Living Well Journal

Healthcare Leaders During a Crisis: Be a Hope Dispenser

Eric Norwood, FACHE, PCC

 

 

Our brains are story-making machines. When faced with the unknown, those stories always spin negative.

The world today is faced with the unknown of COVID-19, and the healthcare environment is moving at an unprecedented pace. As humans, our default setting is to find and focus upon every negative consequence imaginable. That’s fear, and it is paralyzing.

Leadership is using your influence to co-create coordinated movement forward, shifting from the paralysis of fear to hopeful action.

But, how can you do that in the midst of a world in fear? I’m reminded of a mental picture someone shared with me years ago.

Swept Away

Imagine a raging river full of rapids that surges over a huge waterfall; and you see many people being swept downstream toward the falls.

You notice people all along the shore of the river trying to help those in the river:

• Some are reaching out at the edge of the falls to snatch victims at the last moment.
• Others are just upstream, stepping out on the rocks to grab whomever they can reach.
• Some are upstream a bit further, throwing life rings to people and pulling them to shore.
• Still others are much further upstream teaching people how to swim
• While others are installing fences along the river to prevent people from falling in.
• Finally, there are still others gathered at the bottom of the falls, trying to recover and save the few who survived going over the edge.

There are many of ways to help people in need.  Which one of these groups of helpers did it best?

Honestly, they all play a crucial part in the helping process. However, many are convinced that their way is the best.

Looking at the current crisis of COVID-19, I see a lot of intramural fussing over the “best” way to help. Some argue for more ICU beds and emergency responses to the crisis. Some argue for procedures for better testing and social distancing. Others argue over alternative ways to support one’s immune system. And I’m sure there are many other approaches I’ve not listed.

All the helpers on the riverbank have a part to play.  None of them can catch everyone in need, and I believe each is called to their own particular station along the way.  One thing they all have in common is a love for helping others, and instead of arguing about it on social media they are out there doing it!

So, here’s an opportunity in front of you today as a healthcare leader: choose to be a Hope Dispenser in the face of fear.

Leading in a Helping Profession

Historically, healthcare helpers were given little opportunity to offer preventative help – standing at the bottom of the falls to try to help the injured.

As we learn more about the processes of disease and ways to supplement the body’s innate ability to heal itself, healthcare helpers take up various stages along the river above the falls: critical care interventions at the point of trauma, procedures in advance of an impending illness, educating people on how to avoid illness, and ultimately teaching people how to take personal responsibility for their wellness.

The fact is none of us can solve this crisis alone. It is a team effort. We must each stand at our station, fulfilling our duty to those in need, and linking arms with those to our right and left. That’s really the best we can do. We must trust that our teammates will do the same and that our combined results will be enough.

One last thought:  What good is any helper who gets swept into the river as they try to help?

The first job of a healthcare helper, and of you as a leader, is to take care of yourself in order to have the wherewithal to help others. If you or your colleagues get swept away by fear, you can’t help others. It’s like the airline crews tell us:  in the event of a loss of oxygen, put the mask on yourself first so you can attend to others.

We’re in for an extended time of challenge in healthcare. Step up as a leader: take care of yourself first, be a Hope Dispenser daily to those on your team and in your life, and link arms with others in the profession of helping and let’s create a force together!

Bounce Forward Not Backward

Eric Norwood, FACHE, PCC

April 23, 2020

A busy healthcare executive told me today, “I don’t want to go back to normal after this.”

“We were all on the trajectory of a train wreck before the Covid Crisis - - running as fast as we could and spinning our wheels in the process.  Why would we want to go back to that?”

“This whole experience has been a reset for everyone in our organization and the community at large: stop, think, regroup.  How will we reengage our society without all the chaos?  What elements of our prior life should we just kill?”

“I’m happier than I was before this … the same or more stress than before, yet it feels different.  I used to think working from home was less productive.  Now I have more family time balanced with my work life.  A lot of “good things” that kept my family on a treadmill have been replaced by more time to really connect together.  If I have to go back to the way it was before, I think I’ll scream!”

 

“Between stimulus and response there is a space. 

In that space is our power to choose our response. 

In our response lies our growth and our freedom.”

Viktor Frankl, “Man’s Search for Meaning”

 

In my recent blog, “Struggle Makes for Stronger Leaders,” I referenced how resilient people seem to “bounce forward” from adversity because it changes who they were before it.

In his book, “Bounce Forward:  How to Transform Crisis into Success,” Sam Cawthorn shares the harrowing story of an auto accident that cost him his right arm and left the rest of his body shattered.  The experience taught him that he had a choice of how to respond to this crisis.

