Physician Leadership and the Stockdale Paradox. Five Steps.
“You must never confuse faith that you will prevail…with the discipline to confront the most brutal facts of your current reality..” Admiral James Stockdale
The “Stockdale Paradox” as it applies to crisis leadership, has received a great deal of attention recently as hospitals and physician groups react to the COVID-19 Pandemic. How does it apply, specifically, to physician leadership?
(See the recent Harvard Business School article by Groysberg and Abrahams, What the Stockdale Paradox Tells Us About Crisis Leadership.)
In reality, though, these principles apply to the challenges that existed before the Pandemic – and that never went away.
The Lesson: [P]eople respond. They want to respond. They just need you to give them the brutal truth, and a path to overcome the barriers. This creates the faith that they will, indeed, prevail.
The Stockdale Paradox
Admiral James Stockdale was a prisoner of war in Vietnam for nearly 8 years. His memoir tells his story of survival. The major lesson? Blind, unfounded, optimism, can be damaging – you will, most likely, be disappointed and your spirit will be broken by that disappointment.
Survival does, indeed, require faith that you will prevail. That faith is not blind, though. It MUST be based on your ability, and discipline, to confront the most brutal facts of your reality.
We often have to get leaders and teams to start believing that every challenge has a solution. This does NOT mean we don’t acknowledge the reality of the situation. Quite the opposite. We want the team to diligently work to understand every potential barrier, so we can address them, one-by-one. Have faith, but confront reality.
Admiral Stockdale referenced the ancient Greek Stoics who focused on understanding reality correctly, and optimally shaping their response to that reality. It has similarities to the Buddhist and Zen concepts of “suchness” and “bare attention” – See the situation clearly for what it is and don’t let your bias or emotion cloud that clarity.
(See our blog about how Phil Jackson’s used the of Zen principle of “bare attention.”)
1. Acknowledge the Emotions
The emotions caused by these challenges are real. Even Stoicism does not, contrary to common misconception, encourage repressing emotions. Like in the therapy technique of “radical acceptance,” though, you let go of desires and beliefs about what should be (or what you’d like the situation to be) and see reality as it is.
[L]et go of desires and beliefs about what should be (or what you’d like the situation to be) and see reality as it is.
We often find that physicians struggle to move beyond the frustration of their situation. There are health system or market realities that change their world, their reality, how they practice, the business of medicine, and what they thought their career path would be - All of them, beyond their control.
The resultant frustration, the despair, stress, disappointment and even anger, are real. Similarly, the Pandemic has caused new feelings, including insecurity, fear, and even emotional trauma.
Survival, or success, however, requires that you cannot let those emotions impede the work, or faith in the glimmers of light and optimism about what you can accomplish.
It also does NOT mean that you accept the changes. If you have the power to positively impact the path, direction, or strategy of your market, organization, or profession – do it. Be an effective influencer. If, however, you identify situations that you cannot change – do NOT let that frustration impede your ability to succeed, otherwise.
Physician leaders have to move their people from “lamenting,” to solving. Sometimes, the leaders, themselves, need to make this shift. Acknowledge the pain, the loss, the frustration. Then work to understand the brutal truth. Get beyond what you cannot control, and engage your team in what you can.
2. Understand the Psychology of Survival
As the Groysberg and Abrahams article points out, resilient people aren’t somehow immune to the emotions. “People who survive disasters are the ones who are able to regain cognitive function quickly, assess their new environment accurately, and take goal-oriented action to survive within it.”
Complicating the situation today - Organizations are now moving from short term to long-term Pandemic crisis mode. The short-term crisis saw many leaders and teams able to focus, to rally, and solve the challenges in front of them.
Now, they are trying to understand, design and navigate a new future– which creates a different type of uncertainty and stress. The “high” and feeling of “team” and purpose that arises during the acute crisis has passed. All of the previous challenges and frustrations still exist, now compounded by the new realities of a Pandemic that is not going away any time soon.
How does a leader help his or her to team to regain confidence in the future, and trust in their organization, in their leaders, and in each other?
How does a leader help his or her to team to regain confidence in the future, and trust in their organization, in their leaders, and in each other?
3. Accept that Values are Critical to Long-Term Survival
“Talk of vision and ideals may seem like a luxury that a crisis does not allow for, but this is a tremendous mistake.”
For long-term survival or success, “the basic facts of the self must be connected to an overarching purpose.” The most important job of the leader is to consistently articulate this purpose, and connect each day’s tasks to it. Not only the tasks, but also people’s behaviors.
People need to understand their own behaviors and performance in this context. If they are bought into the purpose, then tasks have meaning, and it’s easier to stop the behaviors that don’t support that purpose, and to display the behaviors that do.
Step one – Has the group worked to sufficiently define and agree on that purpose? “Having a value system, a sense of identity, a purpose for one’s existence increases the odds of survival and resiliency.”
4. Tie The Values to the Work
A leader’s job is to make sure that everyone knows how their efforts support what people value, and their purpose. Even the most accomplished, intelligent, and conscientious professionals need to understand the organization’s purpose and values, be reminded of them, and how they connect to each day’s work. They need to feel valued, heard, supported and cared for.
Medicine, as profession, values autonomy and self-reliance. What we find though, is that everyone, particularly in times of stress, wants a sense of connectedness – to a vision and to their colleagues, whether they initially understand that need, or not.
[E]veryone, particularly in times of stress, wants a sense of connectedness – to a vision and to their colleagues, whether they initially understand that need, or not.
See Alan Friedman’s recent blog about Connectedness and “Self-Determination Theory.”
For some leaders, this work does not come easily. Their leadership style is not, naturally, visionary, emotionally supportive, empathic, or motivational. It is, more often, concrete, driven, pacesetting, practical, and autocratic. If this is the case, they need to take on the challenge of developing new leadership skills.
(See our blog on Post-COVID Physician Leadership Styles)
5. Work to Understand the Barriers
Leaders and teams often fail to do the foundational work of understanding that brutal truth. We encounter physician leaders who are constantly talking about their situation, but have never done the work to really understand that situation in enough detail to improve it. Once the situation is made clear, you can vet, and deploy, strategies and tactics to make progress.
The article references the exercise of “mental contrasting.” This technique is similar to the approach we take in our “department transformation” process. It starts by articulating – with great clarity, the goals and rewards.
Leaders and teams often fail to do the foundational work of understanding that brutal truth.
We force leaders to collaborate on getting as much clarity as possible about what they want to accomplish, individually and as a team. Done correctly, this is a powerful exercise and important first step – a step teams frequently want to skip, or take for granted.
Then, examine, analyze, and understand the obstacles. We categorize them as:
“Market/organizational” barriers that we must understand but, likely, can’t remove;
“Operational or process” barriers -many of which we can remove with the right infrastructure and deliberate attention; and, most importantly;
Leadership/behavior/relationship/team barriers. These are the barriers that tend to limit success because many people, and most organizations, don’t like the discomfort that comes with acknowledging them, or with confronting them.
Conclusion – Do the Work
In our experience, an open, frank and deliberate focus on this last category yields tremendous progress in a relatively short period of time. Challenge and empower the team to drive the change, to lead, and to grow.
Once they are reminded of their values, of their purpose, and how important they are to them, they are more willing to display the humility required to find solutions.
At the same time, provide people with the support, the infrastructure and the tools. More often than not, people respond. They want to respond. They just need you to give them the brutal truth, and a path to overcome the barriers. This creates the faith that they will, indeed, prevail.
