Immersion 2 Reflection

I felt that the Immersion 2 experience provided teaching that addressed the domains of leadership, landscape, and life. I learned much about leadership as we progressed through the content of the Immersion. I was confronted with the paradigm of the “Servant Leader”. This is a leader who strives to motivate and engage the members of an organization by winning the hearts of the people within the organization. This strategy moves to engage the people of an organization more deeply rather than appealing to employee cognition. A servant leader is effective when actions and values are aligned with the goal of inspiring the hearts of employees. A leader can accomplish this through choosing to the do the right thing when confronted with an ethical dilemma. One of my Immersion 2 classmates shared the story of a CEO in a health care organization who made the tough call to self-report to the Office of Inspector General (OIG) revenue that was collected due to incorrectly submitted charges. The amount of revenue involved was regarded as small, and it was likely to go undetected. However, the CEO proceeded to report the discovery of the financial issue. The matter was ultimately resolved, and this example displayed the authenticity of a leader who is serving the organization by choosing to do the right thing. The action of the CEO inspired the members of the organization to have a deeper sense of pride and commitment to the organization. The Servant Leader also displays authenticity and humility to the organization’s members. I encountered this during the Immersion class meeting with the Executive team for The George Washington University Hospital. The members of the executive team talked about the CEO’s example to engage employees at all levels of the organization in discussions during her walking rounds. In addition to the approachability that the CEO displayed, she would also serve her organization by stopping to pick up trash during the rounds which demonstrated her pride and care for the organization.

Through this Immersion experience I also learned more about the current landscape of the Affordable Care Act (ACA) and the proposed American Health Care Act (AHCA). From the CEO of Innovation Health, I learned that the current structure of the health care exchanges under the ACA have exposed health insurers to higher levels of downside risk than forecasted by the actuaries. One factor thought to have contributed to this higher than anticipated cost for patient care is that the population of patients who entered the exchanges were without care for so long that chronic conditions such as diabetes and associated complications of diabetes such as diabetic retinopathy required increased utilization of services as providers delivered the care necessary to stabilize the patients with these health conditions. The speaker for the Key Note Address during the networking dinner expertly taught me about the forecasted economic consequences of the proposed AHCA. The modeling projections by Dr. Ku’s team anticipate that the US economy will lose almost one million jobs by 2026 (Ku, Steinmetz, Brantley, Holla, & Bruen, 2017). These authors attribute the loss of these jobs to “reductions in support for health insurance cause negative economic effects.”

For me, Gordon Hawthorne’s discussion entitled Value-Based Leadership in Healthcare was a life lesson with significant implications for leaders in health care. Mr. Hawthorne’s professional and personal journey displayed the attributes of authenticity and transparency that are frequently simply “buzzwords” heard bantered about in today’s leadership circles. Additionally, Mr. Hawthorne described the strategy of using an interval of reflection to restore a personal sense of centeredness. One can use the term meditation or sabbatical to describe this mental exercise of restoring one’s personal calmness and clarity. This will position oneself for success in professional and personal relationships.

While I have learned much during Immersion 2, the content that I find myself continuing to reflect upon align with the domains of leadership, landscape, and life. I am hopeful that I will be able to successfully incorporate the principles discussed throughout this immersion into my leadership style such that my future followers are inspired by my form of servant leadership that I display to them and to our organization.

 One of the ways that I intend to incorporate the content of this Immersion experience into my professional life is to reflect more deeply upon Mr. Hawthorne’s discussion about the stay strategy, leave strategy, and the serenity strategy to realize the implications for my professional aspirations. This part of the immersion will have the most significant impact upon my professional career. Closely associated with these strategies is Mr. Hawthorne’s description of “discontent” as a positive event in one’s career. In reviewing my career path to this point, I can agree with Mr. Hawthorne that discontent has been one of the forces that has moved me forward in professional and academic pursuits. In high school, discontent motivated me in the positive pursuit to acquire more education to move myself from being an emergency medical technician to graduating with my associates degree in nursing. It was also discontent that contributed to my decision to pursue a better job opportunity which culminated in a relocation from New York state to North Carolina. Not only did the relocation address the discontent in the quality of my employment, it also addressed the discontent that I began to sense about the achievement of my associates degree such that I proceeded to complete my undergraduate degree in nursing. In time, discontent urged me forward to move from a front-line nursing supervisor in a major trauma center to completing my graduate degree in physician assistant studies thereby transitioning my career to my current clinical position as a cardiothoracic surgery physician assistant. Most recently, I can see that it has been discontent that has assisted me to make the decision complete my MHA so that I can confidently and competently lead a health care organization into its future. I would have to agree with Mr. Hawthorne that discontent has guided me forward in self-improvement to better understand and to better serve the world around me.

