Perspectives on the Acute Care Continuum

The Acute Care Continuum is the integration of urgent, emergent, inpatient and post-discharge care of patients with acute medical conditions. 

Creating the Change You Need to Thrive

11/20/2014 12:25:11 PM | 0 comments

Welcome to Leading Mindfully Quarterly, a column by renowned leadership and mindfulness expert and author Dawa Tarchin Phillips. LMQ is intent on providing valuable insight and perspective on excellence in leadership, conscious high performance, meaningful professional impact and enhanced work-life balance for healthcare professionals.
 
Mindfulness-based leadership is an in-demand objective that thrives on high levels of emotional intelligence, focus and attention skills, professional engagement and effective decision-making, culminating in increased leadership effectiveness, joy and overall job and life satisfaction.

Imagine Doing Something — Differently

Do you find yourself wondering how you can find more enjoyment in your life and work as a high-performing medical professional? Do you sometimes feel held back by circumstances beyond your control or stuck in an antiquated system of unrealistic demands and expectations on your time and human capacity?
 
If so, the techniques of Mental Contrasting and Implementation Intentions may help you bring about the change you need to thrive. In this post, we'll discuss how healthcare professionals can use these research-tested methods to bring their current work lives more in line with their ideals.

The Need for Efficacy

It's old news that healthcare professionals represent one of the most highly stressed professional groups in the nation. The following research findings underscore the difficulties these providers face:
  • A 2012 study by Shanafelt et al. found that more than 45 percent of surveyed physicians reported at least one sign of significant burnout, with those in front line specialties (such as emergency medicine) at greatest risk. They also found that dissatisfaction with work-life balance was almost twice as high among physicians as in the overall workforce.
  • The physician suicide rate is currently twice that of the general population for female physicians and 1.5 times for males.  
  • In a recent online survey, only a little over half of physicians said they would chose medicine again as a career if they could do it over.
So what makes medicine such a difficult profession? The MEMO study by Linzer et al. identified four leading causes of physician stress and burnout:
  • Time pressure
  • Degree of control regarding work
  • Work pace and level of chaos
  • Values alignment between the physician and administration
These findings suggest that it's not so much the field of medicine that's inherently stressful but characteristics of the practice environment.
 
The good news is that there are research-based techniques providers can use to shape their practices into healthier, more enjoyable ones. Beginning with their own thoughts, intentions and behaviors, they can gradually condition others around them to respond differently. Over time, these behaviors and responses can reshape the environment for the better.

Imagination as Lifestyle Design

A rigorous change management model poignantly termed Fantasy Realization Theory (1) suggests that there are basically three modes of self-regulatory thought involved in your personal desire for change: indulging, dwelling and mental contrasting.
 
Indulging, as defined here, means you repeatedly imagine a desired alternate experience, mentally elaborating its benefits without any consideration of the obstacles posed by present-day reality. For example, you might imagine getting that overdue raise, taking a long-needed vacation, working fewer hours, or having more pleasant interactions with your teammates. Although enjoyable, indulging rarely offers a strong enough impetus for you to make the changes in your attitude and behavior necessary to achieve the desired results.
 
Dwelling, on the other hand, is the act of viewing your present reality as consistently standing in the way of your desired experience. You might spend a lot of time thinking about your unreasonable boss, your overwhelming job demands, your lack of balance, or the dysfunction within your leadership. Without a clear vision of the alternatives, dwelling offers little clear direction for action and creates no urgency for change.
 
Mental contrasting means imagining a desired experience while at the same time clearly discerning the present realities standing in the way — including your current perspective, attitude and behavior. Unlike indulging or dwelling alone, it provides an impetus for change and can be a helpful tool for lifestyle design.
 
With mental contrasting, your growing clarity about the desired experience (i.e., working fewer hours) and the clarity about your present reality (i.e., an unreasonable boss, an understaffed department), create the necessary connection between future and present experience and signal the clear need to make real changes in perspective, attitude and behavior in order to overcome the perceived obstacles.

Failing to Plan Can Mean Planning to Fail

This relationship between mental contrasting and your increased motivation and personal activation toward goal pursuit has been scientifically validated many times over. We know that the greatest chance at accomplishing meaningful change lies in being clear about both where you want to go and what exactly is holding you back (2).
 
People in pursuit of important and meaningful goals benefit from planning exactly how they will engage to achieve their goals, how they will address obstacles, and how they will maintain their positive momentum toward their goals should any obstacles arise (3).
 
A simple cognitive technique called Implementation Intentions can prove invaluable in that process. By reflecting on clear “if… then…” scenarios, you are able to effectively prepare yourself and link specific situational cues to important goal-directed responses and behavior. For example, you might decide that:
  • “If… my boss is being unreasonable, then… I will remind myself and him/her why we are in the healthcare profession in the first place, namely to promote health and wellbeing, not perpetuate employee overwhelm and burnout.”
  • “If… there is too much demand at work, then… I will practice proven stress reduction techniques to retain mission-critical access to my physical, emotional, mental and spiritual resources in times of such increased demand. This means I will eat better, rest more, stay more mindful and take more frequent breaks to relax myself.”
When you use Implementation Intentions to prepare emotionally and mentally for challenging situations, goal-directed behavior tends to emerge almost automatically when needed. This makes the desired response immediate, effortless and deliberate without the need for conscious intent (4), thus moving you naturally and organically from your status quo toward impactful, real-life change and incremental improvement.
 
Mental Contrasting and Implementation Intentions (combined: MCII) have been widely shown to facilitate goal attainment and are methods every healthcare provider should have in their leadership tool kit as we move together toward a new work-life paradigm in the healthcare industry.
 
(1) Oettingen, 2000; Oettingen, Pak, & Schnetter, 2001; Oettingen, 2012.
(2) Oettingen et al., 2001; Oettingen, Marquardt, & Gollwitzer, 2012; Oettingen, Mayer, & Thorpe, 2010; Oettingen, Mayer, Thorpe, Janetzke, & Lorenz, 2005; Oettingen, Stephens, Mayer, & Brinkmann, 2010; Oettingen, 2012.
(3) Gollwitzer, 1999; Gollwitzer & Sheeran, 2006; Oettingen et al., 2001, 2005.
(4) Gollwitzer & Brandstätter, 1997; Brandstätter, Lengfelder, & Gollwitzer, 2001; Bayer, Achtziger, Gollwitzer, & Moskowitz, 2009.


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