Physicians and many executives throw themselves at decades of technical development. This often leads to neglected adaptive capacities. The Rub: the adaptive capacities are essential to function in complex environments and for competent leadership. Fear-based avoidance thinking and behavior, power struggles, unnecessary conflict, burnout, and worse. Our organizational clients understand the need to development their…
Collectively, the following four archetypes symbolize how humans organize thoughts, feelings, relationships, memories, and more.* We can use them to map the mind, essentially. Each archetype has its positive and negative expression. Benevolent leaders nurture the positive expressions of these archetypes in themselves and in the people they lead. The King-Queen Archetype The King or…
“… relationship conflict is generally bad for performance, but some task conflict can be beneficial: it’s been linked to higher creativity and smarter choices.”* Task conflict is productive because the collective cognitive and passion energies of your team, division, or organization are focused (as the name indicates) on the task, mission, or purpose. Relationship conflict…
The over-engineered term we used in graduate school was “misapperceptions.” The self-defeating thought constructs that lead to anxiety, depression, and some interpersonal difficulties. Change the misapperceptions, the thinking went, and you will liberate the individual from anxiety, help them get their feet back on the ground, and empower them to reclaim wasted cognitive and emotional…
“Do unto others as you would have them do unto you.” In healthcare, the Golden Rule can be a dangerous thing. Most healthcare providers easily forgive others’ mistakes, and they tend to be great at offering and endorsing support for their colleagues. Often, they are not good at doing the same for themselves. As a…
Is your Adaptive Child or your Functional Adult running the show?[1] This is a crucial question whether you’re a leader or if you simply face complexity in your personal or professional life. (Remember! All significant relationships are complex circumstances.) The Adaptive Child endures or confronts its world using a fear-based, reactive operating system. The Functional…
Courage is not the absence of fear. Courage is being afraid and not letting it stop you. Rumi says, “Today, like every other day, we wake up emptyand frightened. Don’t open the door to the studyand begin reading. Take down a musical instrument. Let the beauty we love be what we do.There are hundreds of…
“I need to quit healthcare and find another profession.” I’ve heard several versions of this sentiment from clients over the years. Our healthcare system is out of balance, no doubt. But you don’t need to change careers to regain psychological equilibrium and passion. (And you’re not going to make the healthcare world less dysfunctional either.)…
“How do I thrive in a dysfunctional healthcare system and not let it discourage me or drive me insane?” Several of my physician clients have presented different versions of this question in sessions. Before discussing “stay-sane” action items, we must start by articulating the nuance of the healthcare dysfunction we’re dealing with. Know the Function…
“Keep striving until you find yourself.” Run like crazy when you hear this saying or any other bullshit saying like it. The future you is not hiding under some rock out there waiting to be discovered. To better engage complexity, to develop relational depth, to lead with more competence: these all require you to create…
Jeff Bezos suggests the “two pizza rule” for Amazon meetings, no more attendees than can be fed with two pizzas. (About 6-10 people.) Meetings with more than ten people risk diluted communication, allow people to go passive (hide in plain sight), and undermine decision making. Here are 5 other ways to ensure you have productive…
“Brain Plasticity” can get physicians (and executives) into trouble. Physicians are people. In their early years, like the rest of us, many endure bullying, abuse, and traumatic loss. But physician exposure to trauma is more likely to continue from there. Up to 78 percent of residents experience at least one traumatic event during their training,…
If you want to help as many people as possible, you’ll see to it that you’re around for a long time. Sustainability has a very high leadership effectiveness correlation.