Now that I understand my “friendship” with discontent, I can apply Mr. Hawthorne’s discussion about stay strategy, leave strategy, and serenity strategy to my current position and career timeline. For me, a stay strategy with my current organization will involve aligning myself with other professionals who are diligently working to influence the organization to move toward the future of value based healthcare in place of volume based healthcare. In addition, my stay strategy will involve accepting opportunities to work on projects within the organization that will allow me to display the knowledge and skill that I am acquiring through my MHA studies with the hope that I will be able to transition my career into a formal leadership position. Currently, my leave strategy is contingent upon the degree of success that I encounter as I attempt to implement my stay strategy. If the gap widens between obtaining my MHA and my ability to use the skill and knowledge of my MHA within my current organization then my leave strategy will involve listening to my discontent as a guide toward a new position of responsibility and leadership with another organization. Lastly, my serenity strategy throughout all of this will be to use what I have learned about taking a sabbatical to have daily moments of reflection and meditation to maintain my centeredness and well-being throughout this journey.

In closing, the key takeaways for me from Immersion 2 become apparent as I review my notes; and I have listed a few of these below:

1. The Triple Aim
   1. Do the most good
   2. For the most people
   3. With the least amount of cost per capita
2. The Servant LeaderMove healthcare in the United States from being a commodity to being a right of citizenship.
   1. Be authentic
   2. Be vulnerable
   3. Be transparent
3. Move healthcare in the United States from being a commodity to being a right of citizenship
4. Speak to others from a place of authenticity
5. Deliberately step above the “mess” around you in your organization and in your life
6. Frontline healthcare workers are really social entrepreneurs who are struggling to extend care to others in a broken system where the future is crashing in.
7. There are only three levers to reduce healthcare costs.
   1. Lower fees
   2. Lower utilization
   3. Lower the health benefit
8. Value Based HealthcareSimple innovations are easier than complicated ones, but they are still hard to implement!   
   1. Move away from fee for service
   2. Move away from paying for mere volume
   3. Move toward paying for volume
9. Simple innovations are easier than complicated ones, but they are still hard to implement!

Immersion 2 Leadership Portfolio

I view understanding the results, interpretation, and use of my Emotional Quotient Inventory (EQI) as essential to my success as a leader in the future. The EQI tool assesses sixteen elements of emotional well-being. Each of these elements is believed to contribute to one’s interpersonal success, effectiveness in coping with environmental demands, and overall happiness. Each of the elements are aligned with one of the six so-called composites which include the following: Self-perception Composite, Self-expression Composite, Interpersonal Composite, Decision Making Composite, Stress Management Composite, and Well-being Composite. The Composites along with their associated elements of emotional well-being are represented in the diagram below:

Rutledge, H. (2011). EQ Workbook. Toronto, Ontario, Canada: Multi-Health Systems Inc. (MHI).

I would like to frame the review of my EQI results around the three elements that are predominant behaviors that I display to others as well as the three elements that I do not strongly display to others. That said, the three elements that my EQI results show that I predominatly display to others included Assertiveness, Independence, and Impulse Control.

It was helpful for me to have a better understanding of what is meant by the term: assertiveness. I have often thought of assertiveness as a synonym for aggressiveness. However, our EQI instructor was able to clarify that assertiveness is the midpoint between the spectrum that extends from passiveness to aggressiveness. This result seemed consistent with my own perception as I am able to be firm and direct when necessary. I also tend to stand up not only for myself but for others also. My EQI report was able to put this finding into emotional, social, and behavioral context while I am at work. The emotional implication while I am at work is that I do have a solid understanding of what is worth standing up for, and I would agree that I can pull on strong emotions and convictions to state my position. While I encounter many situations at work that require a definitive stance, I do need to be aware of other circumstances in which I need to be more flexible in my thinking. The social and behavioral implications while I am at work are that I have the ability to communicate my points in a clear and confident manner. Other team members can perceive me as one who deals with conflict and one who gives feedback on current work issues. There are areas that I need to exercise caution or restraint. I need to be aware that I can stray into being aggressive if I am too rigid in defending my views or positions which may then be perceived by my work colleagues as being unproductive, stubborn, or even aggressive behavior. While being assertive is a good skill in the work environment, displaying behvior that is pervceived by others as aggressiveness will potentially harm relationships.

