Rebecca Silva-Faville

When I attempt to see the healthcare ecosystem I perceive overlap and entanglement; a mind map of torturous intertwining; frustration-inducing polarities, competing commitments, conflicting desires, and wicked problems. In a word, I perceive complexity.

Where complexity exists, nuance is required.

May our desire to simplify never reduce us into simpletons.

Change is messy. Driving without a seat belt is dangerous. Experimenting with a new response to a bully can’t be worse than what it already is, so let’s go with messy.

Stepping into the street without looking both ways is dangerous. Brain surgery is dangerous. Weaving in and out of traffic at 80 miles an hour is dangerous. Those unspoken boundaries that stop me from making a move toward what I want might only exist inside my own head. Imaginary obstacles aren’t dangerous, and fear just feels messy.

I might not come back from dangerous, but I kinda like cleaning up messes. Especially the messes I make while building something beautiful.

High performance boils down to two things: responsibility and self-awareness. Since we can only exercise responsibility for the things we are conscious of, we begin with self-awareness.

Since the vast majority of our self lies just outside conscious awareness. We don’t rely on our prefrontal cortex to reveal ourselves to us. For that, we rely on the body.  

The language of the body is sensation. Feeling. Every feeling has a corresponding emotion. Each emotion serves as an indicator that points to a belief, an assumption, and a core value. 

But don’t get caught up in the underlying beliefs just yet. Start with the fluttery, flashes of heat, tension or balling up, sinking, lightness, bubbly feelings in your body. Just watch and listen with curiosity. 

If that seems too woo-woo to be practical, then start by watching and listening to the high performers you admire most. The ones who are really living the life and doing the work. DM me if you think you find evidence that self-awareness is not the bedrock of their approach to everything. 

Transformational leaders concern themselves with data that points to underlying assumptions, beliefs, and values because they know their conclusions are shaped by their questions, and their questions are a byproduct of their perspective.

If the questions we’re asking are not producing the solutions we need, we must consider how our most deeply held beliefs are blinding us to the simple rules that govern our world.

When we are satisfied with the way things are, we can be content with a lack of self-awareness. Until then, we make data-informed decisions.

The goal of science is to replace visible complexity with invisible simplicity” – Jean Baptiste Perrin (Nobel Prize Winning Physicist)

The simple rules that explain what we experience are hiding in plain sight. We can learn to see it, but first we must to be willing to loosen our grip on what seems obvious.

Obvious is far too rooted in what we already know to be capable of creating new outcomes. Obvious is the thinking that created the situation we’re in.

Enter perspective-taking. It’s not just a tool for collaboration and stakeholder management. It’s a skill set for innovative problem-solving. Identify and challenge assumptions. Unearth unconscious bias and drag it into the light.  

Exploring the edges is essential; discovering connections and adjacent relationships that open us to new lines of inquiry. This might look like a personal research project conducting a mapping review that informs a series of scoping reviews. It might be a year’s worth of ad hoc hallway conversations with a fellow change agent or a workplace book club. With purposeful agenda-setting and skilled facilitation, it could be our standing leadership meetings.  

Start with questions like these:

• “If we wanted to break this, what’s the fastest way to do it?”  
• “Which polarity are we dealing with? What complementary value could we incorporate?”  
• “Forget the workflow diagram; who wields the influence around here?”  
• “It’s impossible… unless?” (Dr. Alan Barnhard)

The action that leads to the greatest impact isn’t always the one we’re ready to take. Making time for questions is the kind of slow that builds momentum and gradually turns into fast.

Rigidity happens when my vision of efficiency fails to extend beyond my own workflow. When I neglect to consider how my outputs turn into someone else’s inputs, I become guilty of local optimization in a situation where global optimization is a far more effective pursuit.

Local optimization is a system killer. It slows the flow of information and misuses resources. It says, “I matter more than you.” It’s happening all the time in subtle ways—death by a thousand cuts.

