Reflecting on lessons learned is a key aspect of leadership growth. Experience in leadership development is valuable, and successful leaders can learn from earlier experiences through reflection and analysis, shaping efficacy in addressing future challenges based on past experiences.1 Heuristics, best practices and successful leadership strategies emerge as leaders reflect on their experiences and modify their behaviors going forward.
Leadership strategies may emerge in the form of:
- Leading self: developing the psychological capital of self-esteem, self-confidence and self-efficacy
- Developing relationships: enhancing professionalism, listening strategies and good conflict management tactics
- Driving results: the ultimate measure of success in achieving organizational excellence.2
Healthcare professionals interested in enhancing leadership efficacy through reflection will find wisdom in the following 10 lessons, based on more than 75 years of collective experience leading and supporting colleagues in leadership development.
1. Assume positive intent
Effective leadership behaviors: There is a reason for everything, and assuming positive intent provides the impetus to ask questions. Don’t react, get curious. Put yourself in others’ shoes and consider where they might be coming from.
“In order to carry a positive action, we must develop here a positive vision.”3 — Tenzin Gyatso, 14th Dalai Lama
Rationale: Confirmation bias is the tendency to search for, interpret, favor and recall information in a way that confirms or supports one’s beliefs or values.4 Assuming the best does not equal naivety, rather an opportunity to trust that there are reasons why something is happening. Being non-judgmental provides an opportunity to discover the reasons for a phenomenon.
2. Approach individuals as if they are on overload
Effective leadership behaviors: Approach colleagues with compassion and kindness, demonstrate empathy and give yourself and others grace. It is helpful to manage our emotions by allowing more space between stimulus and response.
“Everything can be taken from a man but one thing: the last of the human freedoms — to choose one’s attitude in any given set of circumstances, to choose one’s own way.”5 — Viktor Frankl, neurologist and Holocaust survivor, from Man’s Search for Meaning
Rationale: The prevalence of burnout in healthcare has been well documented,6 and is driven by heavy workloads, inefficiencies, lack of flexibility and control at work, work-life integration, and an inability to find meaning at work. The prevalence of social media provides a constant stream of content that is overwhelming our ability to absorb information. By assuming individuals are overloaded, we enhance our own empathy and patience and improve our relationships with others.
3. Approach challenges as if everything will work out
Effective leadership behaviors: We frequently face challenges, but goals can be accomplished with persistence and understanding how to leverage urgency and empowerment. Through stakeholder engagement, effective visioning, and creation of pathways to goal attainment, complex situations turn into team success.
“Continuous effort, not strength or intelligence, is the key to unlocking our potential.”7 — Liane Cordes
Rationale: Impatience is the desire for some other reality and does not allow for an appreciation of what is currently happening. Attention to mindfulness can be helpful to live in the present, without judgment. Determination is needed to learn from and overcome resistance from a variety of sources, and a focus on the vision, an attribute of transformational leaders, will channel energy to the desired end state. Effective leaders acknowledge obstacles, embrace differing values and gather perspectives from diverse stakeholders to create pathways forward.
4. Assume that resistance is a gift
Effective leadership behaviors: There is wisdom in resistance, and there are change management strategies that can be used to discover that wisdom. Utilize questions and humble inquiry as a coaching strategy to dig deeper and uncover and appreciate the source of the resistance. Develop a compelling vision and offer first steps toward the vision.8
“Nothing so undermines organizational change as the failure to think through who will have to let go of what when change occurs.”9 — William Bridges
Rationale: Life experiences that are embedded in values and cultural norms shape perspectives. Teams that value the diversity and complementary capabilities of each team member are advanced in solving organizational problems.10 Resistance can come from fear, uncertainty and ambiguity regarding the vision. Seeking the human elements (beliefs, assumptions, emotions) causing the resistance will proactively and respectfully enhance the development of strategies to mitigate the resistance.
5. Expect that psychological safety is not present and begin to build it
Effective leadership behaviors: Become more in tune with the human elements present in your team and look for cues to cultivate psychological safety. Humanness in healthcare is limited or lost if staff do not feel free to engage or interact for fear of being rejected or marginalized; seen as incompetent or ignorant; or labeled as negative, disruptive, or creating conflict. Model inclusion by inviting staff to speak, listen to comments and acknowledge contributions. Model vulnerability by admitting a mistake, say you don’t know, ask for help and acknowledge you were wrong. Model curiosity using open-ended questions and allow others to consider different perspectives or to voice concerns and challenges.11
“Fear is the enemy of flourishing.”12 — Amy Edmondson
Rationale: Psychological safety is a shared belief that the team is safe for interpersonal risk-taking and there is trust that one will not be punished or experience humiliation for speaking up regarding ideas, questions, concerns or mistakes.13 To cultivate psychological safety at Mayo Clinic, the Model of Professionalism identifies essential characteristics required to manifest professionalism. “Be accountable and hold others accountable by listening and speaking up,” is an important part of the model, creating an environment where individuals are invited to speak their mind without fear.