My scores were also consistent with displaying the element of Independence to others. The EQI describes being independent as one who is able to to feel, think, and work in an autonomous manner. My scores fell in the midrange for this element. This is interpretreted as being willing and capable to choose to my own course of action. This also describes me as being willing to be the leader and the follower depending upon the role needed at the time in the workplace. I feel very comfortable with the findings of the EQI in this element as I do perceive myself as someone at work who is comfortable with making decisions. I am open to receiving guidance from others, and I often seek input from others. It was helpful that my EQI report described this finding in terms of the impact at work and possible strategies for action. My level of independence is displayed in my ability to work with others and make decisions in collaboration with other people. I also have the ability to remain free from emotional dependency upon others. It is interesting to note that my results demonstrate my independence to be greater than interpersonal relationships. The implication for me is that I need to spend more time and effort into nurturing relationships with my work colleagues.

My results also showed a high range in the element of Impulse Control. Again, the EQI workbook and report assisted me to have a better understanding that Impulse Control describes one’s understanding of the appropriate times and ways to act upon emotions and impulses. Basically, this is consistent with the sage advice offered by many mothers: “Think before you act!”. With a high level of impulse control, my coworkers are able to be comfortable and confident with me as my demeanor is stable and my decisions tend to be predictable. I also tend to survey a situation before I commit to a course of action. It was very helpful to me that my report indicated that people with high impulse control tend to have a lot of “self talk” going on all of the time as I regularly encounter this throughout my day. I really do play out mulitple senarios in my head which can delay committing to a course of action. My impulse control also exceeds my flexibility which implies that I should focus on actively embracing changes while remaining in control of my impulses. Maintaining a good sense of impulse control will counter susceptability to impetuous changes.

I also want to take time to explore the elements in which my EQI results fell into the low range as I believe that focused attention on my part in these areas will result in improved interactions with colleagues at work. The three areas that my EQI report shows that I am in the low range are as follows: Interpersonal Relationship, Empathy, and Optimisim. For me it is interesting to take note that the elements of Interpersonal Relationship and Empathy are in the same composite: Interpersonal.

My low range score for interpersonal relationships is absolutley consistent with who I am! The EQI describes this element as having mutually satisfying relationships. My report goes on as if the EQI instructor for our Immersion experience is speaking directly to me: “You may have many acquaintances but few cherished, supportive friends or colleagues. You understand how others can help you, but you know few details about them personally. You also tend to rely on your own devices to get the job done, rather than reaching out and asking for help.” I can also agree with the negative emotional, social, and behavioral implications that can occur at work for someone that needs improvement in this area. As described in my report, my colleagues at work will not be able to perceive my emotional intelligence skills unless I engage them in authentic interactions. I believe that my current shortcoming in this area has contributed to a perception among my colleagues that I am preoccupied with work to engage them in the personal conversations that are necessary to get to know them in a more fulfilling way. This is going to require energy and concentrated effort on my behalf to make improvements in this area. I do believe that the increased effort on my part will result in increasing the cohesion between myself and my coworkers.

The other element within the Interpersonal composite that I fall within the low range is Empathy, and this is described as understanding, appreciating how others feel. Again, my report reads as if the EQI instructor for our Immersion experience is speaking directly to me: without empathy “you may find it heard to step into someone else’s shoes, particularly when your view is readically different. While you may prefer to remain slightly detached, this may be at the expense of creating collaborative relationships.” I agree that my low range results for empathy leads me to make decisions by focusing on the facts without much regard for other’s feelings/reactions. It is also difficult for me to articulate another’s perspective. It is very imortant that I make improvements in this area as the EQI explains that underusing empathy puts one at risk in all other interpersonal skill areas. I feel that the recommended strategies to make improvements hold promise. I plan to more actively listen by taking a moment to reflect back on what I have heard a colleague discuss before proceeding to offer my thoughts and opinions. I also plan to take steps to connect with my colleagues on a more personal level such as taking the time to discuss topics outside of work such as children, sports, current events, or traveling.