Instead, we use micro experiments; tiny, informal PDSA’s. They’re part of a conscious process that involves collaboration and upfront communication. They generate useful information for global optimization.

A selfish decision probably isn’t conscious, but it certainly isn’t collaborative. The moment I make myself part of a team, I give up the freedom to be the sole owner of a workflow.

Rigidity happens when I confuse my method for my core values. When I forget that my favorite technique is made effective by a combination of underlying principles (that rarely shift) and an organizational context (that is constantly shifting).

For every set of principles, there are tens to hundreds of aligned methodologies.

The moment we say to ourselves, “Why isn’t this working?” is the moment we can be certain there’s an unidentified assumption hiding in our decision-making process.

I remember the day I first heard the words “emergent strategy.” I knew in my gut that I needed this skill, but I was sure I would suck at it. You see, I’m a recovering certainty addict; I like having answers. I’m pragmatic; if something isn’t applicable, then I can’t be bothered by it. What’s more, I’m a task-oriented doer; waiting patiently isn’t my strong suit. So, being thoughtful about what-ifs and cross-sector trend watching felt daunting because it wanted me to wait patiently for answers that might never come. No way! Anticipating change is the work of futurists and predictive data analysts. Right?

It turns out I was right about benefitting from patience, but I was dead wrong about this being the world of ivory tower experts.

Anticipating change is about watching the horizons of the worlds we’re closest to. It’s a form of navigation. Every navigator has a map, and map-making is just a little exploration. Exploration happens effortlessly when we get curious and venture a step or two toward the edge of our functional bubble. The edges of what we’re good at, what we know well, and who we know well.

RSS feeds are helpful, but single-topic-based news feeds only tell us about what’s right at our doorstep. This is no longer sufficient. We also need to see what just arrived in town and keep an eye on what the neighboring territories are cooking up.

Try this on:

1. What topic is top of mind when you think of your work function? Do you have it?
2. Now, what fields of study inform that topic? Got them?
3. Pick one of them, the one that seems to have the greatest opportunity for impact.
4. Now, move out one more degree of separation; which fields of study inform that high-impact topic? Pick the one that jumps out at you.
5. Who are the greatest minds in that field? Feel free to use a search engine to help you find them. Do they have books, a blog, or a podcast?
6. What do these great minds have to say about the state of the art?

We don’t have to be experts to explore our horizons, and if my family has anything to say about it, the patience we learn is well worth the effort.

Perfection is for sunsets. Nobody drove hours to paint a water color of you working.

“Too late” is for trains and utility bills. Life isn’t something run after to keep up with, and even a broken heart keeps the light on somewhere.

In that moment, when activation happens like a north shore swell. When the adrenaline dump takes hold, I’m greeted by the familiar tightness in my chest, abyss in my stomach, hot flash up my neck. When existential threat is all I feel. I have. Control.

Control of the controllables. Of me. My interpretation. My breath. My choice to be small and my choice to take up space. My willingness to recognize my emotions as indicators of my assumptions. To see another’s behavior as their choice. To be more committed to renewal than avoidance. To compassionately deconstruct the argument. To patiently challenge. To change the rules of the game.

Control enough to drop a pebble into the pool of my soul and watch the ripples move out into the lives of others.

In that moment, when I’m changed, culture must follow.

We tend to talk about purpose as though it is something we have to find. Out there. A particular thing we do. That’s a seductive story to tell; it has the hero’s journey written all over it. Who doesn’t love a meaningful quest? The problem is that this kind of storytelling unwittingly sets us up for unnecessary disappointment.

If finding purpose is about getting (and keeping) that perfect job, then we’re screwed because restructuring happens: it’s the cancer diagnosis, the divorce, an emerging obligation to aging parents, or maybe your department gets outsourced and you’re suddenly working for a new employer, the list of uncontrollable curve balls goes on.

If my sense of purpose is tied to a particular job, then I’m giving a lot of power to someone else to determine the degree of meaning and fulfillment I experience. But I’m a big girl. I know my response to circumstances has tremendous power to shape my life. So what of it?

