Highland Leadership Chronicles: Leverage “the Pause” to activate “Deliberate Calm”.

“Herding cats” is a real leadership challenge! Don’t take it from me – Warren Bennis – in his book, “Managing people is like Herding Cats”, explored the challenge of leadership, especially with respect to knowledge workers which presents a unique struggle. He asserts that “managing any people is like herding cats” – you might ask – why so? He explains that “Cats, of course, won’t allow themselves to be herded. They may, however, be coaxed, cajoled, persuaded, adored, and gently led.” If you have served in any leadership capacity, you can likely relate to this – “the struggle is real” as my Nigerian family will say!

How does one then begin to manage oneself as a leader around the inherent challenges of leadership, and in our case, within the healthcare space?

As a healthcare leader your days are likely filled with some permutation of incessant bequests for your attention, an onslaught of issues related to patient concerns and/or colleague performance, and every so often, a major upending event like a winter storm that deprives your hospital of basic amenities threatening to upset clinical operations, and disrupting life-saving care for patients. It can almost seem like there’s no room to breathe, no space to think and no opportunity to even pause in our busy modern lives as healthcare professionals; much like many other industries – but with the twist that lives can be at stake if we do venture to hit the pause button.

But is this really the case; does hitting the proverbial pause button make you less effective or more impactful as a healthcare leader?

As I navigated the frontline clinical leadership lane as a rookie, reacting to every scenario seemed to be the default; from taking on new projects to communicating senior leadership requests to my team without filtering or attending every meeting that popped up on my calendar regardless of relevance, it became very apparent that this was not sustainable and thanks to advise and nudging from seasoned mentors, friends and insights from SoundPhysicians’ Leadership Development Programs – COMPASS and Emerging Leaders (EMLE) that I was fortunate to be a part of, this did not go on for too long. I was encouraged to lean on others for help as I shared in the last article in this series and relevant to our discussion today – to seek to pause often – be it in the middle of interactions with patients and colleagues, as the day evolved, or proactively incorporate scheduled pauses into my days, weeks and months in an upstream approach to managing personal recovery and resilience. During the course of my day, the pause gradually manifested in different forms as I slowly embraced this important practice: from a deep breath in the middle of a tense interaction to a resilience walk around the hospital savoring the natural beauty of the surrounding greenery or the chirping sounds of the birds, to a more formal meditation session or in my case, “Salah” - the Muslim prayer, in the quiet space of the hospitalist call room or the medical director’s office. ?The value of these pauses progressively became apparent as friends and colleagues shared feedback that suggested less anxiety and tension despite the busyness of the role and the near perpetual state of “herding cats” as alluded to by my dear friend and mentor, Lynda Attaway , one of the key players of the #Highland multidisciplinary Sound Physicians' hospitalist site leadership triad (physician leader - nurse leader(s) - business/administrative operations colleague) at the time. As a group, we sought to cultivate these pauses, and my co-leaders were particularly adept at incorporating necessary team level pauses including social gatherings to foster a more global culture across the team in this regard.

Little did we realize that these early commitments to the practice of pausing as individuals and as a team were essential foundations for what I am now learning about as the strategy of “Deliberate Calm”. Jacqueline Brassey and Aaron De Smet in their recent Harvard Business Review article: “How to Become More Adaptable in Challenging Situations”, address the idea of “pausing” especially under demanding circumstances before positing to optimize the response to the situation. In their article, Brassey and De Smet explain the word complex – “Deliberate” refers to the awareness that you have a choice in how you experience and respond to a situation. “Calm” refers to rationally considering how best to respond, without being governed by old habits.” In essence, slowing down and deferring to pause, creates the necessary space to adequately appraise the scenario unfolding, and responding from a thoughtful and well considered position and “learning by doing” in the process.

Jacqueline Brassey and Aaron De Smet, in their article, specifically address 3 key elements to help cultivate this practice: learning agility, emotional self-regulation and dual awareness. Let’s explore these ideas together.

1. Learning Agility

Ilias Simpson , in a compelling Forbes article; “How Learning Agility Helps Transform Individuals into Leaders”, describes learning agility as “the ability to take something you have previously learned or experienced and apply those learnings to an entirely new or different scenario.” As I alluded to earlier, the very nature of leadership, particularly in a very dynamic industry as it obtains in the current healthcare landscape, necessitates that healthcare leaders stay curious, open-minded, and willing to learn on the go to be well positioned to address the slew of challenges that regularly present themselves from patient care related issues to evolving healthcare policy issues that impact patients and providers as well. ?One can also appreciate that to learn from these challenging situations requires some degree of pausing to be able to come away with key lessons and internalize them as part of the leader’s growing armamentarium. ?Jacqueline Brassey and Aaron De Smet specifically recommend the practice of daily intention setting and choosing how you will show up in a challenging situation rather than defaulting to what often ends up being a defensive stance as a manifestation of our instinctive flight or fight response whenever we sense a threat. This innate tendency to react rather than respond thoughtfully brings us to the next idea.

