On Service and Participatory Democracy

I sit with 400 other Philadelphians in the Jury empaneling room. 400 people a day leave their everyday lives to come and sit in service of our democracy. I love jury duty. I love being reminded by my physical action of coming downtown to the court house, and by the welcoming judge who tells us again, that the United States’ system of judgement by a panel of your peers is unique in the world. And it doesn’t work without people showing up. Flawed and beautiful, one and the same. Together we sit, a true microcosm of our beautiful city. Young and old, black, white, Asian, Latino, and others. From our clothes, handbags, and backpacks, you can see we come from all socioeconomic brackets. We all have cellphones and social networks we are connected to – relationships and causes that matter to us.

Today is also the first day of school. I am thinking of the service it is to society to be a teacher devoted to educating other people’s children. Where would we be without our teachers and school administrators? I, for one, was happy to hand over The Darlings to other adults. Let them learn from other people – absorb their points of view, follow their rules, find role models, debate beliefs.

In the court room is a judge, a bailiff, court reporters, a public defender and a prosecutor. The Judge reminds us that we are not to judge based on the fact that a charge has been made or by the color of the uniform a person wears. We are to listen to the facts, and work together to sort out what happened. Police officers and detectives cycle through reporting what they saw. The crackerjack young lawyers make their arguments of the facts. Our jury sits in deliberations. Through each of our life experiences we listen. And then we debate. In every jury that I have been a part of I am impressed by the care these citizens give. The quality of the listening and inquiring surpasses that of many corporate meetings I have been a part of. A person’s life is on the line. The stakes are high and the citizens know it. We are stronger and humbler by our diverse life experiences. We do our best.

Teachers and Principals instill a love of country and awareness of what a working society demands of its citizenry. I participated in my high school’s student government and in my state’s Model United Nations conventions a million years ago when I was my kids’ age. These days I participate in society as best I can from voting to jury duty; protesting and counter protesting, making donations and generally “representing” for the underlying values of liberty and freedom, self-government, equality, individualism, diversity and unity. There are inherent tensions in our pursuit of living out these values. Yet we do it. My peers in the jury room somehow have absorbed these values and are rising to the challenge using what their teachers taught them ever so long ago as we lean in and decide.

 

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Running Ourselves Ragged

I’ve been here at Teleos now for almost a full year and through that experience I’ve been exposed to a lot of organizations across a number of industries. Part of what I love about being a consultant is entering into different systems and working with different people on a number of different initiatives, from coaching to leadership development to organizational development and change management. To say it’s been a blast and an eye-opening experience for me is an understatement.

I love my job for a number of reasons, but what I appreciate most is that I’ve been given a new lens to see the world through, and I get to share this knowledge with clients. I’ve taken to the metaphor that our boss, Fran Johnston, uses when describing us- we’re pollinators. We’re little bees that get to spread information from one system to the next and help people and organizations navigate the complexity that we’re all up against. Interestingly, what I’ve taken away most from my interactions, is that we’re all up against the same challenges… people and organizations moving at breakneck speed, with little information to help serve them when making decisions, despite the abundance of information now at our fingertips.

Leaders everywhere are overwhelmed, stressed, tired and taxed. The more enlightened organizations are starting to understand that they need to provide help, guidance and care, but it’s few and far between. People are running in and out of meetings, coming in late, because they don’t even have time to stop for food or go to the bathroom during the course of their day. We’re literally running ourselves ragged, pushing for what’s next, trying to one up the competition, which sometimes happens to be our own colleagues. We work in organizational structures that aren’t agile enough for what we’re up against.

We see organizations that continually ask for more from their employees, but give them less to get the job done. The expectations are raised, but the commitment to the employee’s ability to get the job done has diminished. We see organizations that ask leaders to leave emotions out of their work. They want results not relationships. But it’s all short-sighted. Most organizations will tell you that their competitive differentiator is their people, and yet, when we ask how they support their people, they look at us askew, or tell us that financial pressures have forced budget cuts.

The systems and structures in place today are becoming ancient relics. They aren’t agile enough, they don’t provide enough space for the organization or the individual to breath. They’re built to point out deficiencies and imperfections. They’re constructed to tell us what’s wrong in the world. There’s a place for this, at times, but what if we imagined a different way to support and grow our people? What if we were able to share with you the movements that are starting to build across organizations to free themselves of outdated models and start to pollinate the promising ideas across organizations?

