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Management Learning Experiences of an Elite

Occupational Group: Health Care CEOs

Thomas W. Chapman

A Dissertation submitted to

The Faculty of

The Graduate School of Education and Human Development

of the requirements for the degree of

Doctor of Education

Dissertation directed by

Sharon J. Confessore

Associate Professor of Human Resource Development

December 2000 UMI Number: 9999879

UMI____ ®

UMI Microform 9999879 Copyright 2001 by Bell & Howell Information and Learning Company. All rights reserved. This microform edition is protected against unauthorized copying under Title 17, United States Code.

Bell & Howell Information and Learning Company 300 North Zeeb Road P.O. Box 1346 Ann Arbor, Ml 48106-1346 © Copyright Thomas William Chapman 2000

TABLE OF CONTENTS

ACKNOWLEDGEMENTS...... 5 DEDICATION ...... 7 ABSTRACT ...... _...... 8

CHAPTER ONE

OVERVIEW...... 10 Introduction ...... _...... 10 Background: Challenges and Insights to CTsO Learning ...... 14 Fundamental Skill Areas in Management Practice ...... 16 Limitations in Research and Opportunities; for CEO Learning Experiences ...... 20 Problem Statement ...... _...... 23 Purpose ...... _...... 25 Phenomenon...... _...... 25 Significance ...... _...... 28 Research Question...... _...... 32 Summary of Chapter...... 35 Definition of Terms ...... _...... 36

CHAPTER rWO

REVIEW OF LITERATURE...... 38 Learning in a Social Context...... 39 Purposes and Role of Groups in Management Learning...... 40 Leadership Development...... 47 Executive Development...... _...... 49 Learning for CEOs...... _...... 52 Summary of Chapter...... 59

CHAPTER TILREE

METHODOLOGY OVERVIEW...... _...... 61 Study Objective and Research...... _...... 63 Methodological Approach...... 64 Participant Observation ...... _...... 66 Case Boundaries ...... _...... 67 Research Design ...... _...... 69

METHODOLOGY...... 71 Sample Selection...... _...... 71 Unit of Analysis ...... 72 Limitations and Delimitations...... _...... 74 Interview Questions...... _...... 74 CEO Management Learning — Page iv

Interview Approach ...... 75* Research with Elites...... 77 Data Gathering and Thematic Analysis...... 78 Thematic Categories...... 79 Analysis...... 80 Truslvvorthiness of Data Analysis...... 81 Triangulation...... 82 Role of Researcher...... 82 Summary of Chapter...... 83

CHAPTER FOUR

FINDINGS...... 85 Nature and Environment of Exclusive CEO Learning Groups ...... 85 Overview of Chapter...... 85 Common Factors of CEO Learners...... 85 Learning Profiles of Participants ...... 86 Exclusivity of CEO Membership...... 94 Description of the Exclusive Learning Groups Studied ...... 95 The Corporate-Sponsored Group ...... 98 The CEO-Governed Group...... 103 CEO Attractions to Exclusive Learning Groups ...... 106 Emerging Themes from CEO Interviews...... 109 Exclusive Learning Group Benefits for CEOs ...... Ill CEO Preferences for Participation ...... 113 CEO Perceived Benefits and Values to Exclusive Learning Groups ...... 117 Summary of Chapter...... 120

CHAPTER FIVE

CONCLUSIONS AND RECOMMENDATIONS ...... 123 Conclusions...... 125 Discussion of Conclusions...... 130 Recommendations...... 133 Recommendation for Practice...... 133 Study Strengths and Limitations...... 133 Recommendations for Future Research...... 135 S ummary of Chapter...... 136

REFERENCES

APPENDLX A -Letter of Request for Participation to Participants ...... 159 APPENDLX B - Study Question Framework ...... 160 APPENDLX C-Letter with List of Additional Questions ...... 162 APPENDIXD -Letter of Introduction to Study ...... 165 APPENDLX E -Cycle of CEO Learning in Exclusive Learning Groups ...... 167 CEO Management Learning — Page 5

ACKNOWLEDGEMENTS

Completion of this dissertation has been an extensive and often challenging process that required the support of several people without which I would have not achieved my goal.

First, I would like to thank my wife, Cheryl F. Edmonds, for her patience of the process, tolerance of my days and hours of over 3 Vz years devoted to study, and, especially, for her support and encouragement which enabled me to achieved this goal.

Second, I would like to thank Caramela Austin, my executive assistant, who provided the adininistrative support, organization, and technical oversight essential to produce the dissertation in a timely, organized and efficient manner.

Thirdly, I want to acknowledge the influence of my mother, Alice B. Chapman, who was buried during this process, but gave me the stubbornness, determination, commitment and belief in myself, necessary to achieve success.

I also owe tremendous thanks to the 7 health care CEOs who agreed to participate in this study. The time they devoted during interviews, their insights, and perspective as well as flexibility and cooperation was simply fantastic. This dissertation would have not been possible without these professionals' honest and candid participation. I believe their contributions have advanced knowledge concerning professional learning for CEOs in health care. CEO Management Learning — Page 6

I want to thank my dissertation committee. Professors Sharon Confessore, Lisa

Horvath, and John Williams, M.D. for their guidance and feedback which improved the final document. I would also like to thank all the readers for enduring the process of getting through a long technical document and participating in the defense meeting.

Finally, I want to extend a special thank you as well as my deepest appreciation for my committee chair and advisor, Professor Sharon Confessore, whose professional experience and expertise provided precision guidance through this process. Sharon's sharp criticism always resulted in improvements in the document and an increased understanding of theories and knowledge on my part. Therefore, I sincerely thank her for leading this process. CEO Management Learning — Page 7

DEDICATION THIS DISSERTATION IS

DEDICATED TO ALICE B. CHAPMAN WHO UNDERSTOOD AND

BELIEVED IN THE POWER OF LEARNING AS AN INSTRUMENT OF

ADVANCEMENT. CEO Management Learning — Page 8

ABSTRACT

Various researchers have concluded that a considerable amount of management learning occurs outside formal learning events and programs. However, there have been very few studies of these natural or everyday learning processes, especially concerning CEOs. This research was organized as a qualitative study of multiple cases of management learning experiences of CEOs in a group context. The research was conducted through observations and assessments of CEOs as elite members that participated in exclusive learning groups. The objective of the study was to obtain the combined essence of individual experiences in exclusive learning groups that richly describes the environment, condition and circumstances of

CEO learning experiences. The study was focused specifically on management learning experiences of health care CEOs in the context of exclusive learning environments. The study began to address the lack of understanding about experiences of individual CEOs when they participate in learning. In particular, the study examined the linkage between exclusive learning group conditions and learning needs of CEOs as an elite occupational group.

Seven CEOs of health care organizations (hospitals, health systems, health insurance organizations, etc.) were interviewed on multiple occasions and follow up conversations were conducted to verify and validate information. Observations of individual CEO participants were conducted as they functioned as elite members in two exclusive groups. A CEO-controlled and governed group and a corporate-sponsored exclusive group were selected for observation. This study defined exclusive learning groups as those reserved for and limited to CEOs. Study data analyzed from observing the two exclusive groups and from interviews and follow-up interviews centered around CEO Management Learning — Page 9

CEO opinions and values, feelings and emotions, and experiences when engaged in exclusive learning groups.

Broad categories were established to record a topology of the interpretive — descriptive results of each interview and to provide a framework for analyses, findings and conclusions.

Themes from this information were categorized in four categories: opinions/values, preferences, group learning experiences, and motivation and expectations. Findings show that CEOs perceive high value in being with other CEOs for one-on-one, informal group interaction, and for having access to a congregation of CEOs in a unique group setting. Findings also describe that CEOs expect peers in exclusive learning groups to be successful people who value learning, are intelligent, thoughtful and have egos in check. They expect smaller groups (although recognize the value of larger groups when appropriate), exclusion of competitors, good geographical balance of membership, and a well-organized process. CEO expectations for the group centered on trust, honor and commitment that enabled candid interaction and sharing. Being offsite away from job pressures was an important environmental condition. Sociological and human compatibility was also an important expectation for the group context.

Conclusions of this study assert that context limitations create a narrow set of conditions that CEOs expect to experience in exclusive learning groups. Conclusions support the experience that elite occupational group members seek other elites for their occupational learning, and exclusive learning groups offer CEOs a safe, confidential set of circumstances and environment that facilitate their learning. These conditions further support a learning type and pattern conducive to informal and incidental learning opportunities. CEO Management Learning — Page 10

CHAPTER ONE

OVERVIEW

The introduction chapter discusses the overall qualitative approach used in this study of management learning of individual Chief Executive Officers (CEOs) in exclusive learning groups. It presents a discussion of critical factors that attract CEOs in health care to these forums of learning and why this may be an attractive alternative to traditional formal approaches of management learning for CEOs. It also describes the challenge management learning presents for CEOs due to their time constraints, new demands and ongoing need to learn. The essential problem of the study is defined as gaining a better understanding about the experiences of individual CEOs when they participate in learning. The conceptual framework is composed of understanding the linkage between exclusive learning group conditions and learning needs of an elite occupational group. The importance of the learning environment and CEO learning activities is also presented. <

Introduction This research was organized as a qualitative study of multiple cases of management learning experiences of CEOs in a group context. The research

"was conducted through observations and assessments of CEOs as elite members that participate in exclusive learning groups. The objective of the research was to obtain the combined essence of individual experiences in exclusive learning groups that richly describes the environment, condition, and circumstances of CEO learning experiences. This study focused on the management learning experiences of CEOs in the context of exclusive learning environments.

The primary focus was on the overall essence of the CEO Management Learning — Page 11 collective learning experiences of CEO participants in the study within the social context of the exclusive learning groups.

The study is guided by a conceptual framework focused on gaining a deeper understanding of critical learning group factors that attract an elite occupational group (CEOs in health care) to participate in exclusive learning group environments. CEOs in health care are an elite occupational group because of the nature and conditions of their jobs (extensive power and authority, substantial responsibility and unrelenting demands). In these positions they command, control and administer significant influence and authority over people and resources. In the context of American society they control the destiny of complex organizations responsible for production of financial results, important public and private services and products. CEO elite occupations are those that possess autonomy, authority, high income, substantial status and significant responsibility. Exclusive learning groups are those controlled by elite occupations, reserved for their membership and exclude those without the specific elite status.

This study defines health care CEOs as chief executive officers managing hospitals and health systems, managed care companies, health insurance companies, comprehensive ambulatory programs and large independent physician groups.

Some researchers (Burgoyne & Hodgson, 1983; Mumford, 1989; Marsick & Watkins,

1997) recognize that a considerable amount of management learning occurs outside formal learning events and programs. However, there have been very few studies of these natural or everyday learning processes, especially concerning CEOs. Managers rely on practical knowledge vs. technical knowledge to guide their actions because practical "know how" is inherent in the action itself (Eraut, 1994). The uncertainty of CEO Management Learning — Page 12 how professionals access and share professional expertise, know how, judgment and tacit knowledge has emphasized "knowledge eiicitation" as a new area of research (Eraut, 1994).

Despite obvious overlaps between management development and management education, these activities produce different results. Management development tends to develop personal knowledge repertoires and practical skills in organizations. Management education develops analytical and critical skills in the academic disciplines relevant to management (Fox, 1997).

Researchers have described distinctions in management learning between traditional management education (acquisition of knowledge of relevant facts and techniques) and action learning (the closeness of learners and their knowledge of the world) (McClaughlin & Thorpe,

1993).

CEO learning, by necessity, must involve real world action, experiences and outcomes while protecting their aura of certainty. The workplace has some potential to offer relevant learning experience but is limiting for CEOs due to public exposure as leaders to their subordinate staffs and employees. The workplace may also represent an environment that has social and psychological barriers to the CEO's need to relax, open up, and learn. This study assumes exclusive learning environments are critical to the management learning for this elite occupational group (CEOs). These smaller groups offer comfort because they do not have hierarchical relationships or the educational backcloth of assessment (Burgoyne & Reynolds,

1997).

CEOs, as professionals, are not regulated by government or required to continue to learn by professional organizations. However, they constantly need knowledge that their job conditions make difficult to acquire. In reality, the unique nature of their job conditions and experiences suggest they can only learn from each other's experiences. CEO Management Learning — Page 13

There is little known about what these learning experiences are like for CEOs. Attempts to capture this knowledge has cast considerable light on the nature of professional expertise and highlights can relate to theories that discuss the value of reflection in raising awareness of tacit knowledge and transforming knowing-in-action into knowledge-in-action (Schon, 1983;

1987).

The purpose of this study was to gain new insights, clarity and perspectives on CEO learning experiences in exclusive learning groups and how they support and enable CEOs as an elite occupational group in their professional development. The study also considers the role exclusive learning groups play in influencing personal and interpersonal interaction for intimate intellectual exchange, feedback and support amongst the CEOs.

Consequently, identification, determination, selection and participation in specific exclusive learning groups by CEOs were important management learning activities to understand. Their rationale, values and opinions concerning these decisions can be revealing to understanding effective approaches to professional development and strategies to learning. The unit of analysis for this study is the CEO within the exclusive learning group. The case study observations and interviews of individuals focused on the influence of a group's environment and circumstances on a CEO's learning experience. Group observations and interviews were conducted with CEO participants on-site at group meetings and upon their return to work. The interviews represent the primary source of data, supported by group observation. CEO Management Learning — Page 14

Background: Challenges and Insights to CEO Learning A significant amount of attention has been devoted to executive development, management learning, and experiential learning for high-level executives. (McCall, Lombardo & Morrison, 1988; Kaplan, Drath &

Kofodimos, 1987; Margerison & Kakabadse, 1984; McCauley, 1986; Sorcher, 1985; Bloom,

1985; Kolb, 1984). The work of these scholars, and others, emphasizes the scarcity of time executives spend in formal classrooms, the importance of experiential on the job learning, and the unique pressures and highly public nature of CEO learning in performance driven environments. As the highest and most visible persons in organizations, the CEOs' actions are always observed. In the competitive field of organizational management, learning is a constant necessity for CEOs, however, little is known regarding how they define or pursue it, what they prefer, and circumstances and environments they perceive as attractive conditions.

There are no graduate programs in higher education or training programs that specifically teach people to be health care CEOs, yet boards of directors expect they are hiring an experienced professional. In addition, CEOs who manage in a changing and dynamic field must continue to learn and update themselves to remain competent. This challenge is especially important for

CEOs in the American health care system. CEOs in health care are at the pinnacle of decision making for a huge portion of the fastest growing segment of the national health care budget, with a total annual expenditure exceeding a trillion dollars. In most communities, the organizations they manage are as large and complex as any business and are influenced by the same market conditions and pressures. Being a CEO is vastly different from functioning as an executive in an organization. CEO Management Learning — Page 15

The role or context of the CEO position and type of industry they work in has a major influence on how its occupants are observed and function (Judge, 1999). Management practice in health care has public financial and quality accountability at local, state and national levels.

As a CEO, "suddenly, people in the organization see you differently, watch you closely; your movements and actions are more conspicuous, a special aura of authority embraces you"

(Horton, 1992). The assumption of the CEO position in any industry is an entrance into a completely new environment that is visible throughout the organization and community.

The CEO is assumed to be at the pinnacle of performance, productivity and achievement, and the position is defined by a unique environment of privilege, power, responsibility and independence. The identity of the CEO becomes inseparable from organization performance, as well as its future success and failure. CEOs are challenged by unrelenting demands, such as constant phone calls and messages to return, a line up of staff and visitors at the door, and a variety of interruptions as a result of external or internal crisis.

Finally, the CEO will notice that the tough "make or break" controversial decisions are pushed up to them for the final "ok." They are "on the line," publicly accountable, under the spotlight and their performance is viewed through a fish bowl. Therefore, it is lonely at the top and learning is even more difficult and isolated. The unique context of autonomy, power, accountability and psychological isolation contribute to the obstacles and complexity of CEO learning (Sherlock, 1999).

If effective leadership is an art, and mastery of the artistry requires skills, how are they obtained and kept current by the CEO? Some researchers have concluded that CEOs learn how to do their job, on the job, through trial and error, observation of phenomenon CEO Management Learning — Page 16 and from other CEOs (Horton, 1992). However, learning from experience is problematic because there is much less evidence about precisely what is learned from experience and how it is applied in practice (Eraut, 1994). Given CEO job conditions and constant pressure, learning becomes vital and finding a suitable setting for learning is critical. CEOs are required to do many things to lead the organization, from creating vision and planning to achieving profitability. The most important responsibility, however, may be to become an "effective learner" (Dechant, 1990). Although a variety of methods could be pursued by CEOs for management learning, networking is prominently suggested as the vehicle for lifelong learning

(Burke & Bice, 1991). Exclusive learning groups may provide a convenient "one stop shopping" forum for convening and networking.

Fundamental Skill Areas in Management Practice Traditionally, researchers identified three fundamental skill areas in the practice of management: technical, human and conceptual (Katz, 1955). For historical, political and sociological reasons, initial training for professionals has been based in higher education (Eraut, 1994). However, most management learning is natural, that is, relational and experiential (Burgoyne & Hodgson, 1983; Burgoyne

& Stuart, 1976). CEOs also acquire technical/scientific knowledge from consultants, vendors and companies that manufacture specific products (pharmaceutical, computer systems, diagnostic equipment, etc.). It is to the benefit of these purveyors of products and services to educate the buyer. However, learning the best way to reconstruct the board of trustees, reorganize and lead the organization in a new strategic direction, or implement executive evaluation and incentive compensation systems are ongoing human and experiential challenges conducive to networking and social interaction in exclusive CEO Management Learning — Page 17 learning groups. Exclusive learning groups provide access to others who have mastered these tasks. In fact, for the purpose of CEO learning about human and experiential challenges, skills may be best achieved by learning from the experiences of others who have previously mastered such work.

Learning activities for American CEOs have been studied and documented by

Margerison and Kakabadse (1984). Important as it may seem, their study concluded that education in the business side of management (finance, marketing, etc.) played a small role in the CEO's ongoing development. Greater emphasis was placed on communication skills, delegation, respect for others, decision-making and self-discipline. The development of these skill areas for CEOs requires introspection, reflection, interaction and feedback because they are continuously exercising judgment and assessing strategies. Given the nature and role of the

CEO position, participation in exclusive learning groups may enhance examination and acquisition of these skills. CEO learning in exclusive groups reflects a process known as natural managerial learning (Burgoyne & Hodgson, 1983). Natural learning is a non-didactic and indirect way of becoming exposed to knowledge and information. CEOs are subject to the same notion that relationships influence people's lives and is a phenomenon widely studied in social sciences, particularly in psychological literature as: social learning theory and socialization (Bandura, 1986; Van Maanen & Schein, 1979; Lave & Wenger, 1991; Easterby-

Smith & Thorpe, 1997; Marsick & Watkins, 1990; Weil, 1992)).

Exclusive learning groups may be the only places where CEOs can think out loud and openly discuss their successful and unsuccessful experiences without consequences. These exclusive group settings may ultimately become networks for CEOs to conduct CEO Management Learning — Page 18 career strengthening activities and obtain support. Historically, networks represent a reciprocating set of relationships that stabilizes the manager's world and gives it predictability

(Sayles, 1964). This phenomena may also explain the assertion that the majority of management learning is informally achieved (Zemke, 1985). In a psychological sense, these networks could be considered learning support groups for an elite occupation.

Several high hurdles were identified for CEOs in executive self-development studies on learning. These include both self-awareness with their limitations and the tendency of staff to shy away from informing and helping in high-risk situations (Kaplan, Drath, & Kofodimos,

1987). Consequently, these conditions can create blind spots and make CEOs vulnerable when they reach the highest organizational level and have timely valuable information and feedback filtered from them. This phenomenon can produce intellectual and psychological isolation.

Routinely, people in organizations simply communicate with CEOs more cautiously and defensively. Therefore, finding learning environments where information flows freely and openly is important to ongoing CEO professional development.

Another mechanism that may facilitate CEO learning is story telling or executive vignettes in small intimate CEO gatherings (Lombardo, 1986). Executive vignettes are stories of valuable experiences vividly passed on to other executives as they reflect on past practices, both good and bad. They are the experiences CEOs and their organizations don't record about critical moments in strategy development or decision making that were pertinent to its successes and failures. The essence of these experiences is relevant from one organization to another and can be effectively passed on during CEO Management Learning — Page 19 relaxing moments in exclusive learning groups. Relating these experiences from one professional to another is a form of sense making which is defined as a social process (Weick,

1996). Research has confirmed that human thinking and social function are essential aspects of one another (Resnick, Levine, & Teasley, 1991). Exclusive learning groups may be important for CEO management learning if cognition and socialization are mutually reinforcing.

It is also recognized that other people can serve as learning models (Bandura, 1977,

1986) and sources of reinforcement and support. Relationships are also very important to managers and CEOs since most of their time is spent in contact with people (Sayles, 1979).

Other scholars (Van Maanen & Schein, 1979) have emphasized and identified socialization as a critical process by which individuals internalize the norms and values of the groups they become part of and want to join and be identified with. Therefore, exclusive learning groups may foster social relationships that facilitate learning between CEOs primarily through the social learning that occurs in these forums.

Zemke (1985) suggests the bulk of management learning in organizations is done outside of formal training and development programs. Research in management learning has concluded that the majority of management expertise comes from informal uncontrived processes (Burgoyne & Stuart, 1976). CEOs' learning experiences may reflect these findings beyond degrees obtained in their formal undergraduate and graduate education. Survey findings indicate that exclusive learning groups offer attractive benefits, such as safe harbor, confidentiality, and efficient access to a distinguished group of colleagues (Chapman &

Confessore, 2000). Extensive studies (Marsick & Watkins, 1990) have validated that incidental and informal learning are major learning activities CEO Management Learning — Page 20 for managers. It has also been established that professionals learn continually on the job because their work involves a succession of cases, problems or projects they must learn about

(Eraut, 1994) and that are unique to their environment.

The fields of management learning, executive development, and leadership development are very broad conceptual areas. Understanding how they function for CEOs in the context of real world management demands is important to knowing the role and relationship exclusive learning groups have to these learning activities. Theoretical presentations by many scholars have examined critical elements of management and professionals' learning (Fox, 1994 a; 1994 b; Willmott, 1994; Quinn, 1992; Raelin, 1994).

