Chester: So, you’re the leader; now what? I’m Chester Elton, and this is my co-author and dear friend Adrian Gostick.
Adrian: Well, thanks, Ches. Yeah, our guest today is director of leadership development for the Mayo Clinic Care Network, and he says it’s about time we explore our fears and worries as leaders, and he’s got some real-life examples from The trenches to get our people engaged. As always, we hope the time you spend with us will help remove the stigma of anxiety and mental health in the workplace and your personal life.
Chester: And with us is our new friend Dr. Richard Winters MD. Richard is an executive coach and the author of “You’re the Leader, Now What: Leadership Lessons From Mayo Clinic.” He is also a practicing Emergency Physician and executive coach at Mayo Clinic. Prior to joining Mayo, Richard served as the president of an 800-physician medical staff and CEO and founder of a Managed Care startup. Richard, we are delighted to have you on the podcast. Thanks for making the time.
Richard: Yeah, thank you for having me.
Chester: Well, you’re here representing leaders in healthcare, and if there’s any industry that’s been affected with anxiety over the last three years, it’s yours. So, we’d love to learn what you and your leaders have learned; maybe, that can help the rest of us understand, you know, what we can do about resilience, wellness, especially to help, you know, those who may not be in health care.
Richard: Yeah, and to be honest, I don’t think it’s just healthcare. I think because these have been trying times, there’s been a lot of stuff going on, obviously, um, from my perspective. I think as we’re facing these sorts of challenges, oftentimes, we go inward. We think about the things that we’re not doing right, and I think that it’s good to be thinking about the things that we’re doing, but I think it’s even more important to be thinking about the system. And so I think that’s kind of the number one. As we’re facing these moments of anxiety, let’s think about the system. There are things that are going on in the world that are, in fact, that are affecting us that we don’t have any control over.
There’s things within our organization that perhaps we may have some control over. There’s ways that we’re interacting with our friends, our colleagues, the people we’re working with, and having meetings. And then again, finally ourselves. Like, so what are the things that we’re doing that can help promote well-being?
Adrian: Yeah, and along that line, you talk about creating this shared reality on your teams. Can you walk us through that concept? Some of the ways that leaders help create consensus, and how you interpret all this, you know, confusion and change? And, you know, yeah-on your teams, right?
Richard: Yeah, so, shared reality. So I guess what is that by definition? It’s not necessarily my reality, and so I have perspectives of what’s going on. I mean, I have ideas as we’re facing these challenges, but that’s purely from my own perspective. And so shared reality, is-are we coming together as groups of individuals who all have different perspectives? We’ve been pushing for diversity and inclusion, but oftentimes we have meetings which are actually not meetings; they’re tellings. And so we may be sitting in a meeting, and someone says, you know, hey, hey Winter’s, what do you think? And then I say what I think, and then I feel like an idiot because it doesn’t feel like anyone listens and my perspectives weren’t heard. And then maybe I wonder why I was even speaking. And so, yeah, shared reality means we’re coming together around with our many different perspectives.
Chester: Well, and you get to the point of interpretation. You know, like you say, it’s my perspective. Your perspective. What are some of the methods that you’ve got in your teams to help people interpret what we really mean as opposed to a meeting as to a telling? Does that make sense?
Richard: Yeah, it does. So, I think first of all it’s helpful to know what kind of a decision that we’re making. I mean, for some things, we sit in a meeting, and it’s common sense. We all know what to do. Right? And then there’s some things where we just need to ask the expert. And so I’d ask the attorney, or I’d ask, I’d consult the cardiologist about this thing, and so and that’s kind of their domain. But now we’re in a meeting, and we’re talking about things that are really complex, that affect us all, we’re, actually, there’s a lot of unknowns. We’re not sure how things are going to turn out. We’re not sure what to consider. And we actually find ourselves arguing or disagreeing. We need to be identifying that this is a place where we need to be gathering all of our perspectives as much as possible before we move forward. And so I think that’s number one, and then I think, so what do? We come up with a question. Like how do we best? So, in healthcare, how do we best take care of patients? How do we best adjust our staffing to meet the demands of patients? How do we best make sure patients are discharged as soon in the day as possible? All these sorts of things where I have ideas of what should happen, and you may have ideas of what should happen, but if we’re not meeting together, then it’s just me telling you what to do. And so, we come up with our perspective, then we share our perspectives, and only then do we start to come up with options for the things that we might do. And only then do we decide on the way forward, but again we tend not to do that. We tend to jump to the way forward, and then geez, things don’t work out so well.
