Ten Things I Have Learned About How the World is Changed (and how I am changed)
David C. Leach, M.D.CEO, ACGMEAugust 1, 2007
God has no potential; we do.
Before we begin….
A moment of gratitude
Thanks to…
Paul Batalden
The ACGME Community
Don Berwick
Dee Hock
Parker Palmer
Brenda Zimmerman
Michael Quinn Patton
C. Otto Scharmer
Aristotle
Rosa Parks
Martin Luther King
Nelson Mandela
Vaclav Havel
The unremembered many
Recommended Reading
The Birth of the Chaordic Age – Dee Hock
Getting to Maybe: How the World is Changed – Westley, Zimmerman and Patton
Theory U – C. Otto Scharmer
The Way It Is
There’s a thread you follow. It goes amongthings that change. But it doesn’t change.People wonder about what you are pursuing.You have to explain about the thread.But it is hard for others to see.While you hold it you can’t get lost.Tragedies happen; people get hurtor die; and you suffer and get old.Nothing you do can stop time’s unfolding.You don’t ever let go of the thread.
--William Stafford
Lesson One: Be Clear about the Task…
Substance is enduring; form is ephemeral. Preserve substance; modify form; know the difference.
Dee Hock
The Tasks…
How can we be both faithful and effective trustees of the values our profession and traditions offer society?
…and how can we prepare the next generation of doctors to be faithful and effective?
The Task…
Be clear about the aim…
e.g. Improve patient care vs.
Save 100,000 lives by June 26, 2006
Lesson Two:
It is said that people resist change; in my experience people are attracted to change.
But…
They are not attracted to:
Transitions
Burden
Being told to change their way to my way
Lesson Three:
The future is bigger than we are; it is emerging as we speak; we cannot redesign it; we can only notice it.
Lesson Three:
The task is to pay attention ....
with others
Lesson Four:
The quality of conversation…
is predictable
is helpful in knowing the next step
is progressively more authentic
Predictable
I deny that we need to change.
I resist the change you are suggesting.
It was my idea all along.
Is A Helpful Marker…
…and progressively more authentic
●
●
● I-in-Me
I-in-It
I-in-You
I-in-Now
After Scharmer
●
●
● I-in-Me
I-in-It
I-in-You
I-in-Now
Downloading
Seeing
Sensing
Presencing
Voice of Judgment
Voice of Cynicism
Voice of Fear
Habitual
Rational
Relational
Authentic
“Self”
After Scharmer
●
●
● I-in-Me
I-in-It
I-in-You
I-in-Now
Downloading
Seeing
Sensing
Presencing
Voice of Judgment
Voice of Cynicism
Voice of Fear
Habitual
Rational
Relational
Authentic
“Self” “Time”
Disembodied
Chronos
Slowing Down
KairosStillnessPresencing
After Scharmer
●
●
● I-in-Me
I-in-It
I-in-You
I-in-Now
(Re-enactingpatterns from
past)
(Facing exterior data)
(Sensing through social mental fields)
(Connecting to source)
“Org. Action”
From within org. boundaries
From periphery of boundaries
From beyond org. boundaries
Across openboundaries
After Scharmer
●
●
● I-in-Me
I-in-It
I-in-You
I-in-Now
Downloading
Seeing
Sensing
Presencing
Voice of Judgment
Voice of Cynicism
Voice of Fear
Habitual
Rational
Relational
Authentic
“Self” “System”
Autistic
Adaptive
Reflective
Generative
After Scharmer
Lesson Five:
It helps to work with …
…rather than against nature
Working with Nature:Three Faculties and Their Objects
Intellect – seeks Truth
Will – seeks Goodness
Imagination – seeks Beauty
Human Faculties and the Work of Medicine
Intellect
Discerns the truth
Will
Makes good clinical/educational judgments
Imagination
Does so with harmony, creativity and beauty
Primary Values in Medicine with which to Arm Oneself
IntegrityDiscerning and telling the truth
Altruism Putting what is good for the patient/student before what is good for the doctor/teacher
Practical wisdom (Prudence)
Beauty in judgment
Arete: Integrating all the virtues to excellence
Lesson Six:
Change Makes these Values Manifest in Community and in Action
Arete: ExcellenceIntegrated Virtue in Action
The quality of patient care, the quality of health professional formation, and the quality of system performance are inextricably linked.
The Context of the Work of Healthcare
Relentless economic/time pressures
A focus on safety, quality, transparency….
More regulation, duty hours, etc.
New knowledge and technology
Fragmentation of care, alternative medicine, consumerism
Demographics – population, generational gaps…
The (Internal) Context of the Work of Healthcare
Truth telling (or lack thereof)• The 38/54% problem
Promises and forgiveness
Seeking goodness …for whom???
Imposed external controls
Discontent
A need for authenticity
The National Context of Health Professional Formation
Impending physician shortages
Outmoded educational models
Individual formation: role of context
The Institutional Context for Healthcare Work
Frenzy
There is a pervasive form of modern violence to which the idealist … most easily succumbs: activism and overwork. The rush and pressure of modern life are a form, perhaps the most common form of its innate violence.
To allow oneself to be carried away by a multitude of conflicting concerns, to surrender to too many demands, to commit oneself to too many projects, to want to help everyone in everything is to succumb to violence.
The frenzy of the activist neutralizes his (or her) work … It destroys the fruitfulness of his (or her) work, because it kills the root of inner wisdom which makes the work fruitful.
Thomas Merton
From frenzy to wisdom…
…as individuals and as a profession
Lesson Seven:
We have to let go in order to let come.
After Scharmer
The problem is never getting new ideas into your head; it’s getting the old ones out.
Dee Hock
A Midrash
Lesson Eight
It helps to honor both arms of all paradoxes.
Six Paradoxes of Formation Space
Open -------------
Hospitable -------------
Voice of Individual -------
Personal stories ----------
Solitude ---------------
Speech ----------------
Bounded
Charged
Voice of Group
Archetypal stories
Community
Silence
Parker J Palmer
Lesson Nine
Crystallize intentions
After Scharmer
Lesson 9A
Keep Humility at the Ready
“ We exhaust ourselves supporting our illusions.”
Thomas Merton
Lesson Ten:
There are really only two questions
Two Questions
Who is my Self?
What is my Work?
Journey to Authenticity…
as individuals and as a profession
The Journey
One day you finally knewwhat you had to do, and began,though the voices around you kept shouting their bad advice-though the whole housebegan to tumbleand you felt the old tug at your ankles.“Mend my life!”each voice cried.but you didn’t stop.You knew what you had to do.
The Journey (cont.)
…little by little,As you left their voices behind,The stars began to burnThrough sheets of clouds,And there was a new voiceWhich you slowly Recognized as your own,That kept you companyAs you strode deeper and deeperInto the world,Determined to doThe only thing you could do-Determined to saveThe only life you could save.
Mary Oliver
Values are enduring; rules are ephemeral; preserve values; modify rules; know the difference
Dee Hock Modified
Community leads to clarity; clarity leads to courage
I Will Not Die an Unlived Life
I will not die an unlived life.I will not live in fearof falling or catching fire.I choose to inhabit my days,to allow my living to open me,to make me less afraid,more accessible;to loosen my heartuntil it becomes a wing,a torch, a promise.
I Will Not Die an Unlived Life
I choose to risk my significance,to live so that which came to me as
a seedgoes to the next as a blossom,and that which came to me as
blossom,goes on as fruit.
Dawn Markova