Summative Conclusions

(Sheehan, n.d.)

I love to run. It is a five a.m. gut-wrenching, lung-stabbing, leg-murdering war with myself. Every day, my alarm clock rings and it begins. My brain says, “Stay and sleep a little longer.” But I get up anyway. In the first few minutes, my legs whisper, “Just go a little slower.” But I keep pace. Halfway through, my lungs scream, “Cut it short!” But then I see the sunrise over the trees, and push the full distance. It is ugly and shout-y and I will never win anything ever because I am not fast.

But when I get home, breathless and sweaty and shaking, it is worth it. Every single step. I’ve won again against my (worser?) self.

This is leadership. And growth. And life. It is a series of small, unromantic, difficult steps. It is listening to the small things inside my head and choosing what to believe and how to act it out. It is, as Ann Voskamp says, the physical and mental brokenness of running that reminds me I am strong (Voskamp, 2016, 18 October).

The “people” parts of leadership are just as painful (for me) as running. My strong Introverted-Intuitive-Thinking-Judging (INTJ) personality says, “You don’t have to care about other people. Emotions aren’t important” (16Personalities, 2017). My rational side says, “You can skip the relationship. More work will get done that way.” My anger says, “Just get it out. Everyone will feel better” (Thomas & Killman, n.d.). My conflict style says, “Make sure and get your way because you are definitely right” (Ingram & Johnson, 2010).

(Tolkien, n.d.)

Of course this is all terrible advice. People matter. Relationships matter (Porter-O’Grady & Malloch, 2015). And just because these awful thoughts and feelings and beliefs come naturally does not mean that I should trust them. Listen to them? Of course. It is critical to hear and acknowledge yourself, but that is only the first step on the world’s longest five a.m. slog (McHugh, 2013, 15 February). The conversation sounds something like this, “Yes, I feel like I should push ahead but I am going to stop and take time for relationship.” And if you are like me, it is thousands of these internal assessments that build up to growth.

When the slog gets especially dreary, I fall back on the “why” (Sinek, 2009, 28 September). For running, reviewing my long family history of early death from diabetes, heart disease, and obesity pretty much does the trick. As a nurse I am well aware that even the most perfect lifestyle does not come with a guarantee, but this is not an excuse to make poor choices. Besides, how else am I supposed to stay in good enough shape to “wide bikes to the pway-gwound” with the two best little girls in the world?

My nursing and leadership “whys” are rooted more deeply. I am a nurse because “being with” someone at his or her most vulnerable is a powerful and humbling experience. I would happily give up the whole list of nursing tasks, technology, and procedures for the privilege of supporting a dying patient and their loved ones.

(Angelou, n.d.)

Seriously….how much more meaningful and real can it get? (Not much more).

The leadership part is tough. I am not naturally sparkly. The emotional, feeling, “soft” side comes with much difficulty when it is a colleague instead of patient on the other side. And so why am I a leader? Some days I am not sure. Other days, when I have removed a barrier or taught something new or just listened and I see the nurse connect the dots…I remember that my leadership “why” springs from wanting others to know theirs. Unfortunately this means I have to step outside myself and get curious (McHugh, 2013, 15 February). I have to reach out, learn about uniqueness, and change my approach appropriately. I have to give my fellow introverts the time and space to think and process. I must be sparkly enough to engage those pesky extroverts because I am the leader and it is my job to seek them out (Cain, 2012, 2 March). One team I lead is an interesting mix. In meetings I come prepared to be bright and talkative, and make sure I spend time with the two extroverts just “chewing the fat.” Later that day I seek out the introvert in the group, and solicit her feedback in a conversation that is filled with thoughtful silence. This works well, and I get really incredible input from all three colleagues. It is in stark contrast to just a few months ago when I was less thoughtful about my approach. The extroverts dominated meetings and said I did not seem engaged because I was “too quiet”. The introvert would provide input in a hallway conversation days after the meeting when it was too late to change course. It was a disaster. Learning to manage this team (and myself) has been tough. The whole growth process is not about me and sometimes deep down (or not so deep down) I don’t like it.

To top it off, I must do all this messy sweaty growing in public (Brown, 2010, June). For all to see. Because the best leaders are comfortable with change and live it out loud. How else will others learn how it’s done? I cannot expect anything from anyone that I refuse to do myself. For example, as a quality professional much of my work involves asking others to change their practice. Good leadership says that therefore I must be willing to change my own practice (Porter-O’Grady & Malloch, 2015). This means listening to ideas, changing the plan (or scrapping it and starting over), and acknowledging that there may be a better way. And as I said before…I have to do this ugly vulnerable work where others can see. The perfectionist part of me HATES this. I would rather practice something a thousand times in private than mess it up once while someone else is watching. Unfortunately, this pursuit of perfection does not accomplish anything (Goldman, 2015, 15 January). It simply perpetuates the silent, error-shunning culture that stifles good healthy transparency (Goldman, 2015, 15 January). It begs the question…What if we all were open and honest about our mistakes? How much more would we know today if we owned up to what went wrong? Would our patients be safer? The concept of just culture (focusing on transparency and systems-level management of errors while holding staff responsible for behavior) says yes to all three of these questions (Porter-O’Grady & Malloch, 2015). And this culture begins with me. The leader. Modeling it and expecting it (Porter-O’Grady & Malloch, 2015).

The rational part of me (which is most of me) wants to stop here. So let’s stop. Because up to this point, I’ve referenced high concepts and used metaphors and talked about things like growth and struggle. And it’s been good and thought-provoking and perhaps insightful. Unfortunately, fancy high-level talk only gets a person so far. It is the actual implementation of actual behavior that actually makes a difference.

(Lewis, n.d.)

So how do I, the rational (somewhat unfeeling) introvert of introverts, put over eight hundred words of my own advice into action? First, I need to get out of my own way (Abraham, 2015, 24 March). I must stop agonizing over the “right” answer and instead seek out and engage colleagues in honest collaboration (Abraham, 2015, 24 March). In getting out of my own way, I must acknowledge my own fallibility and come to terms with how failure (in public) feels (Ledgerwood, 2013, 22 June). It might never be comfortable, but it will always be critical. A few weeks ago, I had an opportunity to practice this at work. I participated in an event targeted at improving the hospital value analysis process. This process involves the nitty gritty details of finding great patient care products, getting everyone to agree that said products are great, getting the financials and logistics all worked out, and then planning for implementation. Unfortunately I was asked for input because I had recently made a rather large oversight error in the “getting everyone to agree that said products are great” step. The error was absolutely related to defects at the systems level, but I still felt terrible. I wanted to hide. Instead, I bucked up and talked about what happened and how it affected staff. Through this, I learned that others had made a similar mistake, and I was able to contribute to a systems-level solution. I still felt vulnerable and kind of terrible, but at least it was productive!

So that was step one…being vulnerable (yuck!).

The real work comes next. Engaging others is hard. I must be curious about my colleagues and seek to know them (McHugh, 2013, 15 February). I must learn how every colleague lands on the introvert/extrovert continuum (Cain, 2012, 2 March). Knowing (in part) a team member’s uniqueness allows me to frame communication and assign work in the best possible way (Semler, 2015, 15 February). This transformative leadership style honors everyone, facilitates group ownership of the project, and levels the playing field to maximize productivity (Porter-O’Grady & Malloch, 2015). 21^st century leadership principles suggest that motivation is primarily intrinsic, supporting the need for relationship and trust-building in the search for long-term success and sustainability (Porter-O’Grady & Malloch, 2015). As Dr. Tim Porter-O’Grady said in a 2016 presentation, “You cannot have accountability without ownership” (2016, 23 April). I am currently applying this incredible insight to my work with pressure injury prevention. As I round with nurses, I focus first on their perception of this critical indicator, and ask for feedback. I try and say things like, “This is your patient, and you know them best. What do you think about (x)?” Of course I still provide correction if necessary, but in a more collaborative way that respects the nurse’s expertise. It is too early to see an effect in patient outcomes, but each conversation feels more engaged and meaningful (Gawande, 2012, 2 November).