However, they have not precisely focused on CEO learning from the viewpoint of the unique nature of CEOs as an elite occupational group or the context of their positions. Management learning has two domains: educational institutions and work organizations. Neither, however, may be comfortable for an elite occupation such as CEOs (Easterby-Smith, Thorpe, Lowe,

Andy 1991; Fox, 1994a).

Limitations in Research and Opportunities for CEO Learning Experiences Scholars estimate that 99 percent of management development occurs outside the classroom, primarily through on the job experience (McCall, Lombardo & Morrison, 1988). Further, there is a limited amount of systematic research focused on what learning experiences or events are important in a manager's career (McCauley, 1986). Management learning in work organizations is increasingly part of the process of organizational strategy formation and implementation (Burgoyne &

Reynolds, 1997), although continued emphasis surrounding management learning is focused on practical aspects of knowledge acquisition and development derived from the workplace, as well CEO Management Learning — Page 21 as personal and interpersonal experiences. This tradition of pragmatism has been supported by various researchers (Kolb, 1984; Schon, 1983; Raelin, 1994; Easterby-Smith, 1990). However, despite the extensive information available on management learning, very little has been researched and studied on CEO learning specifically and, especially, in the field of health care.

An intriguing article entitled, "Myth of the Well Educated Manager" claims that "men who get to the top in management have developed skills that are not taught in formal management education programs and may be difficult for many highly educated men to learn on the job"

(Livingston, 1971). Although written nearly 30 years ago, current literature suggests this statement is still true today.

The conditions surrounding the CEO position create inherent challenges to learning.

Most corporate management development activity is focused on the CEO's subordinate and corporate strategic initiatives and goals. The CEO's job is to conceive and implement learning and strategic programs for implementation. CEO knowledge needs are immediate; they are also unpredictable and change dramatically to address complex situations within an immediate timeframe. Often these conditions require creative learning of which the response must be flexible, quick and efficiently focused. This can mean finding an environment where access to inside information can be easily obtained.

The trend of participation in formal continuing education programs (CEP) has been identified as critical to maintaining management standards, (Sherman & Lando, 1999; Kaplan,

Drath & Kofodimos, 1987) while other scholars (Drucker, 1998; Kolb, 1976) have defined a direct link between successful managers with their ability to adapt themselves and their organizations to changing demands for knowledge. All CEOs face CEO Management Learning — Page 22 continuous demands for learning smarter and faster under competitive pressures that afford little time to acquire new knowledge. These conditions may influence stronger interest in accessing information in exclusive learning groups where networking, social interaction and experiential lessons are readily retrievable, previously tested and accurate forms of knowledge. Traditional formal management learning may be insufficient to address and satisfy CEO learning needs.

The operating assumption in this proposal is that executives, as represented by health care CEOs, are continuing to learn outside of and beyond formal structures. Their learning is being achieved through both professional practice and theoretical inquiry from the content and process of work experience (Burgoyne & Reynolds, 1997). Validation that management expertise comes from informal and uncontrolled processes has been concluded and reported in past studies (Burgoyne & Stuart, 1976; Marsick & Watkins, 1990; Kops, 1993). CEO's sources of management information are not substantially different from other managers except when special forums and exclusive groups are created. Yet the role as CEO severely limits the accessibility to these means and the value of the experience. The CEO's frequent need for confidentiality may influence the range of available quality learning sources.

The management learning domains of formal educational institutions and worksites for

CEOs have been increasingly supplemented by alternative, market driven, short-term programs, conferences and management courses. They are conducted anywhere from one to five days with two being average. They are issue focused to address immediately pressing needs. This means the learning is driven by internal and external demands, and related to market pressures designed to achieve specific CEO Management Learning — Page 23 organizational goals. Most management learning is either structural (mamtaining a stable and productive environment) or developmental (helping people to change and improve their skills and performance) (Burgoyne & Reynolds, 1997). Most CEOs are faced with these traditional issues as well as leading edge challenges. It is difficult for formal management development and training to keep pace with the dynamics of CEO job demands (requiring "just in time" learning), high stakes, time constraints and fluid circumstances. It is also difficult to get CEOs' attention and schedule time within their busy schedules for learning. Still much remains unclear about how to develop meaningful environments, circumstances and content of effective learning activities for CEOs as an elite occupational group.

What is apparent, anecdotally, is that CEOs, represented by health care CEOs, will attend and do value opportunities to come together as elites informally in exclusive group situations to learn. Understanding the environments and circumstances of exclusive learning groups that CEOs participate in is important to determine the effective structures and organization for high-level management learning.

Problem Statement

Executive development and ongoing learning is important for health care CEOs because of the leadership role they play in directing extremely challenging and vital health care institutions in our society. Their role as stewards and managers of a substantial part of a trillion- dollar plus national health care expenditure is critical. The health care system in America is undergoing unprecedented changes and is being driven to increase productivity, efficiency, quality and lower cost simultaneously. These multiple tasks require organizations that are lead by CEOs that actively engage in CEO Management Learning — Page 24 learning. Currently, little is known about how CEOs learn and, therefore, it is difficult to support them in their learning during a critical period of health care transformation and upheaval.

CEOs, in general, and in health care specifically, are unique because of the major responsibilities and requirements of their positions. They have enormous and continuing pressures to make the most effective decisions for their organizations. The time and attention they devote to producing the best outcomes determines the future success of organizations, welfare of employees and benefit to the community. These pressures and conditions demand unique learning circumstances. Growing evidence exists that exclusive learning groups are an effective, or at least popular, mechanism for CEO learning. In health care, exclusive learning groups are developing both as independent entities and within traditional professional associations.

Despite the popularity of exclusive learning groups, little is known about what goes on within them and why CEOs are attracted to them. Important first hand information has not been available regarding CEO participation in exclusive learning groups or their learning relationships to other CEO members. In addition, the factors that appeal to CEOs, which attract them to the exclusive learning groups and the types of knowledge networks they create, are undefined. Specifically, what CEOs see as ideal circumstances and environment for management learning in tiiese groups is largely unknown.

CEOs are able to proceed unguided and privately in the pursuit of their own learning.

They are expected to continuously adapt to an ever-changing set of circumstances, which often require extensive demands in their time and attention. They CEO Management Learning — Page 25 possess a key characteristic of a good learner: the ability to adapt and change to meet demands.

More should be known about how they acquire this new knowledge on demand. This is critical because increasing knowledge acquisition in organizations is linked to performance, and health care CEOs are under tremendous performance pressures. How CEOs learn and maintain capacity to lead vitally important organizations in the face of increasing change is essential to know if organizations are to insure continued growth and success. This study represents an opportunity to better understand how CEOs overcome these circumstances and continue to learn.

Purpose

The purpose of this study was to develop a better understanding of the role, influence and purpose that exclusive learning groups play in CEO learning, including the role, purpose and attraction of the group for CEOs. The study observed the influence of the nature, structure and process of the exclusive group on CEO learning. The study also investigated the influence of the exclusive learning group in forming attractive social environments for CEO learning. This study provides a beginning portrait for observation of these groups revealing how professionals within occupations and with high status learn through interaction with each other.

Phenomenon

Exclusive learning groups are defined as member organizations reserved for CEOs that

CEOs within a given industry govern, control and regulate. Exclusive learning groups are comprised of elite, high-status individuals with unique positions who possess authority and assume extraordinary responsibiUties. Participation in these groups is restricted to the elite occupational professional group. Houle (1980) discussed the CEO Management Learning — Page 26

popularity and prevalence of autonomous groups or learning societies organized by elite

professions who viewed their continuing education needs as unique. The exclusive group is often

founded and governed by the elite occupation. Its members also routinely control and regulate

the group's function. Invitation, eligibility and membership are regularly managed by the elite

occupation. In health care, CEO status is the fundamental and only criteria for admission.

However, one must be invited (sponsored) to the elite group by a member or organization and, in

some groups, must be acceptable to the full membership. These groups are distinguished from

executive roundtables or associations by their small size, member control over learning content

and accommodation to changing learning needs of its elite members. In general, these are groups

driven by the elite members vs. professional educators and trainers. In addition, an elite member

of the exclusive group can usually veto the nomination or admission of a new CEO. The focus on

selection and group size fosters balance and enables learning for the elite members. These

activities are similar to how CEOs develop and balance executive staff to achieve effective

outcomes.

For this study two specific environments were observed. In one, CEOs comprised the board of trustees, controlled membership, and created and modified the bylaws, program content and logistics. The other environment was an industry-sponsored and controlled group that only invited CEOs to participate and share the agenda.

Health care CEOs from some of the most prestigious and successful organizations in the nation are members of exclusive learning groups. CEOs interviewed in this study ■ stated their objective for participating was to increase professional effectiveness through CEO Management Learning — Page 27 personal and professional development in a setting conducive for candid interaction. There are specific phenomena that occur as a part of these exclusive learning groups. The realization of these phenomena did not come from a literature review but from meetings, discussions, interviews and direct participation and observation of health care CEOs in exclusive learning groups. Anecdotal observation of the level of comfort, satisfaction, relaxation and rigorous intellectual engagement led to conclusions about environments and circumstances created by exclusive learning groups that were important to understand as learning conditions for health care CEOs. The following phenomena guides this study: Phenomenon 1:

Large numbers of health care CEOs participate in exclusive learning groups. Health care CEOs choose to participate as members of exclusive learning groups for support, ideas and affiliation.

Phenomenon 2:

While significant amounts of energy and money are invested in instrumental training — particularly skill training — by professional associations, educational institutions and commercial organizations, the great majority of management expertise comes from informal, uncontrived processes. Issues such as the psychological isolation of CEO positions, the need for shared experiences, and confidentiality while learning may explain the interest and participation in exclusive group environments. Phenomenon 3:

The exclusive learning groups that health care CEOs participate in appear to offer learning and social interactive opportunities beyond formal, explicit, deliberate learning. CEO Management Learning — Page 28

In fact, an uninformed observer might conclude that no learning was occurring. The structure, process and nature of these groups allows for the comfortable sharing, transfer and networking of ideas, and telling of "war stories" from natural learning that has occurred on the job.

These phenomena framed this investigation of CEOs' learning experience in exclusive groups. Health care CEOs' participation in these exclusive learning situations was observed within an interactive social context with the focus on the manner of relationships involved and necessary to meet individual and collective learning needs.

Significance This study is important and interesting because so little is known about how CEOs learn. New knowledge will also expand an understanding of what CEOs, as elite learners consider important from a learning experience and what they do around each other. Developing a good understanding of what occurs in exclusive learning groups will create an understanding of the learning process and needs of

CEOs. It will also provide better vehicles for understanding the unique circumstances of CEO learning and provide mechanisms to enhance, support and devise effective learning opportunities for CEOs.

Even more specific to this study, while CEOs, particularly health care CEOs, utilize exclusive learning groups, less is known about their purpose and activities of the learning experiences. CEOs in health care are members of an elite occupational group and set the priority and pace for organizational learning. They control large institutions, multi-million dollar budgets and thousands of staff. They are often the largest employer and economic entities in their community. They directly influence the trillion dollars of annual health expenditures in the U.S. and effect public policy debate concerning health CEO Management Learning — Page 29

care costs in the U. S. Congress and the federal Executive Branch of government, as well as in

states and local jurisdictions. CEOs manage some of the nation's most prestigious and advanced

academic research enterprises. Because of their status and importance in organizations and the

pressure to improve organizations, it is critical to understand how they learn. The methods and

approaches of management learning for health care CEOs are inadequately documented. In

particular their preferred and chosen methods and strategies of becoming more versatile

learners, accessing stimulating professional development, and improving practice has not been

extensively researched. The nature of CEO attraction and participation in elite learning groups

is an unexplained phenomenon. The relationship of the challenges they face on the job,

experiences necessary to succeed, and perceived value obtained from exclusive group settings

is undefined.

CEOs in health care also are in powerful positions to direct resources that effect the quality of health, safety and illnesses of tens of million of people. They are directly at the helm of steering health care insurance and delivery through the most significant amount of health systems upheaval and change ever experienced in this nation. The health care system changes and challenges require CEOs to manage their organizations at the highest levels of proficiency.

Improvement in management learning must be achieved to improve performance. Knowing more about how CEOs learn in exclusive learning groups is important to facilitate and insure

CEO participation in ongoing better-organized learning efforts. CEOs are unique learners as an occupational group; they are generally unregulated and free to choose from a wide range of alternatives to learn. Understanding the decision making process in professional development of this elite CEO Management Learning — Page 30 occupation is important to attract and motivate organizations' top leaders to improve their knowledge, skills and performance.

Educators, executive developers and trainers would like to know how to attract groups of CEOs to learning programs. They would also like to identify what causes CEOs to take time out of their busy schedules to attend the exclusive learning groups. It is clear that CEOs are unique learners and apparent that they view association with other CEOs as very important and will take time to engage in learning with them. Some exclusive learning groups are highly exclusive with admission controlled by the CEO membership. Others are accessible by membership in professional associations or purchased commercially. Exclusive learning groups are an increasingly popular learning venue for CEOs and represent places where knowledge is introduced and exchanged within a confidential atmosphere. The nature and environment of exclusive learning groups presents a significant opportunity to understand what attracts this elite occupation to them and how CEOs who participate in them learn.

How exclusive learning groups are organized and function, as well as participants' experience and motivation for joining them is generally unknown. The extent to which the attributes and characteristics of exclusive learning groups may be transferable to other settings is also unknown. Exclusive learning groups may be an important part of maintaining the ongoing nature of leaderly learning (Vail, 1996). In professional associations, advocates of life-long learning (Dolan, 1993) encourage participation in conferences for CEOs, where they can learn from their peers and share experience with new-comers to the "CEO circle." However, when

CEOs meet these needs, they appear to seek and desire a unique learning experience relevant to the CEO Management Learning — Page 31 responsibilities of their jobs. Understanding how the learning environment and its organization attracts CEOs is an important first step for building more effective learning programs for elite professionals.

As CEOs seek continuing knowledge by participating in exclusive learning groups, it is undetermined how CEOs perceive learning groups, what their learning activity consists of, how they actually learn (including preferences), and their motivations for participating in learning groups. Essentially, the essence of these collective learning experiences is unknown. It is also unclear how these circumstances are conducive to the personal learning experiences, professional privacy, networking and social interaction needs of this elite occupation. CEO selection and participation in exclusive learning groups is voluntary, but the basis on which their decision to participate is made is unclear. As participation in exclusive learning groups increases in popularity, attempts must be made to understand the intellectual and social phenomenon that groups represent given that they play an important role in the ability of the

CEO to be effective.

This study examines and characterizes the nature of the CEO learning experience by providing an "insider view" of the personal experience of individual CEOs. It contributes to the broader body of knowledge that exists concerning management learning for CEOs by identifying CEO learning objectives, motivations and needs.

The study provides decision-making insight on informal and confidential learning, and sharing opportunities that offset some of the psychological isolation CEOs experience. The study also describes and explains linkages between an elite occupation and its distinctive learning proclivities. CEO Management Learning — Page 32

For those who recruit, hire and evaluate CEOs, this study reveals what they should encourage and expect from exclusive management learning activities. This study also informs continuing education professionals how to effectively serve elite occupations working in high performance situations. Finally, this study provides knowledge about management learning in a specialized context that can contribute to the adult learning literature and strategies for increasing learning capacity for high-level professionals.

Research Question How do members of an elite occupational group, specifically CEOs of health care, describe the role, purpose, experience, and influence of exclusive learning groups as a context of learning?

The objective of this study was to observe how and why CEOs seek opportunities to interact with their peers via participation in exclusive learning situations. This may result in a better understanding of what CEOs desire and how they want their learning experience to be organized.

The conceptual framework for this study connects the individual learning needs of CEOs in health care, with the conditions and specific environment that exclusive learning groups offer.

It also explores how CEOs recognize their need for learning and increasingly choose exclusive groups for this purpose. In addition, the study examines what CEOs seek and the ingredients that attract them to this form of management learning. CEO Management Learning — Page 33

Conceptual Framework for Study Phenomenon Deliberate decision to participate in exclusive learning groups 1. Exclusive group participation and decisions 2. Informal learning, share experiences, and confidential learning offset psychological isolation 3. Unique learning and social interactive opportunities of exclusive group learning I I

Elite Occupational Learning Needs Exclusive Learning Group Conditions Practical, tacit knowledge, Safe, confidential, and trusting Inside information Real environment enabling candid, open world lessons sharing and discussions Exclusive Group Learning Environment

Nature Relatively small & intimate Context and Structure Self governed & controlled Activity of Process Informal, flexible, interactive the Group

'ossible CEO Learning Activities & Experiences

-Information Sharing Experiential i -Experience of results Success and failures — Lessons Learned I Actual reality of — - War Stories practice Feedback - Validation ---- reaction&advice CEO Management Learning — Page 34

The CEO decision-making management learning process flows through three stages consisting of realizing learning needs, engaging in a process to meet the needs, and internalizing and acting on the needs.

CEO Management Learning Process

Approaches Assessment CEO Learning Realization

Strategies Bramstorrning Exclusive Group Process Critical

Concepts Debating Action -> Tactics Sharing Validating

Reflection Decision

Making Conclusion

Flow of CEO management learning in exclusive CEO learning groups

Outside of formal educational settings, there are various exclusive group learning opportunities for CEOs offered by the American Management Association, CEO Circle, Aspen

Institute, Inc., TEC — CEO, Inc. Magazine, and Fortune. The American College of Healthcare

Executives sponsors an annual CEO Circle. The CEO Roundtable and other health care CEO groups also exist, such as the Health Research and Development Institute (HRDI). There are also ad hoc CEO groups organized by major corporations that do business with health care

CEOs, e.g. the Hill-Rom CEO Advisory Council, Microsoft, GE, and various supplier and service groups. The groups are often restricted in size (15-30 attendees) to facilitate meaningful discussion and interaction. CEO Management Learning — Page 35

Summary of Chapter

The strategies that health care CEOs pursue for rruanagement learning are not well defined or known. In most health care organizations, mamagement learning is provided internally through management development programs, o»r can be obtained externally from commercial or professional sources by the individusl or organization. Work-based professional development for supervisors, middle and seniior managers is routinely available and often related to organizational projects. Thoese professional development programs are often initiated by the CEOs of the organizations. However, organizations must keep in mind learning is equally important for the CEOs as for other positions in the organization (Horton, 1992; Senge, 1990).

In fact, what CEOs choose to learn on their own sends a powerful signal about the skills others should acquire (Kanter, 1997). Traditional management development and training programs targeted to management of all ranks may not be the most appropriate or attractive situation for

CEOs, especially if arranged for the entire organization, conducted on the worksite and approved by the CEO.

Anecdotal evidence suggests that in health care, a significant amount of CEO management learning appears to be self-initiated, experiential, and based on problem solving.

Most CEO exclusive learning groups allow parti cipation by invitation only. These small selective groups are a deliberate attempt to create intimate learning clusters from a larger population of health care CEOs.

The individual CEOs who occupy these unique positions of significant status, power and responsibility operate in an elite professional context that contains specific independence, occupational pressure and personal accoumtability for the organization's CEO Management Learning — Page 36 performance (Hall, 1986; Horton, 1992; Pincus & DeBonis, 1994). Upon being appointed to these positions, health care CEOs immediately become members of a visible, prestigious, social network of peers at the local, state and national level of the industry. Invitations to participate in elite learning groups are signs of acceptance and acknowledgement of being a part of the "CEO inner circle." These elite learning groups are often a sign of being legitimized fully into the

"world of CEOdom."

The environment CEOs work in is daunting. The speed of change they must manage is accelerating and their capacity to learn under these conditions is critical. CEOs play a critical role in the success of any organization and they must be able to learn and adapt quickly.

Traditional learning opportunities are not available to CEOs because of their position, relative isolation and need to maintain confidence. Anecdotal evidence says they learn in special circumstances from each other and in exclusive groups.

This study provides important first-hand insights to these learning experiences.

These insights can be used to assist and improve the CEO learning process, and increase knowledge about how to better organize these programs.

Definition of Terms Health Care CEO:

The organization's highest executive officer reporting to a Board of Directors or stockholders.

Exclusive Learning Group:

Group organized for and limited to those possessing CEO status.

Knowledge Elicitation:

Extracting knowledge from professional expertise, know how, judgment and tacit knowledge. CEO Management Learning — Page 37

Management Learning Domains:

Educational institutions and work organizations.

Management Development:

Development of personal knowledge repertoires and practical skills in organizations.

Management Education:

Development of analytical and critical skills in the academic disciplines relevant to management. Considered to be pre-professional education.

Community of Practice:

Groups of people who perform similar practice and learn naturally and socially to reproduce their work in an apprentice type system.

Autonomous or Learning Societies:

Self-formed and organized learning affinity groups with common bonds and interests.

Tacit or Practical Knowledge:

Personal, context specific and experiential. Inherent in professional "artistry."

Explicit or Technical Knowledge:

Codified, published, and transmittable in a common language.

Informal Learning:

Learning that occurs outside classroom and formal structures. Control rests primarily with learner.

Incidental Learning:

Learning as a by-product of some other activity. CEO Management Learning — Page 38

CHAPTER TWO

REVIEW OF LITERATURE

This chapter reviews literature concerning learning in a social context, leadership development, executive development and learning for CEOs. It discusses situated learning, communities of practice, developmental relationships and the value of social learning theories for management learning. Theories concerning types of knowledge for professional learning, reflective practice, technical rationality and the distinction between management development and management education are also presented, as well as the influence they have on CEO learning in exclusive learning groups. The purpose of this chapter is to also discuss how the uniqueness of the CEO job context (Sherlock, 1999) and knowledge needs relate to various concepts, theories and methods of management learning.

CEOs regularly come together to learn from each other and access important information concerning the practice of management and challenges they face in their jobs.

