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It’s our turn to help:
If you see something that needs to change -
take the first steps to influence that situation.
“Returning our patients to health or adjusting and thriving in spite of their illness or injury”.
But I think that no matter where we live, no matter the culture, or the traditions, we realize that we are not accomplishing that goal with each of our patients. So if we all share that goal, why aren’t we winning that game?
I submit that we are not winning because we are not playing together the way a team needs to play to win the game. All of us understand the game of soccer - and for each one of us, we see what we do for the patient as a key position in the team committed to getting them well.
If a key player is missing - can we win?
If you image a soccer team without the goalie - do you think they will win game and accomplish the goals of the team?
Can we achieve our goals for our patients if we exclude essential team members and their respective capabilities? No, we can’t. The evidence from around the world, reductions in quality of life, injuries, medication errors and nosocomial infections all clearly demonstrate we are not winning the game of returning patients to health and a high quality of life.
So what interferes? What can each of us do to change our environments? How do we change behaviors and the status quo? How do we maximize our commitment to “do no harm” and insure that our patients can trust us while we take advantage of every opportunity to return to health and wellness? What areas require our focus so that the goal of keeping our patients’ safe and returning them to their highest level of health will occur?
I submit that in order to accomplish this change in the way many practice health care, will require developing a true collaboration among the various health care team members. I define collaboration with four main components.
• First, we need a partnership with mutual respect.
• Second, we must recognize the separate and combined spheres of responsibility.
• Third, we must have a mutual safeguarding of the legitimate interests of each party.
• Only then to we get to the fourth component, recognized shared goals.
As military members, we have all seen the importance of those basic values in accomplishing the mission.
When I have struggled to develop a collaborative effort and focus among my colleagues, I have found it is particularly important to think about the behavioral perspectives of collaboration. It is through our behaviors that we make collaboration possible. Without open communication, cooperation, assertiveness, negotiation and coordination as the expected behaviors in our work environments, we cannot develop true collaboration. We must respect and value one another’s perspectives and experiences in order to succeed for our patients!
But how do we really move a team towards collaboration if it does not exist in our environments?
There are multiple ideas by multiple authors and speakers about what is essential for any transitions to occur and I believe some of those ideas are appropriate for this circumstance.
• First, individually we must identify and accept the need for the change.
• Second, we need a champion, a leader, who believes and advocates for the change.
• Third, empowerment and encouragement to change is particularly important for those not at a decision making level in our organizations and who may not have been traditionally seen as essential members of the group.
• Fourth, we must find ways to reward and celebrate the small steps of the success.
• Fifth, developing support at the highest levels of our organizations for the change to continue allows for the cultural changes to sustain the improvements.
Some people just want to go directly to why we can’t accomplish our goals. What are the barriers? Rather than simply identify barriers, I want to address what I believe is the cause of barriers. Why do we resist change?
I believe resistance is best described as fear. Fear of moving outside our comfort zone, fear of being outside of the status quo, fear of disagreement, fear of disapproval, or fear of the loss of power or authority.
Fear is a powerful emotion—one that we learned about early in our professional lives, one that results in a flight or fight response.
The good news is that we have the option to choose to fight the status quo to improve the outcomes for our patients and not flee from the challenge!
By suggesting these collaborative teams, I may be suggesting a radical change within your organizations or your cultures for some of you, and I know that. But I also know the same drive to serve your patients and return them to health and well-being can contribute to your ability to start making those changes in how we work together in health care.
If I were to ask you individually, would you feel overwhelmed by the magnitude of the task? I certainly have felt overwhelmed by some of the things I felt it was important to do - until I was able to remember that a journey is accomplished a single step at a time - and the probability was I would not be the one to take the final step to accomplish the journey. I might help to begin a change, but I could not guarantee that I would see the results of that change!
Several years ago, I read of a Buddhist teacher who encouraged people who were despairing over the state of the world. His advice was simple and wise: “It’s our turn to help the world.” We are not the first individuals who have wanted things to be better. I love this statement because it reminds us of many other times and many other people, from every location on the globe, who were willing to step forward to help create the changes that were necessary.
We are living in a period of history that seems unique in at least two major ways. Never before have we seen the damages done to ecological systems and recognized the consequences of our behaviors and some of those consequences are just beginning to materialize in frightening ways. In addition, because of the electronic world we live in, we are aware immediately of tragedies and horrors everywhere in the world, no matter where they occur.
Even with those two radical changes in the world, there is comfort. Because during the entire period of human existence, no matter how terrible the time, there always have been people willing to step forward to do whatever they could to create positive change. Some succeeded, some did not.
As we struggle with the challenge to develop collaborative teams to better serve our patients, it’s good to remember that we are standing on very strong shoulders that stretch far back in history.
As a military leader, I have had the extraordinary opportunity to work with many people from very different cultures. I’ve also had the fortune to study the system concepts of Margaret Wheatley. I agree wholeheartedly with her definition of leadership-though it is different than most definitions you have learned. She defines a leader as anyone willing to help, anyone who sees something that needs to change and takes the first steps to influence that situation.
