Why it matters (and why now)
In highly complex contexts, which you may know as VUCA/BANI – volatile markets, AI accelerating decisions, changing regulations – the question is not only what leaders know, but from where they make sense of reality. In healthcare, this becomes critical: integrating patient safety, care pressure, financial management and staff well-being demands a kind of leadership that transcends familiar prescriptions. This is where vertical development takes on particular relevance.
Why now? Because with the extremely rapid changes that today’s technology allows to be achieved in extremely short times, and with an impressive capacity for global generalization, organizations are challenged to adapt and keep up with a pace to which they have not yet become accustomed (at least not many of them). The solution will probably not be to adapt and use the newest technology trend, and then do the same thing again in 6 months, when the next trend appears, and so on and so forth.
The solution will have to pass through the expansive capacity of the company to assume uncertainty, volatility, fragility and non-linearity, and include them in the strategy and in the organization’s own identity. This is possible when the process of vertical leadership development is carried out, and the leadership lives it and cascades it to the rest of the organization under its leadership.
What do we mean by ” vertical development “?
Brief definition:
Development is a progressive process that produces evolution towards other more complex states.
From the perspective of Adult Development(or Vertical Development, as it is also called), it is understood as: “the progression of different ways of making sense of reality”, or also as “the sequence of stages of meaning-making”.
And there are very characteristic differences in terms of the contents on which this process is based.
- What do we know, what can we do? (horizontal development) is to add capabilities: courses, techniques, tools, specializations, degrees.
- How do we come to know, how do we understand reality? (vertical development) is to transform the way we perceive, interpret and coordinate action. It involves moving from operating with simpler mental frameworks to broader and more flexible ones.
Simply put: vertical development doesn’t add “apps” to your phone; it updates the operating system with which you interpret the world and decide.
What is its function?
- Increase capacity to make sense of complexity (ambiguity, multiple stakeholders, paradoxes). In early stages of vertical development, ambiguity and paradoxes are interpreted as problems to be solved: finding the best option between two polarities. In later stages, it is understood that ambiguity and uncertainty are in my way of knowing the situation, in the perception I have of the issue. In these stages, the individual realizes that what was previously subject to him: the perception of polarity is now itself an object of study: my mind producing the perception of polarity.
- Expand the range of action without falling into reactive responses. From the moment I can study my own mind producing the perception of polarity, and I can see this process from a second, broader perspective, encompassing the whole phenomenon(the situation itself, and my mind producing a polarizing representation of the situation) my ability to operate expands, and allows me to act differently.
- Improve collaboration and organizational learning by integrating previously competing perspectives. When I can do this, I can lead the team down a path that will allow the apparent ambiguity to be resolved, toward a solution that integrates the seemingly irreconcilable assumptions on which it is based.
Three key lenses for understanding development.
Now, we present 2 theoretical bodies on which research in Vertical Development has been based. They are not the only ones, but they are the ones that have initiated research in the field.
1) Loevinger and Cook-Greuter: from more conventional to more integrative structures.
These authors mapped how the “self” evolves through states/stages. Without technicalities: the more developed, the greater the tolerance for ambiguity, the more self-awareness, and the greater the capacity to sustain tensions (e.g., efficiency and care, short and long term).
This is achieved because the mental framework that produces the interpretation of reality has widened, expanded, and now “knows” in a broader way.
Useful indicators for leaders:
- Conjugate multiple metrics without simplifying them.
- Revise one’s beliefs without experiencing being or feeling “threatened”.
- Adjust the leadership style to the context and the team, communicating with each person according to his or her perceived mindset.
2) Kegan: moving from “being subject to” to “having as an object”.
Robert Kegan proposes that we develop when we manage to “see” what we were previously prisoners of (our loyalties, assumptions, emotions). When something moves from being a “subject” (it owns me) to being an “object” (I can observe it), we gain freedom and choice. This is like the difference between when you are looking throughyour glasses, to when you take off your glasses and observe the instrument with which you are looking at reality.