Anecdotal evidence suggests that small exclusive groups play an important role in how CEOs access information. Given their unique circumstances, it may be that CEO learning in exclusive groups facilitates natural learning (Burgoyne & Hodgson, 1983) resulting from observation, interaction, and functioning in their everyday work lives. These gatiierings may be important in supporting confidential and casual validation of professional practice. Also, situated learning

(Lave & Wenger, 1991) is an approach which occurs largely through communities of practice with groups of people who perform a similar practice and learn naturally and socially to reproduce their work in an apprentice type system. Traditional problem solving models have emphasized individual CEO Management Learning — Page 39 cognitive aspects of executive behavior. However, some researchers (Kolb, 1986) have asserted problem solving for management is not just an activity of the individual executive mind; it is fundamentally a social process. Other scholars also have strong beliefs that a climate of trust or psychological safety is required to enhance the potential risk taking that is necessary in learning through experience (Fry & Pasmore, 1983). In an increasingly competitive health care system, exclusive learning groups may play a strong role in creating trust, psychological safety and climates for risk taking for CEOs.

Literature that supports this research is derived from leadership development, executive development, and management learning. These areas are related to other critical subjects such as adult education and learning (Brackfield, 1986; Darkenwald, 1985; Darkenwald & Merriam,

1992; Houle, Cyphert & Boggs, 1987; Knowles, 1980), continuing professional education

(Cervero, Rottet, & Dimmock, 1986; Cervero, 1988, Nowlen, 1988), self-planned learning

(Kops, 1993), and self-directed and self-initiated learning (Penland, 1981; Knowles, 1980; Long,

1994).

This study was an applied research approach intended to support the development of a case study on how management learning among CEOs in health care is effected by a specific involvement in exclusive learning groups. The unit of analysis is the individual. The exclusive group provides a context for understanding how each CEO comes to make meaning of the experience. The role of the group environment in learning for this study serves as the backdrop for understanding CEO decisions, preferences and choices.

Learning in a Social Context

CEOs commonly belong to more than one exclusive learning group. Some of these groups may be small, personal and informal, consisting of a few trusted individuals. CEO Management Learning — Page 40

They can be organized around a local region, by specialty or other affinities such as classmates from a graduate program. These groups may meet annually, ad hoc, or more frequently.

Regardless of the differences in their function, each serves a similar purpose of allowing CEOs to assemble in a safe comfortable place for face-to-face learning.

Health care CEOs attend many types of exclusive learning groups that have different organizational forms. These groups consist of formal, informal, large, small, planned, ad hoc, structured and/or loosely organized entities. They are sponsored by professional associations, commercial professional development companies, corporations serving the health care industry, specific specialty health care societies and CEO affinity groups with common bonds and interests. Houle (1980) described these groups as autonomous or learning societies, widely diffused but major providers of continuing professional education. He further stated these groups are assembled by a few members of a profession, have thousands of purposes, are short and long term in duration. Health care CEOs would likely be considered elitist autonomous groups composed of self-chosen members of their profession. Autonomous groups based on professions have not been widely studied, but observation and frequency of reference indicates its persuasiveness (Houle, 1980).

Purposes and Role of Groups in Management Learning

Groups may serve several purposes in the management learning process. David Kolb's

(1984) influential adaptation of John Dewey's idea of learning through reflection on experience can be seen in the activity - observation — discussion — application model which is commonly used as the underlying structure for management development designs. Exclusive learning groups offer CEOs a place to safely meet to conduct CEO Management Learning — Page 41 important management development work such as one-on-one self-disclosure. These needs in an organizational hierarchical structure or educational setting with assessment as a major objective would be difficult (Hearn, 1983). CEO exclusive learning groups offer an opportunity to add a sociological perspective to management learning that would bring in a dimension which is largely absent from theory and practice (Burgoyne & Reynolds, 1997). CEO exclusive learning groups may also provide a chance for their members to control the structure (roles, rules and procedures) and the scope (focus material and framework) of the learning experience. This dual liberty provides a unique opportunity to uncharacteristically combine what they do and think

(practice and theory) in their management learning process (Boot and Reynolds, 1983a). The issue of group size is discussed significantly in the findings and underscores the often expressed preference for smaller groups over larger by many professionals because less time is wasted, you generally get more done, and they are most comfortable in avoiding the isolation of individual endeavors and the frustration and anonymity of crowds (Burgoyne & Reynolds,

1997).

Concepts that proposed and valued teamwork as a method of management began to emerge in the 1950s as a new method of trust and open relationships (Argyis, 1964; Bechard,

1969; Bennis, 1966). The examination of exclusive learning groups in this study is distinguished by addressing what value the group may represent and why it attracts CEOs to participate.

Therefore, it is important to point out this literature review was not intended to address teamwork focused on solving problems and completing projects (Van Velsor, McCauley, &

Moxley, 1998), experiential groups charged with learning about group dynamics and processes

(Gillette & McCollom, 1995), learning CEO Management Learning — Page 42 organizations to improve management team performance (Senge, 1990), or theories of cooperative learning groups (Johnson & Johnson, 1989). The focus of the literature review for this study is on the dynamic that occurs between the environment and circumstances the exclusive learning group is perceived to offer and the learning needs of the CEOs. In particular, the study seeks to understand the meaning, value, and activities for CEOs of the informal, incidental and social learning time (Lave & Wenger, 1991; Marsick & Watkins, 1997) that provide important opportunities for extending learning. Schon (1977) described informal social networks as patterns of relationships and interaction among persons and collectives that are acquired and persistent, not governed by formal rule and outside the boundaries of formal organizations.

Von Krogh, Ichijo, and Nonaka (2000) stress the importance of micro communities of knowledge, the small groups within organizations whose members share what they know as well as common values and goals. Tacit knowledge and experiential-knowledge reflect the personal knowledge base developed by professionals from their practice (Eraut, 1994). Knowledge is explicit as well as tacit (Von Krogh, Ichijo, and Nonaka, 2000). Some forms of knowledge are explicit because they have been constructed in more technically rational based sciences, (e.g. engineering or chemistry) and can be easily put on paper, formulated in sentences or numbers, or captured by drawings. Tacit knowledge is often tied to senses, skills in bodily movement, individual perceptions, physical experiences, rules of thumb and intuition. Explicit forms of knowledge tend to be codified, published and publicly accessible (Eraut, 1994). Tacit knowledge is developed through the personal experience of practice and reflects a construction of reality rather than something that is true in any abstract or universal way CEO Management Learning — Page 43

(Von Krough, Ichijo, and Nonaka, 2000). The health care CEO has unlimited amounts of explicit knowledge information available to them but faces a challenge in accessing tacit knowledge information. Obtaining tacit knowledge information is a more complex decision and task because it involves questions of who to get it from, what to look for and where to find it. CEOs new to their positions and experienced CEOs managing in turbulent environments facing challenges outside the range of their experiences naturally seek out their peer group to identify current practices (Fusaro, 2000). Therefore, CEOs must consider sociological implications (Which CEOs and how many?) of obtaining tacit knowledge and identify an enabling context that offers shared space and fosters emerging relationships. The Japanese concept of ba (or "place") means such an organizational context can be physical, virtual, mental or more likely, all three (Von Krogh,

Ichijo, and Nonaka, 2000).

Exclusive learning groups may represent cultures for CEOs to achieve psychological and mental comfort that enables learning. Constructive-developmental psychology offers insights into the developmental relationship concerning the individual and social states. Kegan (1982) describes the importance of understanding the interaction between the individual and culture with respect to personal growth. Culture in tius sense was the context or network within which individual meaning making and personal growth take place. Kegan (1982) further defined culture as human behavior expressed in thought, speech, action, systems of thought and values, organizations and artifacts. As an organization, exclusive learning groups fall well within this definition as a source of interplay between the individual CEO and a culture. Nowlen (1988) also points out that the individual and culture are active agents in personal growth, functioning as two CEO Management Learning — Page 44 interactive strands of influences, supporting or thwarting development. His "double helix" suggests that professionals' learning is influenced by two factors: the skills and knowledge professionals bring to the experience and the professional culture in which the individual practices. Each of these separately are influential learning factors. Taken together they are powerful framers of the learning.

The value of the relationship between the individual and self was further explained by

Nowlen (1988) in asserting that even solo practitioner professionals and small shop owners are shaped by a lifetime of social interaction that either steeled the will for achievement or has dimensioned the capacity for sustained commitment. Schon (1983) suggested four lines of inquiry (frame analysis, repertoire building, methods and theories, and reflection in action) in assisting professionals with the challenge that large areas of professional practice do not lend themselves to the applications of basic science. The repertoire building, frame analysis has particular relevancy to exclusive learning groups because it is a method that offers the practicing professional a source of similar experiences particularly appropriate for their practice. Schon

(1983) also asserts that a professional's need for reflectivity in action as a key to life long professional growth and excellence in practice, can be found in cultures that are learning systems open to surprise and spontaneity in determining the boundaries and directions of organizational inquiry.

Nowlen (1988) discussed performance as structured by a double helix in which two complex interactive strands, each bearing only part of me performance code exist. One carries cultural influences, the other individual characteristics. The cultural-based performance code carries the history, values, mission, character, style, symbols, resources and structures in which the individual moves. The individual characteristic strand CEO Management Learning — Page 45 represents the lifetime of prior cultural interaction from every context within which meaning was developed and growth took place. This concept of a double helix may have particular relevancy to the relationship between the exclusive learning group and CEO learner. It is accepted by those who have studied the double helix concept that each strand (culture and individual) overlap, and contain something of the other. It is less understood what individuals gain from cultures and how they are influenced by a lifetime of exposure, and less acknowledge that individuals' Ihinking and knowledge have a social character. The importance of the influence of social character is based on where it is derived from and how it is shaped. Geertz

(1973) suggests human thought is consummately social in origin, function, form and application. Group culture as a social place for humans may have enormous influence over performance and professional practice. Cambell (1983) also asserts that learning — the formation, growth, and reformation of knowledge— takes place within interpretive communities such as scholarly disciplines, businesses and the professions. Exclusive learning groups may represent a group culture, a social place and community where interpretation and meaning for management practice at the CEO level can occur.

It is also possible that the dynamic between the environment and circumstances of the exclusive group and the learning needs of the CEO is a mechanism that can facilitate performance. Van Krogh, Ichijo, and Nonaka (2000) defined knowledge enabling as activities that positively effect knowledge creation such as facilitating relationships and conversations as well as sharing local knowledge across an organization or beyond geographic and cultural borders. They further note that, at a deeper level, knowledge relies on a new sense of emotional knowledge and care in the organization tiiat highlights CEO Management Learning — Page 46

how people treat each other and encourages creativity-even playfulness. CEOs must seek out

their peers in groups to extend sensitive behavior and playfulness because to do so with

subordinates could make them vulnerable.

Bandura (1986) described social learning theory as a framework for understanding how people learn by observing others. Knowledge sharing and creation through originating interaction (individuals share feelings, emotions and experiences) and conversing (groups of people share mental models and skills of individual members) are asserted to be important methods of transferring knowledge between people (Van BCrogh, Ichijo, & Nanaka, 2000). Van

Maanen and Schein (1979) present socialization as the process by which individuals internalize the norms and values of the groups they join. Both of these topics have implications for CEOs in exclusive learning groups. The exclusive learning group may be most closely associated with the cohort role which provides a sense that you are not alone in your struggles and that if others can achieve their goals, you can too. They also point out another way organizations encourage people to seek out developmental relationships is to purposefully broaden their access to other people through networks. Many executives can meet networking needs within large organizations; however, CEOs must have these needs met by accessing other CEOs who are congregating in groups.

Burgoyne and Reynolds (1997) stress that understanding a combined benefit of the value of what occurs in groups is difficult due to the separation between those who carry out research in groups and those who use groups as a basis of learning. This frequently results in theoretical perspectives which lack grounding in practice, and practice which remains uniformed by relevant theory. Exclusive learning groups may CEO Management Learning — Page 47 also provide a unique opportunity for CEOs to constrain their independence and open up to learning because expectations and norms which govern behavior are a condition of membership

(Burgoyne & Reynolds, 1997). The expectations and norms require participation in a form of candid, open sharing of ideas and experiences that uniquely contribute to each CEO member's development as a manager.

Leadership Development Leadership development is discussed extensively in the management training literature. While it is widely acknowledged that managers primarily learn through their experiences, it is not known how experiences contribute to their development. A model of leadership development has been discussed and defined (Van

Velsor, McCauley & Moxley, 1998) as requiring three critical elements: assessment, challenge and support that creates a developmental experience. When identifying how managers develop, past studies identify topics such as challenging experiences, significant people, hardships, course work and training. (McCall, Lombardo & Morrison, 1988; Morrison, White & Van

Velsor, 1987). Also, various forms of feedback and especially 360° feedback (Moxley &

McCauley, 1996) have been associated with making leaders more effective. Levinson (1978),

Kram (1985), McCall and Lombardi (1983) have focused on mentoring as an influential and vital tool of leadership development, especially for top leaders. However, it is important in constructing these relationships to be careful of the potential of creating climates of favoritism

(Murray & Owen, 1991; Noe, 1991; Kram & Bragar, 1992; Kizilos, 1990), ignoring the potential value of exclusive learning environments. Exclusive learning groups bring CEOs together and allow them to play a role in each other's personal development by mentoring, advising and being supportive. CEO Management Learning — Page 48

The research on developmental relationships (McCauley & Douglas, 1998) is most relevant to the interactions between health care CEOs in exclusive learning groups. This research emphasizes the important role other people play in personal development of individuals. It stresses that relationships shape people's lives, and this is a commonly held notion and widely held phenomenon in the study of social sciences. Psychological literature is identified as providing significant attention to social learning theory and socialization in developmental relationships. Van Velsor, McCauley, and Moxley (1998) identify twelve roles played by others in developmental relationships, each having a distinct function in improving personal development. These roles can be grouped into those that assess, challenge and support the individual. They also point out the growing prevalence of people developing individual strategies for securing developmental relationships, including multiple relationships for different needs.

Organizations are also creating environments where developmental relationships may occur by identifying employees that are particularly good at what they do and organizing them as coaches to create a "coach culture" (Palus & Strogolsky, 1996). Other organizations are creating networks for women or racial and ethnic groups (Barclay, 1992; Morrison,

Ruderman& Huges-James, 1993). Organizations are also creating formal developmental relationships to maximize potential of people. Van Velsor, McCauley and Moxley (1998) identify five reasons frequently cited for creating formal development relationships in organizations: 1) socialization of managers, 2) preparing high potentials for more responsibilities, 3) developing women and people of color, 4) meeting developmental needs of senior executives and 5) organizations change efforts. Many of these methods may not be effective or attractive ways for CEOs to CEO Management Learning — Page 49 develop professionally and are more apt to be led by CEOs in their organizations. CEOs cannot learn how to improve practice in their jobs through developmental relationships with subordinates in their organizations. They must obscure, and interact in social learning activities with their peers.

Banduras (1986) on social learning theory emphasizes how people learn by observing others. His articulation of various learning or the capacity to learn from others through observation provides additional insights into characteristics of exclusive learning groups.

Socialization (Van Maanen and Schein, 1979), the process by which individuals internalize the norms and values of groups they join, is also an important contributor. Behavioral role modeling and feedback can be active parts of the learning process within social learning theory.

These techniques have been used in organizational training programs but not often with CEOs or top-level executives. The most important element that learning in a social context may contribute is an enabling context (Van Krogh, Ichijo, & Nonaka, 2000) that drives knowledge creation and appropriate conditions (the right context). Learning in a social context fosters emerging relationships within micro communities, across group boundaries, and throughout an organization for whatever it takes to unleash tacit knowledge.

Executive Development

This review of the executive development literature suggests the context (Sherlock,

1999) CEOs operate in may create a need for peculiar socialization and management learning conditions that are customized to meet the needs of their unique role. These conditions may explain the difficulties outsiders have in obtaining a good understanding of what CEOs and other elites actually want and need for learning. A. CEO Management Learning — Page 50 large part of meeting the unique needs and peculiar socialization requirements of CEOs is the lack of understanding of their need to be with other CEOs and separate from non-CEO executives for many learning experiences.

There is consensus in both the literature and the practice that leaders can have positive effects on the performance of an organization (Bass, 1985; Bennis, 1989; Burns, 1978; Senge,

1990). Organizations worldwide spend millions of dollars each year on executive development programs, and studies have been conducted to determine what makes executives successful

(Bennis & Nanus, 1985; Bray et. al., 1974; Dechant, 1990; Kaplan et. al., 1987; Lombardo &

Eichinger, 1997; McCall et. al., 1988). The common denominator identified in ail of these studies was their emphasis on maximizing performance. Unlocking the key to improving management and organizational performance drives much of the executive development research literature. Competitive forces in business and health care will continue to generate huge investments in executive development programs.

Argyis (1991) identifies various psychological barriers to successful executive learning.

Argyris specifically suggests that "career success" of individuals in business can actually become an obstacle to further learning. This can occur because people develop blind spots or assume there is little else to know about their jobs. The ultimate career success in organizations is becoming a CEO. This achievement may create a sense of false confidence and/or impediments to learning due to the status and conditions surrounding the position. These conditions of success reflect a possible obstacle to learning versus an inability to learn, and could exacerbate isolation due to psychological barriers experienced by CEOs. The challenges that these barriers represent to CEO Management Learning — Page 51 management learning for CEOs are illuminated by the importance of the three main sources most professionals rely on to learn published material, practical experience, and people (Eraut,

1994). Sherlock (1999) found the context of the CEO position had a major influence on learning.

Executive development programs must address the need CEOs have to learning with and from each other and to influence the learning content and process. Organizational ascendance may render the CEO both powerful but psychologically isolated and vulnerable from a learning awareness perspective.

An additional disadvantage may be that the investments of time and money in business and industry in executive development focus on senior managers and professionals, not the CEO

(Horton, 1992). However, other scholars have insisted learning for the CEO is equally important

(Bennis & Nanus, 1985; Senge, 1990). The challenge to purveyors of management learning for

CEOs is understanding and providing what they want and need for professional development.

Some have analyzed context (Bandura, 1977; Clark & Lyness,1991; Gould, 1978; Jarvis, 1987) and concluded that it shapes and limits learning. Few studies, however, have focused on learning strategies that are influenced by CEO involvement in planning, CEOs' practical needs and emphasis on peer interaction for learning.

Because of the potential for isolation at the top and the unique role and context of position (Bennis, 1989; Kaplan, et. al, 1987; Sherlock, 1999), the CEO may need to learn what to learn as a CEO, which is quite different from previous experiences and learning as an executive.

There are complex psychological implications that are a part of being a CEO (Palus, Nasby, &

Easton, 1990) that impact personality identity, and the enormous autonomy of the position, and can. lead to psychological isolation. CEO Management Learning — Page 52

Executives can have access to peers in formal and informal developmental relationships, (Van Velsor, McCauley, & Moxley, 1998) but CEOs have no peers in the organization. Many CEOs become prisoners of their office, overburdened with the need to consume information in quantitative forms, unable to delegate, and submerged in details they cannot master or subdue. They can also become engulfed by a syndrome of "good news" bears who filter honest trutliful information. This condition is exhausting and can drain energy to see the big picture and understand the actual course of events. O'Neil (1993) presents the concept

"mythic success" as a condition that occurs when leaders achieve power, privilege and money.

O'Neil describes the assumptions and hallmarks of the myth of success as: delusion that success is absolute and final, money and buying power are central to the meaning of success, the craving for more is uncontrolled, and success will make you free. These realities of high- powered CEO positions are potential obstacles to learning and allowing CEOs to step back and engage in self-renewal with peers in a trustworthy setting that supports such activities.

Learning for CEOs

In studies of senior executives, Isenberg (1984) concluded that "the primary sources of an executive's knowledge are mental images, experienced and stored scenarios, rules of thumb, and repertoires of familiar problematic situations matched with necessary responses; these forms of knowledge are acquired through extensive experience in problem solving and implementation and are stored in memory."

Sharing past experiences, perceptions, and personally developed concepts is often a basic method of learning for leaders and CEOs (Moxley & Wilson, 1998; Jarworski, 1996;

Vail, 1996). These methods of learning are more easily convened in groups where CEO Management Learning — Page 53

CEOs are most comfortable in sharing the learning process. Management intuition can likely play a role in facilitating the exchanged information that is primarily experiential and practical.

Isenberg (1985) also observes that managers rely on intuition, describing it as not the opposite of rational nor a random process of guessing, but rather an important thought process for senior managers to use, based on very rapid recognition, categorization and retrieval of familiar patterns.

CEOs function in a world driven by practical decision making often supported by technical knowledge. Eraut (1994), after analyzing research on professionals' learning, categorized two types of knowledge: technical or practical. Management courses often feature these types of knowledge as methods of "know how" or being able to carry through explicit procedures to get practical work done. Schon (1983) asserts that technical rationality, because it provides only one way to respond to a given situation, does not account for the processes that are central to professional "artistry" or indeterminant situation — the conditions where most CEOs work. Practical knowledge is important to CEOs because they are measured by organizational performance overall through proficient management execution.

Schon (1993) asserted that higher education for disciplined, codified, prepositional knowledge driven by the epistemology of technical rationality dominates models of professional knowledge. He characterized technical rationality as the systematic knowledge base of a profession that has four essential properties. It is specialized, firmly bounded, scientific and standardized. Schon (1983) asserted that this knowledge excludes situations which many professionals perceive as central to their practices. Describing these situations as the "swamp of practice", Schon advocated for CEO Management Learning - Page 54 an educational process that developed the capacity of the individual to recognize and adjust present skills and knowledge to new situations. Eraut (1994) further refined Schon 's process of reflective practice, noting that reflection in action is highly dependent on the speed with which practice decisions must be made. Nevertheless, both assert that professional education requires opportunities to practice within both technical and procedural realms. The CEO's job is to orchestrate and balance the technical and procedural realms of knowledge in their organizations but they must ultimately make practical decisions which often depend heavily on the artistry of professional judgment.

Reflection and critical reflection has been well established in the literature (Argyris &

Schon, 1974; Argyris & Schon, 1978; Schon, 1983; 1987) as an important ingredient of management learning. Reflection could be employed at various stages of management action

(prior, during and after) to contribute to the management learning experience. For many CEOs reflection might be a valuable tool for management learning because new ideas and strategies can often be developed through shared experiences of failed and successful strategies. Reflecting and making sense after shared experiences may be vital learning activities for CEOs. This process may also be enhanced by group and interpersonal interaction.