In the course of his recovery, Sam became a student of how to bounce forward, studying the lives of others who had done it well.  He framed a 5-stage process as “The Bounce Cycle”:

1. The Crisis: Something has happened that will absolutely change your life.  Face it squarely.
2. The Downturn: At this stage the crisis may have caught you unprepared - - it’s the time between Crisis and Rock Bottom where choices can begin to be made.
3. The Bounce: “This is the turning point and the toughest because it’s at the lowest point of the cycle.” Recognize you have a choice: to try to go Back or to go Forward. 
4. The Opportunities: Pull back the lens, broaden your perspective, take inventory and be surprised by what you CAN do!
5. Bounce Forward: “When you bounce forward, acceptance isn’t an end point from which you mourn a life once lived; it’s merely a stage toward a bigger, better and brighter life…. I can honestly say I wouldn’t change a thing in my life!”

Sam’s book builds upon 4 crucial habits for Bouncing Forward that make his book a great read:

1. Forget the past and press forward.
2. Expect the best.
3. Empower your strengths.
4. Stay aligned and motivated.

The Covid Crisis will be known as a defining moment for healthcare, just as 9/11 was for air travel.  Already telemedicine visits have exploded around the nation.  This is technology that was already present but largely ignored until necessity made it a real-time innovation.  Now insurance plans are beginning to pay for telemedicine office visits.  Healthcare leaders can bereave the loss of office visits to primary care practices or foresee an exponential improvement in primary care access if they Bounce Forward to grasp it.

 

“The challenges we face in life are not meant to be some sort of punishment;
rather, they are an invitation to change –
and an opportunity to create something even better than before.” 

Sam Cawthorn, “Bounce Forward”

 

 

Are Healthcare's Sacred Cows Being Tipped?

Eric P Norwood, FACHE, PCC
March 25, 2020

You’ve heard of cow tipping, right? Frat boys pass their initiation hazing by sneaking up on a sleeping cow and pushing it over? I recently spoke to two healthcare executives who assure me it’s real.

So, I consulted the Internet, our ever-trustworthy Source of Truth.

“The evidence against cow tipping is immense and backed up by both farmers and the laws of physics …. but the simplest bit of proof we can point to is YouTube.

While in the history of the world there have surely been a few unlucky cows shoved to their side by boozed-up morons, we feel confident in saying this happens at a rate roughly equivalent to the Chicago Cubs winning the World Series.”

(Borrowing from Dumb and Dumber, this sounds like a one-in-a-million possibility of love that translates into “So you’re telling me there’s a chance!!!”)

“YouTube, the largest clearinghouse of human stupidity the world has ever known – where you can watch hours of kids taking the cinnamon challenge, teens jumping off rooftops onto trampolines, or the explosive result of fireworks set off indoors – fails to deliver one single actual cow-tipping video.” ¹

 

Many other sites reach the same conclusion: cow tipping just can’t be done.

Nevertheless, the stories of cow tipping still abound, and for some very curious reason I find myself wanting to believe in the possibility of the unprecedented!

That’s why I encourage my healthcare leader friends to pay attention to how the current pandemic is creating an unprecedented opportunity to tip over some of healthcare’s most Sacred Cows.

Have you noticed how quickly regulatory bodies are shifting the strictures of EMTALA for dealing with triaging patients?  Or how HIPPA considerations are being reconsidered to permit broader telemedicine interventions? 

Not too long ago, our immediate impulse when presented with a new idea touching one of these was “Oh, you can’t do that because [fill in your favorite regulatory injunction].”  In other industries, a novel idea attracts interest and curiosity that can lead to innovation. 

In healthcare, our Sacred Cows instead cause us to respond with immediate suspicion. We are trained to go by the book, to trust past experts’ opinions, comply with regulations, and avoid risk. All well-intentioned. Yet, it’s no wonder clinical innovations historically take 15 years or more from the bench to the bedside.

Now I sense things are changing. Just this morning I read a report detailing how 1 ventilator can be adapted with common hoses to serve up to 4 patients at the same time. The comments were full of curious insights and references by providers from Spain to Mass General.

A month ago, I doubt the comments would have reflected any serious consideration of the idea.

What if this pandemic truly becomes a defining moment for healthcare, like 9-11 was for air travel? What if healthcare becomes much more open to innovation because of it?

Attention is the currency of leadership. Pay attention to what’s changing: the tipping of our sacred cows. They may create game-changing opportunities for a fresh wave of unprecedented innovation in healthcare!

______________     

¹  Modern Farmer, “Cow Tipping: Fake or Really Fake? “SEP 04, 2013, Jake Swearingen

 

Struggle Makes for Stronger Leaders

 

Wall Street Journal, April 1, 2020

 

The double-entendre contained in this cartoon really "hooked" me!

The salmon are swimming upstream, just as they are designed to do

Yet it’s exhausting swimming against the flow, enough to question the effort even when it’s the right thing to be doing.  The salmon’s destiny lies upstream, not downstream.

