#H2H Series: Bruised But Never Beaten A Few Lessons from a Lifetime of Challenging the Status-Quo

"Yesterday, I was clever and thought I could change the world. Today, I am wise, and learned that I can only change myself.” Rumi

?I am not sure if I am wise yet, but I am learning that all change must first start with ourselves. For me, the biggest lesson has been to realize that transformative change, the type I’ve been engaged in for almost thirty years, is not a destination. It is a state of being, recognizing, and living one’s leadership moments.

?Action separates a thinker from a leader. Leaders (and I don’t mean titles) are those who act to solve, protect, or improve the lives of others out of social, personal, or moral obligations and not necessarily, as a requirement of their jobs. We are quenched by the people we serve, our patients, students, faculty, physicians, and our teams; we are energized by them.

Why is the transformation mindset deeply ingrained in mission-driven organizations? Simple answer, our broad objectives are nearly impossible to achieve. While on the surface as C-suite leaders, we lead various functions the same as colleagues at other companies, deep inside, we carry the responsibility to move the needle on unattainable goals such as the health of a community, economic mobility of an entire region or groups of people, advancement of knowledge, eradication of ignorance and disease.

The vision statements from leading healthcare systems in the U.S. reveal common themes, “…transformation of healthcare,” “…committed to the care and improvement of human life,” “…to become the national leader in improving the health of our communities.”

Recognizing the challenge, another entity inspires us, “…to continually make progress and pursue the impossible so that we can improve the lives of every person in each of our communities.”

?The status quo, unchallenged, is an unacceptable path. By most measures, our communities are not well. High rates of obesity, heart disease, new and novel diseases, current and future pandemics, opiate addiction, substance abuse, and mental health problems are but a few of the indicators of a struggling society. Moreover, in the United States, over 60% of the people who file for bankruptcy cite medical costs as the key contributor to their financial downfall.

The most significant problem facing our institutions is not the lack of resources, increasing competition, or unrealistic societal expectations. We, too often, miss the forest and the whole ecosystem.

?As healthcare leaders, we must continuously challenge the status quo to improve, change, pivot, and transform health systems in the face of political, social, financial, scientific, technological, organizational, and individual systems, each operating with its own variables and in unprecedented environments.

?Traditional organizational structures are devoted primarily to improving the Capabilities of the organization, the processes, expertise, procedures, units, and components that allow for efficient, effective, and profitable operations. On the other hand, the transformation mindset is primarily concerned with appreciating the myriad systems and developing the organization’s Capacity.

Courage, trust, compassion, innovation, risk-tolerance, agility, and curiosity, allow the organization to prepare for and succeed in the face of volatility and uncertainty in its quest to realize its vision. Naseem Taleb, in his book, Antifragile: Things that Gain from Disorder, argues that the resilient resists the shocks and stays the same in the face of uncertainty, chaos, or disorder. However, the antifragile gets better as a result of tumultuous events. The goal of every transformative agent ought to be to improve the organization’s “antifragility” so that it can thrive amidst the chaos, whether it faces natural events or homemade disorder.

?We are continuously driven to see problems and opportunities through simple cause and effect relationships, where experts of every sort (internal and external) exert a great deal of influence. There is no fault here. Our management training has favored the analytical at the expense of the holistic.

In the Cynefin Framework, we can differentiate and appreciate the different types of problems and thus properly focus our mindset.

For example, divisional strategies or gaining departmental efficiencies fall into the Simple and Complicated. Best practices, expertise, data, and analysis can help pinpoint cause and effect relationships, determine the subsequent courses of action with some degree of certainty.

?Improving the health of communities, on the other hand, is a Complex undertaking, a systems problem, where cause and effect are neither well understood nor are there direct paths that would yield the desired results. There are multiple moving pieces, most of which are not within our control.

?To think in systems is the recognition and respect for Complexity. Leaders and change-makers have long known the value of systems in tackling the status quo. It is the acceptance of the quantum nature of the challenges ahead in the face of a present state which seduces us to think in Newtonian terms: where simple cause and effect conclusions are reached easily, where Knowing becomes the same as Understanding, thus rendering us fully capable, not appreciating the sagacity that is the fruit of experience.