Eraut (1994) further defines procedural and situational knowledge as process knowledge meaning: planning, organizing, mentoring, coordinating and team building. Management courses often feature these types of knowledge as methods of "know how" or being able to carry through explicit rational procedures to get practical things done. Oakeshott (1962) clarified two of these concepts when describing professional practitioners' knowledge: practical knowledge and technical knowledge. Procedural or CEO Management Learning — Page 55 practical knowledge is defined as knowing how to conduct a process while the academic or technical knowledge is defined as concepts and theories stored in memory. Others, including

Schon (1987) and Isenberg (1984) frame procedural knowledge within the framework of more than just "how to" information. While Isenberg talks about intuition, Schon (1987) describes

"knowing in action." This added component makes it possible for the professional to add to their repertoire of skills through "informed practice" — the ability to recognize and adjust present skills to new situations. The practical knowledge must focus on the process of thinking in action or reflection in action (Schon, 1987) and intuition (Isenberg, 1984).

Management learning has been identified as having two domains: educational institutions and work organizations (Easterby-Smith, Thorpe, Lowe & Andy, 1991; Fox, 1997).

Because management education tends to be more theoretical and management development more practical (Fox, 1997) emphasizing a repertoire of career strengthening skills, CEOs gravitate to the latter to learn (Burgoyne, 1988; Burgoyne & Reynolds, 1997; Vail, 1996;

Kotter & Heskett, 1992). CEOs have infrequent connection to formal education as learners and rarely have learning time at work. Therefore, it is logical that an alternative would be sought to achieve continuing professional education by learning from experience. Concepts of learning in practice (Lave & Wenger, 1991) focus primarily on incidental, informal and natural learning.

Incidental learning is a subcategory of informal learning and occurs as a byproduct of some other activity such as a task or interaction. Informal learning is normally outside classrooms and formal structures and control of learning rests primarily in the hands of the learners.

Natural learning is unplanned, often takes place on the job and can occur through discussion, CEO Management Learning — Page 56 observation, or review of activities and actions. Sociology and anthropology provide critical insights into the practical social and learning process that can be a part of a learning experience. Anthropological studies (Jordan, 1989) have demonstrated that knowledge can be developed and transferred to others without observed formal instruction but rather by natural association with those who are accomplished in procedures and processes.

Lave and Wenger (1991) assert that practical and social learning processes outside formal classroom learning have direct links to any complex system of work where relationships between new comers and old timers, and among co-workers and practitioners are involved. Underpinning these concepts are die beliefs of other scholars (Burgoyne & Hodgson,

1983; Mumford, 1989; Marsick & Watkins, 1997) that recognize that a considerable amount of learning occurs outside formal learning events and programs. These scholars also recognize there are very few detailed studies of these "natural" or "everyday" learning processes because they are less easy to investigate than class room and formal settings (Burgoyne & Reynolds,

1997). CEO exclusive learning groups are social learning processes that enable new comers and old timers to share practical experience and knowledge in a natural informal manner.

Burgoyne and Reynolds (1997) discuss various viewpoints surrounding concepts of management learning. They explain positivist view management learning in behavioral terms and identify links between desired end behavior and suitable instructional processes. They view knowledge and skills as content dependent and consequently reliant on correct methods of analysis and instruction. Burgoyne and Reynolds (1997) make the distinction between management development as developing CEO Management Learning — Page 57 personal knowledge, repertoires, and skills, i.e., time management, selling, negotiating versus management education that develops analytical, and critical skills in academic disciplines relevant to management, i.e., economics, operations management, accounting, and organization theory. Burgoyne and Stuart (1976) believe most managers learn from experience and much significant management learning occurs from work related events. Shorter (1993) advances a third perspective that is social constructionist. In this case the manager is seen as a practical author and reality is vague, only partially specified and always unstable. In this situation, greater clarity is obtained through discussion with others and through negotiated meaning. Regardless of the various types, sources and methods of knowledge, CEO exclusive groups provide a vehicle for CEOs to transact knowledge between each other.

An additional difficulty for the CEO is accessing and participating in management learning at work. Most organizations have corporate management development activities that can be placed in two categories: structural and developmental (Burgoyne & Reynolds, 1997). The former is designed to assess and place managers in jobs they are suited for and the latter is intended to help people change and develop to take on jobs in the future. These corporate management development activities can be defined as career development activities or contracts between the person and organization (Burgoyne, 1988). Since many of these programs are designed by the CEO for their subordinates, with the ultimate goal of evaluation or performance, they are naturally uncomfortable places for CEO learning. Therefore, it is likely most corporate management development programs are not ideal or practical for CEO involvement.

Consequently, the CEO may be faced with three challenges concerning management learning; first, when to learn, CEO Management Learning — Page 58 whether prior to, during or after problems develop; second, what to learn, or how to identify the most valuable and productive place between the theory — practice tensions of management education and development; and third, how to learn (pedagogical), tiirough informal or formal means, solo or in groups, problem driven (constrained) or undefined (liberated). Exclusive learning groups bring together new comers and old timers and facilitates relationships to build knowledge and practice. Lave and Wenger (1991) describe this as situated learning or legitimate peripheral participation that allows people to become full participants in the socioculture of a practice. They further define this as a community or practice. Exclusive learning groups may be a method that is a unique opportunity for CEOs as an elite occupation, to function as a community of practice.

In the discourse on situated learning (Lave & Wenger, 1991) several key points are defined that may directly relate to exclusive CEO learning groups:

■ People who perform some practice belong to communities of practice.

■ The practice at the core of any community typically follows a cycle (beginning, middle,

and end) from novice to expert.

■ The community of practice socially reproduces itself (old timers teach new comers) over a

longer cycle than the work cycle itself.

It is important to recognize that CEOs are a special class of workers and subject to the traditional social division of labor when understanding how their distinction represents a unique responsibility and experience. This division of labor places CEOs in a peculiar position in which they are self-defined as a privileged and elite social group that possess unique learning experiences and needs. The expertise and ethics relevant for husbanding privately owned assets are a privilege and unique responsibility in our society CEO Management Learning — Page 59

(Bendix, 1966). CEOs represent the ultimate in this class of professional managers in this regard. Therefore, as a unique occupational and social group they would invariably seek each other to share, discuss, and understand common experiences, challenges and strategies related to these responsibilities. Inherent in this description of community of practice is the idea of incidental and informal learning. Incidental learning represents (Marsick & Watkins, 1997) a subcategory of informal learning and occurs whether a people are aware of it or not because the learning itself is normally a by-product of some other activity. The problem solving cycle of informal and incidental learning is essentially equivalent to the work managers do and, at each stage, opportunities exist to identify learning activities and expand one's repertoire of possible solutions (Mumford, 1994). It is an interactive and reflective process that moves in back and forth directions. Incidental learning has also been described as unintentional adult learning "en passant," a planned event in which learning is not the main purpose but rather an offshoot of life's routines (Reischmann, 1986). Ideas can circulate and revolve around a group of learners until they take hold as meaningful.

The concepts of incidental and informal learning support the notion that, when CEOs congregate in exclusive learning groups, learning can occur through their association. Whether participation in exclusive learning groups by CEOs is an act of intentional learning or not, unexpected events will occur that have not been designed or established as objectives and learning will take place

Summary of Chapter

The effects of changes and new concepts about learning in a social context for development of professional knowledge is important to the fields of leadership CEO Management Learning — Page 60 development, executive development, and management learning. Growing interest and emphasis is being placed upon defining practical knowledge, understanding how to develop it, and share and transfer it to improve practice and strengthen theory. Increased study and understanding is required between academic-based and practice-based experiences to lessen the natural tensions between these domains and increase the flow of information that can advance management learning and practice. Achieving these goals will require a broader understanding of the definition of knowledge and the scenarios, environments and conditions where learning occurs.

Continuing to view CEO management learning through the disciplines of leadership development and executive development will contribute to a better understanding of how CEOs learn. CEO Management Learning — Page 61

CHAPTER THREE

METHODOLOGY OVERVIEW The purpose of this research was to develop a series of cases concerning individual experiences in exclusive learning groups that contributed to the body of knowledge concerning CEO learning. The goal of the research was to obtain the essence of the combined individual experiences concerning CEO learning in a social context. The research also enabled a view of specific components of the essence of that learning experience through thematic categories that made it easier to organize the data into meaningful themes. This approach was utilized because of the uniqueness of the elite occupation in the study, and the difficulty in accessing in-depth information on personal experiences from CEOs.

Consequently, obtaining meaningful information from the CEO participants did not lend itself to one research tradition.

This study was organized as a qualitative research study of multiple cases and combined in its presentation as a case study consisting of qualitative inquiry, wholistic and phenomenological approaches. Stake (1995) described this approach as a collective case study or a study of a number of cases combined. The study approach also included intrinsic case method designed to better understand each particular case, and the study reflected methods from instrumental case approaches that enabled deeper insight and refinement of the experiences being observed in each case. Consequently, the case study method applied was more complex because it borrowed various traditions in the qualitative research literature.

Phenomenological research tradition is a research method within the field of qualitative research that emphasizes people's lived experiences and facilitates the CEO Management Learning — Page 62 location of meaning, people, and place on the events, processes, and structures of their lives

(Van Maanen, 1982). The perspective of inquiry of this study was from the leadership developmental, executive development, learning in social context, and learning for CEOs' framework. The researched cases consisted of observations of exclusive learning groups and interviews of health care CEOs. An applied research approach supported the development of die case studies. Collection of die data through multiple cases and group observation was considered the best possible way to obtain the information. The unit of analysis was the health care CEO as a member of an elite occupational group functioning in an exclusive learning group. The data was derived from direct individual CEO interviews and from observations of

CEOs in exclusive learning groups. Collectively, the individual interviews provided the primary source of data. The group observations served as adjunct sources of information and provided the social context in which to understand CEO learning. The study findings reflect information generated as a result of the combined interviews and collective opinions, values, preferences, expectations and experiences expressed about CEO learning by the participants.

This chapter describes die nature of the research, methodological approach, role of the researcher as participant, research objectives and the boundaries of the study. The research design, sample selection and interviewee profile and interview questions provide a detailed presentation of the essence of the study. The chapter reviews data collection coding, validation, assumptions and role of the researcher. CEO Management Learning — Page 63

Study Objective and Research

The objective of this study was to interpret and describe the meaning of the nature, environment and process of learning activity for CEOs in exclusive learning groups. The study provides a deeper understanding of the workings of how CEOs learn in this environmental context and the influence they have on each other's learning experience. Researchers of case studies (Yin, 1994) have recommended multiple sources of information gathering: documentation, archival records, interviews, direct observations, and various physical artifacts.

Three of these methods (documentation, interviews, and direct observations) were used in this study.

The use of a modified case study methodology approach addresses personal, practical, and research purposes. The researcher's personal purpose is defined by his need as a health care CEO to determine, clarify and understand the phenomena of CEOs' attraction to exclusive learning groups. The practical purpose for this study was to answer questions for those interested in organizing and producing professional development programs for elite occupational groups to enable implementation of the best approaches and designs. The research purpose was to gain better insight as to what is actually occurring for members of elite occupations who participate in exclusive learning groups. Using the case study method in this investigation offers the most effective way to attain a deeper understanding of the meaning of exclusive group learning for the individual participants (CEO). It also offers the most effective way for the researcher to capture the participants' perspective, which includes cognition, affects and intentions related to their actions and experiences. The method selected enabled the researcher to understand the reality of events not just account for them (Maxwell, 1992;

Menzel, CEO Management Learning - Page 64

1978). Use of the qualitative approach in this study was intended to get at how the participants make sense of the exclusive learning group situation, their learning experiences and how their understanding influences their behavior. This focus on meaning is central to the interpretive approach in social science (Bredo & Feinberg, 1982; Geertz, 1973;

Rabinow & Sullivan, 1979).

Methodological Approach The study was designed to conduct interviews of CEOs who participated in exclusive learning groups. This study describes the nature, structure, and process of the learning group and its influence on CEO learning experiences. Based on the typology of educational research (Carr & Kemmis, 1986), this research was conducted in the interpretive form. Findings are presented in the interpretive- descriptive framework (Tesch, 1990). The objective was to view the exclusive learning group and the CEO's experience in it to understand and gain knowledge from the meaning of the process from an inductive mode of inquiry (Merriman, 1998). The primary objectives were to understand what these groups consist of, why CEOs are attracted to them and how they learn in them. The study focused on the individual within the context of the exclusive group learning environment (nature, structure, and process). The exclusive learning group is viewed as the vehicle or conduit for congregation of the elite CEO learners. This study describes links between the exclusive group environment and CEO learning. It also describes the experience of participants in a real life context of the exclusive group. The end product reflects an insider's understanding and interpretation of an exclusive group learning experience for CEOs. Finally, this work represents a holistic description of an exclusive learning group and the experience of

CEO participants. CEO Management Learning — Page 65

Collecting the data for the study focused on four sources of information, conversations with professionals, documents, interviews and direct observations. Conversations were conducted with officials of professional membership associations, organizers of commercial and non profit exclusive learning groups and professionals responsible for continuing education and research in health care management. Discussions focused on efforts aimed at program development, CEO participation retention, and competitive trends in the health care management development field. Documents concerning the nature and content of management development programs of professional associations and commercial organizations offered to executives and CEOs were reviewed. Discussions were held with educators and researchers of these organizations about their efforts to address the needs of CEO audiences. Conversations about learning behaviors and preferences were held with a select number of health care CEOs and opinions solicited from educators in health care management about their understandings of continuing professional education for CEOs.

Observations were made at meetings of two CEO exclusive learning groups to review

CEOs' learning activities in action. Each exclusive learning group observation was conducted over a three-day period during scheduled group meetings. Two interviews were conducted with seven health care CEOs followed by periodic telephone discussions to clarify statements and solicit additional comments. Other related works were referred to, including organizational and management studies (Bouchard ,1976; Webb & Weick, 1979). Observational techniques

(Douglas, 1976; Johnson, 1975, & Webb, et al., 1981) were also employed. CEO Management Learning — Page 66

Participant Observation Participant observation in this study is defined by the researcher's status as a CEO and member of an exclusive group. Case study researchers (Gans, 1982) are advised to be cognizant of several key issues while applying this method, especially maintaining sufficient detachment to avoid affecting what is being observed.

Participant observer status has been defined in (Gold, 1958) classic typology:

1. Complete participant — Researcher is member of the group being studied and conceals his

or her observation role from the group to avoid disrupting natural activity.

2. Participant as observer — The researcher's observer activities, which are known to the

group, are subordinate to the researcher's role as a participant.

3. Observer as participant — The researcher's observer activities are known to the group;

participation in the group is secondary to the role of the information gathered.

4. Complete observer — The researcher is either hidden from the group (for example behind

one way mirror) or in a completely public setting such as an airport or library.

In this study, the researcher's role was that of observer as participant. The researcher's role in this study is closely associated with observer as participant because of my membership in each group observed and status as a health care CEO. However, it is important to note the observations to be conducted in this study are focused primarily on the individual, and secondarily on the group. Each observed group and individual CEOs were familiar with the researcher enabling easy access and minimum anxiety. Therefore, the affect of the researcher's participant observer method should have had minimal influence on the group's natural function.

The research relationship established as observer participant can facilitate or hinder other components of the research design CEO Management Learning — Page 67

(Whyte, 1991). However, observer participants do not generate deeper, more compassionate meanings than passive observers, but one role may work much better for certain people in certain situations (Stake, 1995). The status of the researcher as a CEO and exclusive group member for this study provides advantages of familiarity and rapport that generate comfort and acceptance by the CEOs interviewed. This research relationship produces far more advantages than disadvantages in the researcher's role as observer participant. Observation stages (entry, data collection and exit) were facilitated by the researcher's status as a CEO.

CEOs stated they learned how to function more effectively by observing others in groups of CEOs. "Knowing what to say, how to say it to sound intelligent," "understanding how to ask questions and seek information astutely," "identifying the best practices, organizations, and brightest people," and gaining insights how to conduct themselves socially for personal improvement and career development were some of the lessons learned. In general, significant learning events were characterized as unintentional learning benefits that were incidental to the immediate learning activity.

Case Boundaries

The case boundaries for this study consisted of the individual CEO learning experience within the system of the exclusive learning group (Smith, 1979). Subjects were considered from a range of health care organizations that offer exclusive learning groups for CEOs. Sources of exclusive learning groups such as The CEO Roundtable, the American College of Healthcare

Executives (ACHE) CEO Circle/Forum, the Hill-Rom CEO Business Advisory Council, and

Health Care Research and Development, Inc. were all included as learning environments of the potential CEOs to be interviewed. CEO Management Learning — Page 68

The distinguishing characteristics for these groups was the autonomy of the members in regulating its functions. Rules, programming content, and governing functions are primarily developed and determined by the organizers of the group with input from its CEO members.

The Health Care Research and Development, Inc.(HRDI) is structured more like a professional learning enterprise, where CEOs serve as participants in seminar focus groups, reacting to research and development ideas concerning strategies, products and services of major corporations that manufacture, service, and supply the health delivery industry. The CEO

Workshop and CEO Circle/Forum employ a mixture of traditional presentations with significant time for socialization and interaction. In the HRDI group, the intent is information learning and exchange between the CEOs and major corporations, but the agenda schedules time for social interaction that creates opportunities for informal and incidental learning

(Marsick & Watkins, 1990) within social and recreational activities.

Each of these groups attracts some of the most prestigious and innovative CEOs in health care. These groups are voluntary, but cultivate a bond and loyalty amongst members mat maintains high participation. Each group has approximately 25-30 CEO members (although participation in each session will vary).

There are a variety of types of exclusive learning groups. Some have functioned for several decades and others were established within the past few years. They are unaffiliated with each other and have distinct requirements, objectives and operating rules. The common denominator is reserved memberships for CEOs. Some of these groups are ad hoc, formed by

CEOs with a common interest or purpose, such as technology development or shared interest in similar services, i.e. rehabilitation, CEO Management Learning — Page 69 academic medicine, and multi-institutional ownership. Many CEOs belong to multiple exclusive learning groups whose members can often be overlapping, thus enabling CEOs to see each other in different groups throughout the year.

In the most exclusive groups, admission is controlled by existing group members. In the absence of any hard criteria, human and professional factors such as compatibility, interest, group balance by types of facilities, geographic locations, and organizational size and scope of responsibility prevail. The emphasis is less focused on representation of specific groups and designed more to maintain a balanced chemistry and membership conducive to fostering maximum participation. Group members also strive to maintain an environment that honors confidentiality and attempts to avoid members that are a direct competitive threat.

Research Design

This modified phenomenological research study revolved around the unit of analysis

(the CEO within the exclusive learning group) and the overall learning experience of each CEO.

The document review, observations and interviews attempted to gain a deeper understanding concerning CEO values and experiences from exclusive group participation. The study results are a collective description of the meaning and purpose of each CEO's learning experience. This study utilized three different types of data sources—background documentation and material, group observations and individual interviews. A letter was sent to each CEO requesting their participation in the study (Appendix A).

The investigation began with observations conducted at the two group meetings in the fall of 1999. Each subject attended these meetings and were observed and CEO Management Learning — Page 70 periodically conversed with during these sessions. Observations of the CEOs were conducted during business, social and informal periods of the groups' functions. Four of the CEOs attended the first exclusive group meeting and three attended the second. Following the meetings, two rounds of interviews were conducted with the subjects. The initial meeting was focused on gaining a general understanding of the CEOs' attitudes and approaches to learning in exclusive groups with regard to their history and basic rationale for participating. The interview further explored the specific opinions and values, feelings and emotions, and experiences subjects had concerning exclusive learning groups. Answers to many questions were based on experiences in exclusive learning groups other than those observed, but were consistent with the observation of their group involvement. The initial interviews lasted 1 'A to

2 hours. Brief phone conversations, voice and e-mails were used as means of preparing for the follow-up interview and addressing conflicts or gaps in data already obtained in answers.

The second interview session was conducted after subjects had been provided with transcripts of the first interview and been given an opportunity for corrections and feedback.

This interview session focused more deeply on meaning and preferences concerning the learning group conditions, and needs CEOs thought they addressed. The group learning environment, its nature, structure and process were discussed and specific CEO learning activities and methods were explored. This session also lasted 1 to 1 Vz hours. An interview question framework (Appendix B) was used during the initial interview and a list of additional questions was asked (Appendix C) during the follow up session to provide a consistent and complete process. Each CEO was encouraged to continue to communicate and provide thoughts about their management learning CEO Management Learning - Page 71 experiences in exclusive learning groups as interview material was being reviewed and analyzed. Four of the seven CEOs interviewed responded with additional comments.

In addition, attempts were made to identify remarkable events that may have produced a universal learning experience for the CEO during the exclusive group meeting. Remarkable events are those experiences that have substantial and/or indelible impact and impression on a

CEO's learning experience, sense making and meaning formulation. Remarkable events would likely result from a learning exchange between CEOs that provides or creates new perspectives and ideas that solve difficult or intractable problems. They may also offer insight on how personality, style and/or character impact achieving desired outcomes.

During the interviews, CEOs told stories and reminisced about learning experiences.

Frequently, the researcher engaged in discussions to clarify the meaning of comments and verify the direction of their response as relevant to the interview objective. CEOs were more forth- coming outside the group sessions and were extremely verbal during follow up interviews. All interview sessions were conducted in private places to achieve minimal interruptions.

METHODOLOGY

Sample Selection

Seven CEOs were selected by using a purposeful or criterion-based selection (Patton,

1990) sample. The rationale was to select CEOs that could provide information to form rich case material to understand more deeply the CEO experience in exclusive learning groups. CEO Management Learning — Page 72

Membership lists from exclusive groups were reviewed. Research subjects were purposely chosen to achieve a fair balance of ages, experience levels, gender and race. Initially,

15 CEOs were considered as potential interviewees with the goal of selecting 6 to 8 acceptable and willing participants. Requests were made and approvals obtained from organizers of two exclusive learning groups to conduct observations during the group meetings. General discussions were held by telephone and in person to introduce the study and obtain commitments to participate from each person. Upon agreement to be interviewed, each CEO was provided a letter explaining what was expected of them as a participant in the study.