Maybe this is the way life works for anyone who succeeds.

Our bodies grow stronger when we exercise - - exerting energy against gravity (weightlifting, running).  Without the stress of exertion against gravity, our bodies inevitably deteriorate.  Astronauts manning the International Space Station need special equipment to simulate in space the gravity on Earth to keep their bodies strong.

Overcoming resistance begins at birth: there’s some evidence that a baby who is vaginally borne may benefit from the struggle of birth in ways that a C-section baby may not.    

The 2^nd Law of Thermodynamics says that everything in the universe is gradually winding-down, orderly systems are inexorably moving toward disorder.  Struggle seems to be a fundamental fact of life for all of us.

What does this mean for leaders who are seeking to sustain some sense of order in a complex world that’s changing at light speed?

As coaches, we at MEDI believe that leadership is the exercise of influence to co-create coordinated movement- -  by a group of people toward a common purpose or goal.   That influence flows through relationships, just like electricity flows through a wire.  And co-creating coordinated movement with people always involves change, and change always invites struggle.

It turns out that “change leadership” isn’t a “thing” unto itself.  Leadership is change.

Like our friendly salmon in the cartoon:  the choice to swim against the flow of the conventional wisdom, of “the way we’ve always done it,” is normative for an effective leader.  There will be others who don’t see the need to change or are too afraid to challenge the status quo.  Going with the flow is always easier.  But the future lies upstream.

Hard times are the only way you increase your load-bearing capacity as a leader.

In his book, Resilience:  Hard-Won Wisdom for Living a Better Life, retired Navy Seal Eric Greitens writes about how people survive and thrive in spite of traumatic experiences:

“When people hear the word ‘resilience,’ they often think of ‘bouncing back’ …. Life’s reality is that we cannot bounce back.  We cannot bounce back because we cannot go back in time to the people we used to be…. Resilient people do not bounce back from hard experiences; they find healthy ways to integrate them into their lives [bounce-forward’].”

Lastly, it’s noteworthy that there are 2 salmon swimming together.  Leaders need a trusted confidante at their side.  Resilience grows best in relationship, not isolation.  Who is that person in your life?

So take your experiences in these hard times as part of your ongoing training for more effective leadership.  Don’t succumb to the temptation to go with the flow, because progress is always upstream.

Covid-19, Complexity and Dancing with Chaos

 

By Eric Norwood and Micheal Hein, MD

Over the past several weeks, we are seeing complexity play out in dramatic ways. Significant changes are likely taking place for you in terms of how you view your role and impact as a leader. In this post, we’ll explore crisis leadership insights to help you maximize your impact and navigate emerging dilemmas. Like being exposed during a flash of lightning, sometimes powerful leadership insights are revealed during a storm. Some can be novel and powerful.

The COVID-19 experience is complexity in real time. Critical solutions are unknowable until they emerge and are discovered, if we as leaders are looking out for them. Real experts are hard to find; they are learning along with us. The world appears to be disordered, and next steps are often unclear.

Crisis demands change: Rethinking your leadership approach

We believe our current experience calls for a change of posture in leadership. We need to intentionally shift away from one of “Standing on the Hill” overseeing the battlefield (Heroic Leader) to one of “Walking Hand-in-Hand” co-creating coordinated movement with others (Gardener Leader), finding a way through the fog towards a bold, innovative path. If we pay attention, any member of our team may be the one to stumble upon the path forward, the novel solution, the nudge we need to employ. 

Leaders during these times need to resist the temptation to reach for greater control. That only slows down the responsiveness and agility of the organization, when speed and novelty would serve better. This kind of leadership, where you lean towards co-creation rather than control, requires a great deal of HUMILITY. The leader needs to acknowledge that she not only doesn’t know all the facts, she can’t know all of the facts. But, by co-creating with those around her, she and her team can place some bets (nudge the system). Such leaders will be vigilant for emerging solutions, seizing upon them to rapidly promote the dissemination of those novel solutions across the network, all the while, moving forward, looking for more. That same humility requires leaders to be willing to acknowledge what they missed, as new facts emerge, and then adjust their course. 

Case in point: Humility makes way for the new

A recent example was on display when Neil Ferguson of the Imperial College of London  “clarified” his original worst-case forecast from 510,000 deaths in the UK to less than 20,000 based upon new data and actions taken so far. What if instead of clarifying his original estimates, he changed his opinion based on new data? Chances are his audience would respond with appreciation rather than ridicule.

We see a lot of healthy debate in the scientific community over optional paths forward. We also see much finger-pointing and complaining about our trusted leaders and experts, who we expect to have quick facts and solutions in place. And Heaven help the leader or expert who suggests a course correction!