6. Assume that the biggest impediments to change are the limiting beliefs we impose on ourselves
Effective leadership behaviors: As leaders we are responsible for elevating our thinking about the value we bring. Ask yourself to challenge those limiting beliefs by reflecting on:
- What evidence do I have that proves this limiting belief is true?
- If I were to believe the opposite of this limiting belief, how would my behavior change?
“Do not think of today’s failures, but of the success that may come tomorrow. You have set yourselves a difficult task, but you will succeed if you persevere, and you will find a joy in overcoming obstacles.”14 — Helen Keller
Rationale: Spencer Johnson, author of the bestselling book The Present, provides an insightful reflection about learning from the past, living in the present, planning for the future and having a purpose.15 Biases are an inherent part of life, a natural result of our experiences. Recognizing that our biases may lead to limiting beliefs gives us the gift of self-awareness and an opportunity to examine our thinking and the value we bring.
7. Assume that strong, trusting relationships are the foundation for all successes
Effective leadership behaviors: Display sensitivity to others, demonstrate servant leadership behaviors, respect others’ values and elevate teamwork.
“Wise people are not absorbed in their own needs. They make the needs of all people as their own.”16 — Lao Tzu
Rationale: Written in the sixth century B.C., the Tao Te Ching provides ancient guidance about the importance of serving others and building relationships. Trust is achieved by acting with integrity, demonstrating concern for people and achieving business results.17 Edgar Schein describes the process of humble inquiry to build positive relationships and organizations, utilizing the gentle and artful strategy of asking questions.18 Thus, there is an opportunity to not only provide advice through mentoring, but also to utilize coaching strategies and asking questions to further develop and strengthen relationships.
8. Assume that inviting more colleagues to the discussion will result in improved outcomes
Effective leadership behaviors: Invite colleagues to help rather than trying to solve problems alone. Recognize the wisdom in the team, embrace diversity of thought and experiences, and encourage all voices and perspectives to be heard.
“When we listen and celebrate what is both common and different, we become a wiser, more inclusive and better organization.”19 — Pat Wadors
Rationale: Building a diverse perspective by focusing on equity and inclusion brings all the talent to the table. Additional competencies and capabilities emerge, including those that have been shaped by our experiences, backgrounds, education, habits and challenges traversed. There is wisdom in such a collective and in community, unity, inclusiveness and synergy. Recognize that the challenges we are facing in healthcare will require high-performing teams with members who bring complementary capabilities, a deep commitment to the mission of the team and mutual accountability to their collective personal growth and success.20
9. Assume that anxiety and fear are temporary
Effective leadership behaviors: Engage team members and trusted colleagues to address your areas of concern and shift thinking about fear. Create manageable options for a way forward and acknowledge progress.
“Nothing gives one person so much advantage over another as to remain always cool and unruffled under all circumstances.”21 — Thomas Jefferson
Rationale: Anxiety, frustration, anger, conflict and fear are normal parts of organizational life. Uncertainty, ambiguity and complexity are the new normal, and doubts should be leveraged to drive critical reflection of issues after gathering more information. Recognize the learning process and the lessons available from past actions and the emotional intelligence capabilities you have gained over time, including self-awareness, self-management, social awareness and relationship management.22 Rely on your emotional intelligence, and if you experience anxiety and fear or sense that they are present on the team, embody the capability of equanimity and display composure, calmness, confidence, poise, steadiness and imperturbability.
10. Assume that effective outcomes come from effective processes that require a people-first orientation
Effective leadership behaviors: Make yourself visible to the team and show interest in their well-being.
“Life’s most persistent and urgent question is: What are you doing for others?”23 — Martin Luther King Jr.
Rationale: In The Strategy-Focused Organization,24 the balanced scorecard reflects that outcomes derive from operational process excellence, standing on a foundation of the learning and growth of people. Mayo Clinic has adopted a people-first orientation through the various models that shape our culture, all with a focus on service to each other including the following:
- Mayo Clinic Model of Professionalism, with the commitment of driving values into action
- Mayo Clinic Values, the expression of our founders: Respect, integrity, compassion, healing, teamwork, innovation, excellence and stewardship, with the primary value of the needs of the patient coming first
- Mayo Clinic Model of Leadership, inspiring values, engaging colleagues, bold and forward thinking, and driving results
- Mayo Clinic Model of Care, defining the patient-first approach to care and the environment facilitating this care
- Mayo Clinic Model of Safety, including how we support each other.