What if we don’t find purpose in the thing we do? What if we bring purpose with us in the way we do the thing?

What if my purpose wove its way into whatever job I have, through whatever circumstance I happen to find myself? What could I do right now with the resources I currently have that perfectly aligns with my beliefs and values?

New year, same desires. Same vision, new strategy.

I was waiting for my drink at the Starbucks counter of a local hospital when I overheard a conversation between two nurses. They discussed relationship woes and blamed their experiences on the curse of empathy. Apparently, they considered it their professional duty to take responsibility for the destructive choices of another because they were empaths; they felt everything too strongly; what choice did they have?

That’s when it hit me: empathy gets confused with enmeshment, a dysfunctional internalization of another person’s beliefs and feelings that dismantles healthy boundaries in a relationship and leads to identity confusion and codependency.

In the counseling and psychotherapy professions, enmeshment is diligently guarded against and regarded as a mark of unethical and unprofessional practice. You might hear a licensed counselor speak about it in terms of transference and counter-transference, our universal tendency to project our feelings onto another person and believe that we know how they feel.

Nurses are helping professionals; engaging with strong emotions is part of our job too.

Humans are capable of detecting the emotional state of others; the brain is hard-wired for experiential connection with other humans. But unless I’m practiced in recognizing emotions as additional information and adept at maintaining awareness of how my emotional state is influenced by the environment, then it’s all too easy to regard an empathetic response as an indicator of my own self-concept, “I’m feeling this; therefore, it’s a part of who I am. This feeling is part of my identity.”

While I have every right to regard the emotions stimulated by my own assumptions, beliefs, and values as an indicator of my identity (an indicator, not the whole truth of it), I must also stand sentinel watch on my human tendency to internalize the feelings of others. Especially as a helping professional.

Empathy supports healthy connection and effective interpersonal communication. Enmeshment destroys healthy relationship and takes the entire organizational culture down with it.

Both/And. My Emotional Intelligence (EQ) isn’t just for me. It’s also for my team members. When my EQ improves, I get the remarkable benefits of a recalibrated nervous system and the mental margin to reinterpret my experiences. I want that for myself.

But if my understanding of EQ only tells a story about the benefits to me, then I will never contribute to culture improvement.

Yes, I cultivate EQ for my own immediate benefit. Then, I use it to create an environment for my coworkers that brings their EQ into professional dialogue so that our collaborative decision-making includes all the necessary information.

Yes, emotions are necessary information because emotions shape interpretation and decision-making

Person 1: “Let’s take a moment to check in. I accept that this situation needs an immediate response, but I’m anxious about the impact it’s going to have on my workflow.”

Person 2: “I’m committed to being helpful, but I’m also feeling angry right now; I’d rather go punch my locker than go back into that room.”

Person 1: “No problem. How can I support you? I can ask Natasha to be my second.”

Person 2: “I want to do it. Can you give me 5 minutes to process this adrenaline dump? I’ll meet you outside the room.”

Person 1: I’ll update the Charge Nurse and see if she could give my patient in 432 his lisinopril. See you in 5.

EQ isn’t just a useful tool for individuals. It’s a way of doing work as a team.

In this dialogue, both parties know the fastest way to an effective solution is to begin with a more centered emotional state⏤a reset neurological system. We accomplish this through non-judgemental identification and acknowledgment of the primary emotions involved.

Not everyone is ready for this. We still have people in healthcare who are unwilling to engage in cultivating their own EQ. Which is why the conversation still centers on using EQ for individual benefit.

Find one ally. Make an agreement about how you will weave EQ into your collaboration. As you get better at it, bring another coworker into your circle.

If we wait until everyone is ready for collaborative EQ, culture shift will take much longer. There is no better way to convince an EQ skeptic about EQ utility than to create a professional EQ Circle.

