Resilient #MedEd #Leaders: Bending to Adapt

(From the E-i-C:  This is the third installment on emerging philosophy and tactics for leaders in education.  You can find Part 1 here and Part 2 here.  Stay tuned for the ebook version of this whole series Spring 2017.  For advance registration to access a copy of the book Resilient #MedEd Leaders email us at ice@royalcollege.ca

-Jonathan)

 By Felix Ankel  and Nico Pronk, PhD

“The best is the enemy of the good.”  – Voltaire

You are a #meded leader charged with integrating health professions education within a health system. Operational changes within the system are evolving in an exponential fashion. Educational imperatives are also evolving but are perceived to be lagging behind. How can you align these forces? How can you bend the current system to adapt and accelerate change?

There is a debate about what elements of resilience are related to the capacity of the individual to handle stress, a.k.a. the gene code (see Daniel Cabrera’s excellent posts here and here), and what elements are related to the capacity of the system to handle stress, a.k.a. the zip code.

This is the third of four posts in the #meded leadership series that focus on developing resilient educational programs able to handle system stress (the zip code). The four topics include:

  1. Identifying clear values
  2. Maximizing the density of connections
  3. Maximizing the ability to bend and adapt (discussed in this post)
  4. Incorporating systematic reflective practice

Challenges to bending and adapting

Educational programs stick to the status quo for many reasons: Program directors and faculty are comfortable with it, external accreditation and compliance standards are interpreted in a conservative fashion, and hierarchical organizational structures favor perfectionism and the “illusion of central position” rather than rapid prototyping and rapid failure for learning.

Clinicians have minimal tolerance for error or competing points of view unless backed by compelling data. In academia, committees promote faculty based on the number of peer-reviewed publications and grants, which are surrogates reputation. These forces can produce an “illusion of central position,” where the interpretation of external data is constrained by an inward-facing, deficit-based lens that stifles program innovation and creativity.

This “culture of central position” results in #meded programs being produced and “perfected” without input from diverse stakeholders. Such a production model often leads to small technical improvements, but it does not address the adaptive transformation needed to train the clinicians of the future to work in the environment of the future.

Shifting cognitive perspective

#meded programs and leaders of the future will benefit by developing competencies to remain adaptive and relevant in rapidly evolving health care environments.

One such technique is the ABCD of shifting perspective created by Albert Ellis. The activating event is one that causes stress (e.g., a resident being pulled from an endocrinology service). The belief is the immediate thoughts or assumptions about the event (that the residency does not value endocrinology training). The consequence is the emotion or behavior that is developed (anger and hostility toward the residency director). The dispute involves challenging the initial belief by coming up with a list of alternative beliefs (the resident is pulled from service for reasons unrelated to endocrinology).

#meded leaders that can embed cognitive perspective–shifting competencies in their team will help educational programs bend, adapt, and maintain resilience in a rapidly changing world.

Nico Pronk’s first-person case study in an industry different from #meded, which follows, discusses how maximizing the ability to bend can serve as the foundation for building a resilient system.


Case study: maximizing the ability to bend and adapt

Human capital refers to an organization’s people and their health, expertise, and motivation to function and perform. The ability of an organization’s culture to “bend” according to the evolving and emerging needs of its environment has a profound impact upon the performance of the organization and its people.

Over the course of the past 10 years, I studied the journey of a medium-sized manufacturing company located in the Upper Midwest. In 2003, the company’s Minneapolis location numbered about 500 employees, among whom more than 30 languages were spoken. The company’s performance was floundering and a new CEO was brought in. The CEO decided to focus on the company’s workers as its main asset and lead an intentional effort to create a culture of health and safety that reflected clear values, ethical leadership, support for worker well-being, and organizational performance. In the process, the company built a culture that reflects an organizational capacity to bend and adapt and provides a context in which people (the human capital) can thrive.

Health and well-being

The manufacturer built a platform for worker health and well-being that was intentionally designed to go beyond individual programs and address needs holistically. Support from leaders was enhanced by access to on-site medical clinic, pharmacy, and health-coaching services, sponsored retirement savings programs and financial counseling, profit sharing for retirement, “work-life pursuit” time, company match for volunteering, promoting from within, and tuition reimbursement, among other benefits.

Education

The company created a leadership and development track to support managers and supervisors in optimizing all aspects of employee and organizational health and well-being. All executive, mid-level, and front-line leaders participate in this ongoing program, which includes training in social and emotional intelligence, leadership effectiveness and authenticity, goal setting and coaching, and intrinsic needs assessments.

Motivation

Year-round communications that bring recognition to the services and experiences of the employees and transparency around the company’s performance in the market optimized employees’ energy and motivation to bring their best selves to work every day. The notion of pursuing a “human-centered” culture meant not only paying attention to physical health needs that allow employees to be at work but also to issues that matter most to employees and their families. Through the introduction of “stay” interviews, coaching, and mentoring programs, the voice of the employee is loud and clear.


Why do these changes matter?

Having the ability to bend and adapt as a company is important for health and well-being, education and expertise, and motivation—and vice versa. In fact, a focus on human capital is equally responsible for building the ability to bend and adapt as any other factor. Hence, maximizing the capacity to bend is a leading indicator of a culture of health and safety.

Companies recognized for their cultures of health and safety tend to outperform the market, as measured by the average Standard & Poor’s 500, by as much as 5% to 17%. Over the 10-year journey the medium-sized company described above took to build such a positive culture, it experienced a turnover rate reduction from 15% in 2003 to less than 1% in 2012. (The industry average is 13%). Employee surveys indicated that 93% of the company’s employees give their best effort each day and 91% put in extra effort as needed. Such results reinforce that the benefits of this long-term view include building resilience among people as well as in the organization as a whole.

When building resilient educational programs, consider the following:

  1. Beware of the limitations of perfectionism. Embrace rapid failure, rapid prototyping. Champion human-centered design.
  2. Beware of the illusion of central positioning. Design your programs from many points of view. Embrace criticism as energy for creativity and innovation.
  3. Maximize your cognitive bending practice. Consider embedding the ABCD approach of shifting perspective into your program for maximal resilience.
  4. Recognize the value of investment in human capital, especially health, well-being, and education of your people.

References

Kahneman Daniel, Tversky, Amos.  On the Reality of Cognitive Illusions. Psychol. Rev. 1996; 103(3):582-591

Kegan Robert, Lahey, Lisa.  An Everyone Culture, Becoming a Deliberately Developmental Organization. Harvard Business Review Press 2016

Lipsenthal, Lee. Finding Balance in a Medical Life. Finding Balance, Inc. 2007

Pronk NP. LifeWorks@TURCK: A best practice case study on workplace well-being program design. ACSM’s Health & Fitness Journal. 2015;19(3):43-48.

Image  courtesy of Michal Osmenda , via Wikimedia Commons