Active engagement is the willingness of followers to give it their all because they believe in the people and purpose of the organization. You can evaluate the concept of engagement by how well metrics are being achieved. For example, compliance with regulatory mandates seems to always be an issue with healthcare organizations. Getting people to fill out a check list or complete a form is a struggle when it is approached from a perspective of “must do for compliance” rather than engaging followers to create a process to make this successful for patients, meaningful for staff AND to satisfy the mandate. Frequently we construct a process for compliance that never engages the follower- it misses the mark and doesn’t get the outcome that is intended. To make it successful we have to use the follower’s commitment, knowledge and expertise to tell us how to do it so that it works, instead of just designing something and telling them to do it.

Imagine a  hospital working to improve its metrics and outcomes around staff completing a daily goals checklist for critical care patients. The form was initially created by leaders and then handed off to staff with the requirement to “fill this out every shift”. As expected, staff’s willingness to complete the form was low, as was compliance. After 2 months of very poor results, the unit manager grouped a few staff leaders together to discuss a different approach. She admitted that it would have been much better had she worked directly with them first. Rather than start this discussion with “it is a requirement”, she asked the staff for their ideas about why reviewing and checking goals daily would be a good thing. A staff nurse brought up a recent example where a patient stayed 3 days longer in the CCU than necessary because a floated staff member had not picked up on a goal related to transfer to the rehab facility. A weekend with poor connections for this transfer passed. And likely as a result of this longer stay, the patient developed a hospital-acquired infection. The staff were upset about this, not to mention the patient and her family. So they worked together to decide what needed to be on a daily goals checklist and how best to simplify the process. One nurse had the idea that they should inform families about this process on admission, as a way to strengthen the staff and family partnership, and to have another pair of eyes to help make sure daily goals are being addressed. This staff-led process engaged followers and focused on developing commitment and an investment in the outcome. The process moved beyond simple compliance, and helped to sustain an important change as well as enhance relationships with families.

Followership is an active and reciprocal process. Followers are not passive and don’t just go blindly into doing something without asking questions. In this way followers develop the skills to become leaders. To gain commitment and to have a guiding coalition to marshal change, followers must be engaged by leaders who know how to connect, communicate and build trust.

Craig S. Laser, RN, BSN, MA
Senior Associate
602.579.2826

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