The Audacity To Be Independent
Editor's note: This blog was written by Glen McDaniel, MS, MBA, MT, CLS, CLDir. McDaniel is a former healthcare executive, clinical lab scientist, speaker and freelance writer. His interests include mediation, leadership, change and ethics. He can be reached at glenmcdan@aol.com.
On July 4, 1776, the United States declared independence from Britain and a vigorous new democracy was born. This year we celebrate our 236th birthday. If they were still alive, our founding fathers would likely sputter in wonderment, "Who knew this experiment in democracy would be so successful?"
When American patriots chose to defy King, Crown, a powerful power structure and even history itself, the conventional wisdom was that the fledgling movement could not survive. There was little more than a deep desire to be free, a belief in the power of determination and the shared aspiration to be independent.
Independence is a scary thought. Whether it is a country, a profession, an organization or an individual, the status quo can be safe because it represents a known quantity. One learns how to cope with the expected; it is the unexpected that presents the greatest challenges. Psychologists describe this as the "better the devil you know" phenomenon and posit that it explains why even victims of horrendous treatment will opt to remain in what might seem to everyone to be an obviously untenable situation.
It is not that our forefathers had all the answers, or were imbued with extraordinary strength and courage; it is simply that their desire for a better life superseded their fear. As executives in healthcare, beholden to so many masters and powerbrokers, we are often tentative about moving beyond our fears.
President Barack Obama's autobiography, The Audacity of Hope, recounts his life's journey even before his presidential run. The audacity in the title refers to the gall to dare to believe that he could be more than his circumstances dictated. Despite negative self-talk and public judgments he believed he could rise above the statistical probabilities. Whatever your views about Obama as politician and president, as an author he makes a cogent argument that conventional wisdom is often little more than pessimism, more myopia than vision, more resignation than hope.
Healthcare decision makers have external threats and internal weaknesses to overcome. Many become slaves to metrics of success and year-over-year comparisons of performance. It is easy to obsess about the reality that we are beholden to bosses, physicians, payers, the government, regulatory agencies and patients. Conventional wisdom suggests how can we deny the "reality" that we are negatively impacted and boxed in back by so many?
One consideration often overlooked is that the very preoccupation with the reality prevents us from changing it and moving forward. Limitations set by others are often internalized and perfectly executed by us. What would be the result if we chose not to be subservient or subject to the whims and fancies of others? The strong likelihood is that we would be closer to our dream of independence while succeeding even in traditional terms. The worst case scenario is that we would be where we are right now. So what do we have to lose?
Consider one of the most baffling and disappointing realities. Leaders are supposed to innovate and inspire others to see a vision as well as guide them in making that vision a reality. Yet success is often gauged by how closely a formula is followed or how alike a competitor an organization is. Independence and innovation take a back seat to "usual and customary." Even those who get lauded often do so for a "best practice" which is sometimes simply analogous to "teaching to the test."
What if healthcare leaders got back to the basic responsibility of taking care of patients who cannot take care of themselves and doing so competently, in an environment of caring and at a fair price? What if actions were motivated by that simple mission rather than meeting quarterly numbers? Would it not be so much easier and more tempting to try innovative, novel, customized processes?
Regardless of what the community standard is, try asking staff what motivates them and makes them stay with the organization. Conversely, what factors are deal-breakers and cause them to job-hop? Teams and committees are often comprised of individuals chosen by role. Try ensuring fair representation by department, but also choose individuals by strength, aptitudes, experience and attitude; regardless of role or title. Consider breaking down rigid organizational silos and hierarchical structures. That degree of independence might cause some raised eyebrows, but it just might work much better than the status quo.
Nature abhors a vacuum so that where a need exists - whether it is responding to the expectations of staff or offering culturally competent care to patient, or turning a traditional but ineffective process on its head - if it is not addressed by a leader, others will rush in and fill that void. Those "others" could be a competitor, a superior or informal leader within the organization. Failure to act encourages undermining of legitimate authority.
Independence means the courage to act boldly regardless of what others think, or what is expected. However it also means the courage to allow members of the team to express contrary opinions and disagreement without being punished or ostracized. Dissension, done respectfully and constructively, often spawns innovation and removes the power of group-think with all the attendant staleness and inertia.
In some places around the world, the image of the "ugly American" is perpetuated based on the legend that Americans often claim to be the biggest and best at everything and measure others on how American-like they are. Many Americans argue that there is in fact an American exceptionalism. One can debate the logic and veracity of either view, but it demonstrates how a simple bold assertion can become a self fulfilling prophecy. Most people around the world have come to believe that despite our own foibles and short comings America is the preeminent, most influential nation in many ways.
Those many years ago as the debate about independence proceeded in back rooms in Philadelphia and other places, the founding fathers believed and expressed the belief that others would come to treat us according to how we viewed ourselves, and how willing we were to step forward courageously and independently.
That bold presumption still stands true today in individual and organizational contexts. We send covert and overt messages to those around us about our self-image, what we expect-and what we will tolerate. Our outcomes often fall in line with our expectations; courage brings success and timidity results in failure.
It is very tempting to point to expectations or rules we "must" follow. In a profound but very predictable way it is a truism that others relate to us only in ways and to degrees that we permit them to. We send both subtle and not too subtle invitations each and every day in encounters big and small.
Martin Luther King once said that power is never voluntarily relinquished by the oppressor; it must be demanded by the oppressed. It's obviously an exaggeration to suggest that as a profession healthcare leaders are oppressed. However, in the same way that the American patriots realized that Britain had no vested interest in voluntarily offering American independence, leaders must realize that any significant progress towards independence must be initiated by affected leaders themselves.
Those who make demands and set rules find it easier to simply monitor adherence to these rules. It is not their priority to encourage independence or drive innovation. It is not within their best interest or purview to suggest alternatives. If you are dissatisfied with the status quo, you cannot conduct business as usual and expect a different outcome. Similarly, you cannot simply sit by and hope for change or empowerment by largesse.
Exceptional countries - and exceptional healthcare leaders - reject the ordinary, set their own limits, determine their destiny; they choose to be resilient and independent. That is why they succeed while others fail.
As proven by our founding fathers, real change starts with the audacity of hope, but to enjoy independence one must move from mere hope towards bold, independent action.