Holding Strengths

What’s already good? How can we protect and strengthen that?
What could be better? How will we make it so?

I centered NaBloPoMo 2023 on these questions and set all 30 prompts/topics in advance. The idea was to take an Appreciative Inquiry approach to habit change at both the personal and collective levels. I wanted to shift focus from threats, failures, deficiencies, and shadow to people, places, and practices that thrive, uplift, and inspire. How could this mindset help us all in our current state?

From the Center for Appreciative Inquiry:

WHAT IS APPRECIATIVE INQUIRY?
Appreciative Inquiry (AI) is an energizing and inclusive process that fosters creativity through the art of positive inquiry. It builds new skills in individuals and groups, develops new leaders, encourages a culture of inquiry, and helps create shared vision and purpose by building on an organization’s core values and strengths. Perhaps, most importantly, are the outcomes that emerge during the process which provoke action, inspire commitment, and lead to results.

WHY APPRECIATIVE INQUIRY WORKS
Building upon the framework of positive psychology and human sciences, Appreciative Inquiry builds self-awareness and emotional intelligence to shift our focus, attention, and energy into exploration into opportunities and possibilities. AI does not focus on changing people, rather it invites individuals to engage in building a future they want to live in.

Appreciative Inquiry’s assumption is simple: Every human system has something that works right–things that give it life when it is vital, effective, and successful.

What I like about this approach to problem solving is the concreteness. Asking what already works, what’s not wrong or broken, requires practical, operational answers. It forces us to think and talk objectively about what is, rather than cogitate, theorize, and catastrophize about what could be. It starts from a place of strength and looks to build; it’s about what we’re for more than and before what we are against, so we can dream and design what could be instead.

At first I imagine applying this method to policy and systems collaboration. That would be great, but I don’t see it happening; people are still too negative, polarized, and adversarial for that, at least on large scales. I bet there are small organizations and groups where this strengths based approach to change actually already happens. I’d love to see more of them highlighted in the media.

For now, I think some of us may be ready and willing to apply appreciative inquiry to our existing relationships. I imagine a Blue friend and a Red friend, both wishing to connect across their differences and get closer. Both harbor curiosity about the other, even if it’s repressed. Each senses an intuitive possibility for deeper connection, and also feels stymied at how to achieve it. What if they started by considering the strengths of their relationship? Maybe those include honesty, non-judgment, good humor, and shared experiences. What if they imagined and envisioned together what an even stronger friendship would look, sound, and feel like? I get goosebumps envisioning those conversations.

What other domains of relationship would benefit from this approach to disagreement, challenge, conflict, and growth? I can think of at least a few in my life–she writes sheepishly–hello, walk the talk much? How fascinating! And here I thought this post would be boring and bland–HA!

I Hold Strengths for Us tonight, my friends: Strengths in relationship, in connection, in bond and union. Our relationships save us. I am convicted to this assertion, and I firmly believe it’s our strong relationships, especially across difference and disagreement, that will save our republic.

Help On the Path to Better

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Okay, let’s talk about your eating!

What about your eating habits is already good, that you want to maintain, that you’re proud of?

And where is there room for improvement?

Sometime in the last five years, I started querying my patients about nutrition this way.  It seems to put people more at ease talking about their eating habits, for some reason.  Culturally, we are so judgmental and defensive about food and eating, weight and appearance.  So one day, I decided to start with the positive, and it makes the conversation easier for everybody.  Fascinating!

I did not realize until the past week that this is my personal version of appreciative inquiry (AI).  I have started including AI in my presentations this fall, which is very well received so far.  I got feedback from the talk I gave to my design friends two weeks ago.  They liked focusing on the positives of work before problem solving.  This week I presented to a mixed audience of physicians, from all specialties, early career to retired, on burnout.  I chose to make it similarly workshop-like, a very ambitious undertaking in 45 minutes, but we did it!  In the last segment I invited audience members to identify the first step they might take to address their own sources of burnout, or improve their self-care.

One generous physician shared her plan, initially stated as, “Just commit to doing it,” talking about exercise.  After a few more questions, we arrived at her actual plan: figure out what she will do (treadmill); decide how long she can carve out (30 min); find time on the calendar; write it on the calendar; know how she will be held accountable.  Turns out she had already succeeded at executing–5 times a week for 20 weeks this year—STRONG WORK, MAMA!  I wonder if there are other arenas where she applies this same, stepwise approach to making something better in her life, or the lives of her patients.

When I ask patients what needs to happen to improve their health, we inevitably start at the abstract (“Just Do It”) and must work to get to the concrete, granular action steps that will actually result in successful behavior change.  It’s gratifying for both of us to arrive at a plan that the patient him/herself has an active hand in creating.  Then s/he feels ultimate ownership and agency to execute.

These days I also always ask about help.  Who else can keep you on track?  Can your spouse eat healthier with you?  Can your assistant eliminate junk food from lunch meetings?  Can your kids be your food police?  My best friend in college agreed to do this for me our junior year, and I lost all of my freshman fifteen, God bless him (and yes, we are still friends).  When we go shopping and I look tempted to buy yet more of something I already have piles of, my daughter asks, “Do you want me to be your conscience?”  Usually I reply with a hedonist, “No,” but I’m always grateful for the offer, and it does make me think twice.

