Breaking Free from Leadership Blindspots: Using Immunity to Change to Transform Health Care Leadership

In my work advising health care leaders across Canada, I've noticed that you excel at managing complexity. Whether you're leading a teaching hospital, running a regulatory college, directing a professional association, or educating our future health professionals, you've mastered the art of juggling competing priorities while maintaining high standards of care and professionalism.

But here's a question that often emerges: How can you expand how you see yourself to change the way you lead?

If this question makes you slightly uncomfortable, you're not alone. I've observed that as leaders in health care education, regulation, and practice, you're trained to focus on others - patients, students, professionals, and organizational outcomes. Self-reflection often takes a back seat to the pressing demands of your roles.

Why This Question is Particularly Challenging for Health Care Leaders

Through my advisory work, I've identified several unique challenges health care leaders face when it comes to self-reflection and change:

• You operate in high-stakes environments where mistakes can have serious consequences
• Your decisions impact patient care, professional standards, and the future of health care
• You must maintain authority while fostering collaboration
• The rapid pace of change in health care leaves little time for deep reflection
• Your professional training may emphasize technical expertise over adaptive leadership

Sound familiar? These factors can create what Harvard researchers Robert Kegan and Lisa Lahey call an "immunity to change" - a hidden dynamic that prevents us from making the very changes we know we need to make.

The Cost of Not Addressing This Question

"I don't have time for this kind of reflection," some clients initially say. "I have metrics to meet and stakeholders to satisfy."

But consider this: What if your current self-perception is actually limiting your organization's potential? In my strategic advisory work, I've seen how the way leaders see themselves can create invisible barriers to innovation, collaboration, and organizational transformation.

Research shows that leaders who don't actively work to expand their self-perception tend to:

• Repeat the same patterns even when they don't get optimal results
• Miss opportunities for innovation because they're stuck in familiar approaches
• Struggle to adapt their leadership style to changing circumstances
• Experience higher levels of stress and burnout
• Have more difficulty building truly collaborative teams

Using Immunity to Change to Break Through

This is where Kegan and Lahey's Immunity to Change (ITC) framework becomes invaluable. It's not just another leadership tool - it's a structured approach to understanding and overcoming hidden barriers to change.

Here's how you can apply it to expand your self-perception:

Step 1: Name Your Improvement Goal 

Start with a clear, specific goal related to how you want to see yourself as a leader. Common examples include:

• "I want to see myself as a facilitator of innovation rather than a guardian of tradition"
• "I want to view myself as a collaborative leader rather than the person with all the answers"
• "I want to perceive myself as a system transformer rather than just a problem solver"

Step 2: Identify Your Competing Behaviors

This is where honesty becomes crucial. What are you doing (or not doing) that works against your goal? I often observe leaders:

• Jumping in with solutions before others have fully shared their ideas
• Avoiding situations where they might not have the answer
• Focusing on short-term fixes rather than system-level changes
• Maintaining tight control over decisions rather than distributing leadership

Step 3: Uncover Your Hidden Competing Commitments

Here's where it gets interesting. In my work, I've noticed these common hidden commitments among certain leaders:

• A commitment to maintaining perfect outcomes
• A dedication to protecting your reputation as an expert
• An allegiance to traditional professional hierarchies
• A devotion to avoiding any risk of failure

Step 4: Identify Your Big Assumptions

These are the underlying beliefs that maintain your immunity to change. They take the form of assumptions like:

• "If I don't maintain tight control, quality will suffer."
• "If I admit uncertainty, I'll lose credibility with my team."
• "If I challenge traditional hierarchies, I'll face resistance from key stakeholders."
• "If I focus on transformation rather than operations, something critical will fall through the cracks."

Making the Framework Work for You

Based on my experience guiding busy health care leaders, here's how to make it work in your schedule:

1. Start Small

• Choose one aspect of your leadership identity to focus on
• Set aside 15 minutes weekly for reflection
• Document your observations in a simple one-page format

2. Test Your Assumptions

• Design small, safe experiments to challenge your beliefs
• Gather data on what actually happens (not what you fear might happen)
• Share your learning journey with trusted colleagues

3. Build Support Systems

• Connect with peer groups of other health care leaders on similar journeys
• Consider working with a strategic advisor who understands health care leadership challenges
• Create accountability mechanisms that fit your schedule

The Impact on Your Organization

I've witnessed how expanding self-perception creates ripple effects throughout organizations:

•  Innovation flourishes when leaders see themselves as facilitators rather than controllers
• Collaboration improves when leaders view themselves as co-creators rather than directors
• Change becomes more sustainable when leaders see themselves as system transformers
• Quality improves through distributed leadership rather than centralized control

Measuring Progress

Here are some metrics to help track your progress:

• Collecting feedback from your team about specific behavioral changes
• Monitoring organizational metrics that might be influenced by your leadership style
• Documenting your own observations about situations you handle differently
• Noting changes in your stress levels and job satisfaction

The journey of expanding your self-perception isn't always comfortable, but it's essential for meeting the evolving challenges of leading others. 

It all starts with you. You have everything you need to begin this journey, and the impact of your personal transformation will ripple throughout your entire organization.