Our prior commitments to a Complicated worldview — one filled with simple solutions, expert directions, and transparent cause-effect relationships — are causing us to stumble over a complex reality, one where emerging solutions arise from anywhere and become the preferred approach.

 

Sowing grace, reaping better outcomes

Leaders need humility, and followers need to show grace in times of complexity.

We all need to extend grace toward leaders to make it easier for them to adjust their path forward as new solutions emerge. Laying blame is counterproductive and can make it harder for leaders to make timely adjustments.

The truth is no one knows for sure where this coronavirus will take us — we’re placing informed bets. We are updating them as we learn more from our experiments. We are intentionally nudging, not directing, the organization into the future — a future that isn’t predictable. The arrogance of the Complicated Expert mental model, often unhelpful to begin with, destroys the emergent novel solutions that could be organizational salvation in a Complex World.

 

Dancing with chaos

One more thought: Some parts of our world are dancing with chaos. We’ve been learning that in chaos, leaders need to take decisive action with clarity and confidence. However, it’s essential to be intentional about which direction on the Cynefin graph the leader takes things.

The research admonishes us to lead back towards complexity and avoid the temptation to drive towards the simple. The attraction towards simple is powerful and destructive. The literature is clear that moving from chaos to simple is what breaks organizations. 

For example, forcing the way to simple from chaos is perhaps what happened in Germany in the 1930s or Venezuela in the 2000s — hand the keys to a leader who makes all the decisions and everyone else is forced into a few simple solutions, by dictate.  

Leading back towards complexity is a choice to lean towards humility, a form of servant leadership that engages the insights of the team members to find the way.

Think of General McChrystal and his daily videoconference, and the junior staffer who noticed a critical detail that unlocked the right solution. Be that kind of leader: one who chooses courageous humility over arrogant heroics. You don’t need to have all the answers. Your team will find them. 

 

Becoming the anomaly

Humility captures our attention in all of this because it can be an anomaly in a complicated world full of self-proclaimed experts. Even in the natural sciences, there is very little that is genuinely “settled.” There will always be things that “we don’t know what we don’t know.” But when we find ourselves in complexity, if we, as leaders, can’t be humble and admit to what we don’t know (or act as if we do know!), or even question what we’ve always believed that we do know, it doesn’t work. Humble leaders are just what we need in complex times.  

When the stakes are very high, when the pace of decision making is rapid, when the context is dynamic, the teams that shine are those that had previously invested in developing a culture of co-created movement. 

What are your thoughts about these ideas? Both of us believe that “iron sharpens iron” — we learn and shape our ideas as we engage in dialogue about what we are learning together.

 

Where's Your Anchor in the Storm?

 

Do current events feel overwhelming at times?

Sea mariners know something that can help a leader in the grips of a tumultuous crisis.

When a storm rises upon a ship at sea, the wind and waves can threaten to sink it.

If the storm rises when the ship is in a harbor, an anchor is dropped from the bow (front) to secure it to solid ground below.  The anchor keeps the bow pointed into the wind as the ship safely pivots around it, preventing the ship from capsizing.

When the ship encounters a storm at sea, the captain can deploy a “sea anchor” to perform the same function.  As the illustration below shows, it’s like a parachute tethered to the bow of the ship that drags in the water against the force of the wind and waves.  It’s connected to the bow, keeping the ship aerodynamically pointed into the wind.  No matter which direction the wind blows, a sea anchor keeps the vessel afloat until the storm subsides.

It’s incredibly tough to be a leader in stormy times.  The way forward is often obscured by the fog of conflict, timely information may be sketchy, and all eyes are looking to the leader for confidence and hope.

But leaders who really know their core values - - the ones that never change - - find they serve as a sea anchor in a crisis.

If you took a few minutes to list all the values you hold close to your heart, the ones that never change, that define you as a person, what words would make it to the top of your list?  As an executive coach, I find this to be one of the most valuable, and often illuminating, exercises for my clients. 

Recently a health system executive and I were talking about the unprecedented challenges facing his team due to Covid-19.  He struggled to know how to face the uncertainties and show up at his best as a leader for his team?

We looked back at his core values and, upon reflection, they opened his mind to fresh insights.

1. Family and Friends
2. Making a Difference
3. Reliability
4. Trust
5. Integrity

Reflecting upon these “anchors” of what really matters helped him make some concrete changes in how he’s showing up in the storm.  He plans to double-down on his family rituals despite the demands of the job.  He knows that’s where the most enduring difference he can make in the lives of others.  He knows his work colleagues are trusting and relying upon him to recharge his energy every day, and his family gives him that.  His work is all about thinking and making wise decisions, so the only way he can do that in integrity is to manage his energy well.

Leaders who really know their core values - - the ones that never change - - find they serve as a sea anchor in a crisis.