Insights February 2013

Four Mindset Shifts

Hugh Macleod and Richard Alvarez


Today I am joined on the balcony by Richard Alvarez, a leader known for taking on challenging mandates.  We begin a conversation about the fact that science’s view of intelligence itself has begun to change. Historically,  intelligence has been defined simply as mental capacity and been seen fixed finite and genetically predetermined. Intelligence has other dimensions as well, physiological and emotional. We all have considerably more intelligence then we thought…thank heavens. We talk about Daniel Goldmans work on emotional intelligence that cited example after example showing that emotional   balance and self awareness are essential to success in all aspects of life. He argues that we must begin to value emotional skills at least as much as intellectual ones since standard IQ is rarely an accurate predictor of personal and professional effectiveness. In the context of healthcare transformation emotional intelligence is the ability to motivate oneself and persist in the face of frustrations, to control impulses and delay gratification, to regulate one’s mood and keep distress from swamping the ability to think, to empathize, to hope, and to be passionate about the healthcare transformational journey.

Suddenly the Ghost of Healthcare Despair emerges and shouts out:

“You two are dreamers…You operate in a control mentality environment framed by rules, professional cartels, power, politics and frequent changes in direction. Creativity and emotional intelligence is not nurtured or rewarded. The notion of let’s just feed the beast is alive and well in healthcare.”

Just as quickly the Ghost disappears…

At the heart of all successful healthcare organizations and indeed successful people is a firmly held set of core values which the organization feels passionate about. Values are the source of an organizations creative energy. Leaders must ensure that as our healthcare transformation strategies change, adapt and change again, core values remain stable and protected. Core values are the battery charges for wisdom. Values are experiential, they are felt and organizational life is healthy when we are in sync with our core organizational values. As internal coherence increases by becoming more consistently in phase with the core values, leaps in perception, creativity and transformational adaptability are possible. This is confirmed according to research conducted by the authors of “The Service Profit Chain” where they found that -  the clear differences between high and low performing organization all with strong cultures was the ability of each organization to adapt to changing environments whether legal, technological, social or competitive. The authors discovered that the single most important indicator of adaptability was the adherence by management to a clear set of core values stressing the importance of delivering results to various constituencies, especially customers and employees. They concluded:

  1. Strong cultures don’t win as consistently as adaptable ones
  2. Adaptability is a state of the management mind resulting from a set of core values that include an emphasis on the importance of change and
  3. Organizations that vigorously practice core values and install devices for maintaining adaptability not only greatly improve their chances of sustaining high performance over time they increase their chances of achieving successful transition from one leader to another.

We see a potential paradox emerging. Culture and values are not static, but a commitment to a condition of being. It is all about coherence, the internal order or harmony among the relationship patterns. When the healthcare organization or system is coherent virtually no energy is wasted because of the internal synchronization among the parts. Increased coherence enables the emergence of new levels of creativity, innovation, cooperation, productivity and quality on all levels. We must begin to bring more heart to what we do and to make it safe for people to bring their own hearts into the workplace. This is a time when the health system needs all the energy and passion they can get to transform our systems and people into new ways of working together and that passion will not be available without engaging the heart. Engaging the heart means incorporating respect for the individual.

The nature and role of information has to change from being restricted and used for power to being openly shared, to be available to everyone like the air that we breathe. Relationships will flourish when barriers between and among organizational spaces are removed. People will be able to – even compelled – to bump into each other and literally create and circulate new information. As new patterns of interdependence grows,  trust will begin to increase due to the recognition that listening skills with a willingness to be influenced become critical.  With this, a deep appreciation for the fullness of the healthcare system’s diversity begins to grow. We see four key mindset shifts:

1.    Mindset on Relationship

“I don’t have to know everything if I trust the others.”

Why this is important?

 “If I am committed to being trustworthy myself and will take personal responsibility to build relationships that model this behaviour, others will deliver for me.”

How might this play out?