In every organization that I’ve stepped foot in over the past year, there’s a lot of great things happening. New ideas for how to manage performance, new initiatives to spurn growth and development. The seeds are being planted for the evolution, but we need to help spread the word before it’s too late. There are more enlightened ways to approach business. There are ways for leaders to inspire to drive results, there are ways for organizations to design themselves to engage their people and there are ways to give your people a much-needed break, to allow them to reset and refresh. We can help…

 

 

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Leading Without Formal Authority

In today’s complex and often matrixed organizations, many leaders find themselves in a now all-too-common predicament: having accountability for an outcome with no authority over those responsible to help bring it to completion.

Figuring out which levers to pull to influence teammates that are not direct reports can be frustrating. In these situations, using emotional intelligence and relationship skills is more important than ever. Leaders in these positions have to take a “pull”, rather than a “push” approach to leadership, relying on evocative influence ability more than formal power. The following tactics can be helpful in getting results without formal power.

Create a Compelling Vision – When leading without formal power, it is all about leaning into an evocative, not provocative approach to influence. Essentially, inviting others to join you in your endeavor. One way to do this is by using a visioning influence style, one that relies on inspiration and not force to influence others’ behavior. In these times, being able to articulate your envisioned outcome, link it to your and the organization’s vales and noble purpose and clearly express why it’s important is key to getting their buy-in.

Build Strong Relationships – Another key means of tapping into your influence ability in an informal leadership situation is by strengthening your relationship with the people on your team. This doesn’t mean taking a transactional approach to relationships but instead tapping into your care and concern for others, inquiring about their lives and work reality and genuinely enjoying connecting with them. This is social capital 101. If you have strong relationships with people on your team they will be much more inclined to be cooperative and to get on board with your initiatives.

Create a Positive Environment – To the extent that it is within your control, do what you can to create a positive workplace and team climate. One of the leading psychologists in the positive psychology field, Barbara Frederickson, has developed the broaden-and-build theory based on her extensive research in the field. Her theory states that when individuals are in a positive mood, their range of perception opens up and they become more open-minded and able to see possibilities not available to them when they are in a neutral or negative state of emotion. The bottom line: when people are in a good mood, they are more likely to be open and amenable to your ideas

Find Like Minds – Finally, in challenging influence situations without formal power, it can be helpful to look to your right and left and see who supports the initiative you are leading. Aligned and helpful partners can help move things forward and get buy-in. The key is to do this with utmost care to not create divisions within the group.
 

Fredrickson, B. (2012). Positivity: groundbreaking research reveals how to embrace the hidden strength of positive emotions, overcome negativity, and thrive. New York, NY: MJF Books.

Goleman, D., Boyatzis, R., McKee A. (2013). Primal Leadership: Unleashing the Power of Emotional Intelligence. Boston, MA: Harvard Business Review.

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Be Intentional

I’ve spent the majority of my adult life in and around learning and development. I’ve seen it from a variety of angles: as a high school teacher, as a university administrator, in fortune 50 organizations and as a consultant. I’ve learned a lot from each of these experiences (too much to detail here), but the one observation that sticks with me most, from the high school classroom all the way through to the corporate boardroom, is that intentionality matters. Benign neglect doesn’t work, especially when it comes to learning, development and personal change.

We don’t learn and grow without being intentional…thus we don’t change without intention, and yet, despite this, so many of us walk throughout this world without consideration of how to reach our idealized self. There’s no plan, we leave it to luck. We look to organizations and others to help us grow and we get disgruntled when we don’t see progress, or when that next opportunity passes us by. The world is changing rapidly, it’s moving at an unprecedented clip. You can’t afford to be neutral. You must be intentional.

In his intentional change model, Richard Boyatzis lays out a strategy for how we can use intention to grow and change, ultimately moving toward our idealized self. This model, starting from an idealized view of who you want to be (5-7 years out) then moving through a realistic inventory of where you are today, provides you with deep insights into how to be intentional in your efforts to grow, develop and change. It is exceptional for individuals who have the desire to grow and change, it activates us both emotionally and physiologically to move toward our idealized self.  It helps us create a deliberate learning plan and makes the space for experimentation and course correction.

The challenge of the model for many is moving from self to system. As organizations have come to be our primary association for adult development and growth, they hold a role in helping people work toward intentional development and change. Creating a system that supports growth and development doesn’t have to be overly complicated, or even more importantly, overly costly. With the right intentionality, you can build out a truly developmental organization framework that aligns self to system. Boyatzis’ model is a good place for learning and development leaders to start.

