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 Table of Contents  
REVIEW ARTICLE
Year : 2018  |  Volume : 4  |  Issue : 1  |  Page : 12-20

Leading mindfully and managing compassionately: Strategies for meeting today's challenges in academic medicine


1 Department of Psychology and Neuroscience, University of North Carolina, Chapel Hill, NC 27599, USA
2 Department of Pathology, Rush Medical College, Chicago, IL 60612, USA
3 Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, NC 27599, USA

Date of Submission27-Jun-2017
Date of Acceptance15-Nov-2017
Date of Web Publication23-Apr-2018

Correspondence Address:
Prof. Monte S Willis
University of North Carolina, Chapel Hill, NC 27599
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IJAM.IJAM_63_17

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  Abstract 


Academic medical centers (AMCs) are no strangers to operating in a challenging environment; however, the challenges have never been more significant and the future more uncertain than now largely due to the changes affected by the health care reform and the possibility of more changes stemming from the political arena. The looming threat to the triple mission of outstanding clinical care, education, and research can only be successfully thwarted by a shift in the mindset of health-care leadership to better align with winning strategies for a volatile environment. Adapting some of the proven leadership strategies in a business setting may be beneficial in navigating the challenging and changing healthcare arena. Two strategies are highlighted with examples in this review: the adaptation of a “growth” mindset over a “fixed” mindset, and application of compassionate management during challenging times, both of which have been shown to improve the overall financial performance of a company. Integration of these strategies and allocation of resources to professional growth and leadership development can equip health system managers, physicians, staff and trainees with the adaptive tools necessary for meeting the increasing demands and ensuring the continued success of an AMC. With nearly 6000 pathologists and 2200 residents working in an academic setting, an increasing emphasis on leadership development and management tools for pathology professionals is timely.
The following core competencies are addressed in this article: Interpersonal and communication skills, Practice-based learning and improvement, Professionalism, Systems-based practice.

Keywords: Academic medicine, leadership, management, operations strategy


How to cite this article:
Wilson BA, Reddy VB, Willis MS. Leading mindfully and managing compassionately: Strategies for meeting today's challenges in academic medicine. Int J Acad Med 2018;4:12-20

How to cite this URL:
Wilson BA, Reddy VB, Willis MS. Leading mindfully and managing compassionately: Strategies for meeting today's challenges in academic medicine. Int J Acad Med [serial online] 2018 [cited 2018 Nov 13];4:12-20. Available from: http://www.ijam-web.org/text.asp?2018/4/1/12/230849




  Introduction Top


“Management is doing things right; leadership is doing the right things.”

- Peter F. Drucker

The academic medical enterprise is currently facing significant challenges on several fronts: unprecedented changes in the structure of health-care delivery systems in the US, decreases in funding of the academic infrastructure by states and the federal government, and an evolving business environment contribute to our uncertainty of the future [Figure 1]. As these challenges become more pressing, academic medical centers (AMCs) necessarily evolve and adapt to the new regulatory standards and practices to survive. What is often overlooked as AMCs undergo these transformations in response to industry challenges is an examination and professional development of their key resources: medical personnel, staff, and trainees. They are the critical factors that allow the delivery of superb clinical care and a dynamic research portfolio, whereas training the next generation of biomedical professionals. To conquer future challenges in medicine, not only is it important for AMCs to allocate resources to support emerging medical enterprise objectives, but also to confirm that team members' (i.e., leadership, administrators, staff, and trainees) mindsets are aligned with these goals. Moreover, it is not a simple task. In this short review, we discuss several ideas from the business community and how they may be applied to the AMC.
Figure 1: Challenges and opportunities in academic medicine today. Images from Shutterstock used under Standard Image License

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According to the Association of American Medical Colleges, there are 145 accredited medical schools in the US and over 400 major teaching hospitals and health-care systems.[1],[2],[3] With respect to the pathology discipline, there are approximately 13,710 active anatomic/clinical pathologists in the US, with the distribution of US medical school faculty including roughly 1822 basic science and 4150 clinical pathologists. Out of this number of academic pathologists, 117 are departmental chairs (41 basic sciences and 76 clinical). In addition, there are approximately 2270 pathology residents and a larger community of graduate students and postdoctoral fellows. As the environment of AMCs become more complex, the potential duties of these pathology-specific professionals may one day include more executive, administrative, or management roles.[4],[5] Therefore, a focus on solid leadership and management development is needed to assure that these individuals are equipped with the strategies to grow professionally and lead successfully.


