Appreciation—Where Does It Lead?

Do you still remember and appreciate the moment when you decided to enter the field of medicine or your specialty discipline … and do you fully appreciate the change in professional directions you’ve created for yourself over time?

Chances are you trusted some internal instincts and then corroborated those with external inputs. Or maybe you just reacted in the moment, trusting all would work out eventually. Regardless, we all can appreciate those significant moments when we changed direction.

For me, going into medical school was a presumed pathway. My parents would deny it, but there was clear bias and strong indirect influence in their counseling for me to pursue this profession. Something about “how much you intuitively care for others …” was the catchphrase I remember most. However, it took me many years to appreciate that they were just looking out for my best interests — according to their values.

What I better appreciate, though, is the moment I decided surgery was the optimal discipline for me. I was on a student rotation in a rural community with a small-town general surgeon. It was obvious patients loved him, other physicians respected him immensely, and he was clearly a community icon. There was something about his presence and the way he approached his work that was intangible but easy to appreciate.

Because of him, surgery itself was easy to appreciate. I intuitively learned for the first time that my thought processes and decision-making style were more compatible with surgery than with other clinical disciplines. It became a very simple choice. To this day, I value the opportunity to have spent so many years in the field helping others through surgical practice.

Carl Jung once said, “With trust or loyalty to one’s own experience, an individual had a solid base on which to build a life. Absent such experience, forced to rely on belief and faith, a person was liable to doubt, credulity and fear.” From my perspective, trust and loyalty are an extension of appreciation of one’s experiences. Continuing to acknowledge our life’s trajectory, including its successes and setbacks, allows us to further appreciate how we can continue to better influence our own paths — paths that are pivotal for ongoing success as physician leaders.

So how do patients come to appreciate a physician or surgeon? What helps a leader become appreciated and trusted, enabling others to follow their direction with loyalty?

Sucher and Gupta in the July 17, 2019, Harvard Business Review penned an article, Leading with Trust. They delineate how CEOs are hired “… to address high-stakes challenges and make tough decisions … Their power rests on the willingness of the business’s stakeholders to cede it to them … It depends a lot on stakeholders’ trust.” Five key dimensions are needed to engender ongoing trust for leaders at all levels:

1. Legitimacy — a leader is in that role for legitimate reasons and by a legitimate process.

2. Competence — a leader demonstrates skills well and is obviously good at that job.

3. Motives — a leader serves the interests of multiple stakeholders in a balanced fashion.

4. Means — a leader identifies the means needed to accomplish goals and sets the direction for an organization’s actions. If those rules are perceived as fair, stakeholders will trust leaders and afford them appropriate power and loyalty.

5. Impact — a leader is judged on the impact created, regardless whether it was an impact that was planned or unintentional, positive or negative.

I have observed at recent conferences and in journals much commentary about trust — and the erosion of trust — in our industry. This is not a new topic of focus within healthcare. No doubt, we are undergoing unprecedented change, but complexity of healthcare is not a new issue, nor is the issue of whether trust is present.

A series of articles, along with an excellent editorial, in the January 2002 issue of the Journal of General Internal Medicine presented insightful viewpoints on the study of trust in healthcare, including references that go back many years. An appreciation for the complexity of trust as a field of study encompasses not only healthcare but also psychology, sociology, and philosophy, at a minimum.

Loyalty is pivotal on so many levels. Loyalty to yourself; loyalty to your family and friends; loyalty of others to you and your guidance; loyalty to your patients and patients’ loyalty to you; loyalty of peers and co-workers; loyalty of your practice or organization’s staff teams — the list can go on in many directions. There are volumes of research and literature on loyalty and the value it creates for individuals, patients, customers, and organizations. There even is a discipline of “loyalty-based management” that many follow. But loyalty and how it is generated is something we must all, as leaders, further understand and better appreciate for how it impacts others and our organizations.

In the corporate and association worlds, customers and members will remain loyal and keep buying or engaging only as long as they receive superior value and experiences; therefore, staff and employees must know how much value they are creating, if not individually, then as members of relatively small teams. Disloyalty can stunt organizational growth and performance by as much as 25–50 percent. Those in leadership must appreciate the potential for these levels of impact in either direction. These potential impacts are obvious for patient care as well.

In another significant piece, Matthew Wynia and Ira Bedzow describe the importance of values-based leadership. In their article, “Values-Based Leadership During the Transformation of Health Care,” published in the Summer 2019 People + Strategy Journal, the authors describe how the changes occurring in healthcare are creating the potential for undermining healthcare’s ethical foundations. They posit that leaders must develop the skills necessary to give voice to the core values of healthcare. From their perspective, leaders must:

1. Recognize the competing ethical values underlying the challenges being faced.

2. Be competent in analyzing complex ethical dilemmas.

3. Learn to develop and implement realistic strategies that can maintain the core values of healthcare in a rapidly changing environment.

The article describes their “Giving Voice to Values” methodology to help leaders improve critical skills.

As individuals banding together, we can foster stronger leadership while maintaining core ethical values in addition to engendering trust and loyalty, and a deeper appreciation for our past, present, and future directions. It may also enable us, as leaders of varying size teams, to better appreciate the impacts we create across an organization. These impacts on our teams most often affect patient care delivery as well as healthcare delivery — directly and indirectly. These effects are related to values, trust, and loyalty of our society in the profession and the healthcare industry as a whole.

For me, at this career stage, I find less appreciation for past career choices and how I got to this role. Instead, my appreciation is oriented toward the exceptional team we have at the association and to our outstanding board of directors. Without these individuals and their collective talents, our association would not be in its current position.

The association is approaching its 45th year and the depth and breadth of our footprint in the industry has grown tremendously. And you, our valued members, participants, and collaborators, will better appreciate in coming months just how much more our association is going to contribute to the betterment of the healthcare industry nationally and internationally.

Leadership, although complex, is often about appreciating others and how they are influenced to achieve even greater outcomes by appreciating their own potential.

As you can now better recognize, appreciation in and of itself actually does lead somewhere. It helps reinforce ethical values, builds trust, and engenders loyalty — collectively creating value, optimizing experiences, and improving outcomes on several levels.

Our association’s intent is to lead and create change by helping to promote meaningful change in healthcare through physician leadership. AAPL maximizes the potential of physician leadership to create significant personal and organizational transformation. We must all continue to seek deeper levels of professional development and better appreciate how we can each generate positive influence at all levels.

As physician leaders, let us become more engaged, stay engaged, and help others become engaged. Creating a broader level of positive change in healthcare — and society — is within our reach. Our patients will appreciate the eventual outcome.

We Were Made for These Times

“Ours is not the task of fixing the entire world all at once, but of stretching out to mend the part of the world that is within our reach. Any small, calm thing that one soul can do to help another soul, to assist some portion of this poor suffering world, will help immensely. It is not given to us to know which acts or by whom, will cause the critical mass to tip toward an enduring good.”

— Clarissa Pinkola Estes, author, poet and psychoanalyst