Culture-fit goes both ways, and you are a valuable asset. What if you made your next career move based on which organization or department best aligned with you? Your goals. Your values. Your ideal working environment.

We do ourselves a disservice when we engage with an organization as though it holds all the cards. The organization is far better served by contributors and leaders who take responsibility for their own careers.

So how do you take responsibility for finding your own culture fit? Here’s a hint: It’s not another training course. It’s the informational interview (AKA: Non-sales-oriented Networking). Identify people you want to learn from and see if they’d be willing to schedule 30-60 minutes with you. Make it clear you are not seeking a favor but simply want to learn from them.

Ask about how they got to where they are today, their wins, their challenges, and perhaps a day in their life. Informational interviews are fun, surprisingly beneficial, and a little addictive.

Roughly 85% of jobs are found through networking. But it goes way beyond jobs. Stretch assignment opportunities, mentors and allies, invaluable bits of wisdom, and insider knowledge come through relationships (i.e., networking).

Your best career move may not be a move at all. It’s probably a connection.

She was taking the bullet. It didn’t matter the consequences. This was a hill she was willing to die on. Until that tiny piece of additional data snuck into the conversation and shifted her entire perspective. She almost lost her reputation and the trust of her colleagues, forgetting that complexity involves a funny little thing: concatenation. Weird word. Cool concept. Can we dive into theory for just a moment? Then we’ll get practical.

Concatenation is an idea from language theory, and is also used in computer science for program development. It means “linking together in a chain,” acknowledging that the stuff arriving later modifies the meaning of all the stuff that came before. I can say “Hello,” or I can say “New York.” and despite the richness of meaning each of these carry by themselves, when I say, “Hello New York,” a new meaning is produced.

It’s a time-bound concept that models communication as a string of data, instead of a web. Highlighting that aspect of life that is experienced as a sequence of events. Drawing our attention to the cognitive process of meaning-making.

Reality may be multidimensional, a web, but my experience of that web is still time-bound and therefore sequential.  

So, the only decisions I have the right to turn into a hill that I’m willing to die on, are the one’s that I’ve truly explored and investigated. The only decisions that I get to make intuitively are the ones that are shaped by years of experience. Everything else is a beautiful opportunity for humility.

I can get cynical about “outcomes.” That word gets attached to so many different targets that it’s hard to keep track of what we’re actually talking about. That’s a challenge for leadership because it diminishes clarity. Decision-making for impact demands focus.

We don’t control outcomes. Any more than we control complexity. Too many inputs from too many microsystems. Nobody controls the wind or the waves. They harness it. We create conditions that honor it and move with it; if we’re clever, we convert it into energy.

Then the problem becomes anything that prevents the movement from happening.

Constraints.

Constraints are a powerful way to engage in decision-making because it puts our focus on the conditions that support a desired outcome. Not on the outcome itself. It’s the internal game of tennis for complexity management.

It can feel counterintuitive, but only if we come from a slow-rate-of-change, stable-environment perspective.

Look again from an emergent strategy, fast-rate-of-change perspective. Focus on the flow of information; where’s that flow getting bound up?

It’s starting to feel more intuitive, isn’t it?

“Context is primary.” It’s not an axiom limited to grammar. We know this, intellectually. I can say the same sentence in three different tones of voice or the same sentence in the same tone of voice with three different body postures and communicate vastly different messages with each combination. That’s to say nothing of the reaction evoked in my conversation partner.

Acronyms for communication tools are a nice technique, and when relationship becomes a technique we can be content to check the box for that online training module. Since a relationship (i.e., culture) also involves a felt experience with another person (I.e., emotion), we get to wonder how our emotional state contributes to the context.

Whatever it is you want, be reckless to give. Do you want to belong? Give belonging. Do you want equity? Generously create equity. Do you long for a day when the healthcare industry prioritizes environmental sustainability with the fervor it pursues safety? Let every clinical decision you make be shaped by an ethic of stewardship.