The Boyatzis framework ladders up to the organizational level, and with a little additional support, learning and development leaders can create an organization that promotes a model for growth that aligns the idealized version of the organization to what’s really happening on the ground. The challenge for organizations is in re-conceptualizing its role in the development framework.

In the new frame, there are three pillars of accountability for organizational growth and development- not new in and of-itself, but the emphasis of where ultimate accountability lies, shifts from the organization to the individual.

3 Pillars

  1. The organization- needs to provide the framework and processes in support of learning and development.
  2. The manager- needs to provide candid, honest and timely feedback to the individual, while also organizing work in support of both the organizational needs and the individual’s development.
  3. The employee- most importantly to the triad, it is the individual who needs to take deliberate and intentional action to learn, grow and develop.

 

Development doesn’t just happen in a classroom, it happens across 4 dimensions (Bersin helped develop a frame for our reference):

  1. Environment- the culture, systems and tools you work with and within
  2. Exposure- learning from others and being exposed to new ideas
  3. Education- the formal learning that takes place in classrooms or on-line
  4. Experience- this is where the vast majority of our development occurs- and yet, it’s the one that is most left to chance

When we frame development as a broader set of activities, it shifts the emphasis from the organization owning the full spectrum of development to the employee working on how to grow and develop through a number of frames. We open up the aperture for development and growth and make it more relevant to what’s happening on the job and in the moment. We create a new understanding alongside a new set of capabilities. When done with intention, we can learn to change and grow, both individually and organizationally. The world is moving rapidly, you can be swept up and taken by the current, or you can learn to chart your path and your future. In the end, the choice is yours, just be intentional about it.

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A Case for In-Person Coaching

The reality of our modern and connected world is that many coaching sessions happen virtually these days, either by phone or by using extremely effective and affordable technology like Skype and Facetime. Overall, the use of technology in coaching is fantastic – it allows us to connect with more clients, more often and more affordably. However, there is still something to be said for maintaining the human connection with clients when possible, especially at the outset of an engagement while the relationship is being established. This is intuitive for many of us though we often struggle to articulate the difference between coaching virtually versus in-person.

Author and positive psychologist, Barbara Frederickson, in her book Love 2.0, does a great job of explaining the physiology behind interpersonal connection, something that can help us more clearly understand the difference between in-person and virtual interactions. The physiological dance of connection between two humans is possible in virtual settings but can be more difficult and happen more slowly. To understand why, let’s take a look at the three major things going on physically whenever we are interacting and truly connecting with another individual.

• Brain Coupling – First of all, in conversations with other people, mirror neurons and the insula, a region of the brain involved with emotion and sensation, enable us to empathize with each other and share an emotional state. This sharing of an emotional state with another person is often called “limbic resonance”.

• Oxytocin – Additionally, during positive connection with others, the hormone oxytocin surges enhancing our feelings of trust and cooperation and making us more attuned to positive social behavior, like eye expression and smiling and less attuned to threatening behavior.

• Vagus Nerve – Finally, during connection with others our Vagus nerve, a cranial nerve that connects the brain to the heart, enhances our connectivity with others. It does this by moderating our facial muscles so that we are better able to make eye contact and mirror facial expressions and better able to track the vocal tones of the person we are connecting with. Overall, it helps increase the odds of our resonant connectivity with others.

This physiological connectivity can happen via the use of phones and technology like Skype and Facetime. However, it is still somewhat restricted as screens provide a limited or blurred view of our facial expressions, body language and tone, all of which are vital to producing positive emotions and enhancing connection during conversation. Faceless communication like email, instant messaging and text are even more limited. As coaches, understanding this is particularly important because so much of our work relies on the strong and trusting relationship we form with our clients. It is this relationship that serves as the foundation for effective and true change.

So, while we have all used phone and web technology for coaching and will continue to do so, it’s worth a second thought as to whether our coachees might benefit from more of the original face time.


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Lindsey is a consultant and coach at Teleos Leadership Institute. Teleos Leadership Institute is a leadership development and organizational transformation firm that believes leaders are at the center of change. To support leadership capacity, we have developed a research-based approaches that sparks and supports transformational change. We are industry experts, executive coaches, executive coach trainers that consult and support organizations as they build internal capacity. Beyond consulting and coaching, Teleos has extensive experience delivering leadership trainings, conducting organizational research, and facilitating culture change.

