For the past two U.S. presidential administrations, health care has been a contentious issue. National dialogue and federal policy shifts have caused change to continuously ripple throughout the health care industry.
In part due to the ongoing change, the terms “transparency” and “accountability” have become part of the daily dialogue for workers in health-related fields with a focus on how to improve. In fact, there’s been so much discussion and change that more new words are entering health care management vocabulary: “engagement” and “burnout.”
We keep trying new things to engage workers and better serve patients. But the majority of those efforts are doomed from the start. In the book “Who Killed Change?,” Ken Blanchard and co-authors noted that as much as 70 percent of change initiatives fail.
Through all these conversations and interventions one key element has been missing — something so central to work that it seems impossible we’ve overlooked it. There hasn’t been much talk about self-awareness and the role it plays in the key issues we keep trying to tackle, be it resilience, accountability or something as basic as patient safety and satisfaction in health care.
Recent research by Tasha Eurich highlighted in Harvard Business Review estimates that only 10 to 15 percent of people are self-aware and that true self-awareness has internal and external facets. Internal self-awareness is what we typically refer to as introspection, the process of understanding our preferences, motivations and behaviors. External self-awareness is understanding how we are perceived and the impact we have on others. Both are needed to maximize the benefits of self-awareness.
Without self-awareness, ongoing introspection and social insight, we miss key opportunities for improvement, whether in addressing areas of particular challenge or in capitalizing on strengths. In health care or hospitality, consulting or manufacturing, insight and introspection are critical to addressing the continuing changes.
And when it comes to our organizational leaders, lack of self-awareness can lead to organizational breakdowns that have a direct, often dire effect on results.
The Example of Health Care
Take patient safety in health care. A core issue is the lack of reporting errors when they occur. Although emphasis has shifted away from blame to identifying the reason for an error and instituting a systemwide change in response, this approach has not yet become part of the DNA of health care.
Many reasons contribute to this including pride and fear of retribution. Harvard Business School professor Amy C. Edmondson pointed to a lack of psychological safety as one potential problem in “Managing the Risk of Learning,” published in International Handbook of Organizational Teamwork and Cooperative Working, a scholarly journal.
Independent of the justification or excuse, the fundamental problem stems from an underlying culture that isn’t supportive of introspection and learning from failure. The unforeseen consequence is an inability to grow intrapersonally. Our ability to understand how we relate to others is the foundation of our ability to understand how to lead at the systemwide or organizational level. This could be termed the emotional intelligence of health care.
By admitting and reviewing mistakes, we can change the system or technology, tailor workforce training and change behaviors. Failure to do so prolongs the inevitable — repeating the same mistakes. The same can be said for leadership.
As a broader example, consider the recent flood of sexual harassment claims being brought to light across multiple industries including media, entertainment, technology, startups and government. In multiple instances, the accused admitted to behavior that in hindsight was inappropriate, but at the time of the impropriety the individual failed to question their intent and understand their impact.
The consequences of a hostile work situation are significant. In a study published in Gender & Society, Heather McLaughlin found that women who were harassed were 6.5 times more likely to leave their job compared with women who were not targets of harassment, resulting in increased economic strain. There is also a loss to companies in the form of social and innovation capital as individuals who leave take their ideas and talents with them.
So, what causes a lack of self-awareness for physician leaders? To solve that question, look at the career life cycle of a physician.
Education and Training
By nature of their training, physicians are taught to identify a problem and treat it. In dire cases this can be the difference between life and death for a patient. There is no room to reflect or review the problem. The focus is simply to fix. Anything else is deemed a weakness and falls short of the expectations of both the patient and physician.
Historically, medical schools and physician training did not focus on soft skills like communication and self-reflection. This has changed over the past decade and newly minted medical students and residents now receive more formal training on these topics. The Association of American Medical Colleges and Accreditation Council for Graduate Medical Education have made them a priority in their competency guides for medical students.
Although a variety of training opportunities exist for training current medical faculty and program directors, there has not been the same level of focus and attention. This widening gap, largely generational, is made worse by a shortage of well-trained mentors, low funding for training and a lack of leadership engagement in this type of education. An additional challenge has been the pressure physicians are under to see more patients in less time, leaving less time to focus on these areas.
This shift in focus is no different from many others that the health care industry has seen in recent years. Care delivery has been transforming for the past decade and with it, all the methods, systems and technologies have been turned upside down. No system would be able to adequately address needed changes in these areas without organizational support and resources dedicated to it.
