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Overcome healthcare fears with courageous leadership

January 4th, 2012

by Thomas Dahlborg

These are challenging times in healthcare--an obvious observation. Perhaps not so obvious is the fear that exists in the healthcare system. People are scared. Patients are scared. Your staff is scared. Maybe as leaders you are scared.

The fear throughout the system is palpable. It is tangible. It is harmful. It is injurious to each of us and it is adversely affecting our ability to honor our commitments to our patients, our staff, our communities and one another.

Today I want to focus on the fears of us healthcare leaders and those of our staff, and provide an opportunity for both sharing and learning.


Healthcare leaders are scared--scared of making a mistake that costs lives, impacts the bottom line, effects their status or reputation, could cost them their own job or the jobs of their staff and/or opens up old wounds that have never healed.

Hospital staff is scared--afraid to to show a weakness, be honest, ask for help, share that they are overstretched/over capacity, as well as petrified of making a mistake that could do harm. They also are afraid to share the very fact that they are scared with their supervisor for fear of retribution.

At the recent Institute for Healthcare Improvement (IHI) 23rd Annual National Forum, Eric Greitens, author, United States Navy SEAL officer, and CEO of The Mission Continues, shared many amazing stories of fear, courage and perseverance that not only brought tears to one's eyes (to my eyes) but also joyful victory and wonderful life lessons for us all.

Each of Dr. Greitens' amazing stories provided three key takeaways for me: the importance of friendship, being present and perseverance.

  1. Friendship: Establishing an authentic connection and relationship (for our discussion) with staff that leads to a shared trust, a safe space for open and honest communication and a shared empathy.
  2. Being present: Being in the now and (I would add) truly listening with an open mind and open heart with no preconceived judgments that are based on history or expected future events.
  3. Perseverance: (As defined by Steadfastness in doing something despite difficulty or delay in achieving success ... or in my opinion, even better ... Continuance in a state of grace leading finally to a state of glory.

As a healthcare leader have you developed an authentic relationship with your staff, are you present for each and every staff member, do you remain in a state of grace even while facing huge obstacles?

Now let me add my own experience. Prior to joining the National Initiative for Children's Healthcare Quality, I was the executive director for the Hygeia Foundation d/b/a True North Health Center where we used the leadership process known as Circle.

Some key principles of Circle Process include:

  • Rotating leadership and shared responsibility (shared engagement and accountability, transparency, trust)
  • Speaking from the heart, listening from the heart
  • All voices being heard (creating a trusting and safe space for optimal sharing)
  • Practicing compassionate self-monitoring (respecting and trusting one another and oneself)

When fears arose, we brought them into the light within the safe space of the circle (a grouping of trusted and connected peers with whom relationship was honored) and openly and honestly addressed them ... together. Easy? Absolutely not. Courageous? To be that open, honest, vulnerable ... yes, I would say it takes courage (especially the first time) and yet over time this approach became the culture.

Old management and leadership styles can bury fear ... but it will only remain that way for so long before it arises and causes harm.

So we must change how we lead, connect, engage and honor our staff. We must be open, honest and vulnerable. We must create authentic relationships with our staff, we must be present and truly listen, we must create safe space, we must speak from the heart and we must persevere. If we truly want to position our staff and ourselves to honor our commitments and create optimal healing environments we MUST do these things.

Without fear there can be no courage. And through appropriate leadership we can overcome this fear courageously and together with our staff for the betterment of all.

As healthcare leaders:

  • How are you addressing your own fears?
  • How are you creating a safe space to discuss fears with your staff?
  • Are you opening your minds and hearts to your staff?
  • Are you being courageous?
  • Will you persevere?

Thomas H. Dahlborg, M.S.M., is Vice President for Strategy and Project Director for the National Initiative for Children's Healthcare Quality (NICHQ), where he focuses on improving child health and well-being. He has 23 years of experience leading collaboratively, creating optimal healing environments, analyzing and addressing practitioner and patient needs, and developing and implementing aligned strategic plans.


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