Can intellectual humility help healthcare leaders take better care of frontline healthcare staff?
Have you heard of the phrase Intellectual humility?
When Psychologist and CEO Dr. Ben Palmer used this phrase in a webinar it caught my attention for a number of reasons. The most important one was because I have been thinking a lot about ego lately. As a psychologist, coach, and meditation teacher this is not especially unusual, people like me think about ego all of the time, but recently I have been thinking about the role of ego in healthcare leadership.
I’ve been wondering about how a person’s ego prevents or limits change? In particular, what role is ego playing in healthcare leaders – administrative and clinical – when it comes to taking better care of frontline providers of healthcare.
I have been pondering how leadership in health can bring about better working environments for the healthcare workforce. And drilling down, I have been contemplating whether we, as trusted advisors, coaches, commentators, and disrupters are asking the right questions. Intellectual humility as a thinking strategy has sparked some new ideas in me.
Let me go back a step.
Every human has aspects of themselves that are known and unknown, to themselves. The ego’s job, as the theory goes, is to protect our sense of self. Our ego is the known self, the way we consciously describe ourselves to ourselves and to the world around us.
When a person has strength of ego psychologists mean that the person is able to maintain their sense of self in the face of life’s challenges. When we describe a person having a healthy ego we are commenting on their belief in themselves, their sense of meaning, and sometimes their resilience.
The ego is self-referential and understands the world in relation to itself. A simple example of this might be to describe ourselves as short or tall. We are only tall in relation to other people, it’s relative, our ego is making an assessment and this is part of our personal narrative.
As we repeat these stories of self in the world, these constructions build and reinforce our own image of ourselves. This is the ego. It’s common to think of the ego as defending our more vulnerable unconscious self, those parts of ourselves that we don’t consciously recognise as me.
For instance, if I say to you that I have been thinking about ego because I am a psychologist, this is my ego talking. Defining myself, to myself and to you. There is nothing implicitly wrong with this. Psychologically speaking my ego is looking after me, it is navigating me through the world and keeping me safe. It is defining who I am rather than leaving room for too much that is confusing.
For instance, self-doubt, what we sometimes call imposter syndrome in healthcare and leadership, is being managed, kept at bay, ignored, even hidden, in order for me to survive in the world – according to the ego. These less understood, less welcomed aspects of ourselves are referred to as the shadow in Jungian psychology.
Our shadow selves are often well known to others but can remain hidden from ourselves.
OK, that’s enough of this complex psychological thinking!
So how does this play out for leaders in healthcare.
There is a disconnect between what frontline providers of care say they need and what is provided in many healthcare organisations for them.
Both groups, frontline staff, and administrators look outward using their existing templates for the world, potentially blaming the others, or the system. This can be the ego talking, each person preserving themselves, protecting their position if you will. It can also be the shadow, biases, and assumptions unconsciously operating from our unconscious, also in an effort to protect ourselves. Either way, it is more psychologically comfortable to look at others and defend our existing position than to do otherwise.
Burnout rates of doctors hover around 50%. Nurses, technicians, and allied health workers also experience work-related distress including burnout. Burnout is accepted as occurring because of the failing of the workplace, it is not a mental illness. As a result, we end up talking about the system being the problem.
The system is, of course, built, designed, and delivered by humans, for humans. It can only be altered by humans. COVID19 has created chaos in healthcare around the globe and people have responded, altering the system to meet the challenge.
How the system has been altered is infinite, there is no recipe. What has been common across countries and healthcare systems is the intent, the goal. Systems have been changed in order to:
Care for as many people as possible, prevent as many deaths as possible, keep people alive, reduce the impact of the virus on people.
The countries who have had the most success have been celebrated. Along with their frontline healthcare workers, it is their leaders we have especially applauded. Think Jacinda Adern in New Zealand.
Leadership has much more impact, in shorter time frames, when it comes to change, than grassroots movements. Leaders usually have more coordination capacity, more access to resources, and more voice.
Decision-makers in health have the capacity to make a radical change to how health is delivered in ways that allow providers to remain well and COVID may have presented some new impetus, if leaders choose to seize the opportunities present. But will ego let them?
Is there any room for intellectual humility in the face of so much change?
