Appendix C

Listening to Leadership

Prior to setting the workshop agenda, members of the planning committee embarked on a listening tour to hear from more than 40 key stakeholders within the health and education sectors. Members aimed to better understand how leaders view the systems they and their constituencies work within, and the role culture plays in perpetuating or mitigating stressful work or learning environments. The goal was to gain a better understanding of stress, worker well-being, and organizational resilience from a systems perspective across the education to practice continuum. This paper describes some of the opinions expressed by individuals in leadership positions during these informal conversations.

CREATING A POSITIVE CULTURE

Leaders cannot be passive. They must actively engage with their employees, faculty, or students to stay out in front of any potential pitfalls or conflicts that could erode the trust between leadership and others. Strong leaders avoid top-down governance and aspire to a flattened hierarchy. By ensuring adequate time for reflection and collaboration, they encourage a bottom-up approach that is more dynamic and responsive to change. The bottom-up approach must be equitable and fair, using a reward structure that offers everyone an equal opportunity for success and recognition. This also means sharing leadership by allowing the person with the greatest expertise in an area to take the lead on that issue. Shared leadership can present challenges that could be mitigated by setting up a clear understanding of who is responsible for specific aspects of a program that is maintained

through a nonhierarchical structure. It is up to the leader to hire people who embrace their vision of a collaborative, supportive atmosphere. All of these behaviors, if done in an open and transparent fashion, model what a good leader looks like. It creates an equitable, open, and safe environment for the entire team to work in and care for their patients and their colleagues.

There is a strong push to do more at lower costs, which is restructuring traditional relationships between people as competition for increasingly limited resources intensifies. Faculty and staff must feel appreciated and valued, health professionals must find meaning in their work, and it is up to the leaders to provide the setting in which each employee, faculty member, or student can perform at his or her maximum capacity. How a leader accomplishes this while remaining fiscally responsible is a source of great stress and burnout for those in leadership positions.

ORGANIZATIONAL RISKS

Many great initiatives and interventions to provide leaders with new tools to reward or engage employees come with cautions. For example, linking data to bonuses or other incentives leaves the organization open to individual corruption through manipulation of the data to obtain the bonus without the results. There is also the question of sustainability. Many organizations with positive cultures rely heavily on an individual champion to create a positive organizational climate. When that person leaves, the safe, trusting environment can gradually erode along with individuals’ emotional wellness. This underscores why role modeling is so important—these behaviors should truly lead to a culture change, rather than placing the fate of the organization in the hands of one, albeit competent, person.

ROLE OF LEADERS

Some believe a good leader functions as the buffer between societal, regulatory, and fiscal pressures of the external world and the internal work environment, thereby creating a positive experience for their employees or students. The challenge for such leaders is in maintaining their own health and well-being. Often, leaders who repeatedly sacrifice their own mental and physical health to protect their workers or students from external stresses get increasingly tired, angry, and more punitive—it is human nature. To counteract this risk, leaders can create a leadership environment in which others are also empowered to lead thereby shifting the role of senior leadership to one that shares the effort of creating resilience. Training health professional students on the value of shared leadership may be one way of preparing the next generation of leaders. In this way, the health

professions would work together toward preventing a stress-induced negative workplace rather than attempting to manage the aftereffects of stress, which often is burnout.

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