Why can't I quit doing that?!

For the most part I follow the health care guidelines for preventing disease and improving quality of life. I exercise regularly, eat healthy, and get enough sleep. I am engaged in my community and have strong family ties. However, I have an unhealthy relationship with dairy foods. When it comes to cheese and ice cream I overindulge, every time. This isn’t so different from the people we serve in the health care system. Many times we are working with people who don’t do what we recommend or sabotage their own well being. While I pondered my inability to change I came across a book that provides some insight and information, Immunity to Change by Robert Kegan.

Kegan offers the book to leaders as a way to better understand yourself and those who work for you. With advances in technology to read brain activity and better tools for measuring mental development, researchers know that mental development is ongoing but not continuous. There are periods of stability alternating with periods of change. Moving past the stable periods requires a wariness and willingness to accept that there maybe another answer.  This puts us back into the discussion of technical versus adaptive challenges. From the work of Ronald Heifetz, people and organizations face these two types of challenges. Technical are those where past knowledge and experience informs leaders on the solution. Adaptive challenges are not informed by experience and past knowledge, solutions are found by transforming the way the problem is viewed. The error leaders make is treating and adaptive challenge as if it is technical. It is a misdiagnosis to call an adaptive challenge technical because the leader cannot use this framework bring forward changes to solve the problem.

So when I face my challenge of overindulgence in dairy product I continue to approach it the way I have addressed other personal improvements, and it doesn’t work. The problem isn’t technical, it is adaptive. Kegan offers an approach to look at why behaviors (of individuals or teams) persist. Under the observed behaviors is a dynamic system of equilibrium that sustains itself, for a good reason. Like the immune system in the body, it works for a good reason and is a source of strength. However, sometimes our immune systems protects us when protection isn’t needed or desired. Like abstaining from dairy wasn’t effective for me in creating a sustained healthy relationship, as leaders we sometimes can’t use willpower to make a change occur and secure more than a temporary success. To be successful we have to reveal the real commitment, a hidden commitment. Only when we understand our hidden commitments are we in a position to change.

Kegan provides many examples and coaches readers through a process of uncovering hidden commitments, or our immunity to change. Teams can go through the same process and Kegan has examples of this as well. It is hard work to reach the place where these commitments become visible. Kegan describes it as feeling risky and unprotected. I am not there yet, I have to dig a little deeper. As a leader I have to also look at hidden commitments that prevent me from correctly diagnosing team and organizational challenges. I recommend reading this book and engaging in the process of tackling the adaptive challenges we face everyday, to make the delivery of health care better for the people it serves.

I want to use more of my brain

Over the weekend a neighbor hosted a party where they put up an inflatable movie screen and we watched a movie in their backyard. This has become an annual event, one that I look forward to attending. I enjoy it for the social aspect; neighbors and new people to meet. Another part I enjoy is watching a movie that I might not have chosen. This weekend the movie was Limitless (2012), an interesting look into the idea that we don’t use all of the capacity of our cognitive abilities and what it might look like if a drug could change that fact. At the same time I am reading the book Immunity to Change by Kegan and Lahey, providing evidence on how and why we are so often stuck in what we think and do. These two ideas seem to be colliding in my thoughts.

In health care are we caught fighting change because we don’t see everything we have in front of us? In the movie Limitless the main character, through a drug enhanced state, takes in subtleties of the environment and is able to connect data to create new understandings faster and more accurately than others. Through the work of Kegan and Lahey these authors are attempting to do the same, but without the drugs. If we understand when we are up against an adaptive challenge and we back up to see how past behavior will not support finding a new solution, our eyes will be opened to new possibilities. But it isn’t easy and we have to face some difficult ideas about ourselves and the industry. What are we missing in our limited view of health care? How can we better take the individual views of our team members to build a more comprehensive picture? How do we establish trust and improve communication so everyone sees their role as part of the change?

I am not done reading Immunity to Change, and the authors hint that there are tools in the book to help individuals and groups identify and overcome barriers to change. For now I am focusing on what fears I have that prevent me from doing what needs to be done and how this knowledge will benefit my work projects and the industry. These thoughts will just have to collide in my brain for a little while, with the hope of future clarity and a higher use of my resources.

It's A Head Game

It’s a head game. Pounding the pavement today, in rising temperatures and humidity, I was talking (and sweating profusely) with my sister about quelling the anxiety of starting a new business. Start ups have a lot of unknowns, and while I am not a person who worries frequently, right now is the exception. The worries are about finances, connecting in a meaningful way with customers, staying true to my values, the loss of my past role, and creating balance with all the elements in life. So as I was sharing these concerns, Rosie related it to athletic events. It’s a head game. You know your body has trained for the event and you have done the distance, yet your head keeps telling you to stop. You have to talk to yourself like opposing egos on each shoulder. That is so common, not just in new start up businesses, but also with many health care organizations.

It isn’t easy to sustain the effort. A recent Fast Company article on Hell Yes decision making has stayed with me. Health care leaders are working hard to improve quality and reduce cost. We make a Hell Yes decision and go for it. It is exciting and energizing. After a little while the doubts show up and we have to work through the unexpected and mundane. Here comes the head game. The goal hasn’t changed and we have the right tools, yet we have to fight the urge to stop, give up, and regress to the mean.

With the Supreme Court giving a recent nod to the Affordable Healthcare Act, all eyes are on the health care industry. We have supporters cheering from the side of road and colleagues running next to us. Now is the time to draw up our courage and strength to try new ideas and share our progress. It is also necessary to measure the results. Remember to consider how you can document the outcomes of the changes. It is a head game. We are ready to make a difference and need to push forward despite the worries.