Clinical care delivery often is challenging and, at times, requires numerous opinions. Implicit bias can make optimal decisions difficult to recognize, however, with discussion consensus can be reached. The same holds true for management and leadership
Once more under federal government influence, our nation’s health care industry will continue to be more complex than all other industries and will continue to create significant uncertainty. Such complexity, interestingly, seems to occur regardless of political leanings or opinions. Current uncertainty following the recent election already is being seen at all levels of our industry. And, not the least, large numbers of patients and their families are being negatively affected. Remember: The No.1 reason why people file for bankruptcy continues to be related to health care debt.
Growing up in Midwest North America, I distinctly remember a multitude of societal opinions that often carried distinct bias and deeply engrained ideology. Of course, while I was young, I did not understand these words let alone the nature of the behaviors they represented. Going through medical school, I gradually became aware of these human attributes and how they impacted not only clinical care but also management decisions that eventually influenced educational approaches.
For example, our medical school class was subjected to a unilateral decision that we all had to receive BCG vaccination against tuberculosis. At the time, it was a relatively untested approach of unproven value — and no member of the class was given the option of not receiving the vaccination. Given the nature of our training environment at the time, and the social diversity of patients passing through the system, I still argue that this was not a public health-oriented decision but one of implicit bias and regional ideology within the leadership of the school.
Behaviors, or actions, are predicated on individual and collective values, beliefs and ideals. Behaviors influence our cultures and ultimately the environments within which we live, work and play. Leadership, and the behavior of leaders, is what influences a culture most significantly. Creating a healthy culture is pivotal for improving the health care industry, and health care leadership must take special care to manage implicit biases and contrasting ideologies through exceptional behavior.
Values, Beliefs, Ideals and More
Perhaps it’s a bit remedial, but covering a few basic definitions can be a helpful reminder about what drives our behaviors and actions.
Values: Important and lasting beliefs or ideals shared by the members of a culture about what is good or bad and desirable or undesirable. (Source: Business Dictionary)
Beliefs: Assumptions and convictions that are held to be true by an individual or a group, regarding concepts, events, people and things. (Source: Business Dictionary)
Ideals: Persons or things conceived as embodying such a conception, and conforming to such a standard, they are taken as a model for imitation. (Source: Dictionary.com)
Ideology: A system of ideas that explains and lends legitimacy to actions and beliefs of a social, religious, political or corporate entity. (Source: Business Dictionary)
Implicit bias: Refers to the attitudes or stereo- types that affect our understanding, actions and decisions in an unconscious manner. These biases, which encompass both favorable and unfavorable assessments, are activated involuntarily and with- out an individual’s awareness or intentional control. (Source: Kirwan Institute for the Study of Race and Ethnicity, Ohio State University.)
Consensus: The middle ground in decision-making, between total assent and total disagreement. It depends upon participants having shared values and goals, and on having broad agreement on specific issues and overall direction. It implies everyone accepts and supports the decision, and understands the reasons for making it. (Source: Business Dictionary)
Leadership Is Always About People
Patient care is all about people. Clinical delivery systems are all about teams of people working well together. And the patient-physician relationship remains one of the most intimate, trusted and caring of human relationships known.
All physicians are leaders at some level, and leadership is ultimately about people — regardless of clinical discipline or nonclinical activity. The leadership that physicians provide, whether informally or formally, is still a dominant influence for the culture of health care.
The values, beliefs and ideals of physician behavior remain core to one of our profession’s sacred guides, the Hippocratic Oath. Let us all reinvigorate in consideration of that oath as we seek ways to augment the professionalism that has carried the health and culture of the industry for so many generations. Incoming physicians, and those established in careers, readily gravitate to the altruistic side of the spectrum for these values, beliefs and ideals. It is our collective altruism that shapes our individual, as well as collective behaviors.
Altruism can be considered a core ideology for physicians.
The past few decades have challenged physicians’ roles in health care and in society as a whole. The recent shift to a value-based model of care delivery is likely to sur- vive and become the predominant focus for care delivery. Compared to the recent past, physicians now have a fresh opportunity to demonstrate leadership at all levels. The opportunity for influence by physicians will help shape the evolving culture of health care in coming years.
Physicians value “value.”
Adapting for Perpetual Change
The inherent complexity of health care creates the perpetual expectation for change. We must all be comfortable with this reality. Even with the variety of value-based approaches on our horizon, significant swings in our industry already are occurring. As another important figure from should be constant — to provide the optimal pathway ancient Greek history, the philosopher Heraclitus, once through shifting circumstances. Physicians are positioned said, “The only constant is change.” That readily applies to provide balance and direction within health care during to health care. periods of intense change. Let us all rise to the occasion
The vagaries of national politics contribute to constant and not become excessively distracted by contrasting change, regardless of which party is in control. Obviously, physicians will have opinions and debates not only on politics in general, but also on the impact of politics on health care specifically. In these discussions, contrasting ideologies certainly will surface and, at times, create consternation.
As leaders, physicians also have the opportunity to use their influence to facilitate healthy, balanced discussions while also helping their local, regional or national environments achieve stability in the face of contrasting ideologies. Again, physicians are leaders, and leaders create culture through their influence — not only in their decisions but also through their individual, daily behaviors.
Physician-oriented values, beliefs and ideals can provide the voice of reason when contrasting ideologies are present. Where change is constant, leadership also should be constant — to provide the optimal pathway through shifting circumstances. Physicians are positioned to provide balance and direction within health care during periods of intense change. Let us all rise to the occasion and not become excessively distracted by contrasting ideologies. (To quote another popular phrase: “May the Force be with you.”)
While pursuing my academic career in trauma surgery, followed now by more than a decade of leadership roles nationally and internationally, I have come to realize that contrasting ideologies are always active on a routine basis. The implicit biases that are related to them create the diversity of opinion that ultimately makes our world so special. Navigating ideology and implicit bias are a portion of my daily routine. In so doing, I must always be introspective and on an internal lookout for how my own implicit bias may (or may not) create decisions that are not fully optimal.
To help offset my propensity of implicit bias and ideology, I routinely seek a variety of opinions from a variety of sources that I know will not be similar to mine. I believe this is what successful leaders should do in order to make their best decisions — regardless of leadership style. Building consensus becomes simpler and decision-making more robust.
Coming from a background in surgery, it has been an interesting process to continually unlearn my inherently developed surgical personality traits … and it is an ongoing process, believe me!
In order for our association to continue succeeding within the inherent complexity of our industry, we must embrace differing ideologies. Our association is well-positioned to continue forward in our pursuit of providing gradually increasing influence in health care. Our values, beliefs and ideals are embraced within our strategic plan — a set of values that has been solid now for five years.
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. Helping to proactively man-age transitions in our industry is a critical component of our professional responsibility — in fact, it has been a professional responsibility since our beginnings.