  How Do Leaders Foster Industry Changes Outside of Academic Medical Centers? Top


Industry-specific leadership practices generally stem from years of proven and equivocal measures of productivity and success and are reinforced through the development of trainees and management of staff. Managers generally onboard and lead from traditionalist perspective, resulting in an approach to problem-solving that becomes inundated with standardized solutions. A major challenge for AMC leaders is that most leadership practices are not catered to a biomedical setting, with its diverse medical specialties and an expanding scientific landscape. Aligning these strategies with the values and relevant challenges within the academic medicine industry assists in shaping the foundation by which new industrial standards are built and can also influence AMCs on a larger scale. AMCs may stand to gain considerable competitive advantage and an evolution in best practices with respect to the leadership development of key personnel by undergoing amendment to become adaptable to today's ever-changing professional landscape.

Although change is inevitable, the likelihood of revamping existing professional practices diminishes with time.[6] Despite the dynamic needs of organizations, the resistance to change is evident and can make restructuring of leadership strategies a stagnant process. Although counter-intuitive to progress, resistance to change can be a default mechanism for many and may hinder the process of addressing evolving organizational needs and challenges. Perhaps one strategy to circumvent this trepidation to change would be to provide individuals with more information. After all, it is plausible to infer that when individuals are equipped with more information, they are more inclined to alter their decision-making. However, this belief is often fabricated and abstract in its interpretation and shows limited value in driving change. In actuality, studies by different groups including Kahan and Kahan et al. demonstrate that if you give people more information, they become more polarized in their decision-making.[7],[8] Commonly referred to as the “cultural cognition of risk,” individuals tend to form risk perceptions that are congenial to their personal values.[7] Studies on this topic have focused heavily on the implications of cultural cognition and how it relates to the public's understanding of science and medicine [Figure 2]. Cultural cognition of risk (also known as cultural cognition) is the hypothesis that people's perceptions of risk and related facts are loyal their self-defining values.[29] For example, despite widespread dissemination of scientific evidence supporting vaccinations, the public is still divided on their utility. Similarly, with respect to the implementation of executive strategies to enhance leadership development and overall organizational culture within an academic medical setting, many have opposing views. Could the perception of risk associated with adapting executive strategies within a medical setting outweigh the potential benefits? This remains an open-ended question for some with limited insight on answers. However, emerging evidence is suggesting that strong leadership is an important element in maintaining successful health-care systems.[9]
Figure 2: How a person's “cultural cognition of risk” affects change and behavior in unexpected ways. Cultural cognition of risk (also known as cultural cognition) is the hypothesis that people's perceptions of risk and related facts are loyal their self-defining values

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In the next sections, we offer insight on several leadership strategies that have been used in the business setting including fostering a growth mindset and application of compassionate management through challenging times. We include real-world examples of how organizations have applied these strategies to foster employee professional growth and leadership capabilities and suggest how these practices may be integrated into AMCs to enhance the career development of pathologists and pathology trainees in preparation for administrative or leadership roles.


  Growth Mindset Top


“My experience has shown me that the people who are exceptionally good in business aren't so because of what they know, but because of their insatiable need to know more”

- Michael Gerber

Carol Dweck has pioneered the study of how people think affects how they perceive their success at Stanford University over the past three decades, including multiple New York Times Bestselling books. She introduced the concept of having a “growth mindset,” which stimulated a change in how we perceive our measures of career/personal success and may have many practical applications. The general idea of her work is that obtaining true success in a given area can be measured by one's collective achievement (including accumulated experiences), in contrast to the more conventional perception of success resulting from fixed traits such as intelligence or talent.

According to Dweck's work, mindset can be grouped into two categories – “fixed mindset” or “growth-mindset.”[10] Individuals who believe that everyone is born with a certain set of competencies or fixed-mindset, see the world in this binary fashion. You either have the ability of a leader, or you do not; you have tremendous skills as a scientist or you do not. The possibility for improvement and serious personal growth and development does not exist in their narrative. The pitfalls with this mindset are that it also means that they define success on how smart and talented other people are. In contrast, people with a growth mindset appreciate the need to fail and that talents and abilities can be developed over time with experience and practice. Individuals with a growth mindset are often accepting of mistakes and use the experiences of past failures to grow and become better prepared for future challenges. Alternatively, individuals with fixed mindsets base their success solely on individual achievements and an avoidance of failure. Mindset plays a critical role in a person's worldview or experiences and people, affecting how they perceive the value of education, effort, feedback, and challenges [Table 1]. This makes understanding mindsets other than your own critical in managerial functions.
Table 1: Categories of mindset and their effect on a person's worldviews