Criteria used to guide sample selection was career stage. The framework, "Breaking in, fitting in, and getting out," as discussed by Fox, Mazmanian and Putnam, (1989) was used. In addition, career status: active, transition, and recently retired, was also considered. There were seven participants in the study. However, given the nature of the study and elite status of the subjects, the sample is sufficient to produce quality, not quantity. Given the small number of participants, these criteria guided selection of CEOs interested and willing to commit the time to effectively be a part of the study. Also, some participants were at stages that straddled experience from more than one criteria. Profiles of participants are included in the findings chapter.

Unit of Analysis

The unit of analysis in this study was the individual, and the population sample was the seven (7) chief executive officers of health care organizations in the United States. The selection of the seven interviewees was not intended to be generalizable; however, the study subjects reflect a fairly representative demographic range of CEO Management Learning — Page 73

American health care CEOs. Every attempt was made to include distinguishing characteristics

such as gender, race, age and size or type of organization. The professional CEO experience

of interviewees consisted of CEOs in the early stages of their career through recent retirement.

They had experience as CEOs of public general hospitals, academic medical centers,

insurance/managed care companies, multi-hospital/integrated delivery systems and

freestanding community hospitals. Five of the CEOs were actively practicing their trade, one

was in transition between jobs, and one had recently retired. The study criteria resulted in the

following profile of CEO participants:

Interviewee Profile Matrix

Interviewee Gender Race Age-Range Years Regional Experience Location 1 F W 45-50 25 New England 2 M AA 45-50 25 Midwest 3 M W 55-60 30 Mid Atlantic 4 M W 45-50 25 Southeast 5 M W 50-55 28 New England 6 M W 60-65 25 Northwest 7 M W 55-60 25 Southeast

All interviewees held master's degrees from university programs in health administration or health services management. They currently or recently occupied positions in the Eastern, Southern and Western regions of the United States in both rural and urban communities in die United States. Their career experiences included working in other regions of the country in various types and sizes of health care organizations, both rural and urban collectively. They had experience managing health care organizations of all types: single hospitals, teaching hospitals, managed care systems, multi-hospital systems and public hospital systems. CEO Management Learning — Page 74

Limitations and Delimitations

All the participants in this study are highly educated, middle class professionals. All have master's degrees in health management, had mentors early in their career and may be classified as over-achievers with career development experiences that are not generalizable to their peers.

The data collected are retrospective, thus are potentially limited by the interviewees recollections and by their ability to objectively evaluate the factors contributing to their own learning experience as CEOs in exclusive learning groups.

The seven participants were predominantly white male professionals and could have skewed a more diverse cultural perspective in a sample containing more women and racial or ethnic minorities. Although each participant was guaranteed confidentiality, the general security consciousness and skepticism of CEOs may have caused some interviewees to limit answers.

Finally, the researcher as a CEO and member of exclusive learning groups could have influenced the nature of responses and created undue influence on the responses from interviewees. This study specifically restricts itself to the learning experiences of health care

CEOs in exclusive learning groups and its findings may not be generalized to other professions and disciplines. This study is limited to the experiences of the participants and the organizations to which they belong.

Interview Questions

Interview questions concentrated on opinion or value, feeling, and sensory questions.

These questions were used to understand what the CEOs thought about the elite learning group experience, what they actually felt about learning in this manner and CEO Management Learning — Page 75 what they actually experienced when engaged in this activity. The following question data matrix plan provided overall guidance throughout the data collection process:

Question and Data Matrix Plan

QUESTION DATA METHOD On-site Initial Follow-up Observations Interviews Interviews

Elite Group X Meeting

Question #1 X Opinion and values about the exclusive learning group Question #2 X Feelings and emotion about exclusive learning groups Question #3 X Experience when engaged in exclusive learning group Remarkable events X X

Data from the complete range of specific questions were organized in four broad categories: (opinions/values, preferences, group learning experience, broad motivation and expectations), and are presented in the thematic categories section of this study.

Interview Approach Each CEO participated in two interviews that were guided by a list of initial and follow up questions. These questions provided guidance and focus for the researchers and interviewees across all fourteen meetings and maintained consistency and completeness. Interviews were conducted during the fall of 1999 and winter of 2000. CEO Management Learning — Page 76

Two to four weeks was provided between the first and second interview. The study question framework consisted of 15 questions that focused on opinion, values, motivations, preferences and experiences related to CEO participation in exclusive learning groups.

All interviews were conducted outside the workplace and exclusive learning group meetings in environments suitable for contemplation and discussion. Most interviews were conducted in offices or homes of CEOs. Less extensive conversations were conducted and questions raised at the CEO group meetings. Each CEO was provided a draft of the interview transcripts and was asked to verify the accuracy and validity of the recorded interview. CEOs were also encouraged to provide thoughts and comments after each interview. Therefore, each

CEO had a chance to supplement their interview with additional information.

The researcher provided each subject with a letter introducing them to the study and informing them of its purpose, their role, and the researcher's responsibility (Appendix D). The letter and nature of the study was discussed with each subject prior to the first interview.

Seidman (1998) emphasizes the responsibility of the researcher to inform the study participants of the purpose and parameters of the study. This provides interviewees with protection against any misunderstanding and requires researchers to be explicit about the purposes of the study in a way that leaves participants with a clear understanding as to what they have agreed. All interviews were audio taped and transcribed verbatim. Sanders (1981) asserts that transcribed narratives prescribe the most accurate qualitative data for analysis. Due to the busy schedules and time demands of the subjects, Seidman's (1998) phenomenological interview method was modified to CEO Management Learning — Page 77

two more extended interview sessions. However, his suggestion to use primarily open-ended

questions was followed in this study.

Research with Elites

Obtaining access and maintaining attention span are often the two largest obstacles in studying elites using qualitative methods. Achieving access has been minimized based on prior approval from exclusive group leaders, researcher's status as a CEO, and affiliation with CEO learners. Seidman (1998) notes that interviewing elites presents unique challenges for the researcher. Business elites have been studied less than other professionals or politicians due to the difficulty in penetrating their ranks for meetings and interviews (Thomas, 1994). In addition, corporate and health care CEO leaders are wary of outsiders seeking to disclose trade secrets that could embarrass the organization they are charged to protect. Other challenges, such as the researcher's lack of familiarity with the language and culture of the industry in which these elites work are also important barriers. Also, the rapid change of environment, organizations and leaders in some industries can contribute to the difficulty of research with business elites (Hertz & Imber, 1995).

While interviewing health care CEOs presented many of the hurdles associated with these issues of business elites, this research was able to avoid many of the obstacles identified in the literature. First, the researcher is familiar with the language and culture of the industry.

Second, the nature of learning group observations and brief follow up interviews is less intrusive and easier to arrange than multiple extended one-on-one meetings often attempted with CEOs. Third, use of electronic media for follow up interviews via e-mail, phone, and fax provided flexibility for respondents, built a CEO Management Learning — Page 78 permanent record for analysis and allowed the researcher to communicate with multiple parties simultaneously. The researcher, as a CEO of a health care organization, had credibility, was affiliated with exclusive groups and had previously discussed this research with its leadership.

Finally, the topic is of great interest to both CEOs and leaders of the learning groups, and they were excited about understanding the study and CEO learning.

Data Gathering and Thematic Analysis This investigation was a holistic and interpretive study of a particular phenomenon: CEO learning experiences in the environment of exclusive learning groups. The case study provides a rich description of the phenomenon and insights and understanding for broader meaning. Data collection and thematic analysis was influenced by inductive reasoning in reviewing the raw data. Data from observations and interviews were categorized into a typology of opinions/values, group learning experiences, preferences and motivations and expectations as they related to the CEOs. Comments were also solicited on the influence of structure, process and nature of the exclusive learning group. These themes served as a framework for organizing and analyzing the data as a means of aggregating the data into manageable units (Merriam, 1998; Miles & Haberman, 1994; Patton, 1990; Strauss,

1987; Wolcott, 1994). The data was organized on separate pages by extracting elements by the categories in the typology described above. Statements were then grouped to identify common themes that emerged from the data. Interpretations were made of each group of themes concerning their prevalence, emphasis, and direct relevance to the question being addressed.

Observations and interviews from this particular case illuminates knowledge about what the

CEOs who CEO Management Learning — Page 79

were interviewed think and feel about learning in this particular context. The data gathering

and analysis also supports the understanding of a particular type of management learning and

cannot be generalized to other learning activities that CEOs pursue.

Notes were taken and information recorded during interviews that described the themes

of opinions/values, group learning experiences, preferences and motivations of CEOs. The

themes were defined by categories described in the beginning of this section and organized by

the structure, process and nature of exclusive learning groups. The themes were developed as

the raw data evolved from the interviewing and observations and was aggregated.

Thematic Categories

The initial interviews were pursued to achieve a better understanding of the CEO's

experience in exclusive learning groups in four areas. Broad categories were established to

record a topology of the interpretive-descriptive results of each interview, as well as collect and

analyze the data. These broad categories provided a framework for analyzing the findings and

making conclusions. Themes from this information were categorized in the following matrix

format:

Opinions/Values Group Learning Experience

Preferences Motivation and Expectations

Boyatzis (1998) suggests forming clusters of themes as a useful way to organize data in

conceptual categories. The thematic analysis was part of the early stages of inquiry and the

development of the conceptual framework of the phenomenon. The CEO Management Learning — Page 80 methodology used in collecting and analyzing this data consisted of three phases: collecting the data, categorizing the data into the conceptual framework and grouping these categories into dominant themes that emerged from the data.

Analysis The data was clustered in the four broad themes discussed under thematic categories and recorded by frequency of responses that were similar and identical for the questions discussed. The first phase of data analysis was a search for categorical themes based on the data collected and placed into the four broad categories in the matrix format. The analytic approach consisted of a mixture of three general strategies relying on die concept of sensitivity, preconceptions (Strauss & Corbin, 1990), and case description

(Houle, 1984; Abramson, 1992). Sensitivity for this study represents the researcher's ability to recognize what is important, to give it meaning and to conceptualize the observations, which was made easier because of his connection to the individuals and profession. The preconceptions inherent in this study reflected a belief that some type of management learning is occurring in exclusive learning groups for health care CEOs. Case descriptions of this study offer generalizations about the learning experiences of each CEO interviewed. They also identify and present direct quotes that CEOs made about their experiences in these exclusive learning groups. In addition, the researcher integrated descriptions and vignettes with commentary from interviews and observations within the groups. All of the data was reviewed and analyzed for frequency of common themes and continuity of concepts, thoughts, ideas, and responses amongst the interviewees. CEO Management Learning — Page 81

Trustworthiness of Data Analysis There are various techniques and criteria that are recommended for enhancing qualitative research (Lincoln and Guba, 1985).

All of these criteria may not be of equal importance in the development of this case study, but

each was applied as required. The following criterion were applied:

Criteria Area Technique

1) Credibility Persistent observation of participants through on-site real time observations and follow up interviews to insure consistency and reliability of behaviors and responses.

2) Transferability Thick description of CEO learning experiences and exclusive group influences to determine the meaningfulness and durability of each experience in each elite group.

3) Dependability Maintenance of audit trail using record keeping categories prescribed by Halpern (1983) as indicated in the elite group matrix.

4) Confirmability Researcher maintained a reflective journal to document personal feelings/biases which could influence findings. This information serves as a reference checkpoint to maintain research objectivity.

In addition to the above techniques, other strategies were used to enhance internal validity:

1) Member checks — Taking data and tentative interpretations back to people from whom

tiiey were derived and asking if the results are plausible. Member checks were conducted

once with each CEO.

2) Peer Examination — Asking colleagues to comment on the findings as they emerged

through discussion and interpretation as described in the process of Triangulation. CEO Management Learning — Page 82

3) Research Biases — Clarifying the researcher's assumptions, worldview, and theoretical

orientation at the outset of the study. Conversations were held with members of the research

committee, professional educators in health administration and CEOs in the field.

Triangulation Triangulation was accomplished by testing the emerging findings with each interviewee, and confirming information via discussions with organizers of exclusive learning groups and CEOs not connected to this study. Conversations about the nature of the study, emerging data trends, and preliminary findings were conducted during each phase of the study as meaningful information was available. Discussions addressed the relevancy, validity, and meaningfulness of data patterns and trends. The researcher's evolving interpretation and meaning was shared to obtain feedback and reaction to the direction of the potential study observations and results. Emphasis was placed on developing a holistic understanding of the situation to construct plausible explanations about the phenomena being studied (Mathison, 1988). In addition, data from each round of interviews were openly shared with subjects to obtain continuous feedback from participants. Comments from feedback were compared to original interview data to maintain validity.

Role of Researcher

The researcher for this case study served as the primary instrument for data

collection and analysis. The researcher is a health care CEO and has been involved in the

health care field for 25 years. The researcher is also a member of one of the exclusive

learning groups used for the study and has participated as a CEO invitee in the other. The CEO Management Learning — Page 83 researcher was vigilant of his own bias as a CEO learning, and from prior observations and conversations on this subject with other CEOs. The researcher kept a journal for note taking during the course of this study. This vigilance was maintained through ongoing conversations and questions in the health care field.

The researcher maintains fundamental assumptions concerning the nature and behavior of management learning for CEOs in health care. The following beliefs are strongly held as a function of his overall worldviews:

Health care CEOs seek continuing learning events to maintain professional

effectiveness.

The conditions of CEOs' unique and privileged positions influence and encourage

identification of meaningful and effective learning opportunities.

Exclusive learning groups provide environments and circumstances that are

comfortable and conducive for CEOs to learn effectively.

Social atmospheres are important for CEO learning since they rely heavily on shared

experiences unique to these positions.

Summary of Chapter A modified phenomenological research approach was an effective method to conduct this study of CEO learning and to achieve the objective of gaining a deeper understanding of their perceived experience. Additional insights were developed from the researcher's status as a participant observer and CEO who has experienced exclusive group learning events. The sample selection was purposeful consisting of seven CEOs, but represented a good range of age, gender, race and experience levels for the profession in the study. The interview approach was effective and comfortable for each CEO due to CEO Management Learning — Page 84 its privacy and informality guided by the interview questions selected. The overall approach enabled these elite professionals to relax and freely provide responses. The thematic categories were the best approach to capture important themes to conduct an organized analysis of the essence of the multiple learning experiences reported. Finally, the role of the researcher as the primary instrument for data collection, and his status as a CEO strengthened the process of triangulation for maintaining relevancy, validity and meaningfulness of the study. CEO Management Learning — Page 85

CHAPTER FOUR

FINDINGS

Nature and Environment of Exclusive CEO Learning Groups

Overview of Chapter

This chapter presents the findings of the nature and environment of exclusive CEO learning groups. It discusses the observations of the activity of the sponsors of exclusive learning groups. Exclusive learning groups attractions, motivations, preferences and expectations of CEOs are presented. In addition, a CEO learning profile is presented for each interviewee.

The framework for interviews (opinions and values, preferences, group learning experiences, and motivations and expectations) is presented and contains the responses organized in each section. The chapter also has responses to the follow-up CEOs' interviews and their expectations of exclusive learning groups, which state and clarify the attractions and anticipated benefits that influence their decisions to participate. This chapter reports the CEOs' perspectives about learning, how they make meaning of these specific learning events and their interpretations of the value of reserving time in their schedule for these activities. Common

Factors of CEO Learners

All CEOs interviewed recognized the importance of continuous learning upon leaving graduate school and early in their careers. Each expressed a thirst for knowledge and a desire to master their professional skills. Consequently, they worked diligently to identify the sources that would assist them in achieving these goals. As a result of this drive to know more about their field, each became autonomous learners, organizing the CEO Management Learning — Page 86 necessary resources and reaching out for appropriate support. The CEOs had strikingly common learning behaviors and experiences. For example, they all had mentors early in their careers who also were advocates of continuous learning. Many of the CEOs belonged to informal learning groups or book clubs. All applied innovative means of learning, seeking out a wide variety of expertise based on personal self-assessment that pointed to areas of development.

They also held in common an important aspect of learning in a social context: the willingness to share and provide feedback on knowledge gained from each other.

The following learning profiles of CEO participants in the study provide a better insight about their backgrounds and learning experiences. Each CEO had similar education but diverse developmental experiences and influences in their career evolution which effected their approach to management learning in general and, ultimately their involvement with exclusive learning groups. Learning Profiles of Participants Participant One

Jane is a 45-year old CEO of a hospital in New England. She was a graduate of a New England university in health administration. She has arrived at this position by working up through the ranks as a nurse and administrator in several hospitals over the past 20 years. She holds a master's degree in health administration and entered the field when women were not usually a part of hospital management. Role models were important to her professional development and she sought to identify a mentor who could satisfy her needs. Her learning behaviors were influenced by the first and only female CEO in her region who formed an informal learning group for other young aspiring female health CEO Management Learning — Page 87 administrators. This group met monthly at evening sessions to discuss common issues in health management faced by the female executives. These early learning group meetings had profound influences for her career, and framed her beliefs concerning the value, benefits, and information available in support groups that executives could provide to enhance skills and strengthen professional effectiveness. This early career experience influenced her desire to continue to be a part of an exclusive learning group whea she first became a CEO eight years ago. This form of learning also reinforced her belief in the value of having access to peers and confidants to brainstorm with and compare strategies. Presently, she is a member of a prestigious exclusive learning group and actively organizes other ad hoc CEO learning groups for specific areas of knowledge acquisition, such as quality improvement and technology. She believes these experiences are critical to her professional development and encourages other aspiring female executives to pursue similar experiences. Participant Two

Edward is a CEO of a teaching hospital system that is the parent company of a multi- hospital system. He is 55 years old and is a graduate of an Ivy League university and holds a master's degree in health administration. He has primarily worked in academic settings and is comfortable with the culture of research and education in health care, and professional life-long learning. His early career influences were primarily from mentors in the workplace who provided experience, advice and instruction about management practice. He has been a CEO for

15 years and exclusive learning group experiences became a part of his professional development at the beginning of his CEO tenure because of his recognition of the pressure to quickly learn the ropes regarding CEO Management Learning — Page 88 practical management skills. The psychological isolation he experienced during his first CEO position also influenced him to reach out to others who he could talk to as a sounding board and solve problems. Currently, he is a member of two exclusive learning groups and also participants in other ad hoc groups organized by professional associations and private industries. His belief in the practical benefit and value of exclusive learning groups for CEOs is absolute. His strong feelings about these management learning experiences result from the dynamic changes in health care and the unique learning needs of health care CEOs. He believes his fellow CEOs contain a wealth of experience and practical knowledge that can only be tapped by interaction, discussion and exchange. He is a believer in life-long learning and considers exclusive learning groups as a major method to achieve this goal. Participant Three

Johnathan is a 46-year old health care CEO of a Midwestern managed care organization who earned a master's degree in health care services from an Ivy League university. He has primarily worked in the health insurance industry in the Northeast, Midwest, and Western United States. He is a hard driving executive who is constantly pursuing performance improvement for his organization. He developed this aggressive attitude about knowledge acquisition by working in a large for-profit health insurance company and a national not for-profit managed care system. He is an avid time manager and rarely attends organized professional conferences because of his view that they are superficial and do not provide practical information he can use as a CEO. He has been a CEO for five years and previously served in other executive positions. He has high ambitions to advance his career as CEO in larger organizations and considers continuing CEO Management Learning — Page 89 professional education as a method to achieve his goal. Therefore, he has a strong desire to obtain more information on new and best practices of CEO management in different types and sizes of health care organizations. He is fundamentally a loner and finds the exclusive group experience as his only professional social outlet for learning. Currently, he is a member of one

CEO exclusive learning group, has a personal management coach and prefers ad hoc CEO learning groups that are organized around specific topics or hot issues in his organization. His attitude about learning is that it must be efficient, meaningful and current in context. He believes established continuing professional education programs and, particularly, universities have missed the mark of what CEOs need to meet their professional development requirements. He is, therefore, heavily dependent on exclusive learning groups, yet is a member of only one group.

Participant Four

William is a 60-year old health care CEO who is in transition between jobs. He recently left the CEO position of a large regional hospital in the South. He has a master's degree in health administration but has also worked as a consultant and business school professor in a public university. His ascendance to the CEO position in his organization 20 years ago was sudden and unexpected. He had worked as the associate executive director until his boss abruptly retired due to illness and he was given an unusual opportunity to prove he could do the job. He was encouraged and supported to participate in major management and business training programs including one specifically designed for people who were young CEOs. Early in his developmental career years, he had a mentor who was a renowned physician and educator who encouraged him to become an avid self-directed learner by developing a habit of reading CEO Management Learning — Page 90 a book a week on management. Consequently, he is one of the best read managers in his region and regularly is called upon to give lectures and speeches on various management subjects.

Despite his highly educated orientation, he is a strong believer in exclusive learning groups for

CEOs because he feels the sociological dimension to learning for CEOs is critical. He is doubtful a CEO can continue to grow if they do not interact with the best and brightest in their trade. He thinks the real learning comes from lessons learned that are shared in open, honest conversations. His view of management is that it is a dynamic science that responds to change.

This belief frames his value of exclusive learning groups for obtaining new insights that come from those more experienced and people who have had cutting edge experience. He believes practical knowledge is obtained from those who have been on the front line and in the hot seat of management. His view of traditional approaches to professional development for executive managers is that they are too slow and often irrelevant to the nature of just in time learning

CEOs need. Participant Five

Kennetii is a 45-year old hospital CEO who works in a small community in the

Southeastern United States. He has worked in hospital management for 23 years. The majority of his experience has been in the north and mid-Atlantic regions in larger hospitals in urban communities. He earned a master's degree in health care administration from a New England university. His developmental years were influenced by a solid education in Catholic prep schools and colleges. Kenneth has always thought it important to have a mentor and personal career advisors to serve as sounding boards and to provide strategic guidance. In addition to hospital management, he has experience CEO Management Learning — Page 91 with professional group practice and association management. Although his management career is impressive, the job he currently holds as a CEO of a hospital in a small southern town was his first time in that position. He immediately recognized two impacts on his career that were barriers to learning. First, he had migrated away from the urban setting were he had access to a wide range of people in his profession, and, secondly, he was more isolated in a smaller organization and community that in many ways was more competitive and less anonymous. He quickly recognized that reaching out to the CEO in the next county could be problematic when he was in direct competition with both the administration and the hospital. Also, efficiently identifying people who had experiences that could be useful was now more difficult because the population of CEOs was sparse. Therefore, he soon found an exclusive learning group operated on a commercial basis that provided access to a diverse range of CEOs from across the country.