Often patients return the next year living healthier in one way or another.  Sometimes the plan works; many times they find another way.  Sometimes plans are executed and then derailed.  So we get to work on a new plan, asking all the same questions over again.  It doesn’t have to be a slog!  It’s just what we’ gotta do—keep getting help on the path to better.   It’s my privilege to serve as helper.

These last two weeks (months?), I’m definitely not sleeping enough.  Exercise is hit or miss.  Eating is pretty erratic and unhealthy.  Stress ebbs and flows with travel and events.  But my relationships are thriving and I’m doing some seriously fun and amazing sh*t.  Next year maybe the eating and workouts will be on autopilot and I’ll have to lean on folks to get through rough times.  The path to better always gets blocked, takes detours, and makes us reroute.  Those twists and turns are so much more fun, and we notice so much more beauty that we might otherwise miss, when we take them with good friends, no?  I’m so grateful to have such loving help on the journey, and also honored to offer it.  Onward.

 

The Importance of Peer Support

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What a privilege to present again to a group of smart, creative, fun, and engaging designers on Friday.  This time I was asked to address burnout, as so many folks are feeling overwhelmed and stressed.  I did my homework on stress and burnout in the creative fields, and found enough similarities in medicine to feel like a credible speaker.  “It’s not just a job, it’s a way of life,” seemed to capture how we see our respective vocations.

I presented a brief mini-lecture on self-care practices, including habit formation and maintenance in the 5 reciprocal domains of health, and narrative awareness.  The latter is always something we can do when we find ourselves in untenable circumstances:  Ask ourselves what story we tell about the situation, how that story compounds our suffering, and then tell a new story that does nothing to change the objective reality, but can dramatically improve our personal experience of it.  I have learned from work in physician burnout that people don’t just want to be told how to fix themselves.  They want someone to address the problems of the system that oppresses them.  So that’s where I tried to go next.

I started with an Appreciative Inquiry (AI) exercise.  In small groups, I asked participants to share team success stories, and listen for recurring themes around what’s already great about their teams, their work, and their organization.  Words like openness, flexibility, and “we have leaders, not bosses” made the Post-It easel list.  Then, in this headspace, I asked the groups to identify issues they wanted to address.  Instructions were to find important, urgent, and solvable challenges.  Guiding questions included, “Why will the organization be better if it’s addressed?” and “What does better look like?”

Similar to the AI results, common issues arose from multiple groups.  There was general consensus, reviewing the list at the end of 20 minutes, that overall work satisfaction would improve with less digital and more face to face communication, better project clarity, and taking better care of the shared spaces.  I would meet with team leaders and show them the list later in the day.

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When I opened the floor to questions, a self-proclaimed ‘Debbie Downer’ presented a query that I will ponder for many months as I prepare upcoming talks:  “When you ask someone how they’re doing and they say they feel like they’re drinking from a firehose, telling them to adjust their attitude is probably not helpful…  How can we change things that are not in our control?” The Universe had prepared me for this question by sending a new mentor who taught me to ask, “Who owns the things we don’t control?”  Thank you, my loving Cosmos.

I only partially answered Debbie’s question by suggesting she think about how she might influence the owner(s), how she might impact decisions being made in those spaces.  I segued too quickly, I’m afraid, to the question that I wanted to ask the group:  “When someone asks you how you are and you express that you are overwhelmed and drowning, what is a helpful response?”  I thought the discussion that ensued was productive…  It seemed to stimulate people’s intrinsic empathy and compassion.  We recognized the importance of feeling connected, that I’m not the only one feeling this way.  People recognized the relief found in just speaking aloud the list of stressors to a sincere and empathic listener.  We also talked about being prepared to hold space for any potential answer when we ask, “How are you?”  Even if we have no control over the flow out of the fire hose, maybe we can take turns holding the nozzle steady, and at a slightly oblique angle for each drinker, so it doesn’t have to knock us all over when we try to take a gulp.

I had a chance to talk to Debbie a little later (Cosmos offering me a second chance, Thank You Again), and we agreed that stress and burnout, in both medicine and design, are best addressed at both the individual and systems levels.  We can each start with personal accountability for our own experience of the system.  Then we can decide how we show up in the system each day.  We can choose, at any time, to either participate passively in the status quo (which is what we all need to do sometimes), or find a way, however small, to advocate effectively for change.

The latter is much better done with peers, with friends.  Take time to connect (no lunch meetings, let’s just eat together!).  Share stories.  What do we love about this work?  What’s already great?  How could it [realistically] be even better?  How can we help one another, including our leaders, envision and pave the way there?  Who else needs to be enrolled?

My meeting with the team leaders was less structured.  I worried that they left feeling disappointed because I did not offer more concrete advice on personal resilience practices for leaders, and ‘how to lead’ teams in burnout.  But over the hour, I felt no desire or need to lecture.  I queried various aspects of their self- and team awareness, personal resilience practices, and communication.  We briefly reviewed the issues list from the morning workshop, and I left with confidence that they would take it seriously.  It also occurred to me that these designated leaders were already supporting one another in their efforts to lead intentionally, effectively, and compassionately.  Maybe they have also felt overwhelmed sometimes.  Maybe it was also good for them just to talk it out with each other this day.  Maybe we can all do this for one another a little more often.