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  What Does a Growth Mindset Mean for Leaders? Top


The authors believe that it is important to understand your own mindset and how taking a growth mindset can improve you as a leader. First, it can help you see the positive in every situation, knowing that you and your colleagues are human and that failing from time to time is part of the process. When you fail, you figure out what went wrong and design ways to not let it happen again. We believe that leaders with a growth mindset are more likely to focus on acquiring new skills - skills to manage people better, learning new technologies and systems, or mastering other skills outside of their jobs to support their development into a more complete human. We would also predict that a growth mindset allows people to build stronger relationships because they are more patient and understanding as it removes any expectation that they (or others are perfect). That is not to say they do not have high expectations and do not expect to improve, but they know perfection takes times. Just like developing your own skills, it is our opinion that leaders who are governed by a growth mindset are always finding ways to improve their company and individuals around them.

The successful adaptation of growth mindset among various organizations has been shown to be linked to enhance employee effectiveness and morale. Organizations that successfully integrate a growth mindset culture among their key leadership and employees have observed improvements in overall their company's financial performance.[11] One example of successful growth mindset integration into an organization's culture was demonstrated by Robert Pink, an industry executive at Google, UK. During Pink's tenure, he embedded a cultural philosophy called “20% time.” The 20% time encouraged employees to spend 20% of their time developing new ideas and being innovative.[11] As a result of this program, employees developed powerful tools on their own such as Froogle (catalog indexer of online stores) and Suggest (most notably part of the autocomplete feature in Google search) applications. Similarly, 3M initiated a “15% Dream Time,” which gave employees space that led to the creation of the “Post-It” note and Scotch tape (also known as Sellotape in Britain). When Phupinder Gill became CEO of the American-based financial firm CME Group in 2012, he recognized a need for employees to develop a growth mindset to effectively think of how technology and globalization effected their company. To facilitate this, Carol Dweck gave a lecture on growth mindset to the key leadership first and then all employees. What resulted was a collection of recorded content, in which the company now uses to orientate all new employees. In addition, the CME Group began incorporating growth mindset evaluations as part of the hiring process. When employees are interviewed, they are not only asked questions about to their skills but also they are asked questions such as “describe a time you confronted a challenge. How did you work through it to overcome your doubts?”[12] To support the growth mindset culturally, the CME Group discourages the use of praising employees for individual achievements and instead utilizes language such as, “Thank you for your effort”[12] By incorporating growth mindset strategies, the CME Group institutionalized their innovation process and now innovate more quickly.[12]

While incorporating a growth mindset has proven beneficial in corporate settings, examples within higher education settings are just beginning to emerge. For example, High Point University employs best practices and encourages innovation across campus to help students transition from a fixed to a growth mindset using a quality enhancement plan to roll out these initiatives (http://www.highpoint.edu/qep/) [Figure 3]. By prioritizing specific practices and implementing cultural change to support the development of growth mindset among faculty, staff, and students, universities are fostering ways to expand their own possibilities. One challenge of applying growth mindset beyond the corporate setting may have to do with the type of evidence that has been collected on the topic. The literature on leadership, management, and organizational behavior is generally observational and more anecdotal. For the biomedical experts, this may invoke skepticism as their training emphasizes the importance of randomized and prospective study design. However, randomized and prospective studies of growth mindset are extremely rare and difficult to plan. However, the collective body of work from numerous observations by management professors and social scientists has characterized many of the traits of successful leadership for both private and public enterprises.[13]
Figure 3: Adapting a culture of growth mindset in higher education: Benchmarks from Highpoint University's Quality Enhancement Plan Integrating Growth Mindset into the community. Brief summary of benchmarks from the 2017–2018 Annual Report. For more details and specific benchmarks, see: https://goo.gl/kFCuag

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While the design of specific strategies to implement growth mindset development within AMCs is limited, the biomedical field can still learn and tailor programs based on corporate research analyses. As C. David Naylor explained, “there is not one leadership genotype or phenotype that perfectly fits every circumstance” or “fully captures the complexity of social reality.”[13] Therefore, utilizing social science-based observations to develop biomedical professionals and AMC organizational culture could spark change and ultimately demonstrates adaptation of the growth mindset needed to innovate and successfully lead.

