Daring to lead in medicine (Part 2)

Dr Bethany Boulton – Emergency Physician @bethany_boulton; co-founder of WRaP EM. WRaP EM event lead

Dr Charley McNabb – Emergency Physician Princess Alexandra Hospital, Brisbane

By Bethany Boulton and Charley McNabb

In part 1 of this blog, we explored the challenge of courage, vulnerability and shame in medicine. Here, we discuss the issue that if there is to be change in medicine, where do we start?

Workplace culture could be the perfect place. Culture is defined as the accepted way that we do things in the workplace. These are the unwritten rules for communication, behaviours and how we interact with each other in our workplace.

Brené has decades of solid academic research showing that courageous clinical leadership can create culture change, and rescue staff and patients from the damaging spiral of shame. She has interviewed hundreds of leaders across industries including healthcare. The future of leadership is relationship, not brawn – intellect and brain, but with heart.

According to Brené, courageous leadership is a set of four skills that can be taught and measured:

1. Rumbling with vulnerability
2. Living our values
3. BRAVING trust
4. Learning to rise

Rumbling with vulnerability

To rumble with vulnerability is to have that difficult conversation, without the armour, but with curiosity, and to “listen with the same passion with which we want to be heard”.

Living our values

Living our values is exactly that – walking the talk and leading by example. Many of our organisations have “values” but how many of them are linked to specific behaviours that we can recognise and acknowledge? We need to increase our level of self-awareness including awareness of our behaviours.

In medicine these may include:

I give feedback in a respectful and daring way.

I do what I say I am going to do. 

I own my mistakes and discuss them in an open and honest way.

I talk to you, not about you.

I challenge or question the status quo or traditional way of doing things and am open to new ideas even when things are going well.

I’m willing to ask for help. 

I’m willing to put myself out there even if it means getting criticised or put down.

I don’t judge others when they ask for help. 

I am fully engaged. For example, you won’t hear me saying things like, “It’s not my job” or “It’s not my problem” or “I don’t care,” or showing up in a way that indicates that I don’t care or that I’m unwilling to own problems.

I’m prepared to offer my point of view to the team. 

In Dare to Lead, Brené writes:

“One reason we roll our eyes when people start talking about values is that everyone talks a big values game but very few people actually practice one. It can be infuriating, and it’s not just individuals who fall short of the talk. In our experience, only about 10 percent of organizations have operationalized their values into teachable and observable behaviours that are used to train their employees and hold people accountable.

Ten percent.

If you’re not going to take the time to translate values from ideals to behaviours—if you’re not going to teach people the skills they need to show up in a way that’s aligned with those values and then create a culture in which you hold one another accountable for staying aligned with the values—it’s better not to profess any values at all. They become a joke. A cat poster. Total BS.”

BRAVING Trust 

Vulnerability, Brené says, is the birthplace of innovation, creativity and change. When we can show courage and be vulnerable, we build trust. With trust, we deepen relationships and connectedness; we develop the empowering culture we all crave, and that provides the clinically excellent scaffold to deliver our patients’ care.

The seven elements of building trust according to Brené are (BRAVING):

• Boundaries – we set and respect boundaries and ask when they’re not clear
• Reliability – we do what we say we are going to do
• Accountability – we own our mistakes, we apologise and make amends
• Vault – we share only our own stories
• Integrity – we choose courage over comfort and do the right thing even when it’s hard
• Non-judgement – we ask for what we need and can talk without feeling judged
• Generosity – we extend the most generous interpretation possible to the intentions, words and actions of others

Learning to rise 

If we are living our best life, being both courageous and vulnerable, showing up and having a go, there is nothing surer than we will sometimes fail. In medicine, failing can have catastrophic consequences and so we have been conditioned to expect perfection – which is simply impossible. The most important thing we will ever do as doctors is learn how to manage the suffocating shame of making a clinical mistake, find something valuable to learn from the experience, get back up and keep on going.

Courage is contagious.

“To scale daring leadership and build courage in teams and organizations, we have to cultivate a culture in which brave work, tough conversations, and whole hearts are the expectation, and armour is not necessary or rewarded. We have to be vigilant about creating a culture in which people feel safe, seen, heard, and respected.” Brené Brown

Daring leaders never stay silent about hard things. They put more value on getting it right than BEING right. We can all be leaders, if only we dare to lead.

References

Brown Brené. (2018). Dare to lead: brave work, tough conversations, whole hearts. New York: Random House.