Optimism is the final element in which my results are displayed in the low range. For me, I actually need to know that optimism is defined as a positive attitude and outlook on life! I am confident that my wife would exclaim something to the affect that, “You didn’t need to take that emotional intelligence evaluation for me to know that your are an eternal pessimist!”. It is important for me to learn from my EQI report that my lack of optimism can inhibit my ability to perservere or interfere with my ability to view change as a good thing. For me, the concern is that my less optimistic disposition may be discouraging to my colleagues, especially when I am needed to contribute brainstorming or creative thinking. I really feel that I can begin making some improvement in this EQI element with the strategy to focus first on the best possible realistic outcomes. These best outcomes are the ones that I should devote time to plan for and time to discuss with others. Only after considering the best outcomes should I then allow myself to turn my attention to anticipate and prepare for a possible worst case scenario. I believe that this initial strategy to improve optimism will move me in the direction where I can begin to see the good in my life as personal, permanent, and justifiable.

Linkage of EQI to MBTI from Immersion I

My MBTI results revealed that I have an ISTJ profile which describes me as dependable, practical, and realistic. I also display loyalty to family and organizations. I am one that values structure and schedules. These MBTI results also confirm that I tend to be calm, serious, traditional with a preference for clearly defined roles and responsibilities. In refreshing my memory about my MBTI results, I recalled that Katherine Briggs and Isabel Briggs Myers were investigators who embraced Type Theory. Their assessment instrument is crafted to aid oneself to identify the “hardwiring” of personality type which can be viewed as more static or fixed. In contrast, emotional intelligence is a more dynamic view that is interested in evaluating the behaviors displayed by an individual to others in the environment as the individual engages the world that surrounds him. From my perspective, my range results for each of the sixteen elements of the EQI are displaying the behaviors that my ISTJ profile uses to successfully engage and manage my environment. I intentionally envisioned myself in the work environment as I completed the assessment tool for the MBTI and the EQI. Therefore, I believe that the results from both assessments accurately capture my “work self”. From this perspective, I feel that my ISTJ profile is using the EQI elements of Assertiveness, Independence, and Impulse Control in a well-balanced manner. However, my ISTJ profile is under utilizing the EQI elements of Interpersonal Relationship, Empathy, and Optimism thereby leaving me vulnerable to experience periods of discontent and withdrawal from social situations, friends, or colleagues.

Examples of Leadership Practice Since Immersion 1

Since my Immersion I experience, I have stepped forward to demonstrate leadership in my organization to prepare for the launch of Lumedx which is an electronic database now used to warehouse clinical data of patients undergoing cardiovascular procedures. This clinical database is used by the Duke Heart Center to report patient outcomes to the Society of Thoracic Surgeons which then uses the data to determine the star quality rating for the heart center. My specific role involved meeting regularly with the database manager and database programming team to be the subject content expert in developing the data entry fields for the program. I also provided post-launch feedback to the database manager and programmers to correct errors in data fields.

Another example of leadership in practice occurred when I was given the opportunity to assist the members of a research team to improve their efficiency by adopting the best practices that I identified as being in place in other high performing research teams. During this improvement process, I directly observed the members of the high performing team. I noted the use of specific electronic templates and personalized order sets by the members of the high performing research team members. I made similar observations of the research team in need of improvement during which in noted disparities in practice steps being completed by the low performing research team. After discussing my observations and recommendations with the Associate Vice President of Heart Operations, I proceeded to meet with individual team members of the low performing research team to provide education on the use of new electronic documentation templates and electronic research order-sets. My leadership directly resulted in improving the efficiency and accuracy of the underperforming research group.

Needed Areas of Growth in Leadership

I believe that my EQI results provide me with the insight into the areas that I need to grow as a leader. As stated earlier, I have scored in the low range for the emotional intelligent elements of Interpersonal Relationship, Empathy, and Optimism. The colleagues at work who I consider to be my “first team” have struggled with building trust. As I have learned from Lencioni’s The Five Dysfunctions of a Team the absence of trust is the base of a pyramid of dysfunctions. The insight that I feel that I have gained during my reflections on my EQI results and Lencioni’s book is that my own inability to display Interpersonal Relationship, Empathy, and Optimism to my colleagues is likely contributing to a climate in which trust is having a difficult time taking hold and growing. I know believe that trust will improve for my team as I begin to display these EQI elements more strongly to my colleagues.