An AMC's organizational culture is influenced by the mindsets of individuals who actively lead and manage staff and trainees. Similarly, AMCs may also take on a collective organizational mindset as a reflection of influences from these individuals. Given this reality, applying Dweck's strategy to the organizational leadership can clearly have important influences on daily operations. Organizations with growth mindsets think differently and embrace new perspectives with a dedication to continuous learning, development, and the pursuit of change. Contrastingly, organizations with a fixed mindset culture are shown to be talent-obsessed, where employees feel as through their abilities determine their success and their failures reflect their own perceived value. This way of thinking can negatively impact company performance and may hinder an organization's ability to solve problems. For example, although the fall of the Enron Corporation was primarily due to accounting fraud, it was also partly attributed to the company being overtly talent obsessed, which led to employees lying about problems and not admitting mistakes when challenges arose.[14],[15] This type of organizational culture impedes a company's ability to effectively strategize objectives and create solutions to address them.


  Compassionate Management Top


“Wisdom without compassion is ruthlessness, compassion without wisdom is folly”

- Fred Kofman

The ever-evolving demands and challenges of AMCs create complex environments, in which leaders must adapt. Managers are expected to handle several factors including maintaining daily operations on limited budgets, boosting employee morale, conflict resolution, and showing resilience through problem-solving. Researchers have found that self-compassion is emerging as a useful conceptual tool to assist leaders by enhancing their abilities to optimize decision-making processes to address these organizational factors.[16]

Self-compassion is an Eastern philosophy that has been practiced for over 2000 years, but its implications in leadership development are relatively new.[17] Neff describes compassion as the ability to show oneself positive self-regard when faced with life challenges and involves three components, kindness, common humanity, and aspects of mindfulness.[17] Individuals who display higher levels of self-compassion are shown to be more resilient through difficult times.[18] Normally, it is easy to become emotionally consumed during times of failure, feeling inadequate, and feeling emotional pain and suffering. However, self-compassionate leaders have learned to remain calm during difficulties and do not hold themselves to a negative regard when failures occur. Instead, self-compassionate leaders openly admit and address the aspects of themselves that need improvement, while taking full responsibility to decipher ways to change in an effective and positive manner.[19]

Compassion has been shown to potentially have similar outcomes to growth mindset.[20],[21] Growth mindset individuals believe their progress and efforts in a given area leads to future success. Moreover, they understand that certain abilities can be enhanced with experience and practice. Similarly, compassion is a skill that can be developed over time. However, it takes the will of a leader who is open to sharing common humanity with all stakeholders (patients, employees, funding agencies, and trainees). LinkedIn ® CEO Jeff Weiner is a huge proponent of compassion within the workplace and has infused it in every aspect of his organization. In his essay on managing compassionately, Weiner described three elements: (1) the meaning of compassion, and specifically how compassion differs from empathy; (2) the fact that compassion can be learned and is not solely innate; and (3) the importance of striving to achieve both compassion and wisdom and not one without the other.[22]

Since managing compassionately does not come naturally for some leaders, Weiner suggests recognizing our shared humanity as individuals. The relational nature of compassion as a concept means “to suffer with,” but this suffering is not solely based on the negative connotations of suffering. At the core of compassionate leadership, managers make an intentional decision to share in an employee's experience to gain a better understanding of their motivations, fears, and values (i.e., take a walk in someone else's shoes). Such assessments may enable leaders to give appropriate feedback based on situational context. For instance, could an employee's personal life be impacting their work? Could this employee be caring for an ailing relative or dealing with the financial burdens of being the sole provider for their family? When it comes to evaluating employees, these factors are often neglected but can impact employee performance in significant ways. Hence, it is critically important for managers to gain a deeper understanding of the circumstances affecting their employees rather than projecting self-motivated solutions.

Although compassionate management may seem altruistic in nature, it is not simply a form of charitable giving to employees, and can positively affect organizational performance. Studies by Marcus Buckingham demonstrate that compassion benefits the corporate bottom line.[23] AppleTree, a call center company integrated conscious compassion into its company culture when it launched the “Dream On” initiative. Similar to the “Make-a-Wish” foundation, the “Dream On” initiative served to give adult employees access to positive life experiences and allowed employees to express compassion to each other on a daily basis. The program gave the executive team at AppleTree a glimpse into the lives of their employees and observed that a staggering number of them had financial challenges and were caretakers of ailing family members. In its first year, the “Dream On” initiative resulted in a 20x return on investment for AppleTree and contributed to the highest employee morale in company history.[24] Studies of companies who practicing conscious capitalism, focusing on providing for the economic and social benefit of others in the community and broader world, perform ten times better than companies that do not.[25] These specific applications of compassionate management not only provide for improved employee satisfaction but also it reaps the rewards of having motivated and complete people that are more productive, leading to improved company performance.