He joined a group which meets biannually in different locations. He did this to maintain interaction and consultation with bright people and to have direct information about viable management practices. It also offers a source for continued network building and professional socializing that he cannot obtain in his community. He is convinced from this experience that people who are in smaller communities need exclusive learning groups more than those in larger areas, and they should heavily participate to keep current. Participant Six

James is a 58-year old hospital CEO in the mid Atlantic region of the United States. He manages a specialty hospital that provides services to the local and regional communities. He has been in hospital management for over 30 years in the Midwest and CEO Management Learning — Page 92

Eastern United States. He earned a master's degree from a major private university in a mid western city and began his career there as a young executive. His early exposure to the health aa*niinistration field left him fascinated with the personalities and characteristics of the CEO leaders in his community. He observed many of the CEOs who were the stars of the field and was determined to find out what made them this way so he could also grow. Studying these leaders became an obsession towards his goal of advancing his own career and becoming a CEO himself one day. Consequently, early on, his learning style became one of observation and conversations with superiors. He was a detailed mental note taker and later transferred many ideas generated by observations and conversations to a diary. He also adapted professional and personal styles of these leaders such as how to conduct oneself at meetings or what to do and say at cocktail socials. James became a CEO 14 years ago and has remained in that position in the same organization. In his transition from associate administrator to CEO he quickly realized his style of learning would have to be transformed to accommodate his new position. Despite this change, he now realizes how important it was to have access to those who blazed trails ahead of him. He was soon invited to join an exclusive learning group and immediately accepted and has been an active participant. He has also become a national leader serving on boards of many health care organizations. His style at first was mostly observation in the exclusive learning group, but now he is comfortable in contributing and engaging in good debates. He has also organized a small exclusive learning group of specialty hospital CEOs who have even greater common interests and challenges. They meet annually or when their needs dictate, brainstorming and interacting. The exclusive CEO Management Learning — Page 93 learning group has become a highlight event he looks forward to attending and arranges his schedule far in advance to assure he can be present. Participant Seven

Phillip is a 65-year old CEO of an integrated health system who recentiy retired after a

40-year career in health care management. He earned his master's degree from a large prestigious public mid-western university that offers a well known, highly respected health administration program. Upon graduating, he was considered one of the bright "wiz kids" of his class and was placed in a training program for two years in a large teaching hospital. The CEO there was a sophisticated leader and strongly endorsed the philosophy of continuing education for management by inquiry, visitation and observation. As a young executive in this organization, Phillip was allowed to participate with top management in their visits to the organizations that were considered best managed and on the cutting edge of practice. His exposure to this exciting and stimulating form of learning and idea development created a thirst for mamtaining sound continuing professional education in his career. He initially achieved this by maintaining constant contact with key peers and superiors in the field. However, when he became a CEO he realized a new kind of CEO network was necessary for him to achieve management learning success. As a result the exclusive learning group as a format became very attractive to him. He has been a member of exclusive learning groups for over 25 years and continues involvement in them during his retirement. He feels these groups provide and maintain his cutting edge thinking, and provided a sounding board and good friendship during the ups and downs of a management career. He has served on many boards and as a leader of various CEO organizations and continues to identify CEO Management Learning — Page 94 exclusive group environments as a means to continue to learn. He finds it hard to believe that any CEO can function without a CEO type exclusive learning group to maintain meaningful skills, knowledge and practices.

The seven interviewees were not intended to represent a complete range of types of health care CEOs. They do, however, serve as good examples of management professionals with different backgrounds, real world experiences and learning needs. Their approaches to management learning and perceived value of exclusive learning groups reflect real decisions made about learning needs and metfiods to address them. Exclusivity of CEO Membership

The common element of CEO groups is the "exclusive CEO membership." CEO membership is the required status for entrance or invitation. In some instances, CEOs establish and organize these groups as well as control invitations to membership. Sponsoring organizations can also determine who will be invited to participate. In either case, the invitation method is usually a selective process to ensure a balanced, noncompetitive mix of participants.

This is done to achieve meaningful member interaction for the group's intended purpose.

Some of the groups are highly focused on the CEO's professional development. Others are organized to solicit opinions and advice by engaging CEOs in candid, lively interaction mat may take the form of discussion, debate and problem solving. Regardless of the intent and program content, CEOs naturally become focused on each other's comments regarding recent experiences, challenges and results of management practice. This rich exchange of communication invariably becomes a dominant force at CEO CEO Management Learning — Page 95

exclusive learning group meetings. These exchanges become a focal point for CEOs'

interactions and major learning activities of the group guiding CEO-to-CEO dialogue.

The approach to forming CEO exclusive learning groups usually consists of identifying the membership, establishing the program objective, convening at an off-site (away from job) location, which is normally a comfortable resort, and scheduling a combination of professional, recreational and social activities over several days. Some exclusive learning groups are ad hoc and have self-limiting interest and, therefore, are easily established and executed. Some groups are more ad hoc in nature and are spontaneously formed to meet specific learning interest. They may only meet once or twice or infrequently and can disband if the learning objectives are achieved. Description of the Exclusive Learning Groups Studied

The study included two exclusive learning group environments; one consisted of a for- profit health care supplier corporation sponsored CEO group and the other was a CEO founded group organized to foster interaction and learning with leaders from commercial companies serving the health care industry. Both of these groups had been in existence for several decades.

The nature, environment, circumstances and conditions of each were remarkably similar.

Membership in these groups was by invitation only and the primary criteria for acceptance was active CEO status. In many instances, efforts were made to balance gender, race, age and experience levels, as well as types of organizations and geographic locations. Each group was scheduled to meet between Thursday and Sunday with expectation of arrival on Wednesday evening, with the business and professional portions of the meeting occurring between 7:30 am

— 1:00 pm Thursday through Saturday. Afternoons were reserved for personal time (recreation and CEO Management Learning — Page 96

relaxation), evenings usually involved a reception (cocktail social) and dinner (planned and

unplanned). Sunday was used as a day of relaxation and travel. During the course of the business

and professional meetings, ample food and beverages were available and several breaks were

taken to allow for stretching, phone calls, and personal time. These resources, as well as flexible

scheduling, supported socialization and casual discussions CEOs had with each other.

The group meetings are intense, intimate and interactive and provide CEOs with ample focused time with each other. The intensity of these group meetings is created by the continuous number of hours CEOs are scheduled to be with each other over a 3 to 5 day period.

The activities regularly begin 7:30 a.m. and conclude with dinner ending at 10:00 p.m. Intensive

CEO-to-CEO exposure for such prolonged periods is difficult to create outside of similar group settings because of distractions and interruptions on the job.

The following findings were identified by the researcher through group observations and individual interviews. Intimacy for CEOs in these exclusive learning groups is created because of the multiple opportunities to have one on one or small group confidential conversations. The larger group's capacity to support intimacy and confidentiality within its meeting framework increases its credibility as an environment for CEO learning. For example, if a CEO has recently been terminated from his or her position, the group environment offers a comfortable framework to have intimate conversations about what caused the termination and where to begin searching for a new CEO position. Interaction is constant from the moment CEOs arrive at the hotel registration desk to the day they leave. The interaction has the character and quality of an CEO Management Learning — Page 97 alumni reunion. Many of the group members have known or known about each other for many years. Some of the newer members are less familiar with group participants but are quickly assimilated into the group culture through a process of better known and highly respected CEOs introducing them to the learning community. Several of these CEOs are active in other elite professional exclusive learning groups and routinely meet with each other to discuss and solve problems outside of these settings. The exclusive learning group meetings that only occur once or twice a year are reunions for CEOs who have anticipated being with their peers in this environment to interact around ideas, gossip, and obtain first hand interpretations of what is and has occurred in recent months. For example, one CEO said, "These groups are the best places to assess which leaders and organizations are on the cutting edge, and tells me where to point my staff for good information and ideas to solve critical problems." Humor and comic relief is often prevalent, allowing CEOs to laugh at their own and others' exploits within the group.

Although confidentiality is rarely mentioned, there appears to be a silent understanding that what is said stays in the group. The need for confidentiality and the group's ability to honor it was addressed by each CEO interviewed. A CEO stated, "confidentiality has two benefits: it provides protection for the CEO's organization's strategies and fosters open candid discussions in the group." Much of this conduct is shaped by the extraordinary predominance confidentiality plays in the world of CEOs as a normal way of transacting business. Consequently, CEOs instantly respect the personal and professional need to keep what is in essence "locker room" discussions to themselves. It is a form of a "CEO agreement" essential for group membership because the universe of CEOs in health care is relatively small and communications pathways CEO Management Learning — Page 98 amongst them effective. Violating confidentiality would be the ultimate violation of trust of the group.

The Corporate-Sponsored Group

This group began with a reception and dinner for CEOs, and corporate staff and their spouses. Spouses are not involved in the learning sessions with the exception of occasional large general presentations. There was an ice breaking activity to familiarize all participants with each other. Six small teams were created and a "competition" was provided where each group had to identify famous personalities from clues provided about each of their careers. Each team was comprised of a mixture of CEOs, spouses and corporate staff. A winner was selected and prizes were awarded. This was followed by cocktails, dinner and surprisingly rich and candid conversation about families and life in general. For example, discussions about raising children and the stress of two career families, and issues around adult children who live at home were prevalent. At dinner, seating arrangements were determined by membership in competitive teams. This social time was structured to facilitate the group achieving a high comfort level. The size of this group's dinner was relatively small with six people at each table; this accommodated a very effective method of socialization and trust building due to the previous time

(approximately one hour) team members spent with each other. Thus, it appeared the participants (sponsors, spouses and CEOs) bonded faster than they would have under more traditional social conditions where people simply arrive for a social hour or even simply dinner.

The next morning the CEOs met with corporate sponsors at 7:30 am. Continental breakfast was provided. The group consisted of 12 CEOs and corporate staff members CEO Management Learning — Page 99 from the hospital supply company. Very quickly CEOs began to recognize who they knew and various connections they had with other CEOs through past associations, employment and networks. Some continued conversations that began the night before. They all engaged quickly in recent gossip and inside information on what was happening in the health industry. A few

CEOs had not seen each other in years and, based on their open expression of happiness and pleasure, they were very pleased to be able to spend time with each other. This included reminiscing of old times and catching up on personal, professional, and family events. Others actually worked geographically close to each other but had little contact and were also pleased to become acquainted in a relaxed comfortable environment conducive to conversation and exploration. Two CEOs who were instantly compatible had identified several mutual problems they shared, and spent more time talking with each other than with the group in general.

The first group activity was personal introductions and presentations by each CEO about what was happening with his/her organization and local market. This information sharing was rich and provided several questions and discussions with regard to challenges and potential strategies to solve pressing problems. A CEO stated, "The hospital supply industry must become partners with their hospitals in managing cost." Others stated, "The solution to problems was achieved in the political area of their state." Two CEOs talked about resolving problems in a follow up meeting during the next month. Some of the exchange was in the form of a mixture of instigating and bantering and creating a comfortable environment, such as who gained more weight, lost more hair and was focused on their retirement date. Others provided comment that creates serious thought and expression about management issues, such as the rate of hospital financial CEO Management Learning — Page 100

failures and impending government policies. Sharing of mistakes and failures is also

common, such as the CEO who told the story of being terminated.

The information sharing lasted 1 Vi hours. The corporate sponsor then organized a more

structured discussion of the health care environment in terms of how it could impact their

company's products and profitability . The company representative outlined its strategy to

address the problem and invited CEOs to react to the plan. The entire group of CEOs was

challenged to share their thoughts on how they interpreted these issues and whether it affected

the working relationship between their organization's use of the product and services of the

sponsoring company. Various CEOs presented a specific point of view concerning the company

strategy. A lively discussion ensued with CEOs agreeing and disagreeing about the future

implication of various trends. The discussion was facilitated by a senior retired CEO, who was

assisted by a staff member of the company. Initially, two CEOs from larger health care

organizations dominated the discussion, but within thirty minutes, participation was shared

equally. The discussion was enhanced by the diversity of experience of CEO participants and the

different types of health care organizations they represented. Some participants knew more about

trends in government, others had first hand experience with mergers, and all could articulate a

detailed understanding of important developments in their region that had national implications.

Outside observers may conclude the corporate sponsors are primarily focused on selling their products. While this is a valid point, the CEOs interviewed expressed doubts about the effectiveness or reality of this result. They further stated the opportunity and experience to learn from other CEOs during these meetings was invaluable and CEO Management Learning - Page 101 outweighed any other agendas. They stated this type of a meeting was an opportunity because in most cases they were too busy and involved in their own work to think about or take the time to organize such unique learning events even though they understand its importance to their professional development.

During the course of the morning meeting, breaks occurred where small caucuses and sub groups discussed a particular idea or statement that had been made by a CEO member. For example, a few CEOs discussed how to increase their trade association's activity on advancing favorable policy for improved reimbursements. Throughout the meeting, business cards were exchanged as well as contacts of other CEOs and resources participants could access to resolve various problems. This was stimulated by the ideas and concept sharing that came during group discussions, debates and disagreements. For example, in one conversation a CEO discovered that a group member had conceived and implemented a unique program to increase market share for the same type of population that his organization served and an agreement was reached to exchange information and arrange for a visit when they went home. Personal addresses and phone numbers were exchanged or updated by all participants to enable further social and professional contact outside the exclusive learning group setting. The group concluded at 1:00 pm. CEOs and sponsors went off to find their spouses for afternoon recreation. Golf was scheduled for those interested, others planned their own activities. Some

CEOs spent their social time together, and included spouses.

A reception and dinner was scheduled to begin at 6:30 pm. Dinner arrangements were organized at an upscale restaurant in a reserved private room that accommodated the entire group of about 30 people. Five tables were set up for 6 people each to dine. CEO Management Learning — Page 102

Seating arrangements were prearranged to assure a good mix of CEOs, spouses, and sponsors.

The seating arrangements were changed each night to assure participants would become more familiar with each other. Although this activity was purely social, the CEOs continuously engaged in business chitchat between appropriately social activities. These conversations consisted mostly of industry news or gossip about the latest organizational problem or CEO termination. The CEOs who were interviewed validated this process when they talked about always looking for new ideas and solutions to problems and found groups like these provide unusual opportunities to accomplish their goal.

On Sunday some of the CEOs and spouses had breakfast or visited with each other before they departed for the airport. During this time, the spouses engaged in the mixture of social and light business talk and strengthened the personal connections through identification of personal and family interest. Some spouses initiated invitations to their breakfast partners to visit them and made plans for attending the next CEO meeting. Often spouses become friends if CEOs attend such meetings regularly.

Most CEOs continued to interact with each other and with the sponsors via e-mail or

U.S. mail a few weeks after the meeting. These communications provide an opportunity to follow up on issues, continue discussions and act on professional and business ideas conceived during the meeting. Two of the CEOs arranged to meet to specifically follow up on opportunities defined at the corporate-sponsored group meeting. Based on the interviews, continued interaction with each other was driven by common problems, opportunities and interests. Also, some of these CEOs will see each other again soon in other CEO exclusive learning groups. Some CEOs indicated they CEO Management Learning — Page 103 participate in two or three such groups and they mention the duties, stress and the importance of being there. The CEO-Governed Group

The CEO-governed group is a relatively large CEO group consisting of 35 CEO members. The group has been in existence for over 30 years and schedules two meetings annually. It is governed by a CEO member board that establishes the rules and bylaws and determines membership. Invitation is by unanimous vote of the membership. Therefore, admission entrance is exclusive and restricted to those who are active CEOs. The CEO members of this group represent the largest and most prestigious health care organizations in the nation and can be considered the best and brightest of their classes. The CEO-governed group is well organized and experienced, has a full time executive leader and staff who plan and execute meetings. The executive leader provides administrative support with a small staff. This exclusive learning group is preeminent and membership is desirable to many CEOs.

This exclusive CEO group offers major companies serving the health industry access to their meetings, which are held twice a year. These corporations become members by paying a subscription fee. These fees underwrite the cost of group meetings and provide exclusive access to the CEO members. The exclusive meetings are organized around a series of panels (focus groups) that consist of 6 to 8 CEOs. Each panel is pre-arranged, lasts 2 Vi hours, and the agenda is established by the corporate member. CEOs are assigned to panels and participate as advisors, reactors and contributors to ideas presented by the corporations. The purpose of the panel is to provide dedicated, focused, exclusive time between the elite CEO members and the CEO Management Learning - Page 104 corporation to discuss ideas relevant to the health care field and the corporation's strategic direction for their products and services. There are 50 corporations currently subscribed, with a waiting list. The full time executive director manages the solicitation and maintenance of corporate membership. The panels for this exclusive group meeting are scheduled from

Thursday through Saturday afternoon from 7:30 am to 1:00 pm. Wednesday evenings are usually reserved for travel and a reception is usually held for arriving attendees (CEOs, spouses and corporate members).

CEO members are usually scheduled to participate in 2 to 3 panel sessions per day from

Thursday—Saturday. Structured educational sessions are also scheduled for CEO members and corporate sponsors. These sessions involve formal presentations by CEOs and client members on markets, strategies, policy, products, and new technology. All participants are invited to attend all sessions. Despite the emphasis on interaction in small groups, periodic but limited (1 to 1 Vz hours) exposure and presentation from corporate leaders and academic experts was also expressed by participants as "useful" and desirable. These types of sessions sometimes involve larger groups and information from them discussed later in smaller groups. Afternoons are reserved for recreation (planned and unplanned) and evenings consist of large group receptions and individual dinners. The entire meeting is tightly scheduled with continuous activity, although breaks are planned and informal gatherings outside meeting rooms frequent. The group holds an annual business meeting and social/recreational event on two additional occasions with the same membership. The business meeting involves education and idea sharing as well as dinners and receptions. Spouses are invited and their travel expenses are paid for by the group. CEO Management Learning - Page 105

Due to the meeting frequency and consistency, the group has a well established culture, membership attendance is high, and turnover very low adding to stability. The CEO members of this group are collegial, comfortable with each other and constantly pursuing new ideas and information from each other and the company representatives. Membership stability and the biannual meetings reinforce familiarity and friendships. There is a lot of camaraderie and humor during these meetings, as well as serious conversations about organizational activity, strategies and challenges. For example, organizing stronger national purchasing organizations and improving funding for research, medical education and charity care are consistent topics. Some of these CEOs have been meeting together most of their careers. Many of these CEOs are also members of other exclusive learning groups and consequently discuss business matters relevant to other settings. In fact, as one CEO described it, "I have become a prominent member of many professional groups because of my involvement in this CEO group learning activity." In both types of exclusive learning groups, a considerable amount of time in these meetings is spent on sharing personal and professional experiences that have a direct bearing on the state of the industry and the organization's approach to working with it in the future. Experiences such as mergers and acquisitions, or major business and clinical transactions with the medical staff, are always a high priority in these discussions. One CEO interviewed said, "It is the most effective network building I have done."

Networking is a by-product of the meeting, facilitated by continuous close interaction in the group. Interviewees consistently cited the importance of having stability in CEO group membership to build trust and comfort levels. One said, "I have CEO Management Learning — Page 106 become friends over time with some CEOs because the group was a bridge to build trust."

Another said, "I think it is imperative to have low turnover and the same CEOs with each other year after year because it maintains a stable environment and makes sharing, and therefore learning, more comfortable." Another CEO comment was "how else could I make fun of these guys' mistakes, hare-brained ideas or golf scores without mutual respect for each other?"

A significant amount of CEOs' communications occurs between panels, official sessions and during breaks. It is difficult to know the nature of this knowledge exchange; however, some interviewees described it as primarily personal and/or strategic. One CEO said

"I think you can get technical knowledge anywhere and you don't need a CEO group to do it, however, it is the inside information that you get from groups." CEO Attractions to Exclusive

Learning Groups

The CEO-sponsored group is more tightly organized than the corporate-sponsored group because of its greater stability of membership and more frequent meeting schedule. Both groups, however, provide attractions to their CEO members and have some of the same benefits. The exclusive learning group also is a place for humor and friendship and is a rare opportunity for CEOs to congregate with a diversified group of elite leaders. The atmosphere is private and protected from the normal exposure to their organizations and communities. It is a time CEOs can act and be observed as individuals vs. organizational representatives. In addition to the learning experience, it is a chance for these professionals to suspend playing the role of

CEO and experience their personal being and development. CEOs interviewed consistently stated, "personal development was a challenge due to the tendency to overlook its importance relative to getting the CEO Management Learning — Page 107 work of the organization finished." Regardless of the type and organization of the CEO exclusive learning group, what matters most is the oasis-like nature and environment that enables this elite occupation to feel liberated enough to learn from each other in a variety of ways.

A CEO interviewed said, "It is not the status or title that makes the group viable, it is the common experience mat bonds us in a special learning venue." This special closeness is enhanced when the group composition is consistent. This allows for trust building around these

CEO experiences. Another interviewee said, "Identifying some of the commonalities of background personality and experiences desirable for new members facilitates people opening up faster when admitted and makes a richer group experience." Humor was also seen as a critical factor of these groups. An interviewee stated, "Self deprecating humor and a sense of group humor is absolutely critical for meaningful CEO participation and benefit." Interviewees saw this as a relief mechanism for people constantly dealing with a lot of pressure in extremely serious and often difficult situations. The humor also brings out the human side and personality dimensions CEOs believe they often cannot disclose on the job or in other settings.

CEO interviewees stated overwhelmingly they felt exclusive learning groups were important due to the isolated status of their position and general challenge to learning on their own due to time pressures. CEOs felt learning groups help them distill the over supply of information they receive and help them understand how other organizations are learning.

"Sometimes when people become CEOs they are so busy overseeing everything they stop learning." Another CEO felt "the real learning CEOs need is about themselves and the participation in groups helps because it provides objective feedback CEO Management Learning — Page 108 and a way to measure yourself." Those with experience in small and rural communities also had high value for exclusive learning groups because it exposed them to a larger universe of CEOs from more diversified communities. An interviewee said, "CEO exclusive learning groups teach you who the winners and losers will be and who you should go and visit to gain the benefit of their organization's experiences." All respondents thought exclusive learning groups were an efficient way to organize and convene a diverse range of CEOs with busy schedules. They also believed exclusive learning groups were an important mechanism to productively organize their time for management learning. One CEO from a small town said, "This is the best way for me to access a wide range of talent in one place at one time." Excluding competitors from exclusive learning group membership and including members of comparable status, experience levels and interest were identified as critical criteria for group selection.

