We chose this profession in order to use our talents providing health care to children. We find joy in making a difference in their lives. We find our chosen field dynamic, interesting and rewarding. Our work is hard, challenging, and yet we love what we do.  We all strive every day to provide health care that’s valued by the patients and families, by our teams, by the system at large and the public.  

What are the most important virtues as individuals we need to nurture to be part of a team with this creed? Humility, flexibility, excellence, openness, courage, collaboration, appreciation, gratitude, awareness, commitment to serve others, and a commitment to learn from others.

According to Adaptive Leadership theory, there are two types of challenges, technical and adaptive.  Currently we’re facing multiple adaptive challenges in pediatric healthcare.  Complexity, both diagnostic and therapeutic, is increasing.  Expectations, good, bad, and indifferent, of both the consumers and the payers are not only shifting and expanding but increasing in intensity.  Advancements in technology, data analytics, and artificial intelligence are increasingly impacting our business.  Disrupting ways to deliver health care are threatening our current business models.  The economics of health care delivery are evolving into an impossible calculus for these current business models as well.  And most importantly the workforce has irreversibly changed in capacity, context, complement and culture.

Technical challenges can be addressed with known methods and tools.  Adaptive challenges require developing new methods, tools, and systems.  This implies the need for change and innovation while doing the daily work.  Missteps are likely to occur; disruption is inevitable.  PDSAs can be rewarding.  Yet, PDSAs in the middle of an already overwhelming workload, especially if the learning includes what doesn’t work, can be demoralizing and disengaging.  Messiness, failed experiments, change that is hard, and learning new ways of doing things are often unwelcome in the workplace.  Perhaps the biggest challenge is just finding the time to do the work that innovation, experimentation, collaboration, and learning takes.

One risk of not meeting these adaptive challenges is a decline in pediatric health outcomes.  As the larger system evolves out of forces not necessarily aligned with the needs of children, we may see outcomes worsen before they start improving.  Families will opt for convenience unaware of the risks.  New entrants will claim excellence and deliver something else.  Web based services, including AI, will be advertised as a better option, but not be.  I assert there is an urgency to addressing the adaptive challenges facing the pediatric healthcare system.  Addressing adaptive challenges starts with changing how we see things and how we think.  One of those paradigm shifts is looking at how we’re doing through a value perspective.  Value is better outcomes with minimal waste.  Value is deploying resources and getting meaningful, measurable output, and the most important outputs in health care are patient-(& family-) related outcomes.  Process metrics can be good surrogates for outcomes if we measure both, check our assumptions, and connect the dots.

Leadership matters.  It is both a rebarbative essential and a winsome desire.  What makes an effective leader matters; yet, what matters may shift with the situation, the culture of the social environment, and the demographics and perceptions of the followers.

What kind of leadership will work today and in the future?  What kind of leadership will you embrace and embody?  If leadership is a calculus, then it stands to reason that style and methods may need to shift over time, even over a single day, perhaps in the same meeting.

A style increasingly referenced, and yet frequently misunderstood, is servant leadership.  Simply put, a servant leader is one who serves others first, who is selfless, not to a fault, but to an end that is not their own.  A servant leader may have common visible attributes: kindness, humility, a strong sense of balanced responsibility, but not all are universal.  Some historical military leaders were  servant leaders, but kindness and humility not always outwardly present.  However, a strong sense of balanced responsibility is a common thread even in the military.

A balanced sense of responsibility can be found throughout military history in both myth and true accounts.  It is most commonly expressed as a leader feeling responsible for victory, or successful defense against invaders, while protecting the lives of civilians and soldiers, and minimizing damage to civilian and military infrastructure.  It often includes thinking ahead to the next battle while considering the capacity and capabilities of the people and the collective company or battalion they constitute.

How does a leader achieve the right balance?  First, by recognizing the need to surround themselves with a balanced group of advisors and lieutenants, to listen to what the people have to say, and to check their assumptions and biases.  Second, by crafting their communications with balanced perspective and recognition for the various receiving constituents and their unique perspectives and roles.  And third, by making decisions that clearly and outwardly maintain integrity of the balance for which they’ve chosen to be responsible.   In other words, by being dedicated to the truth, simultaneously honest and visionary, and committed to the people and their purpose.

Taking the path of servant leader isn’t essential to achieving a proper balance in every possible situation, but I would argue it is the one path that works consistently in every situation in a balanced way with integrity and sustainability.  Our founding fathers had faults and made mistakes.  They had moments of bias, self-centeredness and breaks in integrity and humility.  Yet, many of them embraced servant leadership.  George Washington, John Adams, and yes even Thomas Jefferson were servant leaders.  Abraham Lincoln’s secret to success was embracing servant leadership.  He is by far the best historical example, which is why most of the historical books in my library are about him.  Read a book about A. Lincoln if you want to learn more about servant leadership.

We’re faced with what seems to be impossible challenges: doing more, doing better, and doing it all with less, while at the same time promoting professional joy, facilitating engagement, and ensuring legal and regulatory compliance. On top of that, the expectations of the families and communities we serve too often goes beyond what we can meet.   And dare I say, the expectations of our front-line colleagues has followed suit in some cases.

There’s a team leadership loop I’ve observed when teams are at their best.  I call it the MLSA loop: mindfulness, learning, sensemaking, and action.   The learning and action steps are the easiest for people to understand (but often the hardest for teams to do). Whereas mindfulness and sensemaking are hardest to understand, but the best teams seem to do it naturally.

Sensemaking is facilitated when there is sufficient wisdom present, which comes from practical knowledge of theory and best practice, and accumulation of thoughtfully and honestly reflected experiences.   Sensemaking can be recognized when its there, but its hard to insert when its missing. It can be nurtured when leaders support training, professional development, provide time for open reflection, and have a plan for recognizing, and retaining senior people.

Mindfulness is facilitated when high-reliability attributes are present along with humility and acceptance. Humility is necessary to create the right environment of openness and collective presence. Acceptance is necessary in order to eliminate the negative emotions that can derail a team.  Acceptance also helps drive the needed amount of focus a team needs to stay on the correct rail.

Collective presence refers to the combinations of team alertness and calmness, and  team diversity and respect, which allow for optimal flow of information and ideas.

Applying this loop to the broader context of today’s healthcare environment could aid leaders as they struggle with the seemingly impossible challenges they face. There is hope and solace for the beleaguered leader in this model of how effective teams face complex, high-risk, and high-emotion situations.

Achieving mindfulness before we begin to learn ensures we are open, thoughtful, and broad minded. Learning before we make sense of things, ensures that we frame things in a helpful, focused and positive way, which will drive optimal and flexible action. More importantly perhaps, is that mindfulness enhances our ability to assert a positive and confident outlook, and meet the challenges with confidence, calm, and the positive outlook and impenetrable will others need from us to stay on track.

Be mindful my friend.