Arthur Lazarus, MD, MBA

Talking honestly about problems can help organizations, so long as those in charge take a compassionate approach

Arthur Lazarus, MD, MBA

Conflict in organizations is pervasive; the challenge for health care leaders is to handle it constructively. It is often useful to externalize conflict in order to resolve it. The metaphor of a "moose on the table" can be used to externalize conflict and provide some distance from the source of tension, making it easier to deal with. The moose symbolizes painful issues no one wants to confront; yet a leader will always address them.

Randall Tobias, chairman emeritus of Eli Lily and former vice chairman at AT&T, frequently used the moose metaphor as a leadership tool. In Tobias's book, Put the Moose on the Table, current Lily chairman and CEO Sidney Taurel observes: "We had a tendency [at Lily] to sometimes not say things as they really were in order not to offend one another. That can be very counterproductive. So we adopted Randy's phrase 'get the moose on the table' as a lighthearted way to signal that we needed to speak openly and honestly about an issue at hand."

It was also a pharmaceutical executive (not Tobias) who introduced me to the phrase "put the moose on the table." The executive frequently uttered those words during high-level merger discussions whenever parties appeared to reach an impasse. The executive's well-timed comments kept the discussions going and the merger occurred on track.

Apart from handling conflict openly and honestly, conflict should be embraced with compassion. The psychologist David T. Kyle has identified compassion as one of the four "powers" of leadership, along with presence, intention, and wisdom.

The myth that leaders must be aggressive and cannot show compassion is debunked in Built to Last, the book that identified 18 visionary companies and determined what is special about them. One of the core myths, according to the authors, is that domineering and charismatic people lead visionary companies. There are examples of that pattern, but there are also just too many counterexamples — in reality, the majority of the visionary companies are run by remarkably self-effacing leaders. In fact, a take-charge charismatic leader can be detrimental.

I once worked for a health care organization led by an individual admired for his winning personality, yet he caused the company's demise. The organization filed a $1.3 billion bankruptcy in 1998, the largest ever in not-for-profit health care. Detailed published accounts of the bankruptcy faulted the CEO for ill-advised acquisitions in a medical arms race with competing health care systems. But the real lesson was embodied in the moose.

The CEO's strategies were never challenged, and the CEO himself went about his business unchecked and unopposed. Coworkers feared him, and nobody ever said "Put the moose on the table."

Arthur Lazarus, MD, MBA, is senior director of clinical research for AstraZeneca Pharmaceuticals in Wilmington, Del. He is editor of MD/MBA: Physicians on the New Frontier of Medical Management (American College of Physician Executives, 1998). He can be reached by phone at 302/885-4542 or by e-mail at His opinions are his own, not necessarily those of AstraZeneca or Managed Care.

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