“Wherever you go, don’t forget to take your body with you!” Adaptive Development tends to be “top down.” It goes something like this: However, now we understand that our thinking is often impacted when the body reacts to a dynamic or circumstance and sends counterproductive messages to the brain. In other words, sometimes it’s the…
Peel back the layers of physician anxiety, depression, suicidal ideation, physician suicide, and you’ll often find the negative manifestation of the Socialized Mind.[i] “You can’t reach out for help because you’ll be seen as weak.” “It doesn’t matter that it’s unsustainable. You must power through, must keep going.” “You’re a doctor. You’re supposed to have…
The minimum level of Adaptive Development required for competent leadership is observable, measurable, and predictable. It is called the Self-Authoring Mind, and you’ll know it when you see it. Self-Authored thinking empowers people to thrive in situations that provide ambiguity, complexity, volatility, and oppositeness. The Self-Authored Mind ups our ability to engage complex circumstances. Since…
Healthcare Leaders: Did you know that there are 317,987 health plans in the US market? Did you know that there are 599,204 unique codes to describe healthcare products and services? And were you aware that each code requires each individual healthcare plan to establish a pricing model for the service with the provider? Did you…
“They never teach us this in medical school!” One of my surgeon clients said this to me a couple weeks ago, and it wasn’t the first time I had heard it. (He and I were reviewing Joel Trammell’s “The CEO Tight Rope,” which gives sage advice about creating a top-notch recruiting function.) In addition to…
“Take the results of their personality profile, crumple it up, and throw it out the window.” These were the words of the trainer who was teaching us what to do after we debriefed clients who had taken a popular personality profile. Obviously, she didn’t mean it literally. Her point was that personality profiles are tools,…
“We’ve been to the battlefield and met the enemy. He is us.” A modernized version of this famous paraphrase: “We have been to the battlefield and met the enemy. The enemy is the way we’ve been interpreting the challenges we face.” Technical development teaches you things to know. Adaptive Development facilitates better ways of…
You assume the brilliant surgeon will be a brilliant leader. You promote or onboard your most talented people to positions of authority. Then, because they are indeed brilliant, you set them free to do the job with little or no developmental support. “I call it cruel and maybe the root of all crueltyto know what…
Don’t let your most valuable resource go to waste! Fern EPC founder and president Brad Fern shares insights on how organizations can help their people reclaim wasted cognitive and emotional energies. In his latest video, Brad describes the importance of the Challenger, the Attuned, and the Contributor in forming the ego strength necessary to lead…
Do you have your strengths, or do your strengths have you? Michael Watkins teaches that what got you where you are won’t necessarily serve you there. “Success often requires us to stop doing some things we’ve been doing and to embrace new competencies.” The surgeon leader who tells herself, “To meet expectations, I must do…
The Spanish poet Antonio Machado wrote, ‘I caught a glimpse of him in a dream, expert hunter of himself, always in ambush.’ Machado reminds us that the self is perpetually incomplete. Growth is not just what we can do. It’s what we can be. The idea of self-growth can be daunting, but courage is not…
“Mankind owns four things That are no good at sea: Rudder, anchor, oars, And the fear of going down.”[i] In leadership, we are often responsible for things we don’t completely control. Some refer to it as the Authority Paradox. The more authority we have, it seems, the less we can rely on authority to get…
Fern EPC President Brad Fern describes the Assertiveness Spectrum: https://youtu.be/jQ-zWDe7rOY
When leading or generally interacting with others at work, consciously or unconsciously, we choose default “relational modalities.” In other words, we act passively, assertively, or aggressively. Awareness of your default mode will increase your relational agility and leadership efficacy. Passivity, on the far right of the Assertiveness Spectrum, is a fear-based state in which ego…
One Quarter of US Physicians and Surgeons are Foreign Born Dr. Fatima(1) immigrated to the United States from North Africa with her husband and three young children. Growing up in Libya, she had seen her brother struggle with severe scoliosis. Her love for her brother made her decide at an early age to dedicate her…
When Better Communication Isn’t Going to Help You You’ve been taught how to motivate people, how to communicate better, and how to get others to buy-in. You may have relied on popular personality inventories to help you align and collaborate with colleagues, and you may have read all the latest leadership books. But all of…
Whenever three or more people come together for a sustained period of time, they form unwritten and unspoken contracts. This is as true for leadership teams as it is for any other group. Subliminal team contracts set the rules for how team members treat each other, who speaks most, whose skills are valued, which qualities…
The growing problem of burnout among medical professionals has created divergent schools of thought, and the subsequent debate has begun to reverberate throughout the entire healthcare system. Within the context of this complex conversation, two distinct groups have emerged, each supporting their own vision for improving the lives of overworked physicians, nurses, and others. On…