(King, n.d.)

A simple illustration called The Elephant and the Rider breaks staff engagement and change management down beautifully (4-H iGrow Video Resources, 2014, 25 September). The first step to getting an elephant and its rider to take a new path is to give clear directions. I use this a lot in my work. Communication is key here, “Use this new checklist.” Hard-wired alerts in the electronic health record are also helpful, “Are you sure you want to order this medication?” Quality improvement teams appreciate clear direction as well, “Our short term goals are x and x. These small steps will build to achievement of our long term goal of y.” After experience as a nursing leader and quality professional, this step is pretty easy. Simple messages, tools, and resources delivered at the right time and at sufficient volume tell the rider where to go (4-H iGrow Video Resources, 2014, 25 September). Jesus exemplifies this servant leadership mentality. He understood what the people needed through the principle of “being with” and came up with simple solutions. Think about it! In Matthew 22:37-39, He condenses life into two edicts; Love your God and love your neighbor (New International Version). Amazing stuff. It tells the rider exactly where to go.

And hence lies the sticky piece…motivating the elephant (4-H iGrow Video Resources, 2014, 25 September). Because the rider and elephant only go there if they want to (Porter-O’Grady & Malloch, 2015). This is where the transformative leadership as discussed above kicks in. And it is hard. I’ve talked a lot about how I plan to do this (seeking to know others and individualizing my approach accordingly) so I won’t waste time rehashing. What I will say is that the most successful projects are deeply owned by the team (Sinek, 2009, 28 September). Everyone is invested and cares fiercely about the work and one another. In my experience, if you can get to this point with a team, you’ve got it made. One of the teams I lead is like this. We can accomplish more in a thirty-minute meeting than most other groups can in six months. We all want the project to succeed because it is ours, and so everyone comes prepared to plan and leaves ready to do what needs to be done. I can’t take credit for it entirely. It’s a variety of things coming together; amazing executive leadership, the right mix of staff, and several years of sweaty effort. This work is saving lives, and if I could bottle it I would…well I would still probably work because nursing is the best but I’d also have a yacht or something. It’s that good.

(Safina, 2013, 28 June)

Once you have (magically?) convinced that elephant that it wants to move, you smooth the path (4-H iGrow Video Resources, 2014, 25 September).  This step is unglamorous and frustrating and infuriating and satisfying all at the same time. It’s about busting assumptions, knocking down barriers, and finding a new way to go (Porter-O’Grady & Malloch, 2015). It is being like Jesus and doing what needs to be done so that others can move forward. Think about Jesus for a minute. He suffered. Washed feet. Made wine. He loved and lost and cried and taught and performed incredible miracles. And then he died so that we could find our way to The Father. He smoothed the path.

Of course I will never measure up to Him. But I can sure try. I must listen closely and devote my time and the team’s time to making it easy to do the right thing (Porter-O’Grady & Malloch, 2015). Through this, if the way is clear and smooth and looks pretty good, the traffic will come (4-H iGrow Video Resources, 2014, 25 September). In my work, this step is rooted in strategies like automation, keeping information to a one-sided, large print document, and minimizing steps. A great example is my organization's work on sepsis. We have a nurse-initiated process that empowers those at the bedside to assess and act. It is great. Really great. However, two years ago I was getting a lot of feedback about the many steps it took for the nurse to complete not only patient care, but also notification of other team members (provider, laboratory, patient placement, pharmacy, IV team, etc.). To smooth the path, a group of nurses and I designed and implemented an automated pager-related communication that sent an urgent message to the team when the nurse placed the process initiation order in the the electronic health record. It only saves about two minutes, but our process use rate went up. Way up. More patients with sepsis were being identified early all because of a (relatively) small improvement. The hospital really is a complex adaptive system (Porter-O'Grady & Malloch, 2015)! In more traditional, machine-like systems there is no way a two-minute reduction would have such a large effect on the whole process (Porter-O'Grady & Malloch, 2015). In general, smoothing the path works, especially when the rider helps by pointing out the bumps. 

(Diamond Roads US, 2017)

Wow. Step two of “Better Leader 2017” got wordy. So let’s recap. Step one…get out of my own way. Step two…engage others because they matter. Step three…repeat steps one and two over. And over. And over. Fail publicly. Grow where others can watch. Get out and run.

References

[4-H iGrow Video Resources]. (2014, 25 September). The elephant and the rider. [Video file]. Retrieved from https://www.youtube.com/watch?v=-XYxudAQk5w

16Personalities. (2017). Architect personality (INTJ). Retrieved from https://www.16personalities.com/intj-personality

Abraham, M. [Big Speak Speaker's Bureau]. (2015, 24 March). Think fast, talk smart communication techniques. [Video file]. Retrieved from https://www.youtube.com/watch?v=S1IaLvRYBnw

Angelou, M. (n.d.). Quote. Retrieved from https://www.nursebuff.com/nursing-quotes/

Brown, B. [TED Talks]. (2010, June). The power of vulnerability. [Video file]. Retrieved from https://www.ted.com/talks/brene_brown_on_vulnerability

Cain, S. [TED]. (2012, 2 March). The power of introverts. [Video file]. Retrieved from https://www.youtube.com/watch?v=c0KYU2j0TM4

Carr, J.L. (2016, 12 September). A secret to parenting that no one tells you: The strength is in the struggle [Blog post]. Retrieved from http://annvoskamp.com/2016/09/a-secret-to-parenting-that-no-one-tells-you-the-strength-is-in-the-struggle/

Diamond Road US (2017). Road smoothing. Retrieved from http://www.diamondroad.us/specifications/road-smoothing/

Gawande, A. [HarvardEducation]. (2012, 2 November). Atul Gawande: The difference between coaching and teaching. [Video file]. Retrieved from https://www.youtube.com/watch?v=VabtGPVVihA

Goldman, B. [TED Talks]. (2012, 15 January). Doctors make mistakes: Can we talk about that? [Video file]. Retrieved from https://www.youtube.com/watch?v=gKqYMpWZbV8

Ingram, C. & Johnson, B. (2010). Overcoming emotions that destroy: Practical help for those angry feelings that ruin relationships. Grand Rapids, MI: Baker House.

King, S. (n.d.). Alone. Retrieved from http://legendsquotes.com/tag/stephen-king-quotes/page/3/

Ledgerwood, A. [TEDx Talks]. (2013, 22 June). Getting stuck in the negatives (and how to get unstuck). [Video file]. Retrieved from https://www.youtube.com/watch?v=7XFLTDQ4JMk

Lewis, C.S. (n.d.). Hardships. Retrieved from http://dustoffthebible.com/Blog-archive/2015/12/02/the-best-cs-lewis-quotes/

McHugh, C. [TEDx Talks]. (2013, 15 February). The art of being yourself. [Video file]. Retrieved from https://www.youtube.com/watch?v=veEQQ-N9xWU

Porter-O'Grady, T. [AONE Nurse Leader]. (2016, 23 April). AONE thought leader: Tim Porter-O'Grady. [Video file]. Retrieved from https://www.youtube.com/watch?v=ytAV0jcIVPc

Porter-O’Grady, T. & Malloch, K. (2015). Quantum Leadership: Building better partnerships for sustainable health (4th ed.). Sudbury, MA: Jones & Bartlett.