Many people around the world have been calling for a different kind of workplace environment in healthcare, well before COVID19, largely because of the high burnout rate of providers, especially doctors.
The mental health impacts from COVID on healthcare providers are projected to increase, meaning that workforce shortages are likely to increase due to healthcare workers being offline recovering from burnout, anxiety, depression, PTSD, and other crisis of meaning, already a problem before the pandemic. In Australia, there were already workforce shortages predicted for doctors, nurses, and some allied health professions.
Collectively we have been calling over and over for better leadership, for more compassionate workplaces, for better systems.
There is lots of research now that describes in detail what healthcare providers need to be well and there is a huge library of knowledge established about performance, motivation, and engagement, at work more generally.
Which brings me to intellectual humility. This way of thinking is about being willing to say when we are wrong. A way of thinking that helps us ask how else could we …..
But can ego let us?
What do we need as humans in order to set our ego down and explore other options?
What can allow us to openly explore other ways of being without fear of losing our self?
How can we explore new ways of delivering healthcare without feeling like our own ego, our sense of self, is in jeopardy?
What if we are asking the wrong questions? As coaches, as leaders, as clinicians?
Are our egos getting in the way, making sure we use the same thinking templates over and over, keeping us safe – ensuring our position, our power, and our self.
This of course is highly likely, the world is changing faster than we are evolving, described as VUCA way back in 1987 the volatile, uncertain, complex, ambiguous nature of our world has only increased. Hanging on to our concept of self as the person who knows or seen to be steady, might feel like all we have.
Science is predicated on the idea of testing hypotheses. Each ‘knowing’ exists until it is disproved, or the hypothesis is refined or replicated. In this way, we gradually test the variables and learn about the nuances of our world. Medicine highly values this scientific evidence base. Although we use the term evidence-based, it is worth remembering that it is predicated on the notion in science that this is the evidence so far.
An example of this would be recent concern about the many pharmaceutical trials that have only had men as their testing participants. Some pharmaceutical drugs have been found to have different actions in women due to differences in hormones, so questions arise about what is true. A stance of intellectual humility allows for more testing of the evidence by setting up trials with female participants, acknowledging that we may not have all the information we need.
Intellectual humility is a recognition that what you believe in might be wrong. What we have believed about some medications might be wrong for women. It’s not shyness or failure, it’s about being more interested in learning the truth, it’s about being actively curious about the world, alternative views, and what we might be missing.
I spend a great deal of time working with people to raise their self-awareness, to be curious, to look consciously for biases and assumptions, to seek other perspectives.
Great coaches endeavor to open the mental field for new thinking, for new experiences. I have been grappling with this idea – are we asking the right questions of healthcare leaders when we say they need to change the system so frontline staff are better cared for.
My question today (and I hope there are more new ones opening up…) is:
Are we asking the right questions of healthcare leaders so that they can foster new ways of delivering health, ways that allow ongoing frontline staff wellbeing?
Questions that help them innovate so that healthcare is caring for the health of everyone – patients, their families, and providers. Questions that let people keep their ego intact and make room for their shadows to contribute too. As a coach I am practicing intellectual humility, I am a novice, my ego keeps getting in the way…
I notice that I haven’t even been asking a question a lot of the time. More like stamping my feet or wringing my hands and saying do something to our healthcare leaders! I wonder what would happen if I could remember more often Steven R Covey’s advice – seek first to understand.
So, I’m looking forward to practicing more intellectual humility, to learning:
As a healthcare leader what do you value and how do you seek to deliver these values?
As a healthcare leader, what do you think about healthcare provider wellbeing, mental health, and burnout?
As a healthcare leader, what do you need in order to lead systems that do better at consistently caring for healthcare workers as evidenced by reduced burnout and other wellbeing challenges.
Intellectual humility is a method of thinking that makes room for us to say I don’t know or to ask questions like; how do you think we could achieve our goals, what are some other options?
Will you join me in practicing intellectual humility so we can find some better ways for all healthcare providers to do their work and be well for the long term?
*Thanks to Dr. Ben Palmer, CEO at Genos for stimulating my thinking for this piece
Sharee Johnson is the Founder of Coaching for Doctors, she works as an executive coach, psychologist, and meditation teacher. She is committed to helping doctors change the culture of medicine to care for everyone more effectively, including doctors.