Inter-disciplinary teams including patients and families, general practitioners, specialists, nurses, pharmacists, technologists, home care workers and others, all working together to ensure care that is comprehensive, coordinated, timely, reliably communicated, convenient, respectful, continuous, stable, empathetic and fair. Clinicians will openly and actively share their information and knowledge in a trusting environment that truly puts the patient first.  Individuals will benefit from their care providers working together to seamlessly manage their care and actively engage with them.  There will be a continuity of care across all care settings and administrators will be able to support appropriate changes in scope of practice in this trust environment.  

2.    Mindset on Identity

“I understand and am committed to what is in this - for us. “

Why this is important?

“If I don’t have this sense of personal connection I require a far larger information area to protect myself and my interests and many more people to complete tasks.  That is the need for control based on fear.   To overcome this, I must see myself in the vision.”

How might this play out?

New models of care will evolve where incentives are clearly outcome based.  The care team, of which the patient is a member, share information and use clinical analytics to make care decisions.  Patients will be supported in their quest to maintain good health or monitor their health conditions through services such as online health information, patient communities, monitoring devices and personal health records, eventually having access to their full electronic health records.

3.    Mindset on Information

Why this is important?

“I openly share information as a tool for relationship building.”

“Accurate information must be the air that we breath in a system and the more open the flow, the more easily we will learn to summarize data into meaningful knowledge.”

How might this play out?

It is estimated that the volume of data has increased 800 per cent in the past five years. Up to 80 per cent of health data is estimated to be unstructured, and that will be the case for the foreseeable future. To address this, we will continue to see significant innovations in health data analytics, especially with regard to clinical decision support (CDS) and health system use (HSU). In the area of CDS, there will be tools to automatically analyze the data and alert the right clinician. There will be tools that can process data out of the electronic health record (EHR) along with the clinician’s natural language, for input into a CDS service. These tools will aid the clinician in an area where the knowledge base is growing beyond the clinician’s ability to keep up, and they will link to the underlying evidence-base to inform clinical decisions. 

4.    Mindset on Tapping Unexplored People Gifts

Why this is important?

“We cannot do it alone.  The only way to become effective is to realize that we contain within ourselves the seeds of all our undiscovered skills, talents and potentialities, as well as all the intellectual, emotional and systemic barriers to their planting.  Together, we can transmute the lead of organizational life into the gold of a truly healthy organization.” 

How might this play out?

Leadership in healthcare will increasingly involve a willingness and ability to adapt the delivery of healthcare to improve the patient experience and make it the best it can be. Forward-looking healthcare organizations and systems demonstrate the importance of quality by supporting continuous improvement and engaging frontline staff and patients/families to design and implement those improvements. This experience based design contends that patients can provide valuable contributions because they are the experts who have experienced the gaps and transitions of the healthcare system. As with other industries like banking and hospitality, technology in healthcare will not be the sole reason for an improved patient experience, but it will be a key enabler that will produce better quality care and health outcomes.

Bottom line, we do not make things in healthcare, we deliver services through people. When they are engaged and connected, magic happens.

Next Week’s Guest on the Balcony of Personal Reflection: G. Dickson in a conversation titled “ Passive Following vs Future Focused Leading”. 

Click here to see the First Series of Ghost Busting essays.


Click here to see essays from the Second Series: The Ghost of Healthcare Consciousness.

About the Author

Hugh Macleod is CEO Canadian Patient Safety Institute. Richard Alvarez is President and CEO Canada Health Infoway.


Austin E. Changing the System. South Fraser Health Discussion Paper. 2001

Goldman D.  Emotional Intelligence Review by L. Abbott 1995

Heskett J. Service Profit Chain. Amazon Review. 2006 



Rob Robson wrote:

Posted 2013/02/22 at 01:27 PM EST

This is an excellent description of some of the most important elements that allow healthcare (as a fairly typical complex adaptive system) to be influenced in positive (albeit frequently surprising and unpredictable) ways. I applaud your emphasis on involving patients, families, and frontline staff. For an interesting and more detailed discussion on the importance of information flow as a way of promoting transformative exchanges, see Olson and Eoyang's Facilitating Organizational Change.


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