Action flows from a way of seeing, believing, and making sense of the world. Culture is our collective doing and being together. There is only one person on the planet with the authority to be and do for you.

“Be” together. Play with the work of becoming. The tipping point is imminent.

Facilitating change begins with vision and proceeds with acceptance. Reaching and rooted. 

I must see the possibility so clearly that I feel it in my body so that everything about me is dripping with hope. And be so connected to the reality of right now that someone watching from the outside might accuse me of being too pragmatic. That’s their mistake… and our challenge; existing in two worlds at the exact same time; the already and not yet.

This is transformational leadership: When our hearts and hands are so intertwined that we can’t be certain where one ends and the other begins. A dance of the possible and the actual. Which one is leading and which one is following? We can’t tell.

I can want anything, for myself. I am the only one on the planet with the authority to decide what I want and choose to pursue it. I alone have that power.

I have no right to exercise that same commitment for someone else. My contribution to the well-being of others comes in the form of context, of creating conditions in the relationship (i.e., culture) that supports their vertical development and emotional maturity.

Do I regard them as capable? As powerful?

Or do I believe my presence in their life is a magical key that unlocks their future for them?

Do they “need” me? Or does our community need them to function at their highest potential?

One of these perspectives is the way of a coach, the other is the way of the rescuer. One supports healthy relationships (culture). The other produces resentment and fuels drama.

Compromise is a valuable form of conflict resolution, and it’s frequently mistaken for collaboration. True collaboration is a win-win: an innovative smash-up of all the stuff that’s most important to everyone.  

Compromise is a lose-lose. It means we live with the assumption that it’s going to be hard, that we’re going to have to sacrifice, but that’s okay because the other side won’t be happy about the outcome either. We live with it because getting something is better than nothing.

Is it, though? What if we expected to find an innovative combination? What if we expected to work a little harder and leave with something brilliant?

The next time someone tells you that collaboration is going to require you to sacrifice something important to you, politely inform them that they’re mistaken. We get what we expect.

At the very least, compromise with your eyes wide open and call it what it is.

The actual and the possible. We tend to focus on one or the other, inadvertently creating a zero-sum game that leaves us exactly where we started. No progress on the one hand. No traction on the other. Both equally stuck.

Are you a visionary feeling stuck? What’s right in front of you that you’re not willing to deal with? Which uncomfortable reality (realities) are you conveniently avoiding? If you can’t make your vision practical then there’s something you’re not being completely honest about.

Are you the brilliant tactician who can’t find your way out of the mess? What are the benefits of rescuing? When did you decide to cut yourself out of your own dreams? If you can’t find an internal spark that lifts you above the burnout, then you’ve probably given your power away somehow.

Like a car in the mud getting pulled out by a someone with a tow line, getting unstuck requires an experience of tension. Allowing ourselves to feel pulled or pushed is the only way to progress.

Go slow. Because the results we want aren’t produced by something that’s easily measured. Not at first anyway. The measurable results come, but they come later. First we have to be the kind of person that the kind of person we want to to work with, wants to work with. Patient, thoughtful, mindful, considerate, gentle.  

It’s a heart rate and a blood pressure just moments before it becomes a rate of speech and a furrowed brow leaning forward. So, if we can bring ourselves to call it neuroscience and acknowledge that it’s something embedded in our neurology, can we go a small step further and call it what it really is?

Energy. If you can feel it in your body, then the people around you can feel it, too.  

Be slow. It’s the fastest way to all the things we want to measure.

Physical Therapists seem obsessed with pain. They take us to the edge of it and ask us to spend time there. They’re always looking for the place where pain begins, never pushing completely past it, but purposefully, gently circling into it. Moving just to the edge, then backing off, over and over. 

Recovering range of motion is tricky business. The process requires us to adopt a new relationship to pain.  

Slowly over time, if we give ourselves to the process, capacity expands and we are reinvented. 

It’s an out-dated notion that pain is to be avoided at all costs. Pain is the boundary of what currently is, but not necessarily the end of what could be. Time will tell, but time is useless without a willingness to approach the edge.