Healthcare example: a hospital manager who is subject to the daily urgency only reacts to the fire of the day; when he/she transforms urgency into an object of study, he/she can redesign flows, develop middle management and build capacity so that the urgent does not always swallow up the important.
3) William Torbert and David Rook
These authors popularized the term in the corporate world when they published the summary of their 5-year study in the April 2005 issue of the prestigious Harvard Business Review, in which they explain in a simple way their approach to “ActionLogics“. This approach implies that each stage is marked by a structure of perception and understanding of reality, and this is what determines the contingent response to perception. That is, we interpret the world with a particular logic, and we act in the world with a behavior consistent with that logic.
For example, if the organization’s manager interprets uncertainty as a threat, he will deploy a behavior that will not be the same as if he interprets it as if one and the other were integrated in a broader system, where uncertainty and the organization are two of the multiple actors in the dynamics. In this case, the leader will act in a manner consistent with this logic, and the strategy will be very different.
Learning vs. developing: why is skills training not enough?
Learning: “project management course”, “feedback workshop”. It is still useful and indispensable for daily operations. Of course it is important to increase competencies, knowledge and skills. But if the underlying mental framework that serves as a matrix remains the same, more competencies, more skills, more abilities, more skills will not solve the limitation in the understanding of the whole system, and will not correct the perception of scarcity of resources, opportunities and time.
Develop: question and broaden the assumptions from which you give feedback, manage projects and measure success. This would mean being able to “understand” with a perspective that goes beyond the apparent conflicting opposites, and that can interpret the meaning of uncertainty and ambiguity in a different way, perceiving the organization AND the uncertainty AND the ambiguity as parts of a larger system that interact with each other over time, in constant evolution and transformation.
Therefore, if the organization seeks to evolve and expand, it is not enough for leaders to know more. It is essential that leaders discover HOW they know what they know – what
Practical signs of vertical development in leaders
Observable features
- From Expert to Achiever: you move from optimizing and specializing your area to aligning areas towards global results (e.g., waiting time WITH patient satisfaction WITH financial sustainability).
- From Achiever to Redefining/Transforming: you widen the game: you rethink metrics (health value, patient-reported outcomes), you sustain paradoxes (productivity, productivity), and you make the game more interesting. Y staff care), and redesign the system, not just the goals. You redesign the system to understand reality with an expanded perspective.
Day-to-day micro-scenes
- Crisis committee: instead of imposing a quick decision, you open up the map: what do we know, what do we assume, what voices are missing (clinicians, nursing, logistics, patients). By including these perspectives, you decide in layers: today mitigation, this week learning, this quarter redesign.
- Physician-administration conflict: you change the question from “who is right?” to “which partial truth does each side bring and which design integrates both?”.
- Clinical innovation: you go from buying technology by feature set to defining outcomes (what change in the patient’s trajectory -or customer journey- are we looking for) and co-designing with teams.
What is in it for the organization?
When leaders operate in mental frameworks that correspond to later stages in development, states in the organization can be reached that can achieve more sustainable goals in the long term:
- Better quality of decisions in uncertain scenarios: less bias, more integration of data and values, leading to better adapted decisions and actions.
- Cross-cutting coordination: areas stop competing and design together. This turns out to be a huge competitive advantage that can deliver unique value that is difficult to replicate.
- Psychological security well understood: space for professional voice and learning without losing responsibility. This reduces burnout, and the costs associated with absenteeism, and high turnover , with the loss of knowledge that this also generates.
- Management of paradoxes (cost vs. quality, speed vs. safety) without forcibly “solving” the unsolvable. Being able to integrate paradoxes and polarities leads to resolving situations that are apparently contrary. This increases efficiency and profitability, because several situations are addressed in one or two integrative initiatives.
- Sustainability of change: improvements do not depend on heroes, but on architectures (rituals, metrics, roles, practices). If the organization grows in this way, and there are leaders in post-conventional development stages, continuous adaptation no longer depends on an irreplaceable person, but becomes part of the nature and identity of the organization.
