From Our CEO: Generations, Wisdom and a Hero’s Journey

Society often sees physicians as heroes, and we must consider moving along a multistage path to find satisfaction with the outcomes in our industry. Forgiveness, not simple acceptance, is essential.

As we all know, there are usually four generations in the workforce at any point in time. In this era, sometimes, there actually can be five present. While we can recognize the differences between those generations (see Table 1), we often fail to integrate changes in our personal and professional behaviors to accommodate them. Each generation often complains about the inadequacies of the other generations — failing, more often than not, to acknowledge the accomplishments and special attributes of each. But the older can learn from the younger and, certainly, vice versa.

peter angood

Peter Angood

As physician leaders, we must not only apply knowledge of these differences to our patients as we decide how best to help them with their health issues, but also as we help our peers and others in the workforce adjust to these variations as well. Leadership most often is about influencing others to create improvements and adjustments that positively affect outcomes. Being aware of the recipients’ expectations or attitudes, and how best to adjust your approaches to those preset attitudes, can improve the outcomes of your leadership potential significantly.

Whether we recognize it or not, as physician leaders, we often are seen as heroes from many vantage points: our patients, our staff, our peers, our neighbors, our friends — and, yes, even our families. It is often too easy to become comfortable with the automatic and implied respect that comes with this role. Interestingly, the “physician hero” archetype crosses all generations — in the majority, each generation still views physicians in strongly optimistic ways. Our responsibilities therefore are significant.

TABLE 1: COMPARING THE GENERATIONS

 

Traditionalists

Baby Boomers

Generation X

Gen. Y/Millennials

Generation Z

Strengths and Assets

Strong work ethic, discipline, loyalty, emotional maturity

Customer service-focused, optimistic, dedicated, future-oriented

Adaptability, tech literacy, creative, willing to buck the system

Optimistic, tech-savvy, global worldview, team player

Digital native, service-oriented, receptive, culturally sensitive

Influences

Great Depression, World War II, G.I. Bill, Eisenhower, Korean War

Suburbia, Civil Rights

Challenger accident, gangs, internet, AIDS

Oklahoma City bombing, rise of Facebook and MySpace, 9/11 attacks, high-speed internet

Social networking, mobile games, Columbine massacre, Boston Marathon bombing

Information Sources

Newspapers, books, peers, TV

TV, websites, newspapers

Websites, TV, books

Email, social media

Chat rooms, social media, YouTube

Learning Styles

Traditional, source of institutional knowledge

Traditional learning, participation, reflection, feedback

Highly receptive to e-learning, series of structured lectures

Integrated technology and media

Personalized learning through customized environments

Career Planning

“I am happy to be where I am.”

“My dedication and service should be rewarded.”

“It’s about time I got a promotion.”

“I delivered the results. I’ll get promoted.”

“I’m smart. I’ll get a job. I need a job.”

Source: Velasco and Columbaro presentation, CESSE 2014

What’s a hero? By definition: a mythological or legendary figure, often of divine descent, endowed with great strength or ability; an illustrious warrior; a person admired for achievements and noble qualities; and/or one who shows great courage. And one could argue that physicians often are viewed by all levels of society in each of these ways at some level. Certainly, the public media can portray us this way.

James Bond seemed like a good hero when I was young and growing up. I read all of Ian Fleming’s books in sequence and tried to emulate the behaviors I thought appropriate in trying to be a good Mr. Bond replicate. (And I will admit to having watched pretty much all of the movies available to this day.) Having grown up in Canada, I needed to deal with my divided loyalties of following too many hockey heroes as well: Jean Béliveau and Gordie Howe, to name only a couple. Homer’s heroic tales, The Iliad and The Odyssey, were injected into my school readings as well. (I made attempts to read them again in later life — still somewhat boring, unfortunately.) And other heroes also have influenced me over time.

Being swayed by hero worship is a natural for us all as we move through life.

FIGURE 1: THE HERO’S JOURNEY MODEL

angood hero

Source: Myth and the Movies, by Stuart Voytilla (1999)

TRANSFORMATIVE THRESHOLDS

Shifting gears slightly, with books such as The Hero with a Thousand Faces, The Power of Myth and The Inner Reaches of Outer Space, Joseph Campbell reported on the synthesis he found while comparing the myths and legends of heroes in many cultures, writes Christopher Vogler in the foreword to Myth & The Movies, by Stuart Voytilla (Michael Wiese Productions, 1999). Vogler adds that the “hero’s journey” was Campbell’s all-embracing metaphor for the deep inner journey of transformation that heroes in every time and place seem to share, a path that leads them through great movements of separation, descent, ordeal and return (see Figure 1). While too lengthy to describe here, Campbell delineated 12 stages of the hero’s journey, and these stages have been embraced by many as the most relevant paradigm for describing heroic journeys, including George Lucas in his Star Wars series.

