By Sondoss Elsawah and Anthony J. Jakeman
This brilliant blog post using a conversational form to query prediction, expertise, practical action, and our expectations and ‘rationality’ around it was retweeted by David Chapman: http://bactra.org/weblog/1174.html
That led to me sharing one of my favourite little canters about ‘medication adherence’, cut-and-paste here as much for my own convenience as anything else:
‘Medication adherence’ is brilliant for this. I’ve seen (but can never find) a paper which puts the number of people who – fill the prescription and – take the medicine – in the recommended way – to the recommended course to be in the teen%s.
and this is with *every aspect of the symbolism of General Practitioners reflecting courtly ritual of time spent visiting the Monarch*! (Ooh – and you have to factor in the %age doctors got the right medication and wrote it down correctly, and legibly)
and the literature seems… thin… and vague… There’s a suspiciously round figure of 50% reported a lot ncbi.nlm.nih.gov/pmc/articles/P and there seem to be few really predictive factors ncbi.nlm.nih.gov/pmc/articles/P
“40-60% of patients could not correctly report what their physicians expected of them 10-80 minutes after they were provided with the information.” “over 60% of patients interviewed immediately after visiting their doctors misunderstood the directions”
and what tickles me even more is that data collection in adherence monitoring is vague, varied, and unreliable frontiersin.org/articles/10.33 …so if you want nebulosity in medicine, it’s here in layers – it might *look like* we know what we don’t know… but we’re not sure!
(interest: Garath is a friend and sometime collaborator)
A few years ago I went to a job interview and was asked a question about how I deal with uncertainty. In my answer I described myself as someone who is ‘comfortable with uncertainty’. At the time I had recently completed an executive education programme on systems leadership where we considered the idea of a VUCA world. VUCA being a term first coined by the US military and stands for volatile, uncertain, complex and ambiguous. The term VUCA has now become something of a cliche, and for good reason as it perfectly describes the modern operating context not just for the military, but for public services, not-for-profits and the commercial sector.
The same programme focussed on the idea of Adaptive Leadership, developed at Harvard Kennedy School of Government, as the profound social technology to lead in uncertain times. This learning experience helped me give what sounded like a well informed answer at interview. I also believed it to be true, I believed that I was ‘comfortable with uncertainty’ and that adaptive leaders have this capability. My answer convinced the interviewer and I got the job.
Today I know uncertainty triggers anxiety for me and is something I have to work on. How then did I convince myself of the opposite? My answer for myself is that I had heard that this was how leaders were supposed to be and I believed it. It became part of a ‘story’ that I told myself and I clung onto it. Often these story lines can get in the way of our leadership; I was unconsciously lying to myself because it fitted a model that I had imagined about how leaders should be.
Denying anxiety as I did, may only put the day of overwhelm off. Through coaching and work on myself I have noticed the role anxiety plays in my psychology and how it is often triggered by uncertainty. My habit, developed over a lifetime, was to push this emotion away and to tough it out. This wasn’t something that started in my leadership career, its origins were much earlier. My own experience of being a coach has shown me that I’m not the only one, our past presents in the moment for all of us. The challenge is to become increasingly aware of how old habits impact on how we lead today.
One senior leader I worked with would do anything to avoid conflict, he oscillated between trying to please everyone and taking an authoritarian style that closed conflict down abruptly and often aggressively. In coaching I asked about his experience of his family of origin – he described a childhood characterised by continual conflict. He was eventually able to link this experience to what was happening today, noting the feelings of uncertainty and insecurity that conflict provoked and how the same tapes were still being played out.
Becoming aware of this unconscious process allowed the leader to see it happening and grow in the capacity to change. Seeing it means you don’t have to be it. For me, this is what leading with awareness means; working on your blind spots and making them conscious. This work involves observing yourself with objectivity, without the normal judgements we make when we notice something we don’t like about ourselves.
This is very similar to an adaptive leadership practice known as ‘balcony work’. When an adaptive leader ‘gets on the balcony’ they view the ‘dance floor’ (system) observing what is happening and working out what intervention to make. The difference is that the system here is your inner-system and its about what is going on interiorly, your thoughts, feelings and sensations. Cultivating this ‘noticing practice’ supports us to be in uncertain situations, seeing and even dropping our unhelpful storylines.