Please don’t conflate workplace engagement for workplace wellbeing. I can jump through hoops and get rewarded for a job done to organizational specification and still go to bed that night wondering what I’m doing with my life.  

The rat in a maze will tap the lever to get a short-term win without ever finding its way to true nourishment. Even though the healthcare system is a maze, we’re not rats. A strategic tapping of the lever doesn’t prevent us from noticing the difference between reward and purpose.

And the system may be dysfunctional, but it’s not a conspiracy. It’s up to us to take the work that exists and create a purpose from it.

I’m a control freak. One that differentiates between happiness and joy. Happiness is entirely situational. It comes and goes with the circumstances. Joy, on the other hand, is a product of my internal narrative. A result of the meaning I give to my circumstances. One of these I have absolutely no control over. The other I have complete control over.  

As a confirmed and unashamed controlled freak, I know precisely which one I’m giving my time and energy to.  

Pain is additional data, not the whole story. We could say, “I can’t move forward because it hurts too badly.” Or we could say, “I wonder what this pain is teaching me about how to move forward?” 

Pain teaches us the under, over, and through of maneuvering. So we listen, and we embrace. Neither avoiding nor obsessing. 

Gather all the available data, make an evidence-based decision, and keep moving.

All change is loss. So don’t ask me to let go if there isn’t something to reach towards. How can I let go of something so meaningful if I’m not clear of what I’m moving towards, how can you ask me to do that?  

Or worse, how can I expect someone else to create that meaning for me? Why would I give that power away?

If I can’t avoid the chronic grief and emotional exhaustion that constant change brings, the very least I can do is make it all mean something that revitalizes me.

Pain points are pure gold. For entrepreneurs, CEOs, content creators, and anyone seeking to sell a widget: Find the pain. Develop a plan to stop the pain. Then full speed ahead to rapid-prototyping your way to a minimum viable product.

Because that’s the ticket. The solution. To the problem.

Which is fine for infomercials. Fine for problems that are isolated to a specific time and place. Those kinds of problems are everywhere, so more power to you.

But that’s a horrible way to approach problem solving for organizations.

Organizations are, by nature, highly integrated things. Nothing about them exists in isolation. The pain you experience in one department has connections to problems (or solutions) that exist in another department, another team, or a person.

If we find one problem and focus all our attention there, we don’t solve anything. In fact, our “solution” will only create more pain for someone else. Exhibit A: The holy grail IT upgrade that breaks the accounting department. Yikes!

In an organizational context, a single pain point functions like a synapse in a neural network. It’s just a smaller, integrated piece of a much larger series of events. Niching down too quickly blinds us to the context that the problem stems from.

Instead of looking for the pain, follow it. Follow that pain wherever it takes you. Discover all the things it’s connected to. All the people, the processes, and policies. Discover all the solutions that have already been tried. Map it out. Invite others to look at that map with you.

Instead of regarding pain as the pathway to specificity, use pain as a pathway to a broader perspective.

Focus on perspective. Explore the edges and all the meaningful connections. Do it in conversation with others.

I’ve spent most of my life looking for the rules. I grew up in an environment where I wasn’t given any guidance at all and came into adulthood desperately seeking a set of parameters. Just looking for somebody to tell me how to play the game.   

I could see others experiencing success. But what boggled me was that when I tried to copy them, I would get different results and just end up more confused and frustrated.  

Then I got angry. I experienced my first coaching conversation, and I learned that there really are no rules. I got seething rageful over this idea because I could not comprehend a world without a black-and-white, well-worn path to follow. If this were true it meant that most of my life was built on sinking sand. I still get uncomfortable thinking about it.  

But what I came to understand is that the life we experience, the success and failure, isn’t really about the stuff we do. What we do is important, but it’s not the most important. What it comes down to is the way we would do the stuff.