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A Coach’s Greatest Contribution

Executive coaches bring many skills with them into a coaching engagement: an ability to facilitate adult development and change, a knowledge of systems, keen observation and powerful questioning are among a few. But, one of the most impactful capabilities of a coach is also one that is often  overlooked in the shadow of more tangible skills. This skill is the ability to create a safe environment in which the coachee can take a clear look at him or herself and begin the process of true, deep and sustainable change. The place where true change happens is often scary and hidden so it is only in relationship and in a psychologically safe environment that individuals have the courage to take a glimpse at their true selves and begin to address deep-seated barriers to change they are working to make.

Perhaps no one understood the importance of this skill better than Carl Rogers, a psychologist and creator of the person-centered approach to therapy. The three tenets of his approach are:

  1. Authenticity – Acting and speaking in a way that is genuine
  2. Empathy – Imagining what the experience of the client is like
  3. Unconditional positive regard – Withholding judgement and appreciating the client for who they are in that moment  

His approach is based on the belief that personal growth is most likely to occur in a non-judgmental, supportive environment where the individual enhances their self-awareness and thus finds their true positive potential. When Carl Rogers created this approach in the 1940’s, it was an unorthodox contrast to the traditional “therapist know best” directive approach used in counseling at that time

Rogers’ belief in the importance of unconditional positive regard is the most instrumental in creating a safe environment for the coaching engagement.  Unconditional positive regard is the optimistic, non-judgmental view that a person is valuable, worthy of respect, and has the ability to figure out how to overcome their obstacles in order to fulfill their potential. When therapists and coaches practice unconditional positive regard, it creates a safe, trusting and non-judgmental environment where a person is able to lower their defenses in order to see issues that might be inhibiting them from making their desired changes. In essence, unconditional positive regard means entering the coaching engagement with the intention of change but affirming the individual’s value and personhood as they are that day.

As coaches, it is important to reflect on the environment we create for clients. Spending time getting grounded in these assumptions prior to a coaching session is a great place to start. Additionally, reflecting on our tone and non-verbal signals in a client session can be helpful in assessing the type of relational and emotional environment we are creating for our clients, whether we mean to or not. This is also one of the reasons it is important for coaches to “do our own work” as part of coach training so we know the issues or personalities that trigger us and make it more difficult to create a non-judgmental environment. After all, all the change theory and skill in the world, won’t bring about true change if clients are not affirmed, supported and appreciated for who they are today.

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Relational Learning in a Volatile and Hyper-Fast World

It’s no small statement that the impact of globalization and technology on the way we work, learn and live is profound. The world we live in today is vastly different than the one to which we’ve been accustomed. However, most every generation in history has faced monumental upheaval. The world has been interconnected for as long as history can recount, the difference today, is the speed at which information flows and the overwhelming amount of information that is at our fingertips in a moment’s notice.

To use a military analogy, the world is volatile, uncertain, complex and ambiguous, but it’s also full of hope, promise and potential. And it’s through this lens that we need our leaders to operate. Globalization is a man-made construct, we control the inputs and although it doesn’t always feel like it, we also have control over the outputs. The challenge that lies ahead of us, is teaching leaders to understand and learn how to operate in this world in a way that offers hope, promise and compassion for those around us.

Our belief is that we need to slow down the ways in which we learn and create systems and processes that allow us the space to learn, to grow and to prepare us for working and living in a complex but beautiful world. We recognize the paradoxical nature of this request. And we hear the response all too often, “my people don’t have the time,” “I can’t be gone for that long,” etc. But the reality is, for most of us to truly be effective and to meet the challenges ahead of us, we need to better prepare ourselves mentally, spiritually and physically for what lies ahead.

The skills required to operate in our current environment; collaboration and communication, critical thinking and problem solving, innovation and imagination require us to fundamentally slow down our thinking in order to truly master any of these skills, yet we continue to fall into the trap outlined by Kahneman in Thinking, Fast and Slow:

“A puzzling limitation of our mind: our excessive confidence in what we believe we know, and our apparent inability to acknowledge the full extent of our ignorance and the uncertainty of the world we live in.” (Kahneman, Daniel. Thinking, Fast and Slow (pp. 13-14). Farrar, Straus and Giroux)

The world we live in today is uncertain, it’s hard for leaders to fully grasp the monumental nature of the challenges that lie ahead. But that shouldn’t prevent us as leaders to take a stand and learn how to navigate the world ahead of us.

