@suzanakm - stream of consciousness

Another Physician Leadership session by Barry Dorn. What a treat. Today he introduces us to Meta-Leadership. Meta-leadership is the ability of someone to have influence over someone who you have no control. In every leader that has been studied as being successful has more influence over leadership.

Five dimensions to the model of meta-leadership

  1. The person (leader) - Components to this include emotional intelligence EI (self-awareness, self-regulation, empathy, motivation, social skills) and attributes (courage, curiosity, imagination, passion, integrity). Leaders are often asking for more information - what else? and then take that information to see what else can be done. None of this is effective without integrity and trust.
  2. The change/problem, context/culture
  3. Silos - need to lead the silo
  4. Upward leadership - “lead up” - perhaps within the silo
  5. Lead connectivity - across silos

Leadership analysis - think about 3 people: you (and how you lead), a leader you know and look up to/admire, and a leader who know and don’t think you as a good leader.

An introduction to the new UMass Med Capstone course.

  • The first step for students is to begin to conceptualize an idea…
  • Next to find an advisor… who will help them formulate the project.

Thank you to my fellow #edcmooc-ers for introducing me to videoscribe!

Breaking down the Citadels of Healthcare Illiteracy through Digital Technology: one Utopian perspective of social media in education

The potential for both utopian and dystopian consequences of social media in education were presented in the E-Learning and Digital Cultures MOOC.  In this talk, Regina Holliday and Dr. Ted Eytan present compelling arguments on how open access to information, social media and art can help break down the barriers of medical knowledge to improve patient care and literacy. #edcmooc #meded #hcsm

Barry Dorn (@drbarrycbones) is a visiting lecturers at today’s physician leadership program on conflict resolution and negotiation.

Otis - my dog - on a walk in the woods

Using the “Walk in the woods” process as the framework for the discussion on conflict resolution. The goal of conflict resolution is to move the conflict to a lower level of conflict - shift bargaining from positional or adversarial to interest-based or collaborative.

Interest based negotiation:

  • What do you want to accomplish?
  • What are your concerns or fears?
  • What are your experiences?
  • What do you see as fair?

So, in this model, similar to our discussion with patients and families in goals of care discussion is the principle of listening. First ask. Ask and listen some more. The more information we receive, the better off we are from a negotiation standpoint - in that we know more about the other person’s position. Understanding is the foundation of negotiation and finding resolution.

Your brain on conflict:

What happens to the brain, to our ability to think, when we are in a place of conflict? Well, the conflict can cause a shock, triggering the amygdala to create a brainstem response of flight or flight. How do we stay? How do we respond, instead of react in that moment? We can’t immediately - physiologically - move from brainstem (our brain’s basement) activity to cortical reasoning, but have to move through the mid-brain.

Never lead or negotiate when you are in the basement. So, what do you do? But recognize that going to the basement is not the problem, but rather the problem is how long you stay there and how deep in the basement you choose to go.

How do you get out of the basement? The first step is to give the brain a simple task that can be handled. Or “activate what you have prepared.” Use the toolbox - mindfulness, taking a breath, coming back to a place of success.

What is your negotiation and conflict resolution style?

The Thomas-Kilman assessment:


from http://cgmlca.wikispaces.com/conflict

A useful reference on how to use this tool can be found here. Recognize that initially, this tool was developed for middle managers in the mid-1900s, so likely gender-biased.

There can be more than one truth: To negotiate well, one needs to recognize that different people see the same thing from different perspectives.

For example, looking at a prism from the side, it looks like a triangle. From the top, it looks like a circle. Two people who have different perspectives could simply say the other person is wrong - but if each listen, really listen, they can come to realize that they are looking at something that is multidimensional, not flat.

Each thought that they either say a triangle or circle:

image image

But only after hearing one another could they see the cone:


If they listen, and collaborate, they can come to realize that they both right and wrong - and learn that with each perspective, they have gained a 3-dimensional view of the problem at hand. This allows for both to see the same object in a way that neither could have seen alone.

Ultimately, however, it is more than simply both seeing the cone - but also recognizing the shared humanity in each person.

Now that this is the framework for the problem and the possibilities…

Dr. Dorn took us through the Walk in the Woods:

  1. You start with a naming the problem or conflict.
  2. Define the self-interests. Who are the stakeholders? What are their interests? Where are the shared interests (linkages)? and the conflicts (frictions)? Especially in the area of conflict or friction - aim to understand the other person’s perspective on this. One can understand the other person’s interest without agreeing with it. One must also differentiate between self-interest and selfish interest. The latter is a wish that is detrimental to others. The value added by this step allows each to better recognize the stakeholders (the who), the differing guiding operational assumptions, and in turn have developed an understanding of the complexity of the multi-dimensional problem.
  3. Explore the enlarge interests. What are the themes of agreement and disagreement? Usually, the agreements are greater than the disagreements. This conversation can lead to the concept of enlarged interests. At this stage of discussion, it is important to distinguish the choices from the consequences. When you are in a negotiation, there are some things you have no control over, others that you have complete control over and everything else is negotiable. So, you want to expand what is in the list of negotiable items in order to create a larger opportunity for a win-win situation. The added value of this step: Create a deeper understanding of distinct and overalapping insterests and responsibilities, clarified misunderstandings, and perhaps most importantly, created a wider platform on common good and options for negotiation.
  4. Aligned interests. Now the interests change from enlarged to aligned. Success is defined by this: “When you succeed, I succeed. When I succeed, you succeed.” - This is worth celebrating. This particular piece reminds me of some of the discussions in the framework of “tribal leadership” by Dave Logan: moving the tribal type from a lower level to a higher level - perhaps from 2-3 to level 4-5. (for more information - visit the Tribal Leadership website, or this short introductory essay.)

