I was intrigued when I read in Beyond the Wall of Resistance by Rick Maurer about Douglas McGregor’s theories on leadership. (Apparently, McGregor wasn’t the first to put forth these theories, but was the first to name them, back in the 1950s.)  McGregor was a social psychologist interested in how human factors affected organizational behavior and organizational outcomes.

In short, McGregor’s work described two approaches to leadership. Theory X maintained that workers need to be led. That without tight oversight, workers will become unmotivated, unambitious, and resistant to change. In contrast, Theory Y put forth that workers were not passive and under the right conditions, the average adult will accept responsibility and engage in work with creative energy.  

McGregor described the difference between the two approaches this way, “Theory X places exclusive reliance upon external control of human behavior, whereas Theory Y relies heavily on self-control and self-direction. It is worth noting that this difference is the difference between treating people as children and treating them as mature adults.”

Theory X dictates the need for a dictatorial style of management. It’s the old “top-down, mandating” type of leadership that is about control. It fuels a lack of engagement and fails to extract the full potential of employees and of the collective whole. Theory Y treats workers with respect and engages them fully in their work.

From my observations, Theory X seems to be a lot more prevalent in health care. And there is evidence it contributes to clinician burnout. A 2015 Mayo Clinic study showed that certain behaviors of leaders predicted a lower risk of burnout among physicians. These behaviors, such as “Encourages employees to suggest ideas for improvement,” are consistent with Theory Y.

Where can we find theory Y? There are a number of leadership philosophies that embrace it. For example…

Lean, when it is executed as both performance improvement tools AND respect for the workforce (the latter a too-often-forgotten tenet of the Toyota Production System that forms the basis of Lean), creates front-line problem-solvers who become experts at identifying and fixing the “bugs” and inefficiencies that bog down workflows, including those in the clinical world. For real life examples, see Leading the Lean Heathcare Journey  by Joan Wellman, Patrick Hagan, and Howard Jeffries.

Simon Sinek, in Start with Why: How Great Leaders Inspire Everyone to Take Action, emphasizes the importance of communicating the underlying reason for management decisions. When workers understand why something needs to change, they are more likely to fully engage in improvement initiatives and row in the same direction as leadership.

Bob Chapman and Raj Sisodia, In Everybody Matters: The Extraordinary Power of Caring for Your People Like Family, describe an approach to leadership that Chapman implemented at Barry-Wehmiller, referred to as “Truly Human Leadership.” By respecting the abilities of each worker and adopting humanizing practices, the company watched both morale and the company’s performance improve.

In Beyond the Wall of Resistance, Maurer provides an example from commerce. Apparently, the entirety of the Nordstrom’s employee handbook read, “Use your best judgement at all times.” How energizing it would be to work in an environment that embraced that philosophy and supported employees with sufficient training and resources to do their best work.

I’m not sure why Theory Y is the exception instead of the rule. But wouldn’t it make sense—in all kinds of ways—to embrace it in health care?