We need leaders that understand complexity, adaptive systems and aren’t afraid to experiment and try new things. But most importantly, we need leaders to understand that the answer to our challenges is not an individualistic pursuit. We learn best alongside of others and through experience. It’s very tempting to jump head first into the challenges we face and fearlessly push through with sheer will and endurance. Yet, with constant change and turmoil, we can’t keep up and fatigue sets in.

We don’t have the capacity to go at this alone. We never have…throughout all of our history. Humans didn’t evolve because we were the most prolific hunters in the ecosystem, we thrived because as a tribe we were able to outlast the prey, we worked together to wear them down and we used ingenuity to survive even when the odds were stacked against us.
We’re social beings. We exist in a relational context. But in order to effectively be a part of the tribe, we need the to spend time with one another. We need to slow down and engage in the moment with those around us. We need to learn from one another, we need to grow with one another. In order to do that, we need time and space- two resources that feel really scarce at the moment. But we have the capacity to make that happen, because when we do it right, we actually learn to how to better handle all that this beautifully chaotic world throws at us.

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The Paradox of Power

By Eric Vandersluis

“Mastering others is strength; mastering yourself is true power.”  Lao Tzu

In today’s hyper-competitive world, power is multidimensional and complex; technology, speed and the accessibility of information have made it even more so. This diffusion of knowledge and information, constantly at our fingertips, has created a new paradigm for how to manage power in relation to ourselves, to others and across organizations. With information increasingly accessible to all, the traditional notions of hierarchical power are starting to erode. This fundamental shift has created the need for a more nuanced view of power and power dynamics in organizational settings.

The top-down model of leadership through heavy-handed authority is no longer sustainable. Autocratic leaders who lead through scare tactics do more damage to organizations than peers who embrace a new age of leadership. Short-term results may be there for these leaders briefly, but longer term fallout is there too and perilous to ignore:

  •  A poisoned organizational culture
  • High potential employees flee
  • Morale suffers
  • Unsustainable results

Unfortunately, in today’s world, business are still managed to the quarter and the Street looks for short term performance results with little regard for longer term implications of culture and engagement. This short-sighted and myopic view has real impact. Leaders that get immediate results are rewarded. How they go about getting results isn’t always considered, leaving many in power that still lead with an iron fist. In Lao Tsu’s words, they lead through strength, not through power.

The real challenge with this style of leadership, according to the Approach-Inhibition Theory of Power*, is that as we gain influence and power:

  • We lose the capacity to empathize with others
  • Our sensitivity to consequences and punishment decreases
  • We become less sensitive to the conditions and emotions of others
  • We talk/dominate conversation and meetings more
  • We experience an increase in positive emotions (they feel good about being in power)

All of which ultimately creates unhealthy relationships, an unhealthy culture and a power dynamic that has negative psychological impact on the entire organization.

If you think the psychological impact isn’t real, or doesn’t have a place in work, consider this….think about your worst boss ever. What comes to mind? How does it make you feel? Likely, not great. As a matter of fact, when we ask this question in our sessions. most of the responses are heated and emotionally charged. It doesn’t matter how long ago you experienced this leader, the emotions still feel raw and have a powerful impact on how you think and ultimately act in the moment. Imagine operating daily under a leader like this (trick statement- you just did), do you think you can really perform at your best? Be honest. If not, what did you leave on the table? Multiply that impact across your team and organization and think about the amount of lost effort and productivity.

Again, according to the Approach-Inhibition of Power, we know that individuals in lower power positions demonstrate:

  • Increased sensitivity to punishment and the consequences of their actions
  • Increased sensitivity to the emotions of others (emotions are contagious, so if they see their peer upset, it has a ripple effect on them)
  • Increased experiences of negative emotions
  • A proclivity to talk/contribute less

The question then becomes, how do we deal with power in today’s hyper-competitive and fast world where job responsibilities seem to grow exponentially? Leaders feel they don’t have the time to slow down, at least that’s the thought. But what if slowing down was the first step to mastering yourself, to learning the difference between strength and power and thereby becoming a  more resonant leader? We hear it all the time, ‘ain’t nobody got time for that.’ But the reality is, to become an effective, long-term leader today, you must. If you want to adapt to the new complexities we face today and be prepared for what lies ahead, you can’t ignore the fact that we need new ways to lead, and ultimately we need to forge a new understanding of power and its impact on those around us. To do this, first and foremost we MUST start with self. It’s through the process of building self-awareness that we can truly begin to recognize the impact and affect we have on others and in turn we can begin to better understand how we use power in support of ourselves and of others.