You see, when I copied people, I would dutifully check the box and mimic everything they did, but I wasn’t moving with the same attitude. I wasn’t showing up with the same set of intentions and purpose. My mood was different. So, obviously, the people that I interacted with received what I did differently. They responded to me differently, and I got completely different results. Same exact stuff. Different way of doing it.  

This is what’s meant by beingness. If all the stuff we do is coming from a primary desire for efficiency, status, or “hitting the metrics,” then it isn’t flowing from a primary desire for mutual benefit and unconditional positive regard. Others will feel it, and they will resist us.  

So, if your results are off and you know that your technique is best practice, go deep. Pull back some layers and consider, what am I really wanting here? How am I showing up? Who am I being? 

Can you get yourself to “maybe”? There are so few solid No’s in this life. If you can sense that there’s some part of you that wants it, and going after it doesn’t take you out of integrity, then what’s standing in your way?

“Maybe” isn’t a commitment. It’s barely even a vision for a possible future. It’s just an open question. A hypothesis for a mixed-method research study.

What hypothesis do you want to test?

Have you ever caught yourself speaking about your own experience and starting every sentence with the word “You”? “So, you know when you… and then you think…”

Next time, try beginning your sentences with the word “I” “I experience…” “I want…” “It’s my assessment that…”

Notice how much more visceral this feels. How raw and vulnerable. How honest and powerful.

Notice that it puts you deep into your own body and evokes awareness.

Now, invite your conversation partner to share something with you in the same way. Notice the connection you experience.

What seems possible from that place?

Kairos. Time seems to stop. A moment stretches out. My awareness of the tumult around me softens and centers itself on the thoughts that transported me into this delicious experience. What must I do to live in these moments?

Giving ourselves over to appreciation for something given to us. There are no words. Only deep knowing, and my breath deepens in response. I slow, then the world slows, and for a moment, all I know is joy.

Happy Thanksgiving.

Being right is a small comfort in a world where the evidence-based practice of today is based on research published 17 years ago.

When we take the complexity of everything coming at us and try to squeeze into a box of “right and wrong” we don’t solve anything, we just move ourselves toward the cognitive distortion of polarized thinking.

In this time-lagged world there is rarely a “right”. More often it’s a, “this is the best we got right now”

There’s no shame in making your next move with “the best we got right now.” Just make sure to build in a little margin for the unintended consequences that will most certainly ripple out.

Intuition is pre-verbal pattern recognition. Lessons learned through experience, etched deep into your unconscious memory, spring up as a feeling in your chest or your gut every time you catch a whiff of something in your environment that sets off an early detection system. For good or for warning.

That’s why you can trust your intuition. That’s why you can trust yourself. Find the words for what you’re feeling later. For now, stop and listen. You’re trying to tell yourself something.

There is no blueprint. No map. Only a direction to move in. Between you and your vision is a dense forest and tall mountains that offer no path. Yet your vision for human flourishing is extending an invitation.  

Feeling around in the dark is hard work, and the constant whispers of failure knot-up your stomach like an existential threat. The week-long training session you just completed gave you frameworks for budget management and crucial conversations but didn’t do anything to help you identify what’s really holding you back. Stuck isn’t a data set. It’s a relationship. A relationship with yourself. Which means only relationship can get you unstuck.

“Culture is not something that is passively inherited; it is actively created by people in their everyday interactions.”

⎯Stuart Hall. Jamaican-British sociologist. 1932-2014. http://www.stuarthallfoundation.org

I accepted an offer for collaboration and shared a document for comment.

No comments were offered, save one. “Perhaps we ask for someone else’s input?”

What learning did I miss out on?

What growth did they opt out of?

The only way to truly understand an organism (the professional, the profession, the organization) is to see it as an extension of the environment it exists within. I can look inside myself for hours, and learn more about myself from 5 minutes interaction with another human being.

At every level of human interaction – interpersonal, group, community, institution – we are engaging in collective identity formation. This holds true for prefessions just as it does for individuals.