Adrian: Yeah, it’s sort of the Six Sigma approach where don’t jump to the conclusion; see it all the way through. And, I love that idea of meetings versus tellings, and I just have this image of sure, you know, Chairman Putin, it’s a great idea to invade Ukraine. You know, and what are they gonna do? Yeah, if you don’t create a culture of trust, yeah, people aren’t going to speak up, are they?
Richard: Yeah, Adrian, I mean, I think actually, if you want, for the next five minutes, you can throw out any challenge you have, and I can tell you exactly what you should do; it’ll just come to me.
Chester: Exactly, exactly. I’m gonna put you on speed dial right now.
Adrian: Yeah, well, in healthcare, a lot. I mean, I love the Mayo. We’ve worked quite a bit with Mayo, and you have a wonderful culture that is much more democratic than many places in healthcare. Because typically, the doctor’s right. And the physician is king, sometimes over the needs of the patient. And I love what you’re talking about here of bringing this back to that person lying in the hospital bed who’s scared and worried. And you do talk in the book about fears and worries. Not just the person lying in bed, but also fears and worries of being a leader, etc., and you know, common wisdom is that we push those down, we quash any fears we have because we’re a leader. So, why is it important to be a little bit more vulnerable here about what we’re feeling?
Richard: Yeah, remember that old Pixar movie? I guess it’s old now, Monsters Inc., and there’s the monster in the closet, right? And let’s just not turn on the lights, you know? And so when that happens, the monster comes out, and you know, it scares us. And so, as we’re going through these sorts of changes, we need to be addressing the fears and the worries that people have because if we’re not, those are going to be the barriers moving forward. Those are going to be the things that will work against us being successful. And within those fears and worries are kind of the nuggets that we can focus on as we’re creating a vision moving forward to try to make sure those fears and worries don’t occur. So I’m afraid that this is going to destroy teamwork. I’m afraid that it’s going to make me unneeded. I’m afraid that we’re going to do this at the expense of the patient or at the expense of this other important thing that we’re working on. And if we just move forward without even considering those sorts of things, then you know how good of a conversation is that? How good of a plan is that? So fears and worries for me as I go in and give talks, um oftentimes the leaders are like, whatever you do, don’t mention this, and I’m thinking, whatever I do, I’m going to mention that because that is the way forward. That’s the key.
Chester: Yeah, I think you’ve expressed that so well. I love your analogy of the of the monster in the closet. As long as we don’t open the door, right? As long as we don’t turn on the light, we’re going to be safe?
Richard: Yeah, and if we don’t do that, then it’s the monster in our own head, you know? It’s just eating us alive, and it gets bigger and bigger.
Adrian: Uh, what are some other ways that you help teams envision, you know, dealing with that change and those fears? Because they are venturing into new situations, as you mentioned. There’s been crazy change, you know, whether it’s economic or social or, you know, pandemic and so on. And you’ve talked about gathering the information and having people’s voices heard. Are there any other tactics and things you can share with us? Because we get a lot of leaders that are new leaders that listen to our podcast, right? And they want to know how do I venture into that unknown and how do I bring people with me.
Richard: Yeah, and so I think there’s structure there that can help us and, you know, as I coach. So, I’m an executive coach also, and I coach department chairs and senior leaders. I will often find a space where people are afraid of disagreement and then a lack of understanding of how to even help people move through disagreement, which is just a part of change. And so, as we’re building sort of shared perspectives and a sense of shared reality, we have to understand that things aren’t dichotomous. It’s not this or that. It’s not ones or zeros. It’s not right-wing or left-wing. It’s not, you know, us or them. It’s actually all that stuff together. And so what we want to be understanding is all the different perspectives, all the disagreements and bring those things forward because that is the nuance of complexity are these various different perspectives, and now given these different perspectives, these disagreements, how can we move forward in a way that we want to move forward. Not in a fearful way but a way that addresses our fears and makes sure that those fears are decreased that are mitigated. They’re not going to happen.
Adrian: A lot of people are going to be wondering, okay, how do I learn more about your work Richard? Where would you send them?