In the words of one of our founders, William J. Mayo, “the best interest of the patient is the only interest to be considered, and in order that the sick may have the benefit of advancing knowledge, union of forces is necessary.”25 While each of these models has a different focus, they all converge on the people-first orientation: our patients, the physician-scientist consultants and allied health staff.
The journey of leadership in healthcare has obstacles, challenges and conflicts to navigate. However, we also have each other and our community of leaders, with whom we can collaborate.
Acknowledgment: The authors acknowledge our colleagues at Mayo Clinic for providing inspiration for this article and the assistance of Lucy Bahn, PhD, in editing the manuscript.
Notes:
1. Hughes R, Ginnett R, Curphy G. Leadership: Enhancing the Lessons of Experience, Fifth Edition. New York: McGraw-Hill/Irwin, 2006.
2. Menaker R. “Leadership strategies: Achieving personal and professional success.” Journal of Medical Practice Management, 31 (2016), 336-339.
3. “Dalai Lama Quotes.” BrainyQuote. Available from: bit.ly/3vlhIRz.
4. Heshmat S. “What is Confirmation Bias?” Psychology Today. April 23, 2015. Available from: bit.ly/3wuxFGG.
5. Frankl VE. Man’s Search for Meaning: An introduction to logotherapy. Boston: Beacon Press, 2006.
6. Noseworthy JH and Shanafelt TD “Executive Leadership and Physician Well-Being: Nine Organizational Strategies to Promote Engagement and Reduce Burnout.” Mayo Clinic Proceedings. Nov. 18, 2016, 129-146.
7. Cordes L. The Reflecting Pond: Meditations for Self-Discovery. Hazelden Publishing, 1981.
8. Menaker R, Leland JR, Naumann KE and France TJ “Leading, guiding and nurturing through change: An essential capability for healthcare leaders,” MGMA Connection, 21(1).
9. Bridges W. Managing Transitions: Making the Most of Change. New York: Addison-Wesley, 1991.
10. Katzenbach JR, Smith DK . The Wisdom of Teams. Boston: Harvard Business School Press, 1993.
11. France T, Matt Hensrud N, Menaker R, Peters M. (2020). “Cultivating psychological safety: Activating humanness in healthcare.” MGMA Connection, 20(3), 40-46.
12. Edmondson AC. Teaming: How Organizations Learn, Innovate, and Compete in the Knowledge Economy. Hoboken, N.J.: John Wiley & Sons, 2012.
13. Edmondson AC. The fearless organization: Creating psychological safety in the workplace for learning, innovation, and growth. Hoboken, N.J.: John Wiley & Sons, 2019.
14. Keller H. “Address to the American Association to Promote the Teaching of Speech to the Deaf.” July 8, 1896.
15. Johnson S. The present: The secret to enjoying your life and work, now! New York: Doubleday, 2003
16. Lao Tsu. Tao Te Ching: A New Translation and Commentary. Translated by Ralph Alan Dale. New York: Barnes & Noble Books, 2004.
17. Shaw RB. Trust in the Balance: Building Successful Organizations on Results, Integrity, and Concern. Hoboken, N.J.: Jossey-Bass, 1997.
18. Schein EH. Humble Inquiry: Building Positive Relationships and Better Organizations. Oakland, Calif.: Berrett-Koehler, 2013.
19. Reilly K. “How LinkedIn’s HR Chief is Changing the Diversity Conversation with ‘Belonging.’” LinkedIn Talent Blog. Jan. 9, 2017. Available from: bit.ly/32QPRNa.
20. Katzenbach and Smith, 1993.
21. Jefferson T. “Extract from Thomas Jefferson to Francis Eppes.” Thomas Jefferson Foundation. May 21, 1816. Available from: bit.ly/3eBXIDu.
22. Goleman D, Boyatzis R, and McKee A. Primal Leadership: Realizing the Power of Emotional Intelligence. Boston: Harvard Business School Press, 2002.
23. King ML Jr. Sermon. “Three Dimensions of a Complete Life.” Strength to Love, p. 72. Harper & Row: New York.
24. Kaplan RS, Norton DP. The Strategy-Focused Organization: How Balanced Scorecard Companies Thrive in the New Business Environment. Boston: Harvard Business School Press, 2001.
25. “Mayo Brothers’ Wisdom.” Mayo Clinic. Available from: mayocl.in/3nmxngV.
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