by Ronald N. Riner, MD, FACC
"In the fell clutch of circumstance
I have not winced nor cried aloud.
Under the bludgeonings of chance
My head is bloody, but unbowed
It matters not how strait the gate
How charged with punishments the scroll,
I am the master of my fate,
I am the captain of my soul."
by William Ernest Henley
The Why, the How, and the What of It All
As leaders we are often challenged to accomplish tasks for the betterment of the people for whom we care and for the organization within which we work. This can sometimes be an arduous undertaking, but the “lift” and the “challenge” aren’t as mechanical or as structured as some think or would like to think. Leadership is not necessarily about dashboards, artificial intelligence, EPIC workflows, etc. It isn’t necessarily about pushing adherence to processes or complex rules and regulations (though all of the above are within the purview of a leader’s agenda). Coming off a year of pandemic frenzy with seemingly endless stresses and new challenges, I think it might be helpful to drop back and realize that the task of leadership is to move and motivate people in a preferred direction toward a destination borne out of a vision. That vision results from an acknowledgement of “why” we do what we do and “how” we do “what” we do to accomplish that vision.
In the field of healthcare delivery, professionals are very fortunate because our “why” is well acknowledged as a “noble cause” – or at least it should be a noble cause. Admittedly, that noble cause of caring for and helping others in their moments of need or in their quest for better health, is sometimes lost in the blizzard of complexity which we deal with day in and day out – much of which many healthcare professionals view as extraneous work that sometimes is not adding benefit or is overwhelming, even a distraction to the attainment and fulfillment of that noble cause. Much has been said and written about burnout, disenchantment, resilience and the fact that healthcare workers are exiting the field of medicine and nursing as a consequence of the complexity and heavy focus on some of the matters I have mentioned above.
So, can we talk? YES, healthcare delivery is very different than it was just 5-10 years ago - more complex, more fractionated, and in many instances for some – far less satisfying than it was in the past. We could expound at great length on why that may be, but I suspect, in part, based on my interactions and observations, it is because they perceive lack of time to develop rewarding, bona fide relationships. Many of their activities are identified as robotic or impersonal. As more than a few nurses and physicians have pointed out – medicine and healthcare delivery today are heavily business- and process-focused. “We are becoming robots reacting to or completing Excel spreadsheets”, if only our patients would become programmable robots! The irony of our fanatical pursuance of standardization and rote process adherence, while acknowledging and touting the benefits of personalized healthcare and the importance of one’s genetics and personal social determinants of health, has not escaped a growing number of cynics and disenchanted healthcare providers. It’s difficult to argue with some of these observations, so let’s come back to leadership. Healthcare should be considered a very special “business”. Many used to say it was actually a “calling” and, in fact, much of healthcare delivery grew from roots in ministry. Now “God” knows how many other fields of endeavor and study are rushing into healthcare for their different “whys”. It is what it is. As leaders, we need to realize our objectives should remain simple and focused.
1) Establish Direction
2) Align the Team
3) Motivate and Support
These 3 areas of focus need to be anchored by the values and principles that guide us through the ever-changing, complex field of endeavor in which we work. It can be done, but admittedly with challenges.
For leadership in general, but especially in healthcare leadership, we need to be sensitive and supportive of those “why” anchors that bring people into a profession where we frequently deal in life and death situations and other facets of “humanocracy”. We must recognize that leadership is predominantly about people. Great leaders and experienced leaders read peoples’ needs and desires - understanding the nuances of issues and the people involved. Such leaders adapt to the situation at hand in a fair, value-anchored, and solution-focused manner.
Yes – healthcare delivery is at times challenging and seemingly overwhelming. I purposefully chose an emotive word – Unconquerable – as the title for this missive. It is a word that speaks to passion and emotion. This is how I, and so many others, saw you and your colleagues in the throes of the pandemic crisis. I dare say that same unconquerable spirit exists in the hearts and souls of all genuine caregivers – even when not in crisis mode. Unfortunately, it sometimes gets buried with so many distractions and necessities of an imperfect world. Illness, by its very nature, can be isolating and debilitating. Understandably, one can feel overwhelmed by the burden of healing and prevention day in and day out. Resiliency, satisfaction, and sustainability result from adherence to principles, purpose, and purposeful work – the latter reflecting the ability to successfully disrupt the isolation and misery that result from illness and poor health. It calls for meaningful human interaction, engagement, and sharing. Our processes and methodologies need to enhance and reflect such. Boxing provides a good analogy. Being in the ring certainly comes with risk. But if you aren’t in the ring, you can’t throw a punch – nor can you take one either. Taking a few punches builds experience and wisdom for the individual as well as for those we care for daily. Our role as healthcare leaders is to imagine and develop a future that is better than the present. Our experiences along the journey, to that future, are made palatable, no matter how challenging, provided we see it as compatible with our anchor values and purpose. Some even acknowledge that arduous, meaningful journey as a “privilege”. SJ
“What counts in life is not the mere fact that we have lived. It is what difference we have made in the lives of others that will determine the significance of the life we lead.”
“Never be afraid to try something new. Remember that a lone amateur built the Ark. A large group of professionals built the Titanic.”