Richard: Yeah, so I have a very creatively named website called richardwinters.com. A lot of focus groups. Yeah, and so, that’s a way, and then also, you know, the book. “You’re the leader. Now What?” And that’s available at any bookstore. Those are probably the best places.
Adrian: So, one of the things you talk about is this idea of shared reality. Shared Vision. And as you just mentioned, we are such a divisive world right now. Whether it’s, you know, right, left or, you know, it’s whatever we bring into the workplace. We have so much baggage we carry with us. So, can you give us an example of a leader doing that? Maybe at Mayo or elsewhere where you’ve worked where, you know, kind of people coming in with disparate ideas, and within a certain amount of time, they’re a united whole.
Richard: Let’s think of an easy. So let’s say you’re a primary care clinic, and all of a sudden, there’s this huge number of patients, and the Physicians, the NP, the nurse practitioners, physicians assistants are all feeling burnt out, but there’s more patients, how do we start to see them? And so you’re gonna have a lot of different ideas, and so from that perspective, it could be a small executive group that makes a decision. And I’ve witnessed this. And this is why they sought coaching, is they decided what they were going to do is they’re just going to open up clinic an hour earlier every day. And you can imagine, like, oh my gosh, right? Because to the executives, that makes sense. We’re going to meet the volume of patients, but then I’m a working parent, and that is the time I drop off my kid at school. Like how do I do that? Or I’m working on this. The only time I have to work on this research thing, or the only time I have to work out, or the only time I have to get this stuff done is during this time, and so now what am I going to do? And what I’ve just talked to you about are those fears that I have about the change moving forward. And so now, if we come together, we decide, okay, we need to meet the needs of patients; we need to be able to see them and expand our hours. How do we do this in a way that helps us as opposed to hinders us? Are there ways that we can flex our schedules? Are there ways that we can be sure that you can still pick up your child at school, and then oftentimes, these ideas come up that actually are better than the original idea. I mean usually they are, and then people buy in because there are ways of allowing people to still have those opportunities and move forward. Some decisions are difficult. I mean, and sometimes you can’t reconcile, but then as you have a group coming together, at least say I have an understanding of the difficulty reconciling it. And then, even then, you can still try to decrease the bad effects moving forward.
Chester: Yeah, because you felt like you’ve been a part of the conversation, right?
Richard: Yeah. You get it. Hey, I would like it to be this way. I understand why it can’t be this way. It’s arbitrary, right? Yeah, I mean, there’s external realities. I mean, there are finite resources. All these sorts of things, and this is what hurts, I think. As a leader, you’d like to make things all available. There are times you just don’t have those resources. Yeah, you know, you touched on this idea of, um, burnout. It’s just such a huge issue in healthcare like you said. And more hours isn’t always the solution. In fact, it’s probably more of the problem, right? So what’s what are the biggest impacting rates? I mean, what’s impacting burnout the most? And what are some of the things that you can do to offset that trend, you know, for our teams in and outside healthcare?
Adrian: You’ve mentioned some about bring the collective knowledge together. Are there any other tips you can give us on, you know, mitigating and managing burnout?
Richard: Yeah, I think a couple. There’s a lot of stuff that floats from my mind. The first thing is-do we have a language about well-being. And so I’ll ask physicians, and so I give this talk about burnout, well-being to all of our new physician and scientist hires. And I’ll ask them how many of you can name the 12 cranial nerves. Everyone raises their hand. How many of you can name six causes of metabolic acidosis? You know they all raise their hand. How many of you can name six components of eudemonic well-being, psychological well-being? Nothing. Crickets.
Chester: I couldn’t. You’ve stumped me. And Adrian too, I’m sure.
