Monday, May 12, 2014

Wisdom in Health Care

Could there a better place for wisdom to take hold than in health care? What profession is more in need of making wise choices than one trusted with people's lives? What organisations are more in need of wisdom than those charged with caring for the sick and promoting well-being?

We are ready for wisdom in health care. Specifically, we are ready for wisdom leadership. What does that mean? We are ready for leadership that fosters the capacities for wisdom in our healthcare organisations, 
capacities described in Monika Ardelt's three-dimensional framework for wisdom:

The cognitive dimension includes the capacity to see the deeper meaning of things, to understand complexity and tolerate ambiguity, to avoid over simplification of complex situations. It also includes awareness of the limitations of our knowledge, and avoidance of hubris.

The reflective dimension includes the capacity to see things from many perspectives, requiring self-examination, self-awareness and self-insight.

Finally, the affective dimension is compassion, and requires transcendence of self-centeredness. Fostering these capacities can be thought of as the wise leader's virtuous cycle.

Imagine healthcare organisations that intentionally foster wisdom development: compassion, self-reflection, embracing and wrestling with the true complex nature of the work, striving to make practically wise choices with patients!

There are signs of this beginning to happen. For example, in the US the American Board of Internal Medicine have titled their most recent campaign for educating physicians and patients in high value care, "Choosing Wisely".

At the University of Virginia Medical Center in Charlottesville, compassion, gratitude and other positive emotions are intentionally being fostered through the Center for Appreciative Practice (CAP) and the Compassionate Care Initiative. The CAP teaches health care leaders how to use appreciative inquiry to foster positive change, teaches residents about the use of story to build relationships with their patients as persons, and helps to foster positive emotion through simple techniques like appreciative gossip, gratitude journals, appreciative check-in and the use of story.

To foster self-reflection, a number of teaching hospitals in the US are training medical and nursing students and faculty in mindfulness, helping them reflect on their clinical interactions and clinical decision-making in a moment-to-moment way, and helping them focus their attention in critical situations. For example, the University of Rochester School of Medicine and Dentistry developed a series of programs in Mindful Practice including seminars, workshops, and interactive presentations that aim to cultivate the practice of mindfulness and self-awareness in healthcare professionals and trainees.

Some healthcare organisations are beginning to teach complexity science to improve patient safety, and to create a culture where mistakes or poor outcomes are not only openly acknowledged, but also studied in order to discover how to improve, and how to avoid similar mistakes in the future. As a profession, medicine is taking on the task of delineating wise choices and actions (out of the myriad of options) based on evidence and an intimate knowledge of the patient.

These are only a few examples. Wisdom leadership involves the intentional focus on developing these capacities within healthcare organisations, and within ourselves as leaders.

Most leadership training approaches leadership as an "outside in" process: learn a theory, adopt it and you're good to go. I believe the capacities for wise leadership must be nurtured from the inside out, in a community committed to the development of these wisdom capacities. It is time to change our approach to leadership in healthcare and to claim a leadership approach that is more in keeping with the core meaning of healing and the alleviation of suffering. Wisdom, representing the highest of human striving, is perhaps the only framework big enough to represent the seriousness and the responsibility of this task.

What do you think? Are wise leaders a result of an "inside out" or an "outside in" phenomenon, or both? Are we ready for wisdom in health care? Can health care take the lead in developing wisdom in our communities?