There was also general consensus that CEO-to-CEO learning facilitated skill set or skill-based learning networking. One CEO interviewed said, "Once I've achieved a comfort level with another CEO, all the doors of learning and exchange are easily opened for our staffs."

These networks are organized between organizations by the CEOs who have engaged each other in exclusive learning groups and developed a trusted working relationship. The networks consist of phone calls, field visits and various meetings between executive teams that work for the respective CEOs. Some CEOs involve their organizations in multiple networks to obtain various learning experiencesv The familiarity and comfort level the CEOs gain by being in an exclusive learning group facilitates inter organizational learning and collaboration. Networking further benefits their organizations by extending the participants' lessons learned from the CEO exclusive CEO Management Learning — Page 109 learning groups by introducing them to colleagues in organizations led by other CEOs from the group. For example, one CEO said he routinely returns from the exclusive learning group meetings with a range of new ideas and knowledge of the organizations that have successfully implemented them. Various members of his management team can talk and visit about these matters with staff members of another CEO in the exclusive group. A CEO said, "Having a range of different types of CEOs and organizations to network with helps to address the broad spectrum of solutions we need." CEO-to-CEO learning in exclusive learning groups opens up opportunities for additional learning for other executives at various levels of the organization.

This facilitates CEOs' efforts to introduce ideas and assess strategies under consideration in their organizations faster by providing access to a group that has already achieved results addressing similar problems. Emerging Themes from CEO Interviews

CEO exclusive learning groups are perceived as valuable because they provide indirect and discreet ways of obtaining benchmarks and self-measurement for both the CEO and the organization. A CEO said, "Remember a smart CEO is always learning about himself and the organization." While it is important to achieve a good balance and mix of interesting and smart people in CEO exclusive learning groups, their status, the preference for comparable status, positions and experiences to stimulate dynamic peer interaction was expressed as desirable. CEOs continuously stated their participation in a learning group was primarily driven by who was in the group, what their comparable experiences were like and the types of organizations they managed. These criteria clearly indicate CEOs intend to learn from each other as a central point of the exclusive learning group experience. One CEO said the key questions he had about joining an exclusive CEO Management Learning — Page 110

learning group were: Who is in the group? What are they discussing and what is the relevance to

me? This CEO summarized these critical questions as who? what? and so what? This concept

demonstrates how CEOs value their time and want to learn from the most valuable people.

A CEO stated, "Smaller groups also enable faster bonding, trusting and network

building which supports informal and incidental learning." It is also clear that CEOs believe

membership composition always determines group effectiveness, satisfaction, and success,

therefore, selection criteria and process is important.

CEOs expressed two primary conditions concerning membership composition: no competitors from their region and the need for compatibility of interests, experiences, and responsibility. The prohibition to competitors is a direct reflection of the general competitive environment in the health care field. Protection of strengths and weaknesses, and advantages and disadvantages, is high on the priority list for all CEOs. Conversely, participation in these groups constitutes competitive advantages when vital learning experiences are shared with members.

The issue of membership composition was explained as one of developing group utility, balance and effectiveness, not as a vehicle for exclusion. Some CEOs thought various approaches in large groups could achieve good composition such as smaller clusters of compatible CEOs within a diverse group. Balancing these needs often challenged the desire to keep the group small enough to maintain a sense of commonality and intimacy for faster bonding.

Informality and interaction are considered by CEOs more important than structured learning and formal presentations. Structured learning and presentations are beneficial in certain situations, e.g. technical topics such as e-commerce and genetic CEO Management Learning — Page 111 mapping, but these structured formats can be counter productive if they dominate the meeting.

CEOs interviewed routinely stated they did not join these exclusive learning groups to be lectured to because it was not stimulating or a good use of time. The informality and flexibility of group participation was what they valued. Learning during informal and unstructured time is an added benefit because it is unplanned and unanticipated and because it enables spontaneous and unintentional learning (Reischmann, 1986). One CEO characterized these discussions as: "It is a chance I have to be stimulated by sharing and testing ideas, getting candid feedback, gaining insight and framing introspection." "It's also a rare block of time to gain quality time with the peers you respect and admire because of their achievements." Exclusive Learning Group

Benefits for CEOs

All respondents clearly stated exclusive learning groups are valuable to CEOs because they help to validate knowledge and allow them to learn from unique on the job experiences, build trust and respect and provide a confidential and productive way to break isolation. They can also be a tremendous support structure, source of instant information, and offer easy access to an ongoing interaction with a select and elite group driven by similar, yet unique circumstances. Several CEOs commented about what the benefit of their group learning experiences:

"Obtained first hand CEO level explanations and interpretations of effective

management practices."

"Reduced my blind spots and problems I may encounter but could not envision."

"Exposed me to success and failures of great organizations and confirmed my

suspicions and beliefs about best management practices." CEO Management Learning — Page 112

"Good sounding board for validation and non threatening curb side consultation."

"Eliminated my isolated worrying about tough problems."

"Identified mentors for support and counsel during threatening times and network

contacts for immediate and long term problems."

"CEOs can openly analyze and evaluate the benefits of strategies, consultants,

and complex new concepts."

"It is the only place to discuss and test concepts effecting my relationship with the

board."

"The candid discussion is refreshing and provides a comfortable way to get

feedback and learn."

Exclusive learning groups are also extremely valuable for practical learning, confidence building, observation and reflecting on performance as well as to expand strategic thinking and ideas. The combination of observation, validation, contribution and reflection offer the best

"access to inside lessons" that CEOs can get. In response to the question of what they actually gained personally from exclusive learning groups, CEOs said the following:

"The group provides insight, enables introspection and creates a framework for

personal and professional measurement."

"It can reinforce who you are and what you should stand for professionally."

"Insight and input on how other credible leaders address similar problems,

situation and challenges."

"A professional comparative yard stick."

"Access to a safe consistent environment to open up in." CEO Management Learning — Page 113

"My group offers information and ideas at the right level." "It is an opportunity to

creatively process issues with each other." "Everybody can act as a consultant to

each other so its all gain and no loss." "It is an experience that continuously

confirms if my core competencies are effective."

"It is the best access to building and replenishing a network for life long

learning."

Fundamentally, CEOs felt the exclusive learning groups provided environments that created comfort for commonality of learning and effective learning at the right professional level through elite associations not obtainable elsewhere. CEO Preferences for Participation

Respondents stated a variety of preferences for exclusive group learning. Most of the

CEOs interviewed agreed that both formal and informal situations had value for learning.

During the initial and follow up interviews. Each CEO described the value of interaction in exclusive learning groups as important, very important, essential and vital. One CEO said,

"Without interaction you have individual learning," another said, "It is the only reason I participate." Also, the attraction, strong preference and assumed benefit of peer interaction were expressed as more appealing than individual or large scale learning events. A comment by one

CEO was characteristic of all: "Scheduled time for interaction was an overwhelmingly important factor to stimulate creativity and spontaneity, build comfort and trust, that enabled opening up to each other's thinking." When group interaction is achieved, it facilitates one on one discussions and more personal learning dynamics. Smaller groups were identified as more viable but larger CEO Management Learning — Page 114 groups could work if they were thoughtfully subdivided into people with common backgrounds and interests. Group sizes of 10 to 15 seemed most appropriate. All CEOs continuously emphasized the importance of maintaining environments in exclusive learning groups that supported maximum interaction, experience sharing and feedback. As one CEO expressed,

"These are all very smart people and it would be wasteful not to learn from each other because the experiences and insights are so rich." Another CEO said, "The nature of our positions and job demands limit peer interaction, therefore, access to each other in these groups is precious time."

Exclusive learning group composition and balance was further described as a mechanism to maintain a bond through common interests. "Common interests" was defined by interviewees as same type of organization (e.g. multi-hospital or integrated systems), rural, teaching hospitals, or managed care organizations. A CEO said, "The commonality contributed the stability; it all flowed from membership selection." Others further indicated all of these factors contributed to shaping the group environment. CEOs also believed the right group composition helped create and maintain a sense of confidentiality and integrity. The need for groups to have membership stability and meeting schedule consistency was believed by the

CEOs to be essential for busy people. One CEO said, "I want to be with the same people for a period of time to build trust to compare different approaches over time and develop friendships."

CEOs felt the learning potential increased when there was group stability and continuity combined with smart people who respected each other and who had similar interests and experiences. They also felt these factors reinforced individual and organizational networking between official meetings. CEO Management Learning — Page 115

One CEO said he expected "high level discussions focused on how to address broad strategy, health policy impacts and organizational issues such as board, medical staff, and political relationships." A CEO said, "When I first became a CEO, interaction in my group taught me about what a CEO needs to learn about style, image and leading people in organizations." Another said, "If I want to learn technical stuff, I can read about it on my own."

Learning during official program time was viewed as important but social and recreational time was recognized as very valuable. The informal time was seen as reinforcing compatibility because that was when they relaxed, loosened up, shared experiences. CEOs look for an imprinted "code of honor," critical to each group, that protects the confidentiality and sanctity of the environment. This may explain the emphasis on compatibility some groups have when they select members.

Membership requirements, beyond being a CEO, range from specific to nebulous.

Membership in some exclusive learning groups is available through professional association membership, commercial groups simply require payment of a registration fee, and many private groups allow eligibility to be determined by its CEO members or governing board on a "who would be compatible basis." The two groups observed in this study relied on a self-nominating process by existing CEO members. These leaders were aware of who may be interested, seem compatible and have potential to contribute to the management learning activity. Consequently, the nomination, invitation and approval process was highly influenced by professional reputation and personal association.

CEOs in exclusive learning groups also place emphasis on including people with similar practical experience that have in the words of one CEO, "been there and done CEO Management Learning — Page 116 that" in order to maximize exchange, dialogue, and debate, about real world management. In particular, CEOs from large, complex or specialized organizations feel their problems and experiences are limited to a smaller universe of CEOs. "These field generals command unique organizations and want to share their experiences with similar people," said one CEO. Good group dynamics such as improvisation, interpretation, spinning the industry issues in a CEO context are critical to meeting CEO learning expectations. One interviewee stated, "I get more from story telling and lessons learned during the cocktail hour or at the bar than any other time."

Another said, "getting away from the office was absolutely essential including being in a relaxing setting to enable reflection and open thinking."

Learning opportunities may have been more prevalent in the corporate-sponsored group because they were smaller, could be more easily kept together for professional and social events, and focused on the same topics. There was more extensive time for give and take in conversation which regularly overlapped into the break time. The CEO governed group had a more complex and dynamic organization that involved CEOs changing rooms, panels and topics throughout the day. Consequently, ideas, and learning generated in discussions often required follow up during social and recreational time or during meals, although this can be difficult.

Advice and answers are often elaborated on in these relaxed atmospheres outside the regular seminar formats and in the weeks after the meeting. The CEO governed groups' strong culture, frequent and consistent meetings created bonding of membership that facilitated follow up and contact during and after the meetings ended. Consequently, the stability of group composition and trust it produces enable effective ongoing relationships. If these relationships are to continue after the CEO Management Learning — Page 117 meeting sessions, group stability and composition are the starting points that foster CEO communication and interaction when they go home. There is evidence of bonding in conversations many of these CEOs have at group meetings. They often discuss and plan recreational events, other meetings and vacations with each other and their families. CEO

Perceived Benefits and Values to Exclusive Learning Groups

CEOs cited various important factors and benefits of learning experiences in exclusive learning groups. The factors of friendships, humor, networking and mentoring were combined as powerful human factors groups must have. Humor, friendship and fun were considered important elements that were vital to group energy and success because it framed the group's intended purpose with an atmosphere of camaraderie. Networks, contacts and friendships were developed in exclusive learning group meetings. Mentors, confidants and people CEOs could rely on to discuss difficult problems were accessible. The process for adding new members was considered critical and was suggested to be managed in a slow gradual manner to avoid any group disruption. One CEO said "Openness and candid discussions about failure and ingredients for success increased trust and interaction." In groups where CEO expression of feelings and personal/professional experiences could be achieved, faster bonding resulted. The best groups were described by participants as those that pushed for a higher level of learning experience not achievable by other methods. For example, a CEO described how he reversed a new strategic policy his board introduced without his prior knowledge and avoided confrontation and damage to his career. In discussing this scenario he detailed with the group the infighting, political arguments and personal persuasions involved in reversing this decision. CEO Management Learning — Page 118

The CEOs stressed that meetings should be well organized with ample time to discuss their real worries. Two to three days was the desirable minimum amount of time to nurture interaction. They emphasized the need to minimize written material and reading assignments as well as summarizing documents for discussion. Some CEOs stated, "Observation and inquiry in groups are useful for evaluating worthiness of strategies, consultants, and tactics applied in other markets previously used." They believed this could be achieved by brief descriptions of a pressing problem to a small group of CEOs with a request for reaction or in one-on-one conversation. A CEO commented "participating in these dialogues can build an inventory of referenced ideas to access in the future." A CEO also said, "I hear and learn things that are not immediately useful but are filed in my mind for future reference." CEOs believed they could measure readiness, observe behavior, style and character and validate self worth and capability in exclusive learning groups. Their comments also suggested that experience could also help to measure a CEO's status of knowledge within the group in a discrete manner. One CEO described exclusive learning groups as "environments that enable access to experienced and confidential feedback on personal and organizational performance concerning difficult problems in a confidential way." They also affirmed the groups as good sounding boards to validate approaches to management practice.

A CEO in the group said, "I learned some useful tactics that may prevent our organization from dealing with this problem." Certainly, exclusive learning groups represent a range of specific benefits to their participants. However, the environmental circumstances and potential learning opportunities inherent in these unique groups seem to be a powerful attraction. CEO Management Learning — Page 119

There are many perceived benefits and values for CEOs in exclusive learning groups.

The primary benefit and value expressed was being with each other and relaxing while learning as a group of high-level professionals. Exclusive learning groups were perceived by CEOs as being able to meet their combined sociological, organizational, environmental, and professional needs. Sociological, environmental, organizational, and professional motivations and expectations were consistent as rationale for participation. The time structure, content and objectives were organized differently in each group, but did not seem to effect how the CEOs related and benefited from their time together. Being a member of either group was an important and prestigious status for the CEOs. The following matrix illustrates the exclusive learning group attractions for CEOs in both groups:

Exclusive Learning Group Attractions

Sociological Environmental • Networking opportunities • Relaxing educational escapes • Access to best thinkers • Ideas for mini vacation • Identification with elite peers • Meeting content and facilitation • Integration with star leaders

Organizational Professional Efficient use of time Build comprehensive Exposure to cutting edge ideas inventory of ideas Time for quality face-to- - Candid interaction about real world face interaction Proper frequency of issues meetings - Practical management lessons Instantaneous and spontaneous feed back Chance to learn what you don't know discretely Chance to compare CEO Management Learning — Page 120

Summary of Chapter

Observations of two types of exclusive learning groups for CEOs were conducted.

There appear to be more similarities than differences between the corporate-sponsored group and the CEO governing group regarding the attraction to each learning experience. CEOs in both groups expressed the value perceived of being with, other CEOs for one-on-one, informal group interaction, or the advantage of having access to a congregation of CEOs in a unique group setting.

Attributes CEOs expect in exclusive learning groups are smart successful peers who value learning, are intelligent, thoughtful and have egos in check. They prefer smaller groups but recognize larger gatherings are appropriate for certain presentations. They expect a noncompetitive environment defined by the absence of direct competitors, an efficient organizational process and a geographic balance of membership. Maintaining mutual respect and openness to learn and share are also extremely important criteria for each participant.

Highly organized and loosely structured groups are both viewed as valuable. However, mere is an acute appreciation and desire for informal (social and recreational), and ad hoc time with each other. Structured groups must accommodate time for informal meetings for individuals and sub groups that enable impromptu interaction. Normally, this is best achieved by leaving blocks of unscheduled time during the day.

The most important expectations CEOs expressed about exclusive group learning were members who were honorable and trustworthy, and who value learning. CEOs also expected group membership to contain high performers at the top of the industry and people you could learn from. A fundamental expectation of the group is interaction and CEO Management Learning — Page 121 exchange regarding practical knowledge and experiences. Other expectations included meeting in a comfortable environment, and getting away from the job and community because it "freed up the thinking process." The absence of interruptions from the day-to-

9 day job pressures was considered critical for effective interaction, engagement and reflection within the group process.

CEOs perceive a high benefit and value from the comfort, humor and camaraderie gained by participating in these groups. Inside information about industry personal and professional experiences was seen as especially valuable. Their comments describe the exclusive group as an oasis from the grind and pressures of daily responsibilities. Networking was identified as a very valuable benefit of exclusive learning group membership. Networking provided friendships, professional sounding boards and contacts for their staff and organization.

Interview questions focused on four areas: opinions/values, preferences, group learning experiences, and motivations and expectations. Responses to these questions created a framework to understand the sociological, organizational, environmental and psychological attractions CEOs had to exclusive groups. The CEOs' opinions and values of exclusive learning groups centered on the isolation of their positions and the group's capability to efficiently provide a wide range of experiences and information in one place at one time. Participation in exclusive learning groups creates a cycle of learning for CEOs and their organizations (Appendix

E). The cycle of learning is stimulated by the CEO's initial involvement in the exclusive learning group and is extended to their management teams throughout the organization. The exclusive learning group environment represents a resource where a wide variety of knowledge, intelligence, theory, practice and refection can be accessed efficiently. CEO Management Learning — Page 122

Preferences for participating in exclusive learning groups focused on interaction, experience sharing, and feedback. Smaller size groups were preferred to build trust and bonding that supported interesting sharing and feedback. Exclusive learning groups have environments that enable CEOs to relax their natural management guard, and to trust, share and bond with each other.

Exclusive learning group composition was preferred to be non-competitive, with people who have similar interests and experiences, as well as stature. Membership composition was seen as a mechanism for group balance that enabled open discussion, not representation of the profession. The group learning experience centered around the need for a meaningful level of sociological and human compatibility as a context for learning to occur within. This framework is important to support the candid sharing, open discussions and honest feedback CEOs expect to engage in at these meetings. CEOs are motivated to participate in exclusive learning groups for a variety of professional development reasons such as networking, experience sharing, respite from psychological isolation, etc. However, the fundamental motivation is who is in the group, content discussion, and why it is relevant. Much of this is influenced by time pressures of their positions, perceptions of the type of CEOs who make these experiences valuable and nature of the immediate problems on their agenda. CEO Management Learning — Page 123

CHAPTER FIVE

CONCLUSIONS AND RECOMMENDATIONS This chapter presents the conclusions, discussion of conclusions and recommendations for practice and future research generated from the findings in Chapter Four of this study of CEO learning experiences. The findings are a result of interviews with CEOs conducted in the qualitative research tradition and organized as multiple case studies in a group context. The CEOs were defined as an elite occupational group whose position and status as a unique class of professionals, create limitations and opportunities to learning. Exclusive learning groups were defined as entities reserved for and limited to CEOs. The study's specific objective was to gain a better understanding of health care CEOs' learning experiences, including their attraction to exclusive learning groups, and the role and purpose these groups served in their own learning and knowledge development. The study was guided by three phenomena observed during extensive contact and interviews with health care CEOs.

• Health care CEOs choose to participate in exclusive learning groups for support,

ideas and affiliation;

• The great majority of management expertise for CEOs comes from professional

development and activities outside of work and formal classrooms that involve

informal, uncontrived processes; and

• Exclusive learning groups appear to offer health care CEOs unique learning and social

interactive opportunities beyond formal, explicit and deliberative learning. There is a

strong relationship between the limitations inherent in the context of the CEO's job position (Sherlock, 1999) and the environment and circumstances of CEO Management Learning — Page 124 exclusive learning groups. The CEO job position context produces certain conditions that make learning difficult, such as, psychological isolation, workplace barriers, and time pressures. The exclusive learning environment and circumstances address these conditions by offering access to relevant information (tacit knowledge and practical experience) in an informal manner within a socially conducive environment. The compatibility of this relationship incentivizes CEOs to participate in exclusive learning groups because there is a natural attraction between the limitations inherent in CEO context and benefits of the environment and circumstances in exclusive learning situations. This attraction is enhanced by the expectation that the exclusive learning environment and circumstances can fulfill a unique professional learning need. This relationship is presented in the following illustration developed by uie researcher through observations of the exclusive learning groups and interviews of CEOs:

CEO Context Limitations: Exclusive Learning (Environment and Circumstances) Attraction Benefit: Tacit knowledge acquisition Psychological isolation Experiential practice Limitation of learning exchange modes (formal education Personal and professional, and workplace) Job informal and incidental pressure and demands on learning opportunities time Elite social interaction

The relationship between the CEOs' learning needs and participation in the exclusive learning group was described by CEOs in the study as important because they saw these venues as places where they expected to access knowledge experience and learning not available in other professional development settings. CEO Management Learning — Page 125

Conclusions

1. There is a strong relationship between the limitations inherent in the context of the CEO's job

position and the features of environment and circumstances of exclusive learning groups.

The results of this study underscore the consistency of findings of previous work that

suggests that CEOs find learning difficult within the CEO context (Sherlock, 1999). The

findings of this study extend our understanding of CEO learning, particularly as it relates to

the assertion that the individual cannot be decontextualized and development is intrinsically

about the continuing question of the relationship between the individual and the social

situations in which the learning occurs. These findings support Nowlen's (1988) work now

essentially ten years old. The results of the study also reinforce the description by Kegan

(1982) between the interaction of the individual and culture with respect to personal growth.

His definition of culture was the context or network within which individual meaning

making and personal growth take place. These researchers believe the individual and culture

are constantly interacting with each other, having mutual influence on the learning that takes

place.

2. Exclusive learning groups function as communities of practice. Wenger's (1998) framework

of communities of practice provides an additional lens for understanding the phenomenon of

CEO learning. Communities of practice is discussed in the literature review in Wenger and

Lave's (1991) discourse on situated learning and defines key points that link exclusive

learning group characteristics to it as a concept. The results of this study indicate similarities

between exclusive learning groups and communities of practice as described by Wenger and

Snyder (2000). They describe CEO Management Learning — Page 126

communities of practice as informally bound and comprised of professionals who share

expertise and pursue knowledge to improve practice. These groups are organic,

spontaneous, informal and cannot be mandated to form or act. They must be cultivated and

supported with appropriate infrastructure.