Richard: I mean, we don’t have a language there. And so we can talk about burnout, but then what are we trying to.. the very thing that causes our own well-being, we don’t yet have a language to discuss, and if we don’t have a language to discuss this, how do we move forward? And there are many models out there. You know, actually, one of the fun things to do is to read the well-being literature and see the researchers argue with each other about the definitions of well-being, right? It’s still something that’s being evolved, but for me, this concept of psychological well-being and I put it into mnemonic pagers because I’m a physician, and I still wear pagers. So P is purpose. Do we have a sense that we are aligned with the purpose of our organization of others? Are mission or values that are aligned? If not, maybe not so much well-being. A autonomy. The sense that we’re being heard. The sense that our voice makes a difference. That it matters. And it may not be that the group moves in a way that we had thought initially, but we know it was considered. And then G is personal growth. I mean, we have an opportunity. I have an opportunity to do things now that I couldn’t yesterday, and there’s things I want to do in the future and how do I bring this into the workplace? And then E is environmental mastery. So environmental mastery is, do I have the resources I need to get the job done? And it may be these resources are finite. I can understand that, but do I have, are there resources there that can help me do what I’m needing to do? and then R is positive relations. And you know, because it stinks to work with people who are not nice, that don’t get along. And then S is an important one. It’s self-acceptance. It’s our ability to accept the fact that we make mistakes, that we have failures, and so that, for me, is a nice structure. Just to start to think about, um, as we’re running meetings. Are we aligning with purpose? Am I, as an individual, making decisions that are in line with what I want in terms of values? Am I working in an organization that is similar to me in terms of, are they promoting personal growth? Do they want to hear my voice? Those sorts of things are very important.
Adrian: I love that. I love, yeah, putting it into a, you know, a memorable device that we can ask ourselves? Okay, are we living up to z? Because you’re right, we just don’t have the language of well-being. You know, as a physician, you know everything about the human body. If you’re a bricklayer, you know what that thing is that spreads, you know, the trowel. I know what that word is, and yet in mental health, we don’t have the language in resilience and well-being that is accepted by everyone. I love that idea of bringing this together.
Richard: Yeah, as we develop it, I mean, we’re learning together. I think fairness is another thing that maybe not covered by pagers. If we feel like it’s unfair, so we start to add these little bits on. And as you’re using the, you know, the bricklayer idea, this building becomes. There’s many rooms. There’s many places for us to be able to explore.
Chester: So one of the things you talk about is the complexity exacerbates uncertainty in the book. And yet, as you know, we’re not in a simple world. So first off, you know what do we do about why is there so much complexity? What do we do about it, and how do we help our people through more complex and ambiguous times?
Richard: Yeah, I mean, geez, how do we do that? I mean, I think, let me say that I’m going to be working in a place that is aligned with me, that has similar values, and that where my voice matters and where we acknowledge that there is complexity. And there’s many ways to pursue things and that we’re going to be learning from that and that we’re self-accepting and so I can even go back to those domains of well-being and say from a complexity perspective that’s where I’m going to work. And then, as I’m a leader or as I’m someone in meetings, I’m wanting to make sure that we’re conducting business in a way that we’re making decisions, in a way that we’re working together, in a way that again promotes well-being while really dealing with the hard truth, you know, the things that that are going on in the world that maybe that are out of our control. But just like everyone else in the world where we’re going to try to find a way through this we’re going to find what works and what happens is a lot of these complex things over time, and oftentimes we’re handling multiple things, but over time they start to become the domain of experts, and they start to become common sense, and then they start to become known and so it’s I think this is always going to be there the question is am I surrounded by people am I in a position where I’m working in a place where I can flourish.
Chester: You know, that’s one of my favorite words, flourish. Yeah, you know, it’s not just survive. Can I flourish? Am I being engaged? Am I growing my? Am I learning, you know? I’m always interested in personal rituals and, you know, symbols and things that people do to keep themselves, you know, in a state of well-being, whatever your definition might be. Can you share with us some of the things that you do, personally, that keep you in a state of well-being and keep you moving forward in a healthy, yeah, in a healthy way?
Richard: Yeah, that’s right, and I’m gonna go with that flourish idea because they’re just concepts that are very helpful for me, and I think that may be one thing, and so I have in my backyard, we plant a garden every year and, you know it’s at a good location we plant seeds, and for some reason, some plants don’t grow some seeds don’t grow in that place.
Adrian: It’s because you live in Minnesota.
Richard: I don’t know why we can’t grow palm trees. Bananas.