You each have the choice to be a leader and I expect that many of you have already demonstrated this form of leadership. It may have been as a parent who volunteered at your child’s school or for a community sporting activity; as a worker committed to assisting a rural village get clean water; as a professional who refuses to allow mistreatment of others in the workplace; or as a citizen who rallies their neighbors to recycle or eliminate pollution.
Leaders are not limited to the world of politics, nor do they require media attention. Everywhere in the world, no matter the economic or social circumstances, people are stepping forward to try and make a small difference. Because a leader is anyone willing to help, we can celebrate the fact that the world is abundantly rich in leaders.
Some people ask, “Where have all the leaders gone?” But if we worry that there’s a shortage of leaders, we’re just looking in the wrong place, usually at the pinnacle of an organization or a government. I submit we simply need to look around us, to look locally. Look in a mirror! We need to look at ourselves. All of us, at some point, in time moved into action for an issue or concern that we cared about. When we stepped forward to help, to advance a need, we became leaders.
The process of creating change in any venue is quite straightforward. We notice something that needs to be changed. We keep noticing it. The problem keeps getting our attention, even though most people don’t notice that there’s even a problem. We start to act, we try something. If that doesn’t work, we try a different approach. We learn as we go. We become very engaged with the issue, spending more and more time on it. We may feel exhausted by our efforts and the extremely small steps of progress, but still we keep going. The issue just does not let us go, it keeps calling to us. Then for any time we succeed, no matter how small the success, we gain new energy and resolve. We become smarter as we learn more about the issue and understand it better. We become more skillful at tactics and strategies.
As we persevere, and when we are successful, more people join us. Because change can take a long time and we may not see the final results of our efforts, we may remain just a small group focused on making a positive difference. Although sometimes we give birth to a movement that involves tens of thousands, perhaps millions, of people.
This is how the world always changes. Even great and famous change initiatives began this way, with the actions of just a few people, often after a discussion with friends or colleagues over a meal or a beverage. Let me give you a great example of a major change, which of course started small, but resulted in a Nobel Peace Prize in 2004.
Wangari Maatai was a biology professor at the University of Nairobi in Kenya. During a meeting with other Kenyan women, she learned that the fertile and forested land of her youth had been devastated. Landowners had cut down all the trees to establish coffee and tea plantations. Local women walked miles for firewood and chemicals and runoff from the plantations had polluted the water.
She knew that the solution to the plight of these women and their families was to plant trees and to reforest the land. So she and a few women decided to begin immediately. They went to a large park in Nairobi and planted seven trees. But five of these trees died (the two that survived are still there).
Their initial success rate was 28.5%, discouraging by anybody’s standards. But just as Winston Churchill encouraged England, “Never, never quit” during World War II, these leaders didn’t give up. Instead, they learned from the experience and carried their “lessons learned” back to their respective villages. Gradually, they became skilled at planting trees. Other villages saw what they were doing and over time, a large network of villages became engaged in tree planting. In less than 30 years, over thirty million trees were flourishing in 600 communities, in 20 nations.
Villages have clean water, shade and local firewood, improved health and community vitality. What if these leaders had given up when the first five trees died? What if they had walked away and expected someone else bigger or more important than they were - perhaps academia, the government or the U.N., to plant trees?
How was it possible to go from two trees to 30 million trees in just 27 years?
How did a mere dozen men become 9 million people acting as one unified body in just a few weeks, as happened with the Polish Solidarity Movement? This exponential growth is one gift of developing collaborative teams and living in a network of relationships.
As health care professionals, we can enjoy this same kind of success as we work together improving care for our patients. We can demonstrate collaborative efforts, where all contributions are valued and welcomed. Where we openly address differences of opinions in respectful and caring ways.
When an issue is meaningful, people pay attention, see its value, and begin to talk to others. Such passion moves like wildfire through our networks and communities. Suddenly, we’ve reached millions of people and created large scale change. It has always been true that large powerful changes begin with only a few people who decide to make a difference, who want to help improve the lot of others.
We can rely on this change process. If we have an idea, experience a tragedy, want to resolve an injustice, we can step forward to help.
Instead of being overwhelmed and choosing to withdraw, we can choose to act. We don’t need to spend excessive time planning or getting senior leaders involved; we don’t have to wait for official support. We just need to get started. When we fail, which of course we will, we don’t become discouraged. Instead, we learn from our mistakes. Look for openings and opportunities that present themselves, even if they’re different than what we anticipated. Follow the energy of “Yes, I can!” rather than accepting defeat.
We will never know where our decision to make a difference will take us, but it doesn’t matter. Wangari Maathai calls herself an “accidental activist,” stepping forward to plant those first few trees because it felt like the right thing to do. She didn’t know that she would end up in jail, or have her reputation deliberately destroyed by her government. She didn’t know she’d win the Nobel Peace Prize. All she did was take that first step, and then the next, and then the next.
This is how the world changes. And this is why we need to step forward for our patients, develop collaborative teams and improve the health care they receive. Little by little, step by step, we can resolve the challenges of this period in health care and restore hope to the future.
After all, it’s our opportunity to help the world.
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