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This journey not only has stages of significance but also has thresholds a hero must cross to be transformed. A hero’s response to the stages by his or her actions and decisions then creates the phases and pace of growth — a transformative leadership experience, if you will. In fact, our association already has begun incorporating some of this philosophy within our wellness initiative by working with Don Kennedy, DO, MBA, PhD, CPE, FAAFP, and his book, The Surfer’s Journey: The Path to Transformational Leadership (self-published, 2017), based on similar themes from Campbell’s work.

TABLE 2: KÜBLER-ROSS FIVE STAGES OF GRIEF

  1. Denial. The first stage. Individuals believe the diagnosis is mistaken and cling to a false, preferable reality.
  2. Anger. The individual recognizes denial cannot continue and instead becomes frustrated, especially at proximate individuals. Possible responses: "Why me?” “It's not fair!" and "Who is to blame?"
  3. Bargaining. The individual hopes to avoid a cause of grief. Often, the negotiation for an extended life is made in exchange for a reformed lifestyle. People facing less-serious trauma frequently seek compromise.
  4. Depression. The individual despairs at recognition of their mortality. In this state, the individual may become silent, refuse visitors and spend much of their time mournful and sullen.
  5. Acceptance. The final stage. Individuals embrace their mortality or inevitable future, or that of a loved one, or another tragic event. People dying may precede the survivors in this state.

Why is this relevant to physician leadership? Physicians, in our roles as leaders in health care, are on a hero’s journey within the industry. For too long now, however, many physicians have used Elisabeth Kübler-Ross’ five stages of grief (see Table 2) as their paradigm for the ongoing changes in health care. And that is where the understanding of what is happening has frequently stopped — simply trying to accept the complexity and ongoing change in our industry.

I would suggest this is an older, generational approach and that we all — every generation in the workforce — now need to consider how better to move along in our hero journey. By accepting there is more than simple “acceptance” of the inevitable, we can individually (and collectively) help advance our discipline more successfully and collaboratively, and with additional positive expectations of the outcomes from our hero journey.

Each generation can help the others cross a threshold to a new stage of improved health care delivery — and an improved approach in our philosophies for how to deliver better care with compassion, empathy and kindness to our patients, our peers and our fellow workers within this industry we influence so deeply. Let’s learn how to listen more closely to one another — there is much to learn. 

LETTING THE PAST GO

I readily accept that the physician workforce morale is at an all-time low. Our association has launched several initiatives to help change current industry approaches. However, simply accepting will not be enough if we, as heroes, are going to create the change the industry expects of its natural leaders. With morale such as it is, forgiveness also becomes a component of transformation we need to consider.

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A delightful, short read in fable format is a book by another physician, Robert C. Stone. Circle of Wisdom: A Path for Life, Mind and Leadership (self-published, 2015) characterizes how we can gain wisdom continually as we accept the need for inevitable change and routinely prepare ourselves for constant change — not only in our lives but with our circumstances as they present themselves. I’ve attempted to characterize the circle of wisdom from a fable in Figure 2.

FIGURE 2: THE CIRCLE OF WISDOM

angood circle

The first three circles are intuitively obvious. Moving to the fourth circle and then back to the first circle for the next cycle of change is less intuitive. It is more complicated because it embraces the concept of forgiveness — another topic we can’t fully cover here. The essence, however, is that to move forward with change, we must cross a threshold in which the past is let go. Similar to the hero’s journey, this crossing is essential for forward progress. In this case, the act of forgiveness is not only about forgiving the external influences that affect you, but also forgiving oneself for all past actions, attitudes and behaviors. By forgiving ourselves, we can move to a new phase of personal growth and become prepared for the next set of influences that inevitably cross our paths.

We all should be proud of what physician leadership represents in health care. We all have the opportunity to continue building our own skills to become more fluid with the ever-changing environments as we all strive for improvements to the industry. We cannot expect positive personal change if we continue to hold onto elements of the past and keep trying to re-create a time that already has moved beyond our expectations.

RELATED: Respecting Differences, Commonalities of Generations in Physician Workforce

AAPL heavily promotes the message that, at some level, all physicians are leaders. At its core, AAPL maximizes the potential of physician leadership to create significant personal and organizational transformation. By considering the combination of generational differences and how to collaborate across generations better; coupled with understanding and proactively pursuing a hero’s journey; and then also injecting a heavy dose of forgiveness, our path toward increased wisdom can be influenced positively. A net potential result is that physicians can achieve larger scales of change for themselves, our peers and for the industry as a whole — with patients benefiting from improved quality, safety and efficiency in more-compassionate environments.

I encourage all of us to continue seeking deeper levels of understanding and to generate influence at all levels to which we are individually comfortable. As physician leaders, let us get more engaged, stay engaged and help others to become engaged. Creating a broader level of positive change in health care — and society — is within our reach.

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