Plant them every year, every year, you’re disappointed. Yeah, right, right And so I mean, it’s geez, so then you plant those seeds, and they’re gone. And I think, I like to think about us as being like we’re in these gardens, right? And so, but we’re not like seeds. We have legs, and if we find ourselves in a spot where we’re feeling trapped, and we’re not able to flourish, let’s go to a different garden. And so just having that perspective, this thing that we’re not necessarily trapped in the moment but that we can move to another way another, you know, kind of group of individuals or way of working where we can flourish. And it can be difficult because some of us, oh, I have a job in my hometown, and they’re my parents there, and they’re helping me with the kids. I mean, it can be very difficult, but given that, what can you do? Like, what can you do to try to flourish? I think that’s important, and so in terms of rituals, um, I love this concept of dance floor and balcony. Ron Heifetz is where I first learned it from. And so each of us has this perspective of dance floor of what’s going on, and so as I’m at work, as I’m talking to you, I can kind of predict what you might say and how I might respond. I kind of hear the music, and reflexively, I know what to do and how to respond to that. And that helps us very. It keeps us from getting hit by trucks. It allows me to go in and take care of an acutely ill patient. I just know what to do, and reflexively on the dance floor, I can respond. But it’s helpful for us to have times where we can go to the balcony and then think about this from a different perspective. We can think about the situation. We can think about ourselves and how we’re responding from a different perspective. That’s sort of meta, where we’re able to stand above things and look at the whole kind of system, and so do we have time, do I have time where I’m getting onto the balcony and considering what’s going on? Because reflexively, I may just curse the world, go on Twitter, you know, and just maybe that’s not the best reflex. Whereas, from the balcony, I can see all these different ways that I can go and these things that I can react to and, you know, just a broader sense more nuanced, like where is my garden? And so having a practice to do that. For me, exercise is a time that I think. I write. That helps me think. I work with people that encourage me to think out loud, and so those are the sorts of things.
Adrian: It’s beautiful. No, I love this. Yeah, I love the analogies that we’re throwing out here with the garden. You know, finding a place where you can flourish and grow. The dance floor. Are we spending all our time there, or are we able to, you know, get up onto the balcony? So okay, so last question. It’s been such a great conversation, Richard, and one of the things you know; you put yourself. We’ve written enough books to know you put your heart and soul into these. Anything any big takeaways from that work that you’d like to share with us as we close today?
Richard: So, I come to this as an emergency physician and then as a coach. And so, to me, this idea of being a coach is it’s almost sacred in some ways. And so, you know, as an emergency physician, maybe I walk into a room, and I write an order. As a coach, it’s different, and so I think my point is try to surround yourselves with coaches. Try to be your own coach. And so, what is a coach? Let me first talk about what a mentor is. A mentor is someone who can help you see through their eyes. They’ve been there; they’ve done that. On the one hand, I hear you saying this, Chester. On the other hand, you know, this is what I would suggest based on my experience. You know, this is what I think, Adrian, you should be doing as we move forward because this is what I’ve done. You want this opportunity. This is what I have done. This is what I would suggest. I’m helping you see through my eyes. A coach, on the other hand, is going to be saying, you know, Chester, I hear you saying this, and I hear you saying that. How do you put this together? What opportunities do you see what might get in your way, and so rather than helping you see through my eyes, I’m helping you see through your own eyes, and so I would say find those individuals. Find the ways that you can expand your own perspective. Your own perspective as opposed to seeing through the eyes of the others, and it’s just such a wonderful place from a perspective of finding your own well-being as opposed to finding, for example, the way others had achieved well-being. Take some of that in, but really bring that into your own perspective.
Chester: That is brilliant. Thank you. I mean, this has been such an enlightening interview. I appreciate not only you sharing your experience as a physician and your experiences as a coach. Some really practical takeaways from today, so thanks so much for your time today, Richard. This has been really a delight. Thanks.
Richard: Thank you, Chester. Thank you, Adrian.
Chester: Adrian. What a delight! Such practical advice. Really interesting perspective. I’m curious, what were some of your main takeaways?
Adrian: Yeah. No, you know, I love that Richard’s talking about leadership here. And it’s something that does create a lot of anxiety for a lot of people who listen. So, you know, first off, what he’s saying is look, you know, think about what’s happened over the last three years. How much are we thinking inward? What can we do differently, but are we thinking too about the system and healthcare? Mayo does a really good job about this. Trying to take some of the stress off their physicians, their nurses, their nurse practitioners, etc. You know, lab people, and really re-engineer their systems to be more patient-focused and less stressful.
