The first obligation of a leader is, of course, to lead. But leading always begs a question — toward where? The quality of leadership ultimately must be judged by the degree to which followers arrive at an intended place that's worth going to.

A description of that place worth going to is often called vision. It is a picture painted with words that describe an organization's aspirations realized. The path to that vision usually will embody a degree of uncertainty and resistance. How the path will be navigated can be described properly as strategy. Absent uncertainty and resistance, there's no need for strategy. A to-do list will suffice. When the degree of uncertainty and resistance is low, an organization may get by with mediocre and even poor leadership. The more intense the uncertainty and resistance, the more important the quality of leadership becomes.

Clear Communication

Today, there's wide agreement in health care that levels of uncertainty and resistance have risen. Driving this is a confluence of catalytic forces. Obviously, reform efforts have had a major impact, but so have rapidly shifting demographics, advances in technology, a lingering recession and new competitors. Rising levels of uncertainty and resistance generate rising levels of complexity, including increased volatility. Volatility describes loss of predictability related to the frequency and amplitude of swings in situations where consequences can be threatening.

Leadership relies on communication. The need for clear communication increases in direct proportion to the level of volatility an organization faces. Volatility is characterized by lots of noise. By noise, I mean signals that lack relevance. Volatile situations are also rich in the potential for confusion and unintended consequences. In such situations, the quality of leadership is invariably a reflection of the clarity of communication regarding where the organization is going and how it intends to get there.

Clarity requires specificity. Specificity yields precision. It enables focused concentration of resources, both human and financial. It also delivers efficiency because it reduces misdirection and wasted effort. And perhaps more importantly, it reduces the confusion and anxiety that ambiguity generates. Confusion and anxiety are dispiriting, and they chew up precious energy and emotion. Too often, it is when organizations most need clarity that they get empty slogans, overused catch phrases and conventional wisdom dressed up as destinations worthy of commitment.

For an executive, particularly a CEO, there are two places where specificity must be delivered — vision and strategy. A useful vision statement can rarely be distilled to a single sentence. It has to reflect the complexity of the situation in which it is intended to provide direction. To be sufficiently specific, it must clearly address two questions: (1) How will we be different? and (2) What do we need to be really good at in order to be different?

Having answered those two questions with sufficient specificity, a leader must then answer a third question: What is most important to do to realize the vision given the uncertainty and resistance we are likely to encounter? That's strategy. And despite management literature that seems to presume that organizations can succeed with a strategy (as in "What's your strategy for success?"), organizational success demands specification of multiple strategies — five to seven high-level driving strategies usually will be required to provide sufficient specificity.

Specific Language

When it comes to specificity, words matter. In fact, a leader only has two fundamental tools with which to generate accomplishment and performance: words and actions. The two need to be connected. Action validates, reinforces and operationalizes a leader's words. Choosing the right words takes thoughtfulness, time and dialog to generate the specificity needed for clarity of meaning. For example, what does integration mean for us? What about partnership and alignment? I can tell you from experience that those two words often have a different meaning for physicians than they do for executives and board members.

Although vision statements and strategies ought to be clear enough to stand on their own, they usually will benefit from explanations that provide additional specificity. A strategic plan is, or ought to be, the story of the organization's future. Like all good stories, it benefits from drama, metaphors and anecdotes, all of which lend greater specificity. Good leaders illustrate vision and strategies by translating them into the relevance of "what this means for us" and "what this means for you."

Specificity doesn't necessarily mean more words. But it does mean enough words. The directive to "take the hill" may be specific enough if there's one hill and the timing is irrelevant. But more complexity in a situation generates the need for more specificity. If there are many hills, which hill? When should we take the hill? And what if there is an opposing force on the hill?