Professions only exist as reflections of the society that gives birth to them. Shaped by every cultural force that populates the ecosystem they inhabit.

Perhaps the most significant conversation we can have about professional identity formation is the one that spans the gap between professions and seeks to the insight that only comes through someone else’s eyes.

If you’ve ever had an energizing conversation that left you feeling encouraged, motivated, a little more in touch with your best self, I’d like to suggest that you didn’t have a one-off, isolated experience, you tasted a possible future.

Our minds are relentlessly tied the available data: 11 bits of data per second taken in through our senses, our past experiences stored deep in our neurology. The human imagination only works with the material it’s been given. If there’s something your wildest dreams can smash together to create a picture of an ideal future, then it is, by definition, possible.

If that revitalizing conversation can happen once, then it’s possible that it can happen again. If it can happen twice, now we’re delightfully close to a pattern, and that’s something we can model.

Nothing short of our own imaginations is stopping us from creating conditions that grow these encounters in the soil of our present reality. All we need are leaders, with or without a title, to plant the seeds of their own choices.

We are because I am.

Despite healthcare’s emphasis on “having the right answer,” we rarely discuss what it takes to get the answer. Is the textbook and the expert really the magic portal to all knowledge? Where did that textbook come from? How did the venerated Ph.D. become a fount of knowledge?

Every answer begins as a question. That beautiful butterfly of a synthesized framework started life as an unassuming caterpillar of a question. Someone, somewhere, asked a question that burned inside their soul and sent them on a hero’s journey to find, something.

We can hold the textbook up as a symbol of completion, a mission accomplished. Or we can regard it as proof that the hero’s journey is an invitation extended to all of us.

Catch yourself being curious today. What questions are drifting through your mind? Is there one particular question that promises to take you on a journey and leave you on your death bed with no regrets?

Wicked problems aren’t really problems at all. They’re polarities, also known as paradoxes. These are pairs of seemingly unrelated values or qualities that, over time, turn out to be interdependent. There are nuances to polarities, but many can be considered a variation on one of the following themes:

• Optimistic and realistic
• Activity and rest
• Change and stability
• Freedom and responsibility
• Candour and diplomacy

In situations marked by complexity, we frequently find ourselves in a deadlock debate, each side fiercely advocating for its position. When we notice that both sides have really good points and seem to be speaking from a place of wisdom and virtue, we can be confident that we are dealing with polarities.

In an environment ruled by constant crisis, it’s easy to let crisis management become our reason for being. Immediate needs demand resources that pull at the threads of long-term planning and keep us constantly focused on the urgent while truly important matters are continually put off.

While a focus on crisis requires agility, when our attention turns towards strategic planning in service of a grand vision, we begin operating with an eye towards stability and steady progress. These are two entirely different ways of managing and leading. Our best attempts to address both can leave us feeling tossed back and forth inside an impossible balancing act.

When we find ourselves stuck on a cycle of opposing and often competitive demands, fixing problems that refuse to stay fixed, what we frequently have is not a problem at all but a polarity (Johnson, 1976; Polarity Partnerships).

Polarities are interdependent forces, both equally good and right but complete opposites. The “problems” a polarity creates are not meant to be solved or fixed. They’re meant to be managed. There is a natural ebb and flow within a polarity, just like breathing or the seasons. Our job is to understand the positives and the negatives so that we can be intentional to take actions that maximize the one while minmizing the other.

The smart leader acknowledges the dynamic tension that exists within a polarity and seeks to work with it.

When I focus on problems I tell myself a story about all the reasons I can’t do something. My energy decreases. Tension mounts. I feel it in my throat, chest and gut. I don’t problem-solve. I problem-fixate. Crafting solutions from this place inevitably brings me back to the same place I started.

Focusing on outcomes evokes a completely different quality. Now the story is about how I can use my available resources to move toward the vision. Tension transforms to motivation.

Problems don’t go away, but they don’t loom as large. Instead, I feel more expansive. As though the vision in my heart is moving through me.