Understanding Fern EPC’s Coaching Method A variety of coaching modalities provide support and empowerment to individuals and teams seeking transformation. Our method stands head and shoulders above the others for its effectiveness in assisting doctors and healthcare executives., especially when dealing with physician burnout. And it’s all because we use the Fern EPC coaching modality…
The benefits of learning to listen Fern EPC has been inundated with requests seeking clarification on the Three Levels of Listening, and for good reason. Understanding the Three Levels of Listening is essential for cultivating effective communication, empathy, and empowerment. Prescriptive Listening has its place but must be used judiciously to avoid creating dependence and…
Executives and physicians who choose to grow their ability to face complexity generally pass through four stages.[i] These stages are not easy, but they are essential steps toward greater cognitive and emotional agility: 1.) Unconsciously Immune: When you begin the adaptive-change journey, you are Unconsciously Immune to Change. This means you are unable to see…
“My people!” Almost any CEO will say this when asked what their most valuable resource is. But it’s not necessarily true. “The cognitive and emotional energies of my people are my most valuable resource” is a more specific and accurate answer. The Bad News: loads of this valuable resource are wasted every day in healthcare…
When catastrophe is a minor blunder away, when you could amputate the wrong leg or remove the wrong kidney, for instance, it’s easy to get people to embrace High Reliability principles. Give a speech about HROs to a room full of O.R. docs and nurses, and you might see a lot of nodding heads. Give…
If you aspire to be a High Reliability Organization, your primary obstacle will be the adaptive limits of your staff. To be an HRO, your leaders must commit to zero harm. Your board must commit, your C-level leaders must commit, nurse leaders, physician leaders – leaders all the way down the line must commit to…
You should have grown wise before you grew old! This is a paraphrase of King Lear’s fool admonishing him for being naïve. Lear had come to the threshold of a grand transformation, and he assumed the skills and vision that got him there would serve him once he crossed it. Worse, he expected the old…
“Sometimes I feel the physicians demonize us for the decisions we make because they don’t understand why we’re making them.” This quote is from a healthcare administrator lamenting the tension between his department and his physicians. Several colleagues of mine and I conducted 25 administrative interviews. As a professional listener who specializes in physician and…
Careful! So you think you’re looking at a remedial circumstance because one of your physicians or executives is behaving poorly. Behavioral issues are often developmental needs in disguise. When dealing with “problematic behavior,” consider instead that you’re dealing with a normal human being who needs support. No one got up one morning, rubbed their…
Your leadership team does not have a brain. It does, however, have shared perceptions, shared biases and memory, collective thinking, and mutual assumptions. In other words, just as individuals have minds, so does your leadership team have a mind. Many leadership teams are too busy to objectify and examine their own collective mind. The price…
Shame is antithetical to effective leadership. It’s a fear-based emotion that keeps you thinking about yourself. Competent leadership requires altruism. Shame, sometimes referred to as insecurity, can impede or debilitate new, young, and sometimes even seasoned leaders. Worse yet, shame will prevent some of your most talented people from stepping up, speaking out, leaning in,…
Physician leaders and healthcare executives sometimes speak of creating oases of efficiency and people-centeredness within organizations or systems they consider dysfunctional. Get enough people together for long enough, they say, and years of good policy intentions turn redundant, excessively complicated, and wasteful. Dysfunction in healthcare systems (often pejoratively described as “healthcare bureaucracy”) is especially problematic…
It’s a forest-through-the-trees kind of thing. You don’t see your thinking because you’re using your thinking to see. Perception begets interpretation > Interpretation begets emotion > Emotion drives behavior. Many physicians, physician leaders, healthcare executives and leadership teams don’t take the time to examine these perception-feeling-behavior progressions and their impact on performance. Yet failure to…
Physicians dedicate their young lives to technical growth: pre-med requirements, preparing for and taking entrance exams, medical school, passing boards, residency, and so on. Often, the price of this laser focus on technical growth is neglected adaptive growth. Adaptive growth is associated with wisdom, gravitas, maturity, courage, complex thinking, governance, vision, competent leadership, and confidence. Adaptive…
What about the colleague who is willing to sacrifice the truth if being truthful means being wrong? What about the boss who has no concern about the consequences of his or her manipulative style? What about the employee who is a stranger to empathy and has no problem hurting others? What about unreasonable people?
Power, Control, Revenge, Avoidance, and Attention. These are Rudolf Dreikurs’ five motives for troublesome behavior.[i] We can use them to gain insight into ourselves and to understand some of the difficult behaviors we see in others. Dreikurs taught us to look beyond problematic behavior, identify the unmet need, and resist the knee-jerk urge to use…
Fear of being dispossessed was and is a biological brain function promoted by natural selection. Subsequently, we’re hardwired to fear social estrangement. (In other words, you’re normal.)