The same is true for shifts in medical training. Without leadership comprehension and engagement, skills like self-awareness can’t gain traction in a meaningful way.
This is not an issue specific to health care. Business schools have also been on a journey to incorporate soft skill development in the training of aspiring management leaders. MBA programs have historically emphasized teaching content and technical skills over the intrapersonal and interpersonal skills needed for effective leadership.
Even while business schools have brought leadership into the core of their mission and increased leadership development curricula, Gianpiero Petriglieri and Jennifer Louise Petriglieri argue in their 2015 Academy of Management Learning and Education article, “Can Business Schools Humanize Leadership?” that such efforts have focused on career advancement and the economic view of leadership effectiveness and not a humanistic model that inspires trust and creates broad social value.
There are also gaps in corporate education and training. A common missed opportunity to bring the application of self-awareness into the organization is during the onboarding of new employees. An increasing number of companies are utilizing pre-hire assessments with personality, preference and values components to inform selection decisions. After a leader is hired, too frequently that valuable information is set aside and left unused when it could be shared as feedback and leveraged to educate and train the leader on how to successfully transition in the organization.
Changing the Culture and the Pathway to Leadership
Most leadership paths, both in and out of health care, follow a predictable trajectory. High-potential employees are identified and placed in leadership development programs or given stretch assignments or mentors to test their skills and help them grow. Promotion and ultimate success is based on their skill as a manager but also on core leadership skills identified by Jack Zenger and Joseph Folkman in a 2014 Harvard Business Review article, “The Skills Leaders Need at Every Level,” like motivating, communicating and promoting teamwork.
In specialized fields such as medicine, leaders follow a unique path. Instead of managerial accomplishment and growth, physician leaders frequently are selected based on their clinical prowess, research credibility as gauged by a number of peer-reviewed publications and grants, and reputation. They then are often thrust into roles and situations for which they haven’t been prepared without the time or training necessary to adjust. They may lack the practical experience needed to hone their leadership skills — the same skills their nonphysician counterparts have likely spent years developing. The required leadership skills often vary greatly from the skills that led them to be successful in a clinical environment.
This leadership promotion model may seem like an endless cycle and if you’ve dealt with this at your institution it may feel insurmountable. However, there are ways to address it:
Find your “pain point.” When we started looking at this issue in health care, we noticed that 20 percent of orthopedic surgery residents were mismatched in some way with the program they were in. This resulted in a lack of fit between residents and programs but also resource drains due to the time it took to address issues, as well as potential patient safety and satisfaction risks. Building an assessment-based solution to this particular problem can help gain credibility and raise the profile of self-reflection as an important topic.
Use the right tools and resources. Personality assessments have long been seen as successful tools for leadership development and placement in the business world. Their proven scientific methods allow an individual to review his or her strengths and areas for potential development. By adapting these tools to your environment, you gain a strong tool in building a culture of self-awareness, reflection and coachability.
Get leadership walking the walk. Leadership buy-in is critical for anything to be successful. But for a topic such as self-awareness, buy-in isn’t enough. Leaders must be invested and personally believe in the importance of implementing these initiatives. The programs where we’ve seen change are the ones that invest in leadership development activities for their leaders and where leadership participates in these processes themselves. Your front-line employees will automatically acknowledge an initiative’s importance if your leaders are seen leading from the front by action.
Remember the trainees. As you build momentum, look to all levels of your organization including those who are still in training. They are your future generation of leaders. Build in self-awareness as part of their training program and when they finish as fully trained professionals, it will become a part of who they are and how they practice. These individuals, in turn, will serve as the mentors for future trainees, allowing you to begin to bridge the generational divide that exists today.
For the foreseeable future, it’s likely that the health care industry and many other industries will continue to adapt and grow. Leadership must be able to adapt and grow with it. Self-awareness, introspection and commitment to coachability are key factors in one’s capability to do so and an organizations’ future successes will likely be determined by their level of dedication to these concepts. With the right entry point, leadership involvement and a focus on trainees, you can help your organization successfully navigate these uncharted waters.
Joseph D. Zuckerman is chairman of the department of orthopedic surgery at NYU School of Medicine and surgeon in chief at NYU Langone Orthopaedic Hospital. Alan Friedman is founder and CEO of J3Personica, an advisory firm focused on personality assessment in health care. Mekayla Castro is director of global leadership and learning at American Express. They can be reached at editor@CLOmedia.com.