When compassion was utilized to supplement the leadership development of wildland Fire Managers, positive results were observed. In a study by Lewis and Ebbeck, 39 fire managers and crew supervisors were organized into several focus groups centered around interviews and questionnaires pertaining to self-compassion.[16] Initially, study participants struggled with formulating definitions of self-compassion that resonated personally. However, throughout multiple discussions, wildland fire managers began to recognize strategies, in which they utilized self-compassion to achieve higher levels of optimal performance. Fire managers also recalled scenarios where the lack of self-compassion leads to unfavorable outcomes.[16] Of note, was participants relatively quick understanding of common humanity and its importance in the workplace?[16] Together, these observations demonstrate that individuals can develop an understanding of compassion that resonates with them intrinsically and motivates its adaptation into organizational culture. More importantly, such cross-organizational benefits of compassion support its potential efficacy as a useful tool to develop leaders within the academic medical setting.

In a recent Mayo Clinic study of over 94,000 physicians, over 50% of US Physicians now suffer at least one symptom of burnout.[26] In their study, physician burnout rates (assessed by validated metrics) are up an additional 20% in 2014 compared to their initial studies in 2011.[26] The burnout rates of nonphysician control populations did not change during this time, with physicians ~2 times more likely to suffer burnout compared to the normal population. The suicidal ideation among physicians increased from 4.0% to 7.2%. In the “Remedy for Burnout: 7 Prescriptions Doctors Use to Find Meaning in Medicine,” embracing compassion is one tool used to counteract burnout (http://starlafitchmd.com/fight-physician-burnout-with-compassion/). However, compassion can be difficult to come by when daily schedules seem to exceed time available in the day. In this context, the kind of compassionate management we provide as leaders may not result in greater institutional productivity, but it can provide critical support to physicians arguably most in need of the counterbalancing effects of compassion on burnout among our valued colleagues.

Compassionate leaders exhibit multiple traits that you may recognize in yourself and/or other leaders [Table 2]. While the practice of compassion in the workplace may seem obvious to some, to many it goes against our conditioning to think that showing compassion makes you more vulnerable and open to be exploited.[27] However, the compassionate leader may fare better in crises, inspire people to commit to better communication and actions, to effectively counteract the challenging economic changes around us.
Table 2: Compassionate leaders….

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  Conclusion Top


Two strategies with a proven record of fostering employee effectiveness and morale and improving financial performance in the corporate arena can be applied to the AMCs to help meet the current challenges affected by policy and politics. Both strategies require a shift in the mindset at the organizational level and fostering of the culture at all levels.

Growth mindset

Individuals with a fixed mindset believe that everyone is born with certain competencies in this binary fashion. That is, you either have the ability of a leader, or you do not; you have tremendous skills as a scientist, or you do not; you either are an athlete, or you never exercise. The possibility for improvement and serious personal growth and development does not exist in their narrative. In contrast, people with a growth mindset appreciate the need to fail and believe that talents and abilities can develop over time with experience and practice. Pitfalls with the fixed mindset: they define success on how smart and talented other people are. People with a growth mindset appreciate the need to fail and that talents and abilities develop over time with experience and practice. Individuals with a growth mindset are often more open to making mistakes and use the experiences of past failures to grow and become better prepared for future challenges.

The adaptation of the growth mindset occurs at both the individual and organizational levels [Figure 3]. Integrating a growth mindset among key leadership has demonstrated benefits to company's performance. The purposeful integration of a growth mindset into a company's culture can have unexpected benefits, particularly in situ ations where people's creativity is critical to the success of the enterprise, such as an AMC.

Compassionate management

In today's workplace, social psychologists have found that compassion is a better managerial strategy than toughness. Making people fearful of punishment is typically counterproductive, whereas compassionate responses evoke powerful results.[28] However, to be an effective compassionate leader to others, leaders must first be self-compassionate. Self-compassionate leaders remain calm during difficulties and do not hold themselves to a negative regard when failures occur. They openly admit and address the aspects of themselves that need improvement, while taking full responsibility to decipher ways to change in an effective and positive manner [Table 1].[19]

Compassionate management has been effective in improving organizational performance, as shown in the “Dream On” initiative (20x return on investment, highest morale in company history). It is therefore no surprise that companies intentionally focusing on the economic and social benefit of others (much like the practice of medicine in simpler times) perform far better than companies that do not.[25] Applying compassionate management [Table 2] not only improves employee satisfaction but also helps realize the rewards of having motivated, complete, and more productive workforce, leading to improved company performance.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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