Safina, C. (2013, 28 June). An elephant named Tim. Retrieved from http://www.huffingtonpost.com/carl-safina/an-elephant-named-tim-by-_b_3174913.html

Semler, R. [TED]. (2015, 10 February). Ricardo Semler: Radical wisdom for a company, a school, a life. [Video file]. Retrieved from https://www.youtube.com/watch?v=k4vzhweOefs

Sinek, S. [TEDx Talks]. (2009, 28 September). Start with why: How great leaders inspire action. [Video file]. Retrieved from https://www.youtube.com/watch?v=u4ZoJKF_VuA

Sheehan, G. (n.d.). Going the distance. Retrieved from http://www.shape.com/fitness/24-motivational-quotes-athletes-and-runners

Thomas, K.W. & Kilmann, R.H. (n.d.). Thomas-Kilmann conflict mode instrument. Retrieved from http://www.kilmanndiagnostics.com/catalog/thomas-kilmann-conflict-mode-instrument

Tolkein, J.R.R. (n.d.). Tears. Retrieved from http://wordables.com/j-r-r-tolkien-quotes/

Voskamp, A. [zondervan]. (2016, 18 October). The broken way small group bible study by Ann Voskamp: Session one. [Video file]. Retrieved https://www.youtube.com/watch?v=wIBvu_udMqA

Healthy Organizations

(Doig, n.d.)

I was born into this world, faults and all, and the world just keeps happening to me.

Some good things happened. Love. Motherhood. Meaningful work. My cat.

Some less-good things happened. I struggled through postpartum depression (twice), and grew to be gentler and softer. My base personality (INTJ) can be quite harsh and unforgiving, but I learned through this challenge to take a deep breath and give others space to be human (it is hard on all of us) (Voskamp, 2016, 18 October). Though struggle is necessary for growth, there is no fathomable reason why we shouldn't all make things a little easier on one another. As a leader, I now ask questions like, "What could be influencing this person's behavior?" instead of assuming that he or she is performing poorly on purpose. I try to stop and listen and treat my colleagues (and people in general) as gently as I would my patients. (Voskamp, 2016, 18 October). I do not succeed at this every time. Thankfully, I know in part what it is like to be broken, and this knowledge drives me to try again tomorrow.

Our house wouldn't be the same with a cat (or two)

The Anger Profile survey and the Thomas-Kilman Conflict Mode assessment also remind me that I have work to do. I tend to communicate anger quickly, just to get it out and get it over. I have found that this method can feel abrupt and even aggressive to others. It does help that I do not naturally exhibit some aspects of the "Spewer" profile such as yelling, use of profanity, and violence (Ingram & Johnson, 2010). This is probably due to my upbringing, where I learned that it was okay to be angry, but not okay to treat others with disrespect. There are still times where I force myself to slow down, take a breath, and move on without making a small thing a big issue. Asking the question, "Will I care about this next week?" usually diffuses my frustration enough to derail the anger train. This is also helpful in conflict, as I tend to compete (Thomas & Kilmann, n.d.). My second-highest conflict tendency is compromise, a technique I intentionally implemented after learning that "winning" causes more problems than it solves (Thomas & Kilmann, n.d.).

All in all, I was not surprised by the results of the anger and conflict assessments. I am an objective, goal-oriented person who cares deeply about many issues. These qualities, though generally positive, do not excuse cold, harsh behavior. I must temper my strong convictions with calmness, listening, and respect for others (Thomas & Kilmann, n.d.). And again, it all starts with a simple question, "Will I care about this next week?"

(Hale, n.d.)

Dr. Dave Moen's thoughts on patient-centered care tie in nicely with my struggles to stop and see the person (patient) on the other side (Moen, 2012, 9 August). Healthcare professionals are trained to manage medical issues safely, but as Dr. Moen points out we are ill prepared in the crucial relationship-building aspects of providing care (Moen, 2012, 9 August). My nursing education taught me to complete physical assessments, administer medications, insert indwelling urinary catheters, place IVs, and so on. I did not learn how to talk with the homeless diabetic about diet control and smoking cessation. I had no idea what to say to a patient with suicidal ideation. Assertive conflict and competing will not work for these (and many other) patients. It takes a relationship, and I did not learn how to do this in school (Moen, 2012, 9 August). 

Fred Lee heartily agrees with Dr. Moen. Mr. Lee expands on the difference between objective, measurable patient satisfaction and the arguably more valuable yet less concrete patient experience (Lee, 2011, 6 April). Patient satisfaction gauges how I performed my tasks (assessment, medication administration) while the patient experience describes the relationship between the patient and nurse (Lee, 2011, 6 April). There is no better feeling (in my opinion) than "nailing" the patient experience. Most of the time, it involves going off-script (Lee, 2011, 6 April). Phrases like "It is my pleasure" and "Is there anything else I can do for you?" are helpful, but impersonal. My patients appreciated the respectful language, but it rarely helped me bridge the gap to a real therapeutic relationship. In my experience, the homeless diabetic wants to show someone pictures of his dog and the patient struggling with suicidal ideation is a voracious reader who loves to talk about literature. When I left the script behind and just enjoyed the dog pictures, that patient was more willing to engage in his healthcare. This rapport is where the real nursing starts (Robbins, 2015, 9 July). And I did not learn how to do this in school. 

Love this quote (Erikson, n.d.)

Crucial conversations is a required leadership course at my organization. I find it to be useful in resolving conflicts related to resources (Grenny, 2012, 14 December). As a quality professional much of my work depends on convincing others to do things for me. Starting the conversation at a point of shared knowledge, such as the need to improve patient safety or follow best practice, is effective (Grenny, 2012, 14 December). However, viewing crucial conversations in a more human, reflective context has provided me with additional insight. In many crucial conversations (especially with patients), the shared knowledge is simply, "You are unique and I think you matter." In my bedside career I used this (not knowing what it was called) with good success. However, there is great opportunity to use this same tactic with colleagues, especially millenials (like myself). For this group, difficult conversations about needed practice changes or resource allocations may not stand on the objective "why" alone. According to Simon Sinek, this newest generation in the workforce craves meaning and impact, both of which absolutely require relationship (Sinek, 2016, 29 October). What if I started colleague conversations from a "you matter" standpoint as well? Would it make a difference? I think it is worth a try. This ties back to my daily struggle of treating my colleagues with the same gentleness that I would my patients. 

(Pick the Brain, 2013, 13 May)

Caroline Goyder and Matt Abrahams provide great insight in preparing to have a difficult conversation. As an introvert, I do well on stage but struggle with anxiety in one-on-one situations, especially when the topic is "crucial". Ms. Goyder recommends using the diaphragm and conscious, intentional breaths to slow down and relax (Goyder, 2014, 24 November). Mr. Abrahams supports nearly the same technique, suggesting deep breaths while recognizing and naming anxiety (internally) (Abrahams, 2015, 24 March). I learned deep controlled breathing a few years ago from a patient relations colleague while I was still working at the bedside. These methods are effective in reducing my anxiety but unfortunately do not help me understand how to make small talk. As I have mentioned in previous blogs, this skill continues to elude me...