A good way to judge the complexity of something is to ask how many words you need to describe it. Take a standard sheet of paper. It's usually white, 8.5 by 11 inches and has a specified weight. Now wad it up. How big is it now? How many wrinkles does it contain? What are the angles of those wrinkles? The sheet has become more complex and requires more words to describe. For an organization, the need for specificity correlates directly with the complexity of its situation. Here are some shining examples of forward-looking specificity offered in the face of complexity and volatility:

" … We here highly resolve that these dead shall not have died in vain — that this nation, under God, shall have a new birth of freedom — and that government of the people, by the people, for the people, shall not perish from the earth." — Abraham Lincoln

"We choose to go to the moon. We choose to go to the moon in this decade and do the other things, not because they are easy, but because they are hard, because that goal will serve to organize and measure the best of our energies and skills, because that challenge is one that we are willing to accept, one we are unwilling to postpone, and one which we intend to win, and the others, too. … " — John F. Kennedy

"We shall go on to the end, we shall fight in France, we shall fight on the seas and oceans, we shall fight with growing confidence and growing strength in the air, we shall defend our Island, whatever the cost may be, we shall fight on the beaches, we shall fight on the landing grounds, we shall fight in the fields and in the streets, we shall fight in the hills; we shall never surrender, and even if, which I do not for a moment believe, this Island or a large part of it were subjugated and starving, then our Empire beyond the seas, armed and guarded by the British Fleet, would carry on the struggle, until, in God's good time, the New World, with all its power and might, steps forth to the rescue and the liberation of the old." — Winston Churchill

Steve Jobs' Example

A lot of ink has been spilled on the legend of Steve Jobs. And he deserves the attention if Apple's recent success is considered. But the quality of his leadership was far from constant. There were at least three versions of Jobs. Version 1.0 had exhorted Apple to build computers that were "insanely great" and put a "dent in the universe." The language was wonderful, but it provided none of the specificity needed for clarity of direction. Precisely how and when does a computer become "insanely great"? And how do you know when the "universe is dented"?

Jobs 1.0 was a notoriously poor leader and it showed in Apple's performance. Corporate myths and nostalgia aside, for two decades Apple got manhandled by Microsoft and IBM; it sold variations of the same underpowered Apple II computer for 16 years, mostly to schools and hobbyists. Meanwhile, Bill Gates captured the corporate market and all serious computing got done on an IBM desktop or one of its clones. Apple's attempts to compete in the corporate market failed. Two thousand seven hundred of its Lisa computers went into a landfill and, as iconic as the Macintosh was, it remained a niche product and never seriously threatened the Microsoft-IBM combine.

When Jobs was forced out of the company he founded in 1985, it was partly because the Macintosh had hit only 10 percent of its sales projections. It was also because Apple's board had become convinced he was incapable of executing a clear vision. Thus began the "wilderness years" that produced Jobs 2.0. His attempt to start a new computer company called NEXT failed utterly. But out of failure a new, improved Jobs emerged. At that point he began to put his hands around the specificity and discipline that eventually drove Apple to its current heights.

Jobs 3.0 announced that, in the interest of clarity, Apple needed to carve its product line back and get rid of the crap. At a board meeting shortly after he returned to his leadership position at Apple, he walked up to a wall where some two dozen of the company's products were arrayed. He then began to remove them one at a time until only four remained. It was an early indication of the new specificity Jobs had begun to distill into a focused mental matrix.

There would be two lines of computers, one for consumers and one for professionals. Each line would have two models — a desktop and a laptop. There would be a high degree of interrelatedness among the four product offerings. This specificity required Apple to restructure its operations and allowed it to focus its resources. Employees got to know a handful of products intimately down to the details that would make them symbols of elegance in design simplicity.

"Stretch specifications" can challenge and motivate an organization. This was one of Jobs' gifts — a well-honed intuitive ability to see, feel and anticipate products that would stand out, then set the stretch specifications they should meet. As has been well-documented, Jobs could be brutal in extracting stretch from employees. In this, he shared a ruthlessness with entrepreneurs like Edison and Ford. But his stretch specifications became actionable when he finally started setting them short of "denting the universe."