Some principles of Vertical Development:
Here are some general assumptions about vertical development:
- These theories of Vertical Development describe the ideal progress of human potential toward deeper understanding, wisdom and effectiveness in the world.
- This growth occurs in a logical sequence of stages or mental frameworks with which we understand the world, from birth through adulthood to the end of life. This movement is compared to that of an upward spiral.
- In general, these mental frameworks evolve from the simplest to the most complex, from static to dynamic, and from ego-centric to socio-centric to global-centric.
- The later stages are only accessible by navigating through the earlier stages, and it is not possible to “skip” stages.
- Each later stage includes the earlier ones that have already been experienced. This means that the knowledge and understanding of the world contained in the earliest mental frameworks are still accessible.
- Each later stage in the sequence becomes more differentiated, integrated, flexible and able to function more adequately, with more resources and adaptability, without as many defenses and barriers as in the earlier stages.
- As healthy development unfolds, autonomy, freedom, tolerance for difference and ambiguity increase, and thus our ability to relate to reality, while the need for defense decreases.
- Developmental deviations, “pockets” of low integration, trauma and psychopathologies are seen at all levels. Therefore, it is fair to say that later stages do not necessarily mean happier or more adapted.
- A later stage person can understand the mental framework of an earlier stage person – they have lived it, and from time to time perhaps still use it – but an earlier stage person cannot do the same for a later stage person in the same way.
- No matter how much we come to understand and actualize our mental framework of reality, and how much of it we understand, our mental framework will always be restricted, and therefore partial and incomplete.
- Vertical development occurs through interplay between the person and his or her environment, not just between people. It is a potential and can be stimulated and facilitated with appropriate support and challenge, but it cannot be guaranteed.
- While vertical development can be invited, and the environment optimally structured toward growth, it cannot be forced. People have the right to be who they are at any stage of their lives.
- The later the stage of development, the greater the variability for self-expression, and the more difficult it becomes to determine the stage of development – or its “center of gravity”.
- All stages are descriptions and idealizations, and no human being can completely fit into them. We are more complex and deeper than the description of a stage.
Frequent errors when talking about Vertical Development.
There can be confusions and inaccurate or downright wrong interpretations when we talk about vertical development. Here are just a few of them:
- Confuse it with executive education: more courses ≠ more development. Usually, more courses will mean more knowledge and skills, not necessarily a different frame of mind.
- Make it “mystical” or inaccessible: it is practical, observable and trainable. It is not an esoteric figuration. Vertical, or adult, development is a discipline of Developmental Psychology, which has more than 50 years of research and development.
- Looking for shortcuts: the vertical leap is not “bought”; an environment (coaching, practices, metrics, conversations) that favors it is designed. It is not possible to provoke it, but it is possible to build a context in which it can be deployed at the right time.
- Delegate it only to HR. HR. The top management must model and sponsor the process. Empirical evidence to date shows that the state of the leader’s vertical development correlates with organizational results. This is not just a “wellness course” or an “anti-burnout strategy”.
Useful mini-glossary
I offer you a small set of definitions related to these theories:
- Adult development: evolution of how we interpret the world and ourselves, not just how much we know.
- Vertical development: expansion of complexity and perspective; updates the mental “operating system”.
- Subject-Object (Kegan): moving elements from “I am like this” to “I can observe it and choose”.
- Stages (Loevinger/Cook-Greuter): levels of ego/identity complexity from conventional to integrative.
- Adaptive leadership: mobilizing people to face challenges with no simple technical solution.
Conclusions.
In short, development means expanding the way we make sense in order to lead with greater lucidity, integrating tensions and designing better systems. In healthcare and in any sector, this is the difference between putting out fires and building organizations that learn.
Article 2 of the series will address how this process manifests itself in stages, each of them in concrete leadership behaviors and how to accompany transitions between stages.