My storyline was: ‘I’m comfortable with uncertainty’ and this created a blindspot that prevented me seeing what was really happening. It made it harder for me to be comfortable with who I am (an ordinary person who dislikes uncertainty and is continually looking for solid ground). My insistence on clinging to this idea resulted in me pushing my emotions away and I avoided working with my anxiety.
Freud saw anxiety as a signal to the ego of a potential threat. These signals are received physiologically by the amygdala, which resides in our ancient limbic brain and is associated with our fight, flight or freeze instinct. Many situations can activate this instinct: change, uncertainty, loss, rejection and fear of failure – all of which might characterise our current context as we move from one adaptive challenge to the next (remember Brexit?).
In the context of organisational leadership it’s no longer threat of physical attack, but rather a threat to our ego, perhaps our status, our model of ourselves, the story we tell. It may be that your story is getting in the way of your ability to connect with others, to lead.
The Covid19 pandemic is going to tragically affect so many families. Things we once took for granted are now under threat; our health, jobs, and businesses, potentially creating a pandemic of anxiety. This crisis might be inviting us to view our experience differently, put some space between us and our experience so we can see what is going on more clearly, pause and reflect on what to do.
This shock to our system may have some adaptive results, the need to reduce air travel and car use has been immediately achieved – for a time at least. A new global narrative has started to emerge similar to that of people who get a health scare and then reflect: ‘I might need to re-think my lifestyle…’ How we sustainably adapt as a global community remains to be seen, our personal adaptions in the face of uncertainty and anxiety are something we can all take responsibility for.
Garath Symonds is a Executive Coach, learn more at www.garathsymondscoaching.com
When I graduated from Columbia University, I was informed in a professional development workshop at a national conference that my hair should not distract from my excellent credentials. I did not understand how hair that grew naturally out of my scalp could be labelled as a source of barriers. The styles that were mentioned as socially acceptable for professional upward mobility were straight hairstyles that did not reflect the texture of my natural hair.
a bit of Keith Grint 🙂
Prof Becky Malby interviews thought leaders to inform and guide NHS leaders through the current context.
The first interview is with Keith Grint, Emeritus Professor at Warwick University on the lessons from his work on leading Critical, Tame and Wicked Problems. We discuss the interplay between command and control and adaptive leadership, the role of soft power, and how to ensure as leaders are the best decision-maker you can be.
From a great tweet-starter by Thea Snow – ‘systems thinking comes naturally in oral cultures but is v difficult in literary cultures’ – discuss!
Lots here from Leyla Acaroglu, which I appear not to have covered before.
Recent email with links and offer:
If you one of the quarter of the world’s population who are currently in #quarantine, #lockdown and #workingfromhome then you are probably experiencing the same fear and frustration as the rest of us. We are also in lockdown, and yes, that means many extra hours of time to reflect and engage with content. Some of it is helpful, while some of it, well, maybe not so much…
To help everyone #staypositive, last week we gave away lots of free content every day and were overwhelmed with thousands of you downloading and engaging with our changer-maker stuff.
Now it appears this COVID-19 situation is likely to continue for a while, we’ve kept ourselves busy looking for more creative ways to help our community #staypositive and develop skills as a creative change-maker despite these complex times. Our entire existence as the UnSchool is to find unique ways to help more people make positive change so that we can design a more positive, sustainable and regenerative future.
So now, we are excited to launch a new brain activating 30-day challenge to help anyone #staypositive, learn new tools and get cool shit done. Built around the new handbook Design Systems Change by Leyla Acaroglu (which you get as part of the pack), Leyla curated the 30-day bootcamp with daily doses of content that you watch, read and then do. With 30 downloadable worksheets you will be able to explore many different ways you can build your own agency and capacity to effect positive change in the world around you – even if it’s from your bed or lounge room for the moment!
The bootcamp is usually designed to be self-paced and individual, but with so many of us in the same boat at the moment, we figured you might enjoy doing this as a #30daychallenge together! We’re starting on April 1, and if you sign up to join before April 1 (5pm UTC) you also get a 50% discount and keep motivated with us!
Check it out here for all the deets on the booster pack and use code > designsystemschange < at checkout to activate the discount.
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Wishing you all the best in these complex times and hope you stay safe and healthy!
Love from the UnSchool