Another great tip from Mr. Abrahams that I had not considered is staying out of my own way (Abrahams, 2015, 24 March). My analytical mind loves to overthink things while searching for the "best" response, and tends to go into overdrive when I am put on the spot unexpectedly. When this happens I trip over my words and struggle to put together a coherent sentence. Mr. Abrahams calls this stockpiling, and defines it as the brain working so hard to find the right answer that it makes things worse. He recommends training the brain to think more freely in spontaneous interactions (Abrahams, 2015, 24 March). Many times, the knowledge is there but I need to let it flow naturally. I look forward to using deep breathing and forcing my brain to "take a chill pill." Stay tuned for results in next week's blog!

Love these cartoons...I always identify with Brain! (Awkward Yeti, 2017)

As I consider my personal (imperfect) approach to communication and conflict, my thoughts move to these topics at the systems level. Patrick Lencioni, in discussing team dysfunction, lists trust as the critical precursor to a healthy professional relationship (Lencioni, 2013, 9 July). Many of the methods discussed above contribute to trust. Leaders must know their anger and conflict styles and work to improve. Leaders must approach conflict from a place of shared understanding. Leaders must go "off script" and seek to know others. These behaviors are respectful and contribute to a healthy workplace (Porter-O'Grady & Malloch, 2015). I am lucky to be employed at a generally positive, supportive education where toxicity is not tolerated. Executives uphold high expectations for staff conduct towards patients and colleagues. That said, I have encountered individual toxic co-workers whose negative, dismissive, disrespectful behavior can infect an entire nursing unit (Porter-O'Grady & Malloch, 2015). Early in my career, a toxic nurse was tolerated if he or she was considered clinically competent. Excuses like, "he is a bit grouchy, but his care is really excellent" were common. Unknowingly, I internalized this knowledge until a nurse leader in my organization posed a question...

"Is a nurse who treats his or her colleagues with disrespect still a good nurse?"

This stopped me in my tracks. Of course, the answer to the question is "no". We are all responsible for one another, and for the culture of our workplace. Leaders must consider the whole person, and must avoid excusing incivility for the sake of clinical competency (Porter-O'Grady & Malloch, 2015). Since that day I have consciously worked to avoid toxicity in my own practice because I want to be a good nurse.

I will end this blog post as I have concluded others...with the resolution to do a little better every day through reflection, knowledge-seeking, and lots of hard work. Thanks for joining me on the journey.

I know it's not fall, but this is my favorite quote about growth through struggle (LifeWay Women, n.d.)

References

Abraham, M. [Big Speak Speaker's Bureau]. (2015, 24 March). Think fast, talk smart communication techniques. [Video file]. Retrieved from https://www.youtube.com/watch?v=S1IaLvRYBnw

Awkward Yeti (2017). Instant Gratification. Retrieved from http://theawkwardyeti.com/comic/instant-gratification/

Doig, I. (n.d.). Quotes. Retrieved from https://quotefancy.com/ivan-doig-quotes

Erikson, V. (n.d.). Getting to know someone. Retrieved from https://www.pinterest.com/explore/getting-to-know-someone/

Grenny, J. [VitalSmarts Speakers]. (2012, 14 December).Crucial conversations: Joseph Grenny. [Video file]. Retrieved from https://www.youtube.com/watch?v=PuJgqTs-G44

Goyder, C. [TEDx Talks]. (2014, 24 November). The surprising secret to speaking with confidence-Caroline Goyder-TEDxBrixton. [Video file]. Retrieved from https://www.youtube.com/watch?v=a2MR5XbJtXU

Hale, M. (n.d.). Quotes. Retrieved from https://www.pinterest.com/pin/60869032434485857/

Lee, F. [TEDx Talks]. (2011, 6 April). TEDxMaastricht-Fred Lee -Patient satisfaction or patient experience? [Video file]. Retrieved from https://www.youtube.com/watch?v=tylvc9dY400

Lencioni, P. [Jon T]. (2013, 9 July). Patrick Lencioni-The 5 dysfunctions of a team. [Video file]. Retrieved from https://www.youtube.com/watch?v=inftqUOLFaM

Moen, D. [TEDx Talks]. (2012, 9 August). The future of patient-centered care: Dave Moen at TEDxUMN. [Video file]. Retrieved from https://www.youtube.com/watch?v=hUsyuloD198

Ingram, C. & Johnson, B. (2010). Overcoming emotions that destroy: Practical help for those angry feelings that ruin relationships. Grand Rapids, MI: Baker House.

Pick the brain (2013, 13 May). Take a deep breath. Retrieved from https://www.pickthebrain.com/blog/3-surprising-ways-a-deep-breath-can-reduce-your-anxiety/

Porter-O’Grady, T. & Malloch, K. (2015). Quantum Leadership: Building better partnerships for sustainable health (4th ed.). Sudbury, MA: Jones & Bartlett.

Robbins, T. [Shari Leanne]. (2015, 9 July). The art of effective communication: Tony Robbins. [Video file]. Retrieved from https://www.youtube.com/watch?v=meLbMg7ySU4

Sinek, S. [David Crossman]. (2016, 29 October). Simon Sinek on millenials in the workplace. [Video file]. Retrieved from https://www.youtube.com/watch?v=hER0Qp6QJNU

Thomas, K.W. & Kilmann, R.H. (n.d.). Thomas-Kilmann conflict mode instrument. Retrieved from http://www.kilmanndiagnostics.com/catalog/thomas-kilmann-conflict-mode-instrument

LifeWay Women (n.d.). How beautiful. Retrieved from https://uk.pinterest.com/pin/200199145913712182/

Voskamp, A. [zondervan]. (2016, 18 October). The broken way small group bible study by Ann Voskamp: Session one. [Video file]. Retrieved https://www.youtube.com/watch?v=wIBvu_udMqA

Emotionally Competent Leadership

(Ten Boom, n.d.)

As the cool kids say, Corrie Ten Boom is my spirit animal. This incredible woman spent the first half of the Second World War protecting the Jewish people and the second half in prison for her work in the Dutch underground. After her eventual release, Ten Boom returned to her home and began again the labor of providing shelter and love to everyone affected by war...including German soldiers (Ten Boom, 1971).

Ms. Ten Boom exemplifies emotional intelligence. Her capacity to forgive, move on, and lead the hurting challenges me to be better.

A 2015 article in Time details a great list of emotionally intelligent qualities (Bradberry, 28 April, 2015). Of course, I see both personal strengths and opportunities in the list. I am naturally thick-skinned, and have never been disposed to hold a grudge. Years of nursing experience honed my ability to judge character. Growing up in a house rich with love (and not much else) taught me to count what I have, and have that be enough. I am grateful for these strengths, and the experiences that built them (Bradberry, 28 April, 2015).

The group of opportunities was just as easy to define (although less pleasant to think about). As an introvert who is happy to be silent and alone, I must make a conscious effort to get to know others. I do not have an innate need to know people. My family and a very few close friends provide plenty of love and belonging. I also struggle to let go of mistakes and the need for perfection (Bradberry, 28 April, 2015). Holding myself to an unattainable standard does not accomplish anything (unless you count pacing and laying awake at night as accomplishments).

I am not good at being "the second kind of people" (Collins, n.d.)

Dr. Brene Brown's incredible thoughts on vulnerability hit right in the center of my weaknesses. I am not good at being vulnerable. It is uncomfortable and invasive. I have watched her talk several times now, and each time I am convicted to live vulnerability out loud (Brown, 2010, June). At work, I am a change agent and staff must see me growing and learning (Porter-O'Grady & Malloch, 2015). At home, I have two beautiful little girls who (most of the time) want to be just like Mommy. I must show them the struggle as well as the results, or risk setting them up for failure (Brown, 2010, June).