?Let’s take the case of physician burnout. Close to half of all physicians in the U.S. experience burnout, and that was before the pandemic. The statistics are grim as by some reports, 300-400 physicians die by suicide each year, more than double the rate of the general population (relatively speaking). Yet, most of our efforts have been focused on wellness training, helping our providers gain more resilience, better work-life balance, etc. These are undoubtedly helpful but insufficient to address the complex problem of medical care.

Most assuredly, the problem goes beyond individual resilience or the inefficiency of the burgeoning electronic medical record. We must learn to see the other contributing factors in the systems. The financial incentives to move patients through, the loss of autonomy to practice medicine, the culture of medicine and its reluctance to seek mental health services, the macho nature of medical training, and the long hours are equally at blame for creating this untenable situation. The status quo cannot and must not be endured. Nothing short of grappling with all the systems in play will change this dynamic.

Transformation is not a destination, it is a mindset that continuously creates what-if interventions recognizing that cause and effect are only understood in hindsight, but relentless forward momentum against the status quo is essential for innovation to take root.

?How to build and foster a transformational culture in Complex environments?

1.????Do not be afraid. Transformation is not for the faint-hearted, nor is it for the perpetual optimist. It is pragmatic and real; the light at the end of the tunnel is indeed the train coming at you. It is the status quo ‘train’ driven by an army that is at once afraid, satisfied, and entitled. ?You will be bruised, hurt, and set aside. ?[In June of 2008, having presented on the challenges I foresaw with the economy and its potential impact on the institution, I was summarily dismissed, seen as a pessimist, stopping the leadership’s investments. My committees and transformational projects were suspended. My boss’ courage was all that stood between being employed and losing my job. In September of 2008, Lehman Brothers filed for bankruptcy, and the ensuing global financial crisis went on to dramatically change the economy. In October, I was called prescient and wise.] Have courage. Learn to pivot. Stay alive.

2.????Build a strong foundation by recognizing the value of emotional balance, physical health, emotional connection, and positive cycles of interactions among people throughout the organization. People must be well to see the opportunities, to take chances, to reimagine the possible. Nurture psychological safety in all your teams. Diversity and inclusion can only occur when individuals in a group are enabled to engage without negative consequences. This is especially hard to do.

3.????Build teams of those who live their leadership moments. Keep expertise to a minimum in these settings; department heads consciously or unconsciously fight for their turfs. By focusing on the diversity of thought, background, and action-oriented individuals regardless of position, these teams can help people build cross-silo collaborations. Expertise-driven teams arrive at the exact solutions as in the past. Transformations are about emergent problems and possibilities; they require unbounded thinking.

4.????Become an idea champion by creating opportunities to generate new ideas, explore alternative approaches, and engage in novel collaborations and partnerships. Use the power of stories to convey values, create shared experiences, and bring people with ideas together. Teach the organization to celebrate failures.

5.????Help people think like an architect instead of an engineer. Complex problems do not necessarily have easily envisioned solutions but require the balance between form and function; the form is to deal with unforeseen opportunities, the function, to do what needs to be done to achieve objectives. Incentivize the explorer mindset.

6.????Hire pentathletes as often as you can (to balance the experts you’ve been hiring.) Transformational agents exhibit a depth of understanding and wisdom in all these five areas: Vision, Strategy, Expertise, Experience (have seen and done many previous transformations), and Leadership. They are growth-minded, non-zero-sum people.

7.????Exhibit everything you wish to see in others.

?Thinking in systems and building teams that can do the same allows us to lead during uncertainty, transforming our mission-driven organizations to address the complex issues of our time.

Ramin Sedehi, August 11, 2021

The author has served numerous world-class healthcare, academic medicine, and higher education institutions, with full enthusiasm and transformational leadership of debatable influence and impact. He has been a thought-provoking teacher to many successful young leaders. He believes in the power of institutions to lead innovation and to impact our society positively.