This video shows a high-functioning team in action. (I purposely chose a video in a language other than English—in this case French—to ensure we don’t get lost in words.) Notice how the two client-facing team members support each other, blend their voices, yet set each other apart. Watch their eyes as they look to the…
To better understand physician disengagement, discouragement, and burnout, we can turn to the work of Alfred Adler and the foundational concept of Adlerian theory, Gemeinschaftsgefühl, loosely translated as “Social Interest,” the belief that humans have a primary need for social connectedness and to feel that they are contributing to the wellbeing of others. Adler taught…
My wife risks blindness without her glaucoma medication. A month’s supply is 3 ml. That’s barely enough to fill a thimble. It was priced at nearly $300. On vacation recently, she bought the same 3-ml of medication from a Parisian pharmacy for 11 Euros (about $11.50). We walked in, presented an outdated prescription from the…
The following is an adaptation of an email I sent to one of my physician clients after I had sent him a poem by Li-Young Lee called “The Gift.” First the poem and then the reply to his reaction: Here is the edited email to my physician client in response to his reaction: I’m happy…
Know how to gauge the complexities you face; the four types of challenges[1] faced by Physician leaders and healthcare executives. It matters because simple thinking applied to complex circumstances squanders opportunity and creates dysfunction.[2] 1.) Known Challenges: Known challenges are the simplest of the four types because cause-and-effect are repeatable, perceivable, and predictable. If you…
“Is there a way to provide mental health services to medical professionals under the guise of coaching?” A colleague posed this question in an email voicing his concern about physician suicide. He asked me because I am a licensed therapist in addition to being a coach who specializes in physicians and healthcare-industry executives, and he…
Primary care burnout results in $969 million in excess annual spending: Mayo researchers analyzed the financial impact of primary care physician burnout and turnover using American Medical Association Masterfile data October 12, 2017, and March 15, 2018. (Primary care was defined as family medicine, general internal medicine, general pediatrics, geriatrics, general medicine, general preventive medicine,…
In an ordinary organization, most people are doing a second job no one is paying them for. In businesses large and small; in government agencies, schools, and hospitals; in for-profits and nonprofits, and in any country in the world, most people are spending time and energy covering up their weaknesses, managing other people’s impressions of them, showing themselves to their best advantage, playing politics, hiding their inadequacies, hiding their uncertainties, hiding their limitations. Hiding.
Know the difference between technical capacity and adaptive capacity: Which filters do you use to make meaning? Carol Sanford says, “[Most] approaches to change are all working from an old mind. We’ve modified what we do, but we haven’t addressed who we are. It’s no accident that nearly every philosophical and spiritual wisdom tradition teaches…
“As we orient on what we most want, we face what we most fear. Always this energy smolders inside. Always the spark of our purpose and passion awaits our commitment.”
Some of my clients talk about how shame has been an energy drain and how their feelings of “not-good-enoughness” have created a glass ceiling of progress. “How do I heal my shame”, is a question I often hear. Immunity to Change coaching goes after the inner critic methodically by helping high performers get conscious of…
As millions of doses of Pfizer’s and Moderna’s vaccines are being shipped across the globe, there are glimmers of hope beginning to appear on the horizon. Leaders can now start to contemplate how they will lead post-pandemic and consider how they will help to shape the new normal. I spoke to Carrie Guthrie, Vice…
There are two general approaches to solving the problem of physician burnout. One side—typically administrators, managers, and wellness advocates—says healthcare organizations should provide resiliency training to physicians. Teach them mindfulness. Coach them to develop their sense of insight. Teach them to “reframe” their perceptions and objectify their thinking. Provide Employee Assistance Programs and offer counseling.…
Results from our physician focus group: What can we do to improve our organizations and the healthcare system.
Physician burnout is not caused simply because physicians work too many hours or have too much to do. The “cynicism, depression, and lethargy that are characteristic of burnout most often occur when a person is not in control of how a job is carried out or [they are] asked to complete tasks that conflict with [their] sense…
COVID 19 is imposing transformations on nearly everyone on this Earth. Whether it brings out the best or worst in us will depend on the maturity of our response. To better understand, we must first define something called “Formlessness.” Formlessness is the keystone segment of any significant transformation arc. It is the portion of the…
Brad Fern interviews Dr. Scott Nelson
When we think of traumatic stress, we typically imagine thesoldier who experiences the horrors of war, the child who is abused, or someonewho witnesses a horrible accident. But there is a lesser-understood type of traumaticstress. It’s called Complex Trauma (CT), and its impact can be just asharmful. One of the ways CT can occur is…
By Brad Fern All employers, from Amazon to the corner convenience store, pay their employees for the same thing. They pay people to direct their energies toward a task, a mission, or vision. Those energies come in three forms: cognitive energy (thinking), emotional energy (passion and collegiality), and physical energy (showing up and getting it…
Indicate your desire to understand and listen.