 

*Berdahl, J., & Anderson, C. (2002). The experience of power: Examining the effects of power on approach and inhibition tendencies. Journal of Personality and Social Psychology, 83(6), 1362-1377. Oveis, C., van derLowe, I., LuoKogan, A., Goetz, J., Dacher, K., & van Kleef, G. (2008). Power, distress, and compassion: Turning a blind eye to the suffering of others. Psychological Science, 19(12), 1315-1322. Keltner, D., Anderson , C., & Gruenfeld, D. (2003). Power, approach, and inhibition. Psychological Review, 110(2), 265-284.

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Being the Right Choice in Executive Coaching

A year ago, I found myself on a short list of coaches who had been invited to have a chemistry meeting with an executive (let’s call her “Jane”) who was particular about whom she would work with.  The company Jane worked for had started grooming several individuals for very senior leadership positions by hiring a well-known coach to work with these executives, who were on the fast track for senior leadership positions. They ran into problems when Jane who, after having two coaching sessions, decided she wanted to have a different coach. The company suggested 3 other coaches to choose from—and I was on the list.

I met with the Jane for a 1-hour coaching session to see if there was chemistry to build a productive relationship. At the end of our meeting, I asked her to let me know as soon as possible if she wanted to work with me. She replied right away that she did not need time to think about it. Jane wanted to work with me—if I thought that I could work with her.

I was a little surprised at such a quick decision. I knew she was “choosy,” and I did not think so highly of myself to simply assume she would naturally love to work with me. So out of curiosity I asked her how she made the decision so quickly. Jane said it was clear to her that I would not tell her what to do.

In a culture and society that rewards specialization, it can be easy to get stuck in a rut of becoming an expert in a specific type of verbal and nonverbal behavior. In coaching the expert approach can potentially lead to the client not being listened to, feeling that their issue of concern is being ignored by the coach and consequently experience no shift or change in the status quo or issue that prompted the coachee to seek coaching.  The expert focuses more on what they think the client needs to do to resolve the issue. Coaching is relational and as such it is time consuming and cannot be hurried. A tendency and temptation is for a coach who overuses their expertise to tell a client what they need to do in an attempt to get them to move faster in resolving their situation. Therefore, the coach can get into a loop of seeing the same pattern in issues so that for each client, the same things are paid attention to and responded to. But, this choice limits awareness of many other behaviors that also carry meaning and potentially rewarding avenues of exploration in the coaching engagement are left unattended. So, awareness of the choices that are made in “noticing behavior”—that is, the behavior of noticing, rather than the noticing of behavior—are essential competencies for a coach to develop.

We all like to have choices. The ability to choose is a key component of what we may call the human experience. When there is no choice, there is no autonomy, no empowerment. And when these things are lacking, people perceive there is a fundamental loss of quality of life. But engaging in conscious, reflective choice comes at a pretty hefty cognitive cost, and it is unreasonable to believe that absolute freedom of choice for every potential action within the universe of possibilities in our daily existence would result in anything but a crippling paralysis. This is one reason why we build organization—routines, rituals, hierarchies, and traditions—into our lives. We all need a break from choosing. Instead of dedicating precious energy to decision making, we can use that energy for enjoyment. Sometimes we don’t want to choose…and that, itself, is a choice.

Each choice is accompanied by a universe of extinguished possibilities—of choices not made. Choosing something is essentially rejecting something else, and for some this may be accompanied by regret for the road not traveled, while for others it may become a sort of freedom because it simplifies the world and gives a sense of direction and focus.

So what does all this have to do with coaching? In the story I told at the beginning of this article, the well-known coach had met with Jane for two sessions and had decided very quickly what he thought she required. Then he proceeded to tell her what she needed to do. As I worked with the client, I later learned that the coach I replaced had actually suggested—rather than told—her what to do. However, what she heard at the time was that she was being ‘told’ what to do. The well-known coach may have had the right intervention, but he definitely had the wrong timing—and timing can be everything. He had not yet established enough trust, as far as this client was concerned, in the two sessions for his client to agree to his direction. It can be tempting to jump into the work a coach thinks is important, but if an adequate amount of trust has not been established, the attempt is likely to fail.

