The Fourth Discipline: Transition Management

Leadership Transformation Series

This is Part 1 of a Four-Part Leadership Transformation Series (LTS).

2012 Womens Olympic Triathlon finish in London -  After two hours of racing with the best in the world, what would one or two seconds in transition time have meant for the top three athletes?

2012 Womens Olympic Triathlon finish in London - After two hours of racing with the best in the world, what would one or two seconds in transition time have meant for the top three athletes?

Transformation in healthcare is personal: it requires the transformation of health system leaders. This LTS begins to speak to key differences in some of the fundamentals of transformational vs traditional leadership in healthcare.

This article focuses on how the nature of our work is changing. 

Many compare the healthcare transformation journey to one of our oldest Olympic sports: “It’s a marathon!” Although this might reflect the persistence, resilience and endurance sentiment, I offer an analogy upgrade from one of our newest Olympic sports: “It’s a triathlon!” 


First, transformation requires mastery of multiple disciplines. We – and our organizations - may have competency in one or two disciplines, but adaptive learning is required to develop and integrate the different and stronger skills needed for next level or breakthrough performance. We cannot count on simply doing more of the same ‘one foot in front of the other’ plodding and grinding to advance our mission – our people are burning out. Unlike in the run or bike, the first triathlon discipline – the swim - does not ask as much of the legs. While the upper body provides most of the forward propulsion, for swim speed it is more important to reduce drag. Drag is not a material factor in running, but it is in running our organizations – and barnacles, barriers and anchors come in many, mostly self-inflicted, forms. 

Second, continually better Triple Aim outcomes requires use of evidence-based improvement methods. One element of this model is a high cadence of accountability with robust and transparent feedback. On the bike, after addressing aerodynamics, gear choice and pedal turnover rate (cadence) determine speed. Professional triathletes and bikers have found that using a higher cadence – relative to pushing a harder gear - is better for success. As leaders, we need a high cadence of communication and frequent “bio” feedback loops (compare heart rate monitors to rounding and surveys) to help adjust, e.g., shift gears, to assure our pace does not exceed our organization’s ‘lactic acid threshold’ (compare to burnout rate) for too long. 

Finally, we must manage transitions well. The corollary is: we are always in transition. Just as triathletes have acknowledged the criticality of this ‘fourth discipline,’ Triple Aim advocates recognize the “Triple Aim PlusOne” or ‘Quadruple Aim’ as a more apt term to capture the wholistic, human dimension. In his book Managing Transitions, Bridges asserts that “it isn’t the changes that do you in, it’s the transitions.”  A transition involves change on a personal, psychological level that a change may not. And morphing from horizontal-in-a-wetsuit to vertical-on-a-bike, all while still moving forward, does not just happen. Figuring out how to reduce time off a T1 (transition from swim to bike) often yields a better return on investment compared with what it takes to reduce a triathlete’s run split. To help the system and our team work smarter, not just harder, we as leaders must work on the system that our people work in. 

So what?

The trifecta of removing barriers to reduce drag, helping to design and install an evidence-based improvement model, and managing key transitions well are among the reasons why top professionals engage a coach as an integral part of their team. The high turnover rate of healthcare CEOs suggests that many CEO roles are transitional: role tenure is often aligned with a specific transition needed by the organization. One recruiter noted that in the next few years their firm expects 40% of CEO roles to be interim. Managing transitions well often means matching an “interim” organizational transition with an “interim” leader. This can better position the organization, and a subsequent CEO who follows a major transition, to advance to the next level. 

This perspective reminds me that my role in the journey is always transitional. And success is not defined by how long I am in a particular role, but rather did I do what was required of leadership at that time to help the organization advance through a key transition. This is not easy. For me, it is a relentless passion to help a team pursue world-class performance in service to others that gets me up each morning. For leaders and triathletes, mastering the fourth discipline – managing transitions well – is fundamental to the broader transformation of healthcare…and ourselves.

Rob Thames, FACHE, FHFMA, has served as CEO, COO, consultant/coach and Team USA triathlete. He is currently in transition.

Read Part 2 Here.