The Language of Dispute Resolution

  • Negotiators - are always partisan. They are ment to take one side or the other and advocate for it.
  • Arbitrators - start out neutral and end up partisan - ruling in one side or another.
  • Mediator - maintain a non-partisan view. The mediator’s role is to create equality at the table. The good mediator starts assessing the power play at the table and aims to balance it. They try to get as much information at the table as possible. They also recognize that both people want to come to a shared end-point but start in a very polarized perspective. They guide the persons to the resolution of the problem by making each person as comfortable as possible, in order to create a place of shared understanding.

A few tricks of the trade

  • Avoid the word “but” - and substitute it with the word “and”
  • Foster inquiry: Get as much information on the table. “Inquiry before advocacy” - Start with stories from each side, and perhaps the first story should come from the person with less power at the table.
  • If acting as a mediator - maintain a neutral stance throughout.
  • While all negotiations have a beginning, middle and end, not all effective negotiations follow that order.
  • Celebrate small successes - places of similarity.
  • Try to make each party to see the issue as a multidimensional problem.
  • Ask each party if they know how to “sell the resolution back home” - each knows how to share the results and the why of the results with the people “back home” on each team.

Types of negotiation

  • Simple negotiation - two way
  • Representational negotiation - a representive of a silo or tribe meets with a representative of another silo or tribe.
  • Symbolic negotiation - recognition that each person or each group can be symbolic of something larger - i.e. private vs. public, etc. Bias, culture, perception, beliefs all play into this.
  • Interspace bargaining - which is what most of the above is about. It is about seeking collaboration through the walk in the woods.
  • Positional bargaining - The dark side of negotiation that most people think is the principle of negotiation. It is what you see on the law shows. This is about getting what you want through adversarial relationship - At the beginning of this type of bargaining, one needs to be clear on objectives, develop a strategy to achieve YOUR objectives, and assess the importance of the relationship between you and them - in the short and long-terms. You need to find out, what does the other person want to avoid? Identify the problem, then the oppositions interests and their vulnerabilities. Engage in maximum impact by giving things that cost little to you but are gains to them, which getting big gains - if need by using threat against their vulnerabilities. Then achieve victory.

Last words of wisdom from Barry Dorn: As physician leaders, you must remember the fable of the frog and the boiling water. If you put a frog in boiling water, they jump out. If you put it in warm water that slowly gets hotter, the frog stays in and gets boiled. So, don’t put the small stuff aside, because they could become major conflicts later.

My digital artefact - an interactive Image: Social Media in Medical Education: Utopia or Dystopia?

The final project for the e-Learning and Digital Cultures MOOC we were asked to do was to create a “digital artefact” - capturing in some venue, something we had taken from the course.

By the way, for those of you who don’t know, a MOOC is a Massive Open Online Course - this one through Coursera.  I wanted to bridge the what I had learned from this class with some stories and experiences picked up in the world of medical education as it relates to social media.

As we pass 100 years since the Flexner Report that reformed US medical education to be more akin to that in Germany - educators are reconsidering what the next century will look like.  Can we shorten the length of education? (Students in the US spend 8 years at University after high school to become a doctor, then another 3-10 years as interns, residents and fellows working 80 hour weeks).  Can we make it less expensive?  Can we open up information to students in other countries - can we globalize medical education?  What of the role of social media - how do we teach professionalism, protect our patients while exploring the best of it?

Additionally, as Atul Gawande stated at the Harvard Medical School Commencement Address, 

"you can’t hold all the information in your head any longer, and you can’t master all the skills. No one person can work up a patient’s back pain, run the immunoassay, do the physical therapy, protocol the MRI, and direct the treatment of the unexpected cancer found growing in the spine."

Read more: http://www.newyorker.com/online/blogs/newsdesk/2011/05/atul-gawande-harvard-medical-school-commencement-address.html#ixzz2LroQc3jK

Furthermore, patients are asking for more.  They want (and rightly so) a greater role in shared decision-making and knowledge sharing.  The efforts from Society for Participatory Medicine, ePatients, and artists like Regina Holliday are spearheading this efforts.  They see the use of EMR and social media as helping dramatically with creating the solution.  I personally think it is more complicated.  

As discussed in the MOOC, there can be a downside.  Many ePatients are pushing the government in the US to mandate that patient notes be finished within 24 hours and available for patients to review.  I have to admit that I struggle with getting my notes done in a timely fashion.  But I would rather not substitute the un-rushed discussion I have with my patients and their families sitting beside them with a timely note.  This is the crux of the debate - dystopia vs utopia and the lecture by Gardner Campbell that discussed Bateson’s notion of the “Double Blind:”  As a physician committed to shared-decision-making and patient empowerment, I must want to notes in the electronic record within 24 hours, but if I do, I will need to cut my visits with my patients shorter.  Two contradictory concepts that collide head-on seemingly both supporting the same value of good patient care.

That being said, there is so much “Utopian” work being developed - online communities that stem from compassion and contribute to the humanism of the profession and to what is found online.  The digital stories in particular strike me as profound.  These stories teach us all about the resilience of humankind, about love, about illness and hope.

And so - as I have heard others who speak from a perspective of complexity theory - we continue to live in a “both-and” world.  Finally, referring to Kant - we have to choose how we wish to participate and contribute, recognizing that what we do will likely become the larger reality.

So - what will your online presence be?

(Source: thinglink.com)

"I tell my students, tell me about your patient and their family.  Let’s call her by name." - Vicki Erickson APRN-BC, PhD

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