They make me want to be someone worth admiring

These learnings translate well to hiring practices. Though I do not currently have direct reports, I often am invited to interview prospective front-line and mid-level leaders from the quality perspective. I am glad to report that my organization focuses on choosing the "best fit" for the organization from a variety of perspectives. In nursing, we often discuss that nursing tasks such as medication administration are objective and relatively easy to teach. In contrast, emotional intelligence is fluffier and harder to learn in a twelve-week orientation (Porter-O'Grady & Malloch, 2015). Of course establishing clinical competence is important, but hiring on this alone is not advisable (Thygesen, 2014, 21 April). I also want to know how the candidate handles making a mistake or how he or she treats team members on a busy day (Thygesen, 2014, 21 April). Understanding the real impact of emotional intelligence may not change my interviewing practice, but it certainly helps to know that the "best fit" approach is solid (Thygesen, 2014, 21 April).

Dr. Henry Cloud's tips on avoiding leadership pitfalls are simple yet poignant (Cloud, 2014, 24 June). The list reads more like a how-to guide for life in general, and has broad applicability. My favorite is phrased at my organization as, "Don't repeat the same thing over and over and expect different results." One missing item is that the best thing is not always the easy thing. Dr. Cloud's thoughts feel very positive (almost to a fault), and do not account for the healthy struggle and growth necessary to move forward (Porter-O'Grady & Malloch, 2015). A recent article in the Online Journal of Issues in Nursing supports the need for struggle, specifically related to acquisition of wisdom in nursing (Matney, Avant, & Staggers, 2016). In addition to knowledge, the authors called out openness to learning and the capacity for reflection as critical antecedents to wisdom. I find it intriguing that reflection and openness are best framed as emotional intelligence qualities (Porter-O'Grady & Malloch, 2015). Connecting this back again to hiring practices, I wonder if subsequent study of nursing wisdom will find that an emotionally competent nurse with fewer years of care experience is preferable to a less self-aware clinical expert. I look forward to (hopefully) finding out!

Sad but true (DumpaDay, n.d.)

A video that details the importance of derailing our internal assumption train ties in with emotional intelligence (Maber, 2012, 15 October). In the hiring example above, the newer yet more aware nurse may has the ability to stop, assess a situation objectively, and perhaps move forward believing in the the other party's good intentions. This skill is priceless in the fast-paced, emotionally-charged healthcare environment (Porter-O'Grady & Malloch, 2015). I work everyday to force myself back to Maber's bottom rung and review the facts (Maber, 2012, 15 October). This is usually enough to bring me back to reality and see the situation with fresh eyes. Dr. Daniel Goleman calls this self-management, or the ability to recognize and harness emotions (Goleman, 2012, 23 April). Empathy is another one of Dr. Goleman's emotional intelligence (EQ) principles (Goleman, 2012, 23 April). I struggle with this one, especially in the context of work relationships. I am naturally emotionally steady and cannot remember the last time I cried. I just don't know what to do with colleagues whose emotions are more pronounced. This is a big area of opportunity for me, and I have yet to figure it out.

One (now retired) leader at my organization really had EQ nailed down. Her ability to stay steady and focused was almost super-human. A few years ago, this leader delivered a difficult message to my team. Though she remained calm, she was able to empathize with the wide range of emotions and help us to a point where we could resume our patient care duties. This balance of focus and emotional understanding remains a gold standard for me today. As I remarked earlier, I am good at staying calm but not so good at being with co-workers who are not. I later learned that her incredible skill was the result of years of practice...and so I jump into the ring every day and try to do a little better each time.

(Aristotle, n.d.)

My co-workers would wholeheartedly agree with both my strengths and weaknesses. I am widely known to be matter-of-fact and unemotional. In fact, a previous leader colleague of mine still jokes that anytime one of our staff started to cry, I would immediately send them to her. Thankfully the hospital is full of emotion, which gives me lots of opportunity to practice!

I love the statement of Porter-O'Grady and Malloch (2015), which asserts that true leadership is read between the lines. This is evident at my organization, where influence and relationship are highly valued. Much of my work happens through leading multidisciplinary teams whose membership ranges from bedside nurses to executive leaders. I would not accomplish anything if this type of organic leadership was a myth.

Ah, millenials. It seems like any modern leadership discussion must include this topic. I fall just outside, or just inside the millenial generation. It depends on who is setting the boundaries. According to Simon Sinek, the year of my birth kicked off this group of "challenging employees" (Sinek, 2016, 29 October). I find it interesting (and a bit insulting) that Mr. Sinek generalized the difficulties of today's young adults and distilled them into a neat box called failed parenting (Sinek, 2016, 29 October). My (wonderful) upbringing was nothing like he described. Mom and Dad were strict, had high expectations, and made sure I learned early on that the world does not owe me anything. Despite this conservative (and loving) approach, the stiff confines of the workplace still chafe. The incorporation of technology is too slow, dress codes too outdated (who cares about pantyhose?), and the work environment too controlled. Before I get too worked up, I'll end with this...
I do not want my leader to focus her time learning to lead millenials. I want her to focus on leading me. And I promise to do the same.

All in all, I am a calm, focused, self-aware. part-time millenial who needs to work on empathy, cultivating a desire to know others, and being comfortable in the presence of my colleagues' emotion. I have learned that the best way to gain wisdom in these gaps (according to the nursing literature) is through knowledge, openness, and reflection (Matney et al., 2016). So I guess that's what I'll do.

Pure joy

References

Aristotle (n.d.) Quote. Retrieved from http://inspiration.allwomenstalk.com/quotes-about-emotional-intelligence-to-make-you-think

Brown, B. [TED Talks]. (2010, June). The power of vulnerability. [Video file]. Retrieved from https://www.ted.com/talks/brene_brown_on_vulnerability

Bradberry, T. (2015, 28 April). 18 behaviors of emotionally intelligent people. Time. Retrieved from http://time.com/3838524/emotional-intelligence-signs/

Cloud, H. (2014, 24 June). Ten things successful people never do again. Success. Retrieved from http://www.success.com/mobile/article/10-things-successful-people-never-do-again

Collins (n.d.). Two kinds of people. Retrieved from http://www.nicolebaute.com/why-you-need-email-marketing/

DumpaDay (n.d.). Retrieved from https://www.pinterest.com/pin/549228117034855517/

Goleman, D. [Big Think]. (2012, 23 April). Daniel Goleman introduces emotional intelligence. [Video file]. Retrieved from https://www.youtube.com/watch?v=Y7m9eNoB3NU

Maber, T. [Ted Ed]. (2012, 15 October). Rethinking thinking-Trevor Maber. [Video file]. Retrieved from https://www.youtube.com/watch?v=KJLqOclPqis

Matney, S.A., Avant, K., & Staggers, N. (2016). Toward an understanding of wisdom in nursing. Online Journal of Issues in Nursing, 21(1).

Porter-O’Grady, T. & Malloch, K. (2015). Quantum Leadership: Building better partnerships for sustainable health (4th ed.). Sudbury, MA: Jones & Bartlett.

Sinek, S. [David Crossman]. (2016, 29 October). Simon Sinek on millenials in the workplace. [Video file]. Retrieved from https://www.youtube.com/watch?v=hER0Qp6QJNU

Ten Boom, C. (1971). The Hiding Place. Netherlands: Chosen Books.