Chester: Yeah, I appreciated. He said; let’s find a common language. You know, well-being means something to some person, it means something completely different to another person. And then his mnemonic of PAGERS. I thought was great. Are we aligned in our purpose? You know, Are voices being heard? You know, do we have the opportunity to grow and flourish? Do we have the right resources, and do we have positive relationships and then self-acceptance? I thought the S was really great. You know, am I willing to say, look, this is what we have? Here’s what we can do, and I’m not going to try to, you know, dream of what could be. This is what we’ve got. Self-acceptance, I thought, was really an important part of that.
Adrian: Yeah, and I like that he’s talking about look, the monsters in the closet. You know, how often do we do this? You know, you don’t want to turn your lights on that, and you know, honestly, as you and I go into to places now and then, the CEO, the head of HR will say, now guys don’t talk about blank, right? And I love what he said, exactly what we should be talking about, because, you know, there are these things, you know, it’s like, oh look, we just had to get rid of our CFO. He was a disaster. Don’t talk about that. Or we just have to? We just had this merger, and it’s still a mess. Don’t talk about that. It’s like, no, it’s okay; sometimes we need to get into what’s creating anxiety and fears in our organization. Because if you don’t, it just gets bigger, is what he said. Look at it, then it’s a runaway train in your head, you know?
Chester: I loved his analogy of the garden. You know, I plant these seeds, and some of them don’t grow, and sometimes you need to find another garden, you know. Find out what works for you and nurture your garden. I love that.
Adrian: Or add more fertilizer. Yeah, either way, or more credits. Stop planting palm trees in Minnesota. Yeah, you know, burnout, you know, that this was kind of interesting about uh, you know, a lot of it is coming from different ideas, but he talked about the, you know, the meetings versus the tellings. You know, we’re creating a lot of anxiety by not giving people a voice and, you know, and not giving them a way to express. Well, as we found in “Anxiety at Work,” we spent a whole chapter on this right, it is giving people a voice, and that is so important in bringing down anxiety levels.
Chester: Yeah, one of the last things for me was the fairness issue. He said you know that there’s got to be a sense of fairness that we’ve had a chance to talk this through. We’ve worked through the problems and so on, and it’s fair. You know, we’ve all been in a situation. I mean as little kids. Well, that’s not fair. And then what do your parents, well? Life isn’t fair, you know? I want my voice heard. The last thing. I said the last thing before, but this really is the last thing is surround yourself with good coaches. I love that a mentor sees things, you know, you see things through their eyes and their experience, but the coach pushes you and says how would you do it? How would you solve that problem? Really, really great practical advice. It really is okay.
Adrian: Last one then for me was the, yeah, the dance hall versus the balcony. And so yeah, so you know, because we hear it in different ways that I spend all my time putting out fires, right? You know, and that’s, you know, you’re dancing on the dance floor, and you know, that’s almost a, you know, it’s a nice metaphor, and yet how many times do we go up, and we oversee what we’re doing. Our days are so filled with everything, you know? We’re going on a walk, and we’ll put on a podcast. We’re going into drive, let’s put on a book on tape, you know? We fill ourselves with everything, and uh, as Marcus Aurelius would say, there are just moments where we just need to be quiet with ourselves and listen, you know, to what we can what the, you know, what our internal, you know, thoughts are telling us.
Chester: Look at you quoting the stoics! You are a true renaissance man. Well, listen, you know, we’re always grateful for our guests. We’re grateful for everybody that tunes in, and we’re really grateful for our wonderful producer, Brent Klein. He takes our mess and makes it beautiful and easy to listen to. And, of course, to Christy Lawrence, who helps us find all these amazing guests. We really do appreciate the community as well.
Adrian: We hope that if you’ve enjoyed the podcast, that you’ll download it. You’ll share it with friends and family. You’ll visit us at thecultureworks.com for lots of free resources to help you and your team create a culture that will thrive. Or, as Richard said, flourish. Don’t forget to pick up the book Anxiety at Work. uh, I don’t want to say Bible because it’s not that long, but I mean, it’s good, but it’s not at that level. But it really is the playbook for helping bring down anxiety levels in your workplace. And we love to speak to audiences around the world, virtually or in person, on the topics of culture, teamwork, resilience. So give us a call. We’d love to talk to you about your event.
Chester: Thanks again for tuning in. We really appreciate it. We’ll see you again in about a week, and we hope you’ll have a great week full of lots of good coaches, positive people around you, and good mental health.