While descriptions of communities of practice and their purposes are primarily about people within companies, the nature and benefits of this form of organization is remarkably similar to exclusive learning groups. Wenger and Synder (2000) note communities of practice are often formed in response to external changes in an industry. They can solve problems quickly, transfer best practices and develop professional skills. A key feature of communities of practice is that they self-perpetuate but last only as long as there is membership interest. The reinforcement and renewal power of exclusive learning groups and communities of practice are fueled by and subject to the value of the knowledge produced by their members. The findings in this study indicate exclusive learning groups operate under similar function and benefit. In both situations, CEOs believe they can obtain a type of tacit or practical knowledge not actually in existence in the company or within formal professional sources of learning. The results of this study indicate exclusive learning groups and communities of practice attract people for similar reasons. 3. Exclusive learning groups are social organizations that support social learning, which is important to CEOs as a way to learn. Findings from this study indicate the importance of understanding Lave's (1988) research on learning transfer, Rubenson's (1989) concept of adult learning as being firmly rooted in psychological and idea that the orientation of learning is an individual mental process. Lave (1988) argued that CEO Management Learning — Page 127 research on learning transfer was not focused on the right issues because it separated learning from the social world in which it occurred and ignored the contextual elements that gave it meaning. The results of this study indicate that CEOs viewed exclusive learning groups as opportunities for social interaction as well as settings in which to learn. CEOs heavily value this form of social learning. The findings of this study also indicate informal and incidental learning (Marsick & Watkins, 1992) have ample opportunities to occur in exclusive learning groups that enable social learning because the nature of this learning is unstructured and controlled primarily by the learner. Results of this study further indicate CEOs sought out situations where informal and incidental learning could take place. Their descriptions of desirable exclusive learning groups are consistent with and are strengthened by models and theories of Argyris and Schon (1978), Dewey (1938), and Marsick and Watkins (1997) who found that individuals learn from interaction with their environments. Their findings support the idea that learning processes are not straight forward, nor prescriptive, but that steps such as observation and reflection are interwoven and the learning process varies because of situations in which people find themselves. The findings from this study indicate the primary attraction to exclusive group participation for CEOs was the depth of experience of its membership and the unique access to these individuals reflecting an unusual social opportunity for informal and incidental learning. 4. Exclusive learning groups produce a special social context for CEO learning that creates a safe harbor (Chapman & Confessore, 2000) for open and candid discussions for discrete self and organizational measurements, and for affiliation and support for CEO Management Learning - Page 128 difficult problems they are managing. These groups enable the development of confidential and intimate learning relationships within their environment. Chapman and Confessore

(2000) concluded that exclusive learning groups provided comfort and meaningful frameworks for CEOs to learn. Their study of 70 health care CEOs confirmed that exclusive learning group environments provided these conditions. The findings of this study extend

Mocker and Spear's (1982) assertion that the learner's environment is key to directing what will be learned in any given situation. While this reference assumes the learner is pursuing learning as a self-directed learner outside a formal setting, it is relevant to the CEO's pursuit of exclusive learning groups because the CEOs, themselves, tend to think of these learning situations as very self-directed. In this study, CEOs indicated they left their own organizations and traditional continuing professional education programs to experience a new environment —the exclusive learning group—that gives them direct access to practical experiences and a different meaning and experience of management development. However, each described a learning event that was unique to him or her. This declaration is important because CEOs can develop the type of experiences they need in an exclusive learning group and exclusive learning groups are flexible enough to accommodate these needs. Mocker and

Spear (1982) point out that it is the individual's perception of the environment that gives meaning to experience. It can be said that the learning context is a powerful mediator of an individual's learning experience. When CEO participants have input into organizing circumstances of exclusive learning groups, the groups become more attractive to them because they can strengthen the norms, culture and meaning of their experience by regulating and influencing the consistency and CEO Management Learning — Page 129 stability of the functioning of the group. This ability to structure the learning environment may also influence the amount and type of learning that occurs. Mocker and Spear (1984) identified four patterns that help establish the circumstances effecting the learning process (Type I, single event anticipated learning; Type II, single event unanticipated learning; Type III, series of events related learning; Type IV, series of events unrelated learning). The circumstances affecting the learning process CEOs interviewed in this study described about their exclusive group learning are most similar to the Type IV pattern of learning. This means CEOs are focused on the nature of the program and associated activities and how they can enable them to access practical knowledge and experiences available to them regardless of the settings in either small group or one-on-one relationships. Taken together these findings suggest that, to be effective, CEO learning experience must be sufficientiy flexible to allow CEOs to learn wherever they find themselves.

Garrison (1989) describes a model of education which focuses on balancing control between learner and facilitator. This is critical for CEO learners. Some CEOs interviewed stated the degree of influence to shape the group and its activities was an attraction for them that determined their commitment to participate. This suggests that those offering exclusive learning groups for CEOs should focus on attaining similar power balances during the development of the group and formulation of content and activities.

Closely related to group formation is obtaining conditions that ensure stability and consistency of members because stability and consistency are important factors that influences the learning circumstances. In this study, the CEOs said membership CEO Management Learning — Page 130 composition was so important because their industry is so competitive and comparability of each member's level of experience and interest was critical to having a meaningful learning experience. Membership size and composition can also positively or negatively affect the nature and environment of the group and the ease or difficulty of interaction, open sharing and opportunities for informal learning.

Discussion of Conclusions

The findings and conclusions from this study point to several influential factors and theories concerning CEO learning. When these factors and theories are combined, they create a series of dynamic relationships that produce a learning framework that bounds the exclusive learning group experience for CEO participants. This learning framework also helps explain how the conditions CEOs prefer inter-relate and reflect the CEO framework of participation for a satisfying exclusive learning group experience.

The influential factors and theories supporting the conclusions of this study are organized and presented by the researcher in the illustration of the participants' learning framework below: CEO Management Learning — Page 131

Participants' Learning Framework

Circumstances Effecting Learning (Type and Pattern) M------Context of CEO Job Positiont ------►

The conclusions in this study assert the CEO context limitation creates a narrow set of conditions that CEOs expect to experience in exclusive learning groups. The conclusions also support the experience that elite occupatio-nal group members seek other elite in their occupation for learning. Also, communities off practice such as exclusive learning groups reinforce a safe, confidential, set of circumstances and environment that facilitates CEO learning. These conditions further support a learning type and pattern conducive to informal and incidental learning opportunities:. Combined, these factors and theories interact and have continuous effect on the CEO's exclusive learning experience. The findings from this study indicate these constitute an important phenomenon which influences CEO learning decisions concerning whether they will participate in exclusive learning groups. CEO Management Learning — Page 132

CEOs are autonomous learners who seek learning environments that are safe and

confidential where they can candidly interact with peers about the practical aspects of their

work. Environments lacking in these ingredients will not be successful in attracting and

maintaining CEOs in management learning programs. Serious consideration must be given to

include learning opportunities that directly address the context of CEO job positions (Sherlock,

1999). The development of organizing circumstances in exclusive learning groups will be

greatly influenced by the type of learning opportunities (informal and incidental), nature of

knowledge (tacit) and membership composition (comparable experiences and lack of

competitors). Including and maintaining a social context and activities will strengthen the

appeal and attraction to exclusive learning groups for CEOs. Stability of group membership and

regularity of meetings will help to build trust, bonding and safety.

Providers of management education and development programs should recognize the importance of peer-to-peer learning activities (Fusaro, 2000) as increasingly important for new

CEOs who need access to a professional source of confidence, and for experienced CEOs facing new challenges in a constantly turbulent and changing industry (Vail, 1996). The exclusive learning group represents a place that CEOs perceive enables them to share the psychological burdens of the unique challenges in their job positions and participate in and obtain tacit knowledge creation (Van Krogh, Ichijo, & Nonaka, 2000). More importantly, it represents an unusual learning opportunity, sufficiently distinctive, that meets the specific learning needs of CEOs. CEO Management Learning — Page 133

Recommendations

Recommendations for Practice

Based on the findings of this study, the following are recommendations for design and

implementation of CEO learning experiences.

1) CEOs should consistently participate in at least one exclusive learning group

and determine ways to share their experiences in their organizations. This

participation will provide continuous access to tacit sources of knowledge and

practice experiences.

2) Providers of management education and development should review their programs and

approaches to attracting CEOs to determine their consistency with motivations, preferences

and expectations CEOs expressed in this study. They should pay particular attention to

group composition, organization and function.

3) Providers of management education and development should consider the study definition

of CEO learning type (Mocker & Spear, 1982)' as informal learners willing to relinquish

control over what is learned (the objective) for control over how it is learned (the process) in

planning their programs. Strong consideration should be given to obtaining CEO input to

design programs.

4) Organizing exclusive group learning for CEOs can be a great value for these elite

professionals to solidify communities of practice doing similar work and collaborate

on knowledge elicitation and professional practice improvement.

Study Strengths and Limitations

Reflecting on the study after its completion, the researcher identified several strengths and limitations of the study that were not apparent at the outset. One strength CEO Management Learning — Page 134 of the study was the wide range of CEO personal backgrounds, experiences, history of positions held and types of organizations managed throughout their careers. Each CEO understood and was deeply experienced in learning activities and held membership in a variety of learning groups. They had all achieved high leadership positions in health care early in their career and had experienced an extensive amount of formal and structured management learning events. They were also representative of community-based organizations, academic institutions, and financially oriented health care entities. Each participant is highly regarded as an accomplished professional in the health care industry. They were all married and had families that included children of various ages.

The study participants were comfortable with their role as interviewees and were remarkably open, candid and expansive in their responses. Several had served as officers and leaders of national health care professional associations. Some had attained professional experience in other industries outside health care.

One limitation of the study was the research participants partially self-selected because they willingly volunteered to be selected to be interviewed. They were willing to give two to four hours of their time to be interviewed on this topic. Other CEOs of health care organizations may have had other perspectives on this research, but may have been inhibited by the time requirement. Also, the sample of seven CEOs cannot represent the generalized population of CEOs. The sample of participants, while small, underrepresented women and minorities, which means adequate perspectives reflecting diverse cultures, experiences and meaning may have been underrepresented.

Another potential limitation of this study is the potential bias of the researcher who has spent his career as a CEO and participant in exclusive learning groups. These CEO Management Learning — Page 135 experiences may have influenced how the questions were presented to the research participants and the focus of follow up questions. They also may have provided a specific framework for the interview analysis, as well as influenced interpretation of the descriptions of learning experiences. Recommendations for Future Research

Based on the findings of this study, the following are recommendations for future research and further studies.

1) This study was limited to seven CEOs in health care. Studies with larger samples should be

conducted and amongst CEOs in other industries to determine generalizability.

2) Additional methods of learning for elite occupational groups should be identified and

studied to understand patterns of other learning experiences within and outside health care.

3) Studies should be conducted that examine the transferability of tacit knowledge from CEO

to CEO and CEO to their organizations. These studies could test the effectiveness of CEO to

CEO learning.

4) Using findings from this study, CEO learning should be investigated using communities of

practice as a framework. These studies could determine the over attractiveness of

communities of practice outside the workplace and with the profession of CEOs.

5) Studies should be performed to investigate the value of learning in exclusive groups and

how it influences performance improvement of an organization. Organizations CEO Management Learning - Page 136

that CEOs manage should be assessed for performance improvement and best

practices.

Summary of Chapter CEOs seek learning experiences that offer

opportunities for personal insight, practical experience and capacity to access tacit knowledge

of their peers. These experiences are considered most relevant to the daily responsibilities and

pressures of their jobs and are not available in formal learning situations governed by technical

rationality and theoretical knowledge.

Exclusive learning groups offer the circumstances and environments that are comfortable and safe for informal and incidental learning activities for CEOs. This enabling context supports trust building and bonding that encourages open interaction and sharing of tacit knowledge and real world ideas and practice experiences and results. It is also an environment that increases the likelihood of CEOs offering personal insights to their practice successes and failures.

Exclusive learning groups are special cultures that allow CEOs to learn outside the performance spotlight of superiors and subordinates in relaxed social and comfortable conditions. The nature and condition of the environment and circumstances of exclusive learning groups is not perceived by CEOs to be readily available to them elsewhere. The informal and safe cultural context CEOs perceive and experience in exclusive learning groups addresses learners' desires to have control over the learning experience and to maximize the interaction and discussion with each other. This allows CEOs to creatively focus their time, energy and attention on matters considered relevant to their own development needs. CEO Management Learning — Page 137

Exclusive learning groups are effective ways to explore and negotiate the constancy of change and what the impact may be on organizations that CEOs manage in real time. Real world market pressures and rapidly changing conditions (Vail, 1996) require sponsors of management learning for CEOs to offer programs that can be flexible and quickly adapt to their unique needs as frontline decision makers. CEOs are evaluated on how well they execute concepts and programs. They seek learning experiences that will enable them to conduct these responsibilities.

The essence of CEO learning in exclusive groups represents experiences of an elite occupational group in obtaining association, support and knowledge to improve professional performance. CEOs as the organizations' top managers seek environments and conditions as well as people and places that offer the most potential for sharpening management practice.

Exclusive learning groups are also places that CEOs can conduct discrete self-measurement and comparative assessment of the organization's performance. The findings of this study demonstrate that CEOs, as an elite occupational group, have learning needs that are more conducive to the learning experience offered in exclusive learning groups. These learning needs are driven by the CEO's responsibility to rapidly, effectively and successfully execute ideas, concepts and plans. CEOs perceive that tacit practical knowledge is easily accessed and transferred in informal and socially oriented learning environments. The study findings strongly indicate CEOs respond to learning situations that can accommodate these conditions and needs.

Consequently, organizations that attempt to attract CEOs to learning programs need thoughtful, creative and meaningful approaches and strategies that address the context, types of knowledge and learning style of this elite occupation. CEO Management Learning — Page 138

CEOs seeking learning experiences that can update and sharpen their management practice should identify an exclusive learning group that is suitable to their responsibilities, personality and interest. Findings from this study indicate CEOs seek learning where they can have control over the process, be with other CEOs, access tacit knowledge, interact socially and informally in a safe comfortable environment and engage in candid open discussions. These are the conditions CEOs prefer and sponsors of CEO learning activities must address to create relevant and meaningful learning experiences for this elite occupational group. CEO Management Learning — Page 139

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APPENDIX A

Letter of Request for Participation to Participants

A Study of Learning Experiences of an Elite Occupational Group: Health Care CEOs

Thank you for your willingness to participate in this study. I am very pleased that you have agreed to take time from your busy schedule to answer some questions.

The purpose of this study is to develop a better understanding of CEO learning in exclusive learning groups including the role, purpose and attraction of the group for CEOs.

Please be assured that all of the information you provide to me will remain confidential. All results will be reported as group information; when I write up the report I may occasionally take some brief quotes from the interviews to use as examples, however, these will not be attributed in any way, and any distinguishing characteristics will not be included.

Please feel free to ask me questions at any time during or after the interviews. You may ask to stop the study process at any time. Once I have finished the study, I will be happy to provide you with a copy of the results. Again, thanks for your time and willingness to participate.

I agree to participate in the present study as described to me by the researcher.

Participant:______Date:______

Study Coordinator: Thomas W. Chapman (202)454-1221 CEO Management Learning — Page 160

APPENDIX B Study Question Framework Opening

Comments/Questions

1. The reason I am here is to learn about the inner experience of CEO learning in

exclusive groups.

2. In order to capture your exact words and free me up to listen carefully, I would like to audio

tape this conversation. May I have your approval?

3. This information will be used for a research dissertation study. All the interviewees will

remain anonymous.

4. The fundamental objective is to understand the exclusive learning group environments and

conditions that are appealing and attractive to you. In this regard, your perspective meaning

and experience as a learner in these groups is important to this study.

In general, the question framework was an unstructured and informal guide. The following questions reflect the potential area of focus: Group Learning Focus

Questions

1. How did you select this group learning experience?

2. What was most attractive?

3. What was most comfortable?

4. What were your expectations?

5. Why did you do what you did?

6. What have you learned about learning in groups like this, and what do you get out of it? CEO Management Learning — Page 161

7. What was more valuable: formal or informal time?

8. Does casual learning take place between formal sessions?

9. How important are the social activities to learning:

10. What benefits do you gain from group learning —vs.- autonomous learning?

11. What is the structure, process and nature of CEO group learning that is important to you?

Individual Learning Focus Questions

1. What motivates you to participate in this group?

2. What conditions do you prefer in a group learning situation?

3. What specific attractions (environment, conditions, etc) did this group offer?

4. What are the ideal circumstances you seek in a group learning situation?

5. What conditions deter or create barriers to your on-going learning needs?

6. What is the value/benefit gained from this group learning experience?

7. Is mere value or benefit in learning within an elite CEO group?

8. How important is being away from your organization and community for learning?

9. Which learning method is more valuable, group or autonomous? Why?

10. Do exclusive CEO learning groups facilitate effective learning (ease of

communications) versus mix management groups? Why or why not?

11. What type of topics (strategic, technical, etc.) is best for CEO learning groups?

Closing Comments/Questions

1. I plan to transcribe this interview and study it for patterns over coming months.

2. Would you care to have a copy of the transcript?

3. Thanks for your cooperation. CEO Management Learning — Page 162

APPENDLXC

Letter with List of Additional Questions

First Name, Last Name Title Company Address City, State Postal Code

Dear Salutation:

Enclosed are fifteen questions I would like to cover during our phone conversation. In order to make the most efficient use of our time you can answer these questions and return them to me prior to our follow up interview by e-mail or fax. Please feel free to offer any comments beyond the scope of these questions that explain additional opinions, values, preferences, motivations and experiences you have had concerning CEO exclusive group learning.

I know you are always busy so I appreciate the time you have invested in this project. Your contributions have already opened new perspectives on CEO learning experiences. Naturally, you will receive a copy of the final dissertation and I would be delighted to discuss any of the findings and conclusions with you in the future.

Again, thanks.

Sincerely,

Thomas W. Chapman

Enclosure

Phone: 202/454-1221 Fax: 202/454-1251 e-mail: [email protected] CEO Management Learning — Page 16>3

QUESTIONS FOR FOLLOW UP TELEPHONE INTERVIEW

1. If you looked for an exclusive CEO learning group today what kind would it be? The attributes?

2. Would you prefer industry-sponsored (health or corporate), highly organiz&d groups or informal (ad hoc) loosely structured groups?

3. What is the most important aspect and benefit of an exclusive CEO learning group for you?

4. What is the most important characteristic or element an exclusive CEO learning group should have to attract you?

5. What is more valuable to you as a CEO, individual learning or group learning?

6. How important is getting away from the job for learning?

7. How do you use the information and experience from an exclusive CEO learning group meeting?

Comparative or Measurement of Organizational Progress or Status New Strategic Knowledge ______Storing Knowledge for Future References ______

8. What does a CEO gam by learning in exclusive groups?______CEO Management Learning — Page 164

9. What environmental conditions or circumstances make a meaningful exclusive group learning experience?

10. Do you prefer large or small groups?

11. Do you prefer formal structured agendas or loosely structured agendas?

12. How important is peer interaction and open discussion?

13. Overall, how have you felt about the value of your professional CEO learning group experiences?

14. What is the fundamental motivator for your participation in CEO exclusive learning groups?

15. Do you have "critical preferences" or needs that must be met which determine your decision to participate in CEO learning groups?

COMMENTS: CEO Management Learning — Page 165

APPENDIX D

Letter of Introduction to Study

First Name, Last Name Title Company Address City, State Postal Code

Dear Salutation:

Thank you for agreeing to participate in my dissertation research study concerning learning experiences of health care chief executive officers (CEOs). Your role and involvement in this research will be to serve as an interviewee (research subject) regarding your professional and personal learning experiences as a CEO in exclusive learning settings. The objective of the research is to develop five CEO case studies that richly describe the environment, condition and circumstances of their learning experiences in exclusive learning groups.

In conducting this research, I am attempting to gain a deeper understanding of critical learning group factors that attract an elite occupational group (health care CEOs) to participate in exclusive learning environments.

My research question is: How do members of an elite occupational group, specifically CEOs, experience and describe the role, purpose, and influence of exclusive learning groups?

For the purposes of this study elite occupational groups are those who possess autonomy, authority, high income, substantial status and significant responsibility. Exclusive learning groups are those controlled by elite occupations, reserved for their membership and exclude those without the specific elite status.

I have enclosed a copy of the full dissertation proposal for your review. The sections describing Introduction through Research Question (pages 1-21) may be most useful to understand at this time. I would also suggest reviewing the Interview Questions (page 43) and Case Study Question Framework (page 46) to familiarize yourself with the types of questions that I will ask you. This research study will require you to participate in two interview sessions. The first will be person to person and will last for 1 Vi to 2 hours. The second can be by telephone, fax or e-mail and may take 45 minutes to one hour. In addition, I will arrange to observe your learning experiences in exclusive group settings. CEO Management Learning — Page 166

First Name, Last Name Page 2, Date

Your participation in this study will be anonymous. No CEO (research subject) will be identified or disclosed in the findings and conclusions of this study. Throughout the course of these interviews, your participation will be fully voluntary and a research disclosure statement will be provided for your approval prior to conducting interviews. I will call your to schedule a specific date and time for the first interview.

Thank you for your participation and support and I look forward to talking with you soon.

Sincerely,

Thomas W. Chapman

Enclosure APPENDIX E

CYCLE OF CEO LEARNING IN EXCLUSIVE LEARNING GROUPS

Knowledge

Organizational Benefit Embedded in Competent Practice

Exclusive Learning Group Environment ______Tacit Knowledge (Polanyif ▼ ▼ ▼ Knowing in Action (Schon) Knowing in Practice (Schon) (Competence, Experience) Individual "*" Intelligence in Action (Polanyi)(Recognition and Judgment) Practitioner Non Logical Processes (Barnard) Though Intertwined Learning ^~ with Action (Dewey) Action Research (Lewin) (Practice Theory, Practical Inquiry, Actionable Theory) Reflective Transfer (Schon) (Generalization and Reinvention of Knowledge) Exclusive Learning Group Environment

Organizational Benefit