Managing your life in a Heart Center - Two steps to consider when the environment has become toxic

‘Pulling the plug’ and leaving a Heart Center when the working environment has become toxic is not easy for a dedicated caregiver. Decades of training, commitment to our patients, and devotion to the colleagues working at our sides makes the concept of seeking a new job very difficult to seriously consider. Our tenacity to ‘tough it out’, however, can paradoxically undermine our ability to work with our leadership to improve a toxic environment. Stubbornness to endure may unintentionally support those who lead us poorly.

I recently counseled several colleagues working through this dilemma and can share some thoughts …

The admirable characteristic of tenacity to provide anything that our patients need in a favorable environment leads to fulfillment in our careers. For most of us fortunate enough to work in a great Heart Center, we may go home exhausted after long day - but we feel inspired and actually look forward to getting back to work again the next day. For others, in a toxic environment, we may go home equally exhausted, but we carry an additional sense of despondency and vague dread of the next day. Our physical and mental health slowly deteriorates and our relationships with family and friends suffer. A colleague once told me “I started out with a calling, and somewhere along the way it turned into a job - and a bad one at that. I don’t know when it changed…”.

What drives us to contemplate leaving an organization when we would really prefer to stay?

Typically, the reason we want to leave is due to poor leadership – and the first failure of poor leadership is a failure to inspire. When we are deeply inspired and part of a cohesive team engaged in a common challenge, we are willing to overlook gaps in nearly every other aspect of our jobs. To inspire us, our leaders must create TRUST and engage us in a COMMON PURPOSE.

TRUST:

Trust can be defined as faith in the BENEVOLENCE, RELIABILITY, and CAPABILITY of our leaders (McChrystal et al). The absence of any one of these three components will destroy TRUST and is a common failure of leadership.

Lack of BENEVOLENCE towards optimizing patient care is not common in our field. Most people in health care want to do a good job and believe that they are actually doing a good job (See Two Truths in a Heart Center). Absence of BENEVOLENCE contributes to a toxic environment when a leader seems to be perceiving our actions as threats – and responds in a manner that we perceive as aggression. In this scenario, it is likely that your leader perceives a lack of BENEVOLENCE on your part as you, in turn, defensively interpret your leader’s actions as lacking in BENEVOLENCE. This is a common circular communication impasse and must be resolved through engaging in some challenging conversations (See below).

A leader’s RELIABILITY is a problem when we perceive that our leader is not predictable. One day they may seem overly focused on a small issue, the next day it is a big issue, the next day they are kind and respectful, the next day they seem vindictive. When our leader is oscillating unpredictably, stress is added to our work life. It is tempting to blame these oscillations on the leader, but we also must examine the possibility that our sensitized perceptions may be contributing to the magnitude of these oscillations – rather than actual changes in the leader’s behavior. Sometimes over-sensitization resides within us. Whatever the source, these oscillations (perceived or real), erode our perception of RELIABILITY, and contribute to a toxic environment.

Absence of CABABILITY is an important driver of dissatisfaction contributing to loss of TRUST in our leader. A colleague described one such leader as having “all the power, but not a clue about how things work in the heart center”. When a leader doesn’t ‘get it’ and starts intruding into our space with one ill-conceived proclamation after another, it can be very frustrating to hold things together, protect our teammates, and patiently try to educate our leader (who may not be very interested in our perspective). Typically, ‘no clue’ leaders will compensate for their lack of CAPABILITY by using a heavy hand in our space when attempting to correct problems - with obstinate refusal to see the very real subtleties that those of us on the ground know to be true. Clumsy and destructive over-management of big issues and, even worse, persistently unhelpful micromanagement of small issues can effectively drive a wedge between the leader and ‘us’ – based upon a loss of TRUST.

COMMON PURPOSE:

Are we all trying to achieve the same objective? Lack of COMMON PURPOSE can also contribute to a toxic environment. Our ability to tolerate a tough environment grows in parallel to how well we share a common objective. Working shoulder to shoulder to achieve a shared objective gives us strength - while an atmosphere defined by ‘every man for himself’ sucks the life out of us. In your Heart Center, is the purpose of your daily work to care for patients, or to promote the financial wealth of the institution, or to promote the career advancement of your leader? Does your leader promote his/her own career over your career? Is your leader quick to cast blame in public for his/her missteps and disavow ownership of poor outcomes – leaving you stranded and alone? When absent, the lack of COMMON PURPOSE amplifies a toxic environment.

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What can we do to improve our current environment?

First, you must candidly recognize the fact that you are not thriving. This moment of recognition should be documented (yes write it down!) as "Time Zero”. Once you have established Time Zero, then two steps should be considered:

STEP 1: HAVE AN OVERDUE PRODUCTIVE CONVERSATION

Arrange for a well-planned and direct conversations with your leader. But rather than stating your case, focus the conversation (with truth and sincerity) in an attempt to truly understand your leader’s perspective. People working in health care are rarely monsters and, quite possibly, your leader is facing a constellation of problems in the domain of the Heart Center AND in other domains that may be driving their actions in ways that you did not anticipate. Understanding your leader’s perspective can, in many situations, improve your ability to work together and sometimes the solution will be to become a better FOLLOWER (further discussed in Followership). Asking to understand your leader’s perspective with the intention of seeking ways to make their job easier is the proper first step.

These direct conversations, however, need to be carefully planned to avoid triggering the reflexive responses responsible for creating the communication problem in the first place. With preparation and practice, you should be able to conduct a productive conversation with ANY PERSON on ANY TOPIC. An excellent guide describing the communication tactics to engage in a productive conversation is entitled Crucial Conversations (Patterson et al - read it!). A useful template that has helped me on innumerable occasions to initiate a productive discussion includes completing the following three statements as the opening lines:

“What I don’t want do is…”

“What I do want to do is…”

“Because we would both agree that…”

In parallel with your efforts to have a productive conversation, begin STEP 2.

STEP 2: START THE TIMER! (This is the step that we most commonly omit)

The second major component of your plan is to set a private deadline to achieve a sufficient level of optimism and understanding which will allow you to feel fulfilled in your current role. Your well-being depends upon setting a clear deadline to make things right. If, upon reaching your deadline, you cannot honestly state that satisfactory conditions have been met, then you have done what can be done and you must preserve your soul by making a major change. Either seek the same role in a new institution or a new type of role – or both.

The image above is a copy of a sticky note which was used by a colleague in a similar situation. Every two weeks, the note changed in a countdown to a pre-defined deadline of twenty weeks. The colleague had set the deadline and, surprisingly, quickly found that the act of setting the deadline made the toxic environment easier to deal with. The knowledge that there was an end to the toxicity created strength and ushered in new enthusiasm to find creative solutions. Setting a deadline doesn't mean that you must leave - it simply places some limits on what you will endure.

Parallel action

Seeking a solution to the problems in your current role can occur in parallel with seeking opportunities elsewhere. And the knowledge that you are learning about other opportunities can paradoxically free your mind to find more creative/productive solutions within your current environment. Either way, you win because you are taking control of a difficult situation - with a plan – and the concept of taking control is liberating.

With commitment comes happiness.

#ThoughtsOnAcademicLeadership

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REFERENCES

1. Adapted from https://www.mcchrystalgroup.com/capabilities/team-of-teams/trust and McChrystal Group

2. Patterson, Kerry; Grenny, Joseph; McMillan, Ron; and Switzler, Al. Crucial Conversations Tools for Talking When Stakes Are High, Second Edition. US: McGraw-Hill, 2011.