After 4 or 5 sessions I suggested some homework for her to do, waited, and watched for her response. Jane smiled, and I asked her what her smile was about. She said the other coach had suggested a similar homework, but she noticed that she felt more willing to cooperate with me than she was with him. She said she did not know him so how could he tell her what to do? She happily went on to do the homework I had given her and we discussed her experience of doing the work and what she learned from it.

A fundamental ethic of professional coaching is that the client chooses the focus of the work and the conversations that will take place. It is such an important ethic that it is part of the International Coach Federation’s definition of coaching.  This choice is made both verbally and nonverbally by a client, while the coach must be able to maintain flexibility to respond to client choices, to make observations and to offer insights and feedback. To engage with the client is to be “present and flexible during the coaching process, dancing in the moment.” The client may set the course, but the coach has equally important choices to make with regard to what to observe and what to share. When the flow is right between client and coach, the coach speaks and acts with a free and elegant savoir faire, being in the moment and fully present.

So what does the coach choose to focus on and give meaning to? This is not an easy or straightforward question to answer. What can be said is that it benefits the coach greatly to cultivate a healthy openness to experience. It also helps to realize that everything a client says and does—as well as does not say or not do—is rife with meaning as long as the coach has the awareness and ability to support the client to unlock that meaning, drawing on breadth of experience and engaging in conscious and mindful empathy and compassion.

The 20th century existentialist philosopher Jean-Paul Sartre believed that people were absolutely free, and because we are free, we are responsible for all our actions—all our choices. Freedom, in Sartre’s view, meant that each of us chooses the entire world within which we live, and that all we become and do stems from the choices we make. Sometimes we can benefit from guidance in making those critical choices—but they are still our choices. That is where coaching can help in making informed choices following an extensive, and deeper exploration of what is relevant and what is possible within the context of what is important to the client.

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You and Your Doctor Part 2: Solutions

By Mohan Peter

Mohan Peter MD is the Principal at SMS Leadership Coaching specializing in physician coaching and leadership development. He obtained his International Coach Federation Certificate (ICF) from Georgetown University in Washington, D.C. He is an Executive Partner and Leadership Coach at the Mason Business School at the College of William and Mary in Williamsburg, VA. Dr. Peter trained and worked as a cardiac surgeon in United States and abroad including the Cleveland Clinic in Cleveland, OH, the Mayo Clinic in Rochester, MN and Dartmouth Medical School in Hanover, NH. Email: mohanpeter44@yahoo.com.

If you talk with most health care providers today, the ACA (Affordable Care Act) is the all-consuming event in their lives. As we mentioned, this act affects almost everything in the health care arena and we can look at this at the Institutional level, affecting the health care business and at the Individual physician level.

Two eminent physician leaders in the country have chimed in as to how they see this playing out in the years ahead. Writing on LinkedIn, Dr. Toby Cosgrove, CEO of the Cleveland Clinic, and a former colleague, sees the future as follows: He sees a country in which, over the coming years, approximately thirty million people who are currently uninsured, will join the ranks of the insured and increase the demands on physicians and health care facilities to provide added services. At the same time, he anticipates diminishing physician reimbursement per patient as part of ACA. Simultaneously hospitals will not be reimbursed for preventable readmissions thereby putting additional strain on the system. Cosgrove sees hospital systems employing physicians as salaried employees with NO added incentive to physician reimbursement with regard to increased volume of procedures or for ordering increased number of lab tests to help control costs. He sees hospital consolidation as a means for efficiency in implementing electronic medical records, technology and super computers as part of the system.

Cosgrove has walked the walk even as he talks the talk. Under his leadership, the Cleveland Clinic System has evolved into a world class health care center and his views deserve careful consideration.

Dr. Eric Topol has also written extensively about the future of health care. In his book, “The Creative Destruction of Medicine” he sees the future somewhat differently. From his point of view, the future of medicine will be impacted primarily by technology. He sees algorithms replacing some of the work done by doctors today. He cites the example of EyeNETRA in which one’s refraction can be tested over the smart phone with an app that is down loaded and the cost of the whole process just a couple of dollars and a few minutes. Emailing the refraction to the optician can procure the requisite eye glasses, saving time and money. Similarly, smart phone pictures of skin lesions can help dermatologists to identify the lesion without an office visit. There currently are available subcutaneous implantable needle devices that can provide continuous reading of blood sugar, for diabetic patients over a smart phone app on real time basis just as there are similar devices that can provide the readings necessary to control blood thinners.  He sees all these technologies freeing up physicians from having to spend time on these “routine” calls from patients and be able to focus and spend time with patients on more meaningful visits.