Ten Boom, C. (n.d.). Quotes. Retrieved from http://quotesgram.com/forgiveness-corrie-ten-boom-quotes/

Thygesen, K. (2014, 21 April). Why emotional intelligence is more important to hiring than you think. Fast Company. Retrieved from https://www.fastcompany.com/3029306/why-you-should-make-emotional-intelligence-the-cornerstone-of-your-hiring-strategy

Errors as Opportunities

This is Daisy. My miracle. When I had nearly given up hope, she made me a mother. She is beautiful, kind, courageous, and an incurable scamp. I love her the only way I know how, desperately and fiercely.

The wave monster is coming!

My love is a thing of action. I was born to do. To act. And so, on the day when my girl came home from school in tears, I was ready to verb her problem away. 

"What can Mommy do to help you?" I asked. 

She said, "Mommy, I need you to fix the world. It is so backwards."

Cue awkward, clueless silence for one moment...and then two...before I finally get it.

My Daisy is a lefty. And she's right...her world is backwards. Scissors, doorknobs, toilet paper dispensers, restaurant place settings...you name it, it is set up for the right-handed. 

After a moment of irrational planning that involved tearing down and refitting the entire world to serve my daughter, I arrived at a most unpleasant solution.

This cannot be fixed. 

So I bent down and said, "It was a hard day, wasn't it?" And then I let her cry. Because if she doesn't struggle and learn to fight her own battles, she'll never be the woman she was intended to be (Carr, 2016, 12 September). 

I think of Daisy's left-handed difficulties often at work. The relationship-building necessary to move my quality projects forward is a constant struggle. It does not come naturally to me. My default is to get the job done and say hello later (if at all). Unfortunately, like Daisy's challenge, my organization is set up for the opposite. I too must struggle to grow and learn (Carr, 2016, 12 September).

(Double Quotes, 2017)

One such struggle is permanently etched in my memory. Early in my quality career I was assigned a project focused on reversing a trend of poor outcomes. At the start, my attempt to jump in and set things right led to defensiveness on the part of the clinical teams and unchanged patient data. In hindsight, this was a huge mistake. No matter my personal preference, I must understand and tailor my approach to the rest of the team. It was not until I stepped back, listened, and allowed space for relationship that data began to improve. Though this was incredibly uncomfortable for me, I learned (the hard way) about how to get things done respectfully.

I have always admired leaders who exhibit respectful and effective management of teams. During my bedside career, one of my leaders lived her personal goal of, "Every mistake is an opportunity for learning" out loud. To this day, I watch her incredible ability to form relationships quickly while also improving care at the patient level. As I learn more about leadership, it seems that her success lies in transparency. Everyone sees her learning and growing and questioning and working through change (Porter-O'Grady & Malloch, 2015). The empowerment that stems from her example is palpable. I aspire to be this kind of motivated leader (Porter-O'Grady & Malloch, 2015).

This is in direct contrast to a previous leader, whose closed-off demeanor and unmotivated attitude seeped through the nursing unit where I practiced as a new graduate nurse. As patient acuity was increasing, this leader said things like, "We aren't going to get any more staff so we will just have to work harder and hope bad things don't happen."

Ugh. I aspire to never be this kind of unmotivated leader. We (her staff) were not ready to meet the challenge head on. We followed her lead and "did the best we could." It was difficult to be creative or try new ways to manage our complicated patients. We needed a leader to help us rise to the occasion, but all we got was a fellow grumbler (Porter-O'Grady & Malloch, 2015).

(Quote Fancy, 2017)

Dr. Atul Gawande, a surgeon and healthcare thought leader, discussed this need for change-ready healthcare professionals in a 2012 TED Talk (Gawande, 2012). In the talk, Dr. Gawande addressed major issues (variable quality, high cost, fragmentation) in healthcare today and advocated strongly for a new, team-based system that leverages good ideas from other high-risk industries and prizes collaboration (Gawande, 2012). In the current state, so much of the care happens in isolated siloes controlled by independent professionals without the tools or leadership to achieve patient-centered integration through the continuum. Successful overhaul of American healthcare requires a systems-based, data-driven, coordinated change effort led by motivated leaders (Porter-O'Grady & Malloch, 2015). Without this approach, Dr. Gawande's vision will remain unrealized.

An additional critical aspect of healthcare transformation is Just Culture (Dekker, 2013, 29 May). Just Culture focuses on the systems-level and views errors as learning opportunities (Dekker, 2013, 29 May). It is important to note that Just Culture organizations continue to hold staff accountable for individual behavior and willful choices (Dekker, 2013, 29 May). Most of my work is driven by systems-level thinking and process improvement, and my organization has a healthy Just Culture in place. However, in my experience there are still small pockets of staff that hesitate to report near misses or errors. I have learned that many of these staff members had been "burned" in the past by a previous leader or organization. This experience lives on through fear of retribution despite the current supportive environment.  So far, the only effective intervention for this seems to be continued engagement and "living out" the Just Culture. One very public example lies in Dr. Brian Goldman's courage in admitting his mistakes via a TED Talk (Goldman, 2012, 29 January). Dr. Goldman's transparent admission must be replicated over and over to help healthcare talk about error. We cannot begin to make things right unless we know what goes wrong (Goldman, 2012, 29 January).

(Freeduh, 2011)

Mandatory reporting facilitates Just Culture to a certain degree. In Washington State, healthcare facilities are required to report all occurrences of events designated as Serious Reportable Events (SREs) by the National Quality Form (NQF) (Revised Code of Washington, 2017). Each report must contain a systems-level root cause analysis and action plan. It is not sufficient to terminate the person or persons involved in the error (Revised Code of Washington, 2017). Though disciplinary action may be appropriate, this process forces organizations to not only track important data, but also evaluate errors from a systems perspective (Porter-O'Grady & Malloch, 2015). I am very familiar with the process at my organization due to my role in quality. We use a multi-disciplinary approach led by Patient Safety Specialists to understand opportunities and implement corrective action. It is worth reiterating that the Just Culture at my organization facilitates this team-based, systems-level approach. It is possible that Mandatory Reporting in a more punitive organization may be less effective at promoting Just Culture principles.

Dr. Pat Ebright, a nursing thought leader, devoted part of her career to understanding the kind of leadership that both healthcare and nursing needs to move forward (Ebright, 2010, 2 February). Dr. Ebright's views on nurse staffing as more than just nurse bodies and patient census is becoming embedded at my organization. As a part of my quality data, I track turnover and skill mix in addition to hours per patient day, and graph these metrics with nursing indicators such as falls and pressure injuries. In addition, leaders understand the impact of acuity, churn, and nursing experience on patient care; however it is very difficult to operationalize a staffing model to address these complex factors. A few units such as critical care and step down have acuity-based models that account for nurse experience, but this has been difficult to spread to the medical surgical settings where acuity is more difficult (and less objective). Despite this challenge, the nursing leadership is very flexible, motivated, and systems-focused. Several new models are being trialed including post-residency seminars and a twelve-month mentoring program for new graduate nurses. I look forward to seeing how this leader attitude, skill set, and willingness to try a different approach further translates into innovative staffing and staff support models (Porter-O'Grady & Malloch, 2015).

