Reviewed 07/2007

Every day we are faced with with both the challenge and opportunity to demonstrate leadership in our lives. In our work in quality improvement, we continue to demonstrate localized gains, but eventually see ultimate failure to successfully have a "project" become fully ingrained into our practices. The increasing focus on leadership has led to multiple opportunities to learn about leadership skills in many venues.

Leadership on the Line is a book which is a must read in my mind for those interested in making quality improvement work part of our organizational culture. Ron Heifetz and Marty Linsky present a model of adaptive leadership, which delineates the difference between adaptive and technical work. Adaptive work involves addressing our basic beliefs, values, and principles, and is always associated with a sense of loss. But not addressing this type of leadership will ensure we continue to encounter the same limits we see in our work today. Those who read this book will not walk away with a step by step process for success, but will have a greater clarity of the challenges which face us and the work which needs to be addressed.

Over the last year, ICSI has begun to explore this concept, and identify opportunities to integrate this important concept into collaborative activities. In a very readable and engaging style, this breakthrough book discusses adaptive leadership as a model which requires a different type of approach and different skill sets. As the authors discuss the elements of the model they've developed, readers will gain an appreciation for the type of leadership needed, and recognize the tremendous challenges presented to those who become committed to this work.

"Disappointing people's expectations at a rate they will tolerate" is a theme which while glib, is a key essence of this book. Additionally, hearing about the need for personal reflection is invaluable as one contemplates this course of action which while essential, is associated with both personal and professional risk. Those reading this book may disagree with some elements, but hopefully will seek to learn more about its potential application to our work in improving the care our patients expect and deserve.