Another area that Topol sees change occurring is in the area of individualized medicine, which is quite different from the social medicine that we practice today. With expanding knowledge and understanding of genetics, we are entering an era of individualizing medical treatments, so that they are most efficacious for the given individual. Many of the chemotherapeutic agents and antibiotics are beneficial to only select subsets and identifying those through genetic technology helps to individualize the administration of the drugs to those that benefit most from it. Some of this, and other decision-making can be done by super computers, probably just as or more efficiently than physicians. These machines can handle some of the processing that is done by physicians today. I mean, just look at IBM’s Watson for an example of what can be done!

All these lead Topol to think that a physician shortage is not a given – but moreover, the role of physicians may change from its current form to that of “humanistic compassion” and “communicative judgment”.

Predicting the future is fraught with danger, but I believe that the role of doctors in delivering health care is bound for change. At the individual physician level, some of the potential changes are outlined below.

Doctors now assume the responsibility for making the diagnosis and treating their patients.  When you think about it, this is an awesome burden—to be responsible for another human being. Multiply that by the number of patients that an individual physician cares for, and it is no wonder that they tend to develop sagging shoulders and drooping eyelids.  How can we change this?

What happens if some of these responsibilities are shared?

Many health care institutions are now developing the concept of shared caring, or teams. This helps to share responsibility and the interaction among health care professionals helps to create new ideas. The secret to success in these groups may very well be in the group assigning responsibility to individuals best suited to carry them out. A nurse practitioner, a pharmacist or a fellow physician can all share responsibility in the area where they are most competent. Thus, a pharmacist becomes a valuable resource for the team in finding the best suitable drug for the given patient and situation. This frees up the physician from addressing the issue him or herself, and the shared knowledge provides him or her with the best information, resulting in the patient receiving the best possible care.

Being at the top is lonely. By tradition, if nothing else, physicians have chosen or placed at the top of the health care provider pyramid. Sadly, at this level free and frank exchange of ideas and thoughts occur much too infrequently. True, physicians do call on colleagues for consultation, but this is mostly for expertise in areas such as cardiology, rheumatology, etc. Consultations with colleagues in the same field are, surprisingly, minimal. Very often “my patient” is my patient is the prevailing mode in care giving. Facilitating this free exchange of ideas between physicians in the same specialty is often stymied by pride, ignorance and cultural norms. Behavioral change in this existing culture is an area where change can be most effective in creating a partnership atmosphere for patient care.

Almost from the very beginning of their schooling, physicians are trained to be mistake free, because their mistakes can kill or maim. Such a culture results in the physicians over a period of time developing a defensive attitude against committing mistakes and in many cases refusing to own up to them when they do occur. And the overhanging threat of litigation only compounds this problem.  Changing practice in this regard can be beneficial both for the physicians and those they treat. Acknowledging and accepting mistakes helps minimize their occurrence in future.

What to do?

A recent Medscape Survey linked physician burnout to several factors and suggests some of the following as possible changes that would be helpful.

First, find time for yourself. This has to be a priority to be able to rejuvenate and re-energize oneself. Without that a general malaise sets in and life becomes a drag.  Adjusting your mind set to control feelings and thoughts can have powerful beneficial effect over the lives of individuals. Finding time to engage in activities other than those related to work is important for growth and even effective functioning. And as other demands occur such as parenting or caring for elderly parents, you cannot give the same undivided attention to medicine you did as a young physician. Accepting and acting on this reality is difficult for most physicians.

Most professionals realize, and accept, the need for coaches to enhance themselves. Executives, athletes, and performers all employ coaches to improve their craft. Medicine as a profession is lagging behind in this area. It may be partly because of a culture that is not used to asking for help and doing so is almost admitting loss of control. William Osler, father of medicine, lauded the value of detachment for physicians. He found this quality useful for physicians to get not too attached to the problems of the patients, so that it helps them maintain sufficient detachment for sound judgment. But as we see, the role of the physician is changing and it is moving away from just problem solving to being a partner with your patient in creating an environment where the two together create growth and wellbeing.   In other words, Emotional Intelligence becomes a significant part in the physician-patient relationship. For many doctors this is a paradigm shift. Learning to master these skills may very well determine the success or struggle within the profession. Reinventing modern physician to address the changing needs of today’s patient may very well be the most significant  thing happening in medicine today.

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