For Apple, differentiated design, quality and utility led to growing sales and the ability to better manage costs of production. Jobs 3.0 clarified the design principles that brought specificity to the notion of how an "insanely great" computer should look, how it should feel and what it should do. He at last began to offer a vision made clear by specificity, and Apple prospered.

Achieving Clarity of Leadership

When it comes to delivering the specificity essential to the clarity that high-quality leadership demands in complex and volatile situations, here are some suggestions:

Focus for clarity. People have limited bandwidth. They can spread their attention and commitment only so far before they lose the ability to generate impact.

Don't try to borrow clarity from others if you can't specify what it means to you. It's not unusual to hear individuals in leadership positions offer up the same visions repeated with consistency ad nauseam in interviews, articles and speeches. Today, examples abound in health care with visions focused on "bending the cost curve," "moving from volume to value," "embracing population health" and "crossing the chasm." Usually, these exhortations are made absent explanation as to meaning and intent. Such uniformity of vision suggests leaders who aren't thinking for themselves. As the strategy expert Michael Porter has suggested, organizations should compete not to be the best, but to be different. Leaders get paid to think differently, talk differently and act differently.

Don't use ambiguous, empty or worn-out words. Examples include "excellent" and "great." Neither word is sufficiently definable. By that, I mean there's really no way to know you've achieved excellence or greatness because the words themselves describe the indefinable. In health care and other industries the active verb "transform" has been neutered into the meaningless adjective "transformative." It has become a throwaway cliché absent an object and specificity. (Transform what into what?)

Avoid slogans. Slogans are single-sentence exhortations that lack the specificity needed to provide differentiation and direction. A slogan belongs in your ad campaign, not your strategic plan. W. Edwards Deming, the specificity of whose 14 points for management revolutionized quality worldwide, abhorred slogans, as he conveyed here: "Eliminate slogans, exhortations and targets for the work force asking for zero defects and new levels of productivity. Such exhortations only create adversarial relationships, as the bulk of the causes of low quality and low productivity belongs to the system and thus lies beyond the power of the work force."

Don't trade clarity for inspiration. The object of leadership is not to move people to tears, send a shiver up their leg or get them to shout, "We're Number 1!" The first obligation of leadership is clarity. Inspiration is helpful when it translates into an extra dose of commitment and drive. But it's wasted absent a clear goal to stretch for. And charismatic leadership is usually a poor and often a dangerous substitute for clear leadership. Peter Drucker warned of the perils of choosing charisma over clarity: "The three most charismatic leaders in this century inflicted more suffering on the human race than almost any trio in history: Hitler, Stalin and Mao. What matters is not the leader's charisma. What matters is the leader's mission."

Don't continue to deliver the same message without modification. Repetition is an important characteristic of effective communication. Vision and strategies generally need to be repeated many times before they are fully heard. But in volatile situations, strategic direction needs to reflect a combination of resolve and flexibility. Resolve protects the organization from distraction and half-efforts by keeping things on track. On the other hand, flexibility encourages and facilitates adjustments in the specificity of actions as conditions shift.

Specify what to be tight about. Creating the systemness that overcomes fragmentation and lack of coordination is the holy grail of health care. In creating a true system, the first step should be to specify a handful of nonnegotiable things members of the system must be tight about. Then the system usually can afford to be loose about the rest.

Don't over-specify. Just as they can be under-specified, things can be over-specified, although this is a much less frequent problem when it comes to leadership. Over-specification can generate organizational impotence because it robs people of the initiative, flexibility and prerogatives necessary to meet shifting conditions.

Use stretch specifications to generate innovation. Seemingly impossible specifications force people to rethink how they do things as they realize they can't get there doing things the way they have in the past. For health care, stretch specifications might include cutting wait times, throughput and total price in half.

These are complex and volatile times in health care. They cry out for clarity of leadership. For places worth going. For stretches worth making. For paths made discernable. It's clearly time to be specific about where to go and how to get there.

Dan Beckham is the president of the Beckham Co., a strategic consulting firm based in Bluffton, S.C. He is also a regular contributor to H&HN Daily.