(Only a Nurse, 2017)

In my organization, Dr. Ebright's thoughts on the blunt end/sharp end framework are well known among quality professionals (Ebright, 2010, 2 February). One leader's interpretation of this structure is very useful as I work to resolve safety issues, "Do not allow the blunt end to dictate everything the sharp end must do. Those at the sharp end know the work best, and therefore are uniquely positioned to have new, better, effective ideas." This ties in closely with how experienced nurses manage the complexity of their day via stacking, peeking, and prioritizing (Ebright, 2010, 2 February). As a member of the blunt end, I cannot predict how a practice change could affect the nurse and the patient. The first example that comes to mind is documentation. Many times a suggested change involves either altered or new nursing charting. It is critical to involve nurses in the design as only they know what "makes sense" from a practical, patient-focused perspective (Ebright, 2010, 2 February). I have learned first-hand that missing the nursing involvement step leads to less-than-effective implementation. A quality co-worker of mine with many years of experience called the negative effects of blunt end-driven interventions, "unintended consequences." Thankfully despite my place at the blunt end, my peeking skills remain intact (Ebright, 2010, 2 February)! The ability to read the hospital unit by simply walking down the hall is priceless for a quality professional. It answers questions like, "Is now a good time to talk to staff about improvement work?" Many times giving a busy, high-acuity unit an hour or two to "settle" makes conversation and staff engagement easier. My goal is to avoid being "just another interruption" in a long shift. Just as I live out change and transparency, I must also model ways to facilitate a healthy patient care environment (Porter-O'Grady & Malloch, 2015). Showing staff that I respect workflow by minimizing non-urgent interruptions is simple, and reinforces similar behavior modeled by nursing leaders. As my patient relations colleague says, "We are always on stage, so make your work shine."

Lastly, the move towards value-based purchasing is positive, and may partially facilitate a better system for our patients (Porter-O'Grady & Malloch, 2015). However, as I have learned in my personal work, it is incredibly hard to measure value (or anything else in healthcare). Do the outcomes we are measuring actually mean something? For example, overall hospital mortality is considered a "big dot" metric, and decreasing mortality is generally seen as an indicator of value. However, for patients with terminal illness, is the value really based in prolonging life (and improving mortality)? Or is it better to have timely end-of-life discussions that focus on quality, comfort, dignity, and patient choice (potentially increasing the mortality rate)? I do not know the answers, but at a basic level I am glad we are at least making an effort. As a quality professional who is deeply passionate about measuring, I look forward to being included in the discussion.

The best thing about nursing is the opportunity to grow and learn with patients and colleagues. As a more experienced nurse in a position of informal leadership, it is my responsibility to show others Just Culture, change readiness, and transparency through everyday actions. The expectations are high, but so are the rewards.

(Body Mind Success, 2017)

References

Body Mind Success (2017). Walk the talk. Retrieved from http://bodymindsuccess.com/do-you-walk-the-talk

Carr, J.L. (2016, 12 September). A secret to parenting that no one tells you: The strength is in the struggle [Blog post]. Retrieved from http://annvoskamp.com/2016/09/a-secret-to-parenting-that-no-one-tells-you-the-strength-is-in-the-struggle/

Dekker, S. [Erik Sibla]. (2013, 29 May). Sidney Dekker: Just culture (Full lecture). [Video file]. Retrieved from https://www.youtube.com/watch?v=gKqYMpWZbV8

Double Quotes (2017). C.S. Lewis quotes. Retrieved from http://www.doublequotes.net/quotes/c-s-lewis-quotes-experience-that-most-brutal-of-teachers-but-you-learn-my-god-do-you-learn

Ebright, P. [mentorsgallery]. (2010, 2 February). Pat Ebright: Blunt end versus sharp end. [Video file]. Retrieved from https://www.youtube.com/watch?v=Dv1BP9BGPWg

Ebright, P. [mentorsgallery]. (2010, 2 February). Pat Ebright: Stacking. [Video file]. https://www.youtube.com/watch?v=IVHbty3iI9k

Ebright, P. [mentorsgallery]. (2010, 2 February). Pat Ebright: Complex adaptive systems theory. [Video file]. Retrieved from https://www.youtube.com/watch?v=VNFFEJqz9YA

Freeduh (2011). Our company's new transparency policy. Retrieved from http://www.freeduh.com/2011/10/20/our-companys-new-transparency-policy/

Gawande, A. [TED2012]. (2012). Atul Gawande: How do we heal medicine? [Video file]. Retrieved from https://www.ted.com/talks/atul_gawande_how_do_we_heal_medicine

Goldman, B. [TED Talks]. (2012, 15 January). Doctors make mistakes: Can we talk about that? [Video file]. Retrieved from https://www.youtube.com/watch?v=gKqYMpWZbV8

Only a Nurse (2017). Humor. Retrieved from http://www.onlyanurse.com/humor-1/kindalikeadoctor

Porter-O’Grady, T. & Malloch, K. (2015). Quantum Leadership: Building better partnerships for sustainable health (4th ed.). Sudbury, MA: Jones & Bartlett.

Quote Fancy (2017). Five wallpapers. Retrieved from https://quotefancy.com/quote/33296/Antoine-de-Saint-Exup-ry-If-you-want-to-build-a-ship-don-t-drum-up-the-men-to-gather-wood

Revised Code of Washington (2017). Revised Code of Washington 70.56.020. Retrieved from http://app.leg.wa.gov/RCW/default.aspx?cite=70.56.020

Understanding Personality and Preferences

Quiet awaits...

I am an incurable introvert. I love thick books, the crashing breath of the sea, and the quiet hours of the night. Small talk is my nemesis. Put me on stage in front of a thousand people and I won't break a sweat. Ask me to mingle, or network, or make friends...and I am frozen solid. And not in the singing snowman kind of way.

The other parts of my personality feel less overwhelming. As an "architect", or INTJ, I am an introverted thinker who loves to ask why. I fall on the more assertive side of the spectrum, which means when I have something to say, I'm not afraid to spit it out. After first receiving the INTJ label in high school, it has consistently popped up every time I take the test. This latest round (only a few days ago) was no exception. I took the test, and was once again the same as always. This personality fits me well, and after many years of struggle I wear it proudly. 

 (Flickriver, 2010, 12 September)

For a long time, being an INTJ was a challenge. My school was not built for introvert success (Cain, 2012, 2 March). I longed to be open, bubbly, and less awkward in conversation (three goals I have yet to achieve). Similar to Susan Cain's experience, my book-reading, quiet habits were seen as odd and anti-social (Cain, 2012, 2 March). Ms. Cain's recent stance on the positives of introverts resonates deeply, and I sincerely hope that tomorrow's introverted child will be prized for his or her uniqueness instead of chastised for a lack of social skills.

I lead multidisciplinary teams in my current role, and use Ms. Cain's suggestions to help guide my team management strategy. As a fellow introvert, I work hard to create space for everyone to think and speak while balancing the extrovert's need for stimulation (Cain, 2012, 2 March). I am confident in my ability to manage this balance within the team context, but learned quite recently that I still have room to grow. Early in the year, a new co-worker joined my office. At the time I was thrilled. Two months into her tenure, I started looking for another job. I was at the end of my rope. She drove me crazy.