2.?Emotional Self-regulation

James Gross, in an integrative review article: “The Emerging Field of Emotion Regulation”, defined this concept as “the processes by which individuals influence which emotions they have, when they have them, and how they experience and express these emotions.” As I came across this definition, my first thought was that awareness and naming my emotions already poses a significant enough of a challenge, but nonetheless, a skill that can be acquired. As we learned from Warren Bennis’ quote above, the art of leading or of “herding cats” requires a mixed bag of approaches that requires careful consideration of the folks that you lead and importantly, their emotional tendencies while maintaining a strong grasp of your own emotive states and its impact on your team especially as you navigate the less familiar shades of leadership when the going gets tough. Once again, it’s clear that we must summon the pause button to be able to see beyond the obvious and to adjust our emotions effectively as leaders in healthcare.

For this reason, Jacqueline Brassey and Aaron De Smet reference the art of journaling as a space to help cultivate the awareness that’s a key prerequisite for recognizing our emotions and to begin to manage them proactively as we aspire towards the practice of “Deliberate Calm” particularly in those peculiar leadership moments when uncertainty is a major theme.

3.????Dual awareness

To effectively deploy the two elements discussed above, a leader must be able to carefully appraise the situation while being simultaneously mindful of their own internal state – this is where dual awareness comes in. Jacqueline Brassey and Aaron De Smet explain that dual awareness “is the integration of internal circumstances (experiences, thoughts, emotions, and responses) and external ones (an objective reading of the situation and what it calls for).” The capacity to pause and evaluate the situation unfolding and one’s inner state as it relates to the situation is a crucial component of this. I have also found it helpful to spend time appraising the situation with co-leaders and oftentimes, frontline colleagues when one has the luxury of time to do so to gain deeper insights and clarity around nuanced issues to better optimize the approach to response.

It is evident that dual awareness is at the heart of the strategy of “Deliberate Calm”, and one that we should all aspire to. The authors point out that “this (dual awareness) makes it possible to observe yourself while in action — and then match your responses to the demands of the moment.”

It obviously takes a lot of practice to get to this point but like the authors alluded to; while we may not become perfect in this regard, practice does help us become better leaders with the added benefit of translating the lessons to better our lives outside of work as well. In their book with the same title, "Deliberate Calm", they propose a robust 4-week long process to begin to hone in on this practice.

"Deliberate Calm" at #Highland

?As I received the SMS from my hospital CEO Thomas Steen Trawick, MD, SFHM (Steen), friend and mentor during the final days of March 2020 that “we” – meaning the Christus Highland Medical Center in Shreveport, Louisiana where I was as the serving Chief Hospitalist – had just admitted our first case of COVID-19, it triggered a flurry of thoughts about how things would unfold from this point onwards, and importantly, how we would safely care for patients and keep team morale high despite the real fears that we all entertained about this “strange” disease. Thankfully, my CEO in a very thoughtful and inspiring speech had prepared us (frontline leaders across the hospital) for this very moment and he made it a personal responsibility to let my team and I know as soon as our city and our hospital became the locus for the first few cases diagnosed locally. Now looking back at Steen’s approach, I realize that he leveraged this strategy of “Deliberate Calm” often, the careful appraisal and deliberation around challenging situations often accompanied by involving key stakeholders early and inspiring others along the way to lead with purpose. For my team and I, this moment evoked very real emotions in unprecedented ways, and I am thankful that we worked together to curate a space despite the intensity of the time to pause and acknowledge our fears and to assess often, the challenges of each unfolding day and the slew of CDC and other clinical guidelines to do our best for our patients. We called this space – the COVID Cocktail Hour; don’t worry – we didn’t have real cocktails – what we did have was the blessing of a pause and some semblance of “Deliberate Calm” that brought our team together in a way that gave us all the courage to "lead from within" and continue to care with compassion despite the uncertainty.

So, I challenge you to join me on this journey and consider setting a daily intention and choose how you show up as a leader like I shared in a prior article; think "Linchpin", and spend a few minutes daily, if you can, to reflect and journal about your day. Often, there’s a lot to unpack in the “herding of cats” that without an intentional effort to unpack and learn, we are likely to miss opportunities to shore up our arsenal and risk repeating the same mistakes with potentially dire consequences.

?

References

Bennis, Warren. G. (1997) Managing people is like Herding Cats. Provo, Utah: Executive Excellence Publishing.

Brassey, J. and De Smet, A. (2023) “How to Become More Adaptable in Challenging Situations,” Harvard Business Review, 3 March. Available at: https://hbr.org/2023/03/how-to-become-more-adaptable-in-challenging-situations (Accessed: March 28, 2023).

Brassey, J., Smet, D.A. and Kruyt, M. (2022) Deliberate calm: How to learn and lead in a volatile world. New York, NY: HarperBusiness, an imprint of HarperCollins Publishers.?

Gross, J.J. (1998) “The emerging field of Emotion Regulation: An integrative review,” Review of General Psychology, 2(3), pp. 271–299. Available at: https://doi.org/10.1037/1089-2680.2.3.271.

Simpson, I. (2021) “How Learning Agility Helps Transform Individuals Into Leaders,” Forbes.com, 20 August. Available at: https://www.forbes.com/sites/forbesbusinesscouncil/2021/08/20/how-learning-agility-helps-transform-individuals-into-leaders/?sh=4be786a36385 (Accessed: March 31, 2023).?