Introvert fashion accessory! (Ear muffs, 2017)

Thankfully, before I quit the solution came to me one early morning on the treadmill. Ah-ha! My new co-worker is an extreme extrovert. She talks all the time. She talks all the time because she needs stimulation to feel alive...and it was killing me. That very day I spoke with my manager who was able to arrange a separate, private office for part of the work week. Due to this timely intervention my sanity is again intact and my co-worker and I are getting along just fine. I only wish I had realized this weeks earlier. Why was I looking for a new job when all I needed was a little space? This experience highlighted the need for self-awareness in a world full of human interaction. As I watched Ms. McHugh's presentation on this very topic, I realized that both my co-worker and I have the right to be our true selves (McHugh, 2013, 15 February). The world needs both my quiet thoughtfulness and her bright kindness. It is up to each of us to model our true self every day and allow others the space to do the same (McHugh, 2013, 15 February). In my previous experience as a leader I found that it was also helpful to talk about the true self, calling out uniqueness and how it positively contributes to good patient care. As I strive to honor others every day, some wisdom from my dad plays on repeat, "Remember that Jesus died for him (or her) too."

(QuoteHD, 2017)

This experience ties in nicely with the topic of conflict resolution. As an INTJ, I tend to stew over problems until a suitable solution presents itself (as happened in the situation described above). At that point, my natural tendency is to communicate the solution bluntly as if the problem is solved. This technique works well with my manager, who is also an INTJ. Unfortunately, the INTJ personality is quite rare so this strategy is absolutely ineffective the majority of the time (16Personalities, 2017).  I, and other introverted leaders, must work tirelessly to ensure extroverts have the space to talk through problems in a stimulating environment. Conversely, I always appreciate my extroverted colleagues' efforts to intentionally create quiet time (Cain, 2012, 2 March). As Ms. Caspersen discusses, conflict is a not a problem to solve, but rather a place to start (Caspersen, 2015, 13 July). Healthcare needs nimble, savvy leaders who leverage conflict to improve outcomes (Porter-O'Grady & Malloch, 2015). We must individualize our approach to our colleagues just as we individualize care to the patient. This is difficult to achieve, especially on days that are already full of stimulation. The most helpful tip I received was from a Human Resources colleague, who said, "My first responsibility is not to myself. It is to the patient." Keeping this simple 'why' in mind is the best way for me to stay centered. As discussed earlier, management of conflict resolution must begin with the leader understanding his or her self.  This awareness coupled with cultivation of an open, honest, and curious mind has the potential to move the leader's skills forward (Campbell & Clarke, 2015, 13 July).

In a recent Ted Talk, Mr. Semler discusses his unorthodox, democratic company structure (Semler, 2015, 10 February). This style, although very unique, meshes well with the aforementioned individualized personality-conscious approach to leadership. Although many of Mr. Semler's ideas may not work in the highly regulated healthcare environment, the spirit of giving staff creative space remains valid. It is valuable to take a step back and evaluate the healthcare workplace. Which rules are absolutely necessary? How can nurses be allowed the freedom to grow, learn, and own their profession (Porter-O'Grady & Malloch, 2015)? As Mr. Gutsche suggests, companies (healthcare included) die when 'business as usual' becomes the strategy (Gutsche, 2015, 5 March). It is necessary to take risks and capitalize on new, innovative ideas. Where does the healthcare leader begin? Ms. Ledgerwood's advice becomes particularly helpful at this point. Working hard to stay positive in the face of negative experiences (regulatory restrictions and resource limitations) is a critical component of forward motion (Ledgerwood, 2013, 22 June). As an eternal pessimist, this advice is hard to hear and harder to implement. I must continue to both know myself and learn how to grow past those qualities that hinder progress.

Soul Print Path (2017)

Leadership is incredibly complex. Though I have no direct reports, my leadership abilities (and challenges) have widespread and often unpredictable effects. For example, when I am able to effectively engage an extroverted colleague during a meeting, this affects not only the outcome of the meeting but also forms the foundation for a long-term professional relationship. Successful quality work is built on such relationships, and therefore one interaction has the potential to influence my effectiveness for months (or even years).  This web of human relationships and its effects on outcomes is a great example of complexity science where the sum (a group of unconnected interactions or partnerships) is still somehow less than the whole (self-propagating organizational culture) (Ebright, 2010, 2 February). All in all, viewing day-to-day interpersonal and leadership interactions from the systems level increases my personal drive to improve.

In summary, the relationship-based style of leadership that my job requires is less Industrial-Age and more Digital-Age (Porter-O'Grady & Malloch, 2015). I must engage each stakeholder in the way that fits his or her personality, and leverage uniqueness to achieve cost-effective results. It is not enough to dictate. Leadership is a participation sport (Porter-O'Grady & Malloch, 2015). Only through self-awareness and modeling does the leader inspire and drive change.  The team is watching, and nobody wants to follow a leader who fails to 'walk the talk' (Porter-O'Grady & Malloch, 2015).

Gandalf gets it right (Hypable, 2014, 3 January)

References

16Personalities. (2017). Architect personality (INTJ). Retrieved from https://www.16personalities.com/intj-personality

Campbell, C.M. & Clarke, S. [TEDx Talks]. (2015, 13 July). Conflict: Use it, don't defuse it. [Video file]. Retrieved from https://www.youtube.com/watch?v=o97fVGTjE4w

Cain, S. [TED]. (2012, 2 March). The power of introverts. [Video file]. Retrieved from https://www.youtube.com/watch?v=c0KYU2j0TM4

Caspersen, D. [TEDx Talks]. (2015, 13 July). Conflict is a place of possibility. [Video file]. Retrieved from https://www.youtube.com/watch?v=WfQeH3092Sc

Ebright, P. [mentorsgallery]. (2010, 2 February). Complex adaptive system theory. [Video file]. Retrieved from https://www.youtube.com/watch?v=VNFFEJqz9YA

Ear muff photos (2017). Ear muffs. Retrieved from https://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwjb9u7O5OvSAhWph1QKHZ0aA_QQjRwIBw&url=https%3A%2F%2Fwww.pinterest.com%2Falyssaboivin%2Fear-muffs%2F&psig=AFQjCNGH6VbgUnUBIG0GiIQxv24YUmKOrg&ust=1490329611735555

Flickriver (2010, 12 September). Emily Dickinson quote. Retrieved from http://www.flickriver.com/photos/a_hrefhttps06flagcountercommoremjaimg_srchttps06flagcountercomcountmjabgfffffftxt000000bordercccccccolumns6maxflags25viewers0labels0_altfree_counters_border0a/5054568533/

Gutsche, J. [Trend Hunter]. (2015, 5 March). Better and faster. [Video file]. Retrieved from https://www.youtube.com/watch?v=VFshvhzcCVw

Hypable (2014, 3 January). 10 J.R.R. Tolkien, LOTR, hobbit quotes from middle earth to live by. Retrieved from http://www.hypable.com/j-r-r-tolkien-quotes-birthday-lotr/

Ledgerwood, A. [TEDx Talks]. (2013, 22 June). Getting stuck in the negatives (and how to get unstuck). [Video file]. Retrieved from https://www.youtube.com/watch?v=7XFLTDQ4JMk

McHugh, C. [TEDx Talks]. (2013, 15 February). The art of being yourself. [Video file]. Retrieved from https://www.youtube.com/watch?v=veEQQ-N9xWU

Porter-O’Grady, T. & Malloch, K. (2015). Quantum Leadership: Building better partnerships for sustainable health (4th ed.). Sudbury, MA: Jones & Bartlett.

QuoteHD (2017). Conflict quotes. Retrieved from https://www.quotehd.com/Quotes/Words/Conflict/12_25

Semler, R. [TED]. (2015, 10 February). Ricardo Semler: Radical wisdom for a company, a school, a life. [Video file]. Retrieved from https://www.youtube.com/watch?v=k4vzhweOefs

Soul Print Path (2017). Einstein quote. Retrieved from https://www.pinterest.com/pin/182184747401672123/