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Archive for July, 2020

I know a man who grabbed a cat by the tail and he learned 40 percent more about cats than the man who didn’t. –Mark Twain

Greetings Gentle Reader.  I concluded PART IV with a question: So, what is this ‘ELE?’ [Experiential Learning Experiences].

Teaching, as we know, involves putting in – the teacher provides the content via, for example, verbal and written content.  The learner gains what we call knowledge.  We also know that knowing is not enough if we want to learn and not just know.  Learning is highly experiential; some refer to it as applied knowledge. 

In 1973 I began to develop what I came to call: Experiential Learning Experiences.  The healthcare providers I was privileged to serve would engage the experience by serving those who came to them for help.  With the consent of the one(s) to be served, some experiences would be audio-recorded, some would be video-recorded (a one-way mirror would be employed), and some I would observe in ‘real-time’ by sitting in with the provider or by viewing the provider and the one(s) served through a one-way mirror. 

After the experience the provider would take 15-30 minutes to reflect upon the experience and then respond in writing to a number of questions.  Within an hour or two of the experience I would meet with the provider (and perhaps one or two or three other providers) and we would listen or view and share our ‘notes’.  This ‘debriefing’ would also entail feedback and more questions and the identification of what capacities needed to be developed, developed more fully or enhanced.  We would then identify and name one, two or three specific practices that the provider would focus on.  The practices might be reinforced by book-learning (think: techniques). 

Our watch-words were: Essential, Experiment & Experience.  [AN ASIDE: It is crucial to note that those served knew that the provider was in training or was learning and they signed a form stating that they agreed to help the provider with his/her development.]   I served those providers (see PART IV for a short-list of who these providers were) for five years.  During this time I had the privilege of ‘demonstrating’ ‘ELE’ for more than 100 providers at two different large teaching hospitals/universities.

To put all of this in a simple (not simplistic) sentence: The recipients were the educators.  I continue to employ aspects of ‘ELE’ today. 

At this point you might ask: What are some of the interpersonal skills that need to be developed, developed more fully or enhanced?  I continue to experience that many of these are under-valued for folks generally assume that all human beings learn these as a ‘matter of course.’  A common refrain or two: ‘Everybody knows how to listen.’  ‘Everybody knows how to ask questions.’  True. 

What almost everybody lacks, however, is the capacity to use these effectively especially in high stress environments.  To put it another way: We have developed the skill but not the capacity.  For example, most adults can ride a two-wheeled bicycle – they have integrated the skill so that it has become ‘second-nature’ to them.  Most, however, do not have the capacity to ride a bike 100 miles without stopping.  In order to do so they have to identify a need and then develop the capacity so the need can be addressed [AN ASIDE: we ‘address’ needs, we do not ‘meet’ them]. 

Now, there is another important piece to this.  Once we stop maintaining capacity we lose it.  If I have developed the capacity to ride a 100 miles without stopping and then I do not ride a bike for five years I will lose the capacity to ride a bike for 100 miles without stopping. This last point is crucial. 

To return to my question: What are some of the interpersonal skills that need to be developed, developed more fully or enhanced?  We will explore some of these next time. 

Practice any art. . .no matter how well or badly, not to get money or fame, but to experience becoming, to find out what’s inside you, to make your soul grow. –Kurt Vonnegut

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Education is life itself. –John Dewey

Good morning, Gentle Reader.  I concluded PART III with a mantra: Be Prepared!  What might this mean? 

In 1973 I was invited by a large teaching hospital here in Indianapolis to help the Family Practice Residents improve, enhance and develop their ‘relationship’ abilities, skills and capacities.  After a few months of working with the residents I was invited to help the neurologists who specialized in neuro-muscle diseases and then after another few months I was invited to help the medical geneticists (both practicing geneticists and residents and MDs and PhDs).  Within a year I was doing presentations at a number of medical schools and teaching hospitals. 

My focus from the beginning was on the need to learn, integrate and apply interpersonal skills.  The Providers ability to connect, establish rapport, create a safe environment, build trust and as a result to establish and maintain good relationships is crucial.  Too often interpersonal skills are viewed as ‘veggie dip.’  They should be viewed as the ‘vegetables’ that are necessary for good health.

Interpersonal skills shift the position from ‘Provider-Served’ or ‘Professional-Client’ to ‘Person-Person.’  The healthy tap roots that best nurture the relationship are themselves fed, nurtured and sustained by one’s interpersonal abilities. 

In 1973 my approach was ‘suspect’ for I was convinced that interpersonal skills could be taught.  A common perception was that one was born with a personality that supported their development (often referred to as the ‘idealist’ or ‘romantic’) and that if one was not born with the personality (often referred to as the ‘realist’ or ‘analyst’) then one could not be ‘taught’ the skills.  I am thinking of the 1950s t.v. character, Joe Friday, whose favorite line for years was: ‘Just the facts mam, just the facts!’

To put it another way: Interpersonal skills were viewed and accepted as a ‘natural gift.’  If carried out to a logical conclusion doctors, lawyers, teachers, therapists, nurses, etc. are ‘born’ they are not ‘made.’  This leads me/us to a second view.

Interpersonal skills, if they are able to be taught, can only be acquired via on-the-job experience.  They cannot be acquired/integrated via a classroom experience.  Now I do believe that direct experience is more beneficial than ‘textbook learning’ and hence a combination of both is required.  To paraphrase Charles Handy: Experience plus reflection and input is the learning. [NOTE: ‘Input’ comes in a number of forms.]  By the by, ‘experience’ cannot be left up to ‘chance.’  The experience must be purpose-full and intentional and focused.  To put it another way: ‘Trial and Error’ are not helpful when it comes to learning these skills. 

Interpersonal skills are most helpful when they are guided by explicit goals, objectives and action steps enhanced by critical feedback and reflection.  I developed two guiding questions that continue to be helpful to those I serve: Does the way you______get you what you want?  What do you want?  One replies to the second question first.  The questions help one become clearer as to what one wants AND if the ‘actions’ (behaviors, attitudes, perceptions, etc.) enable one to obtain what one wants.  

In 1973 I developed what I called ‘Experiential Learning Experiences’.  So, what is this ‘ELE’? 

I am always ready to learn although I do not always like being taught. –Winston Churchill

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Good morning Gentle Reader.  I concluded PART II with a question: ‘How come nobody told me/us that it was going to be like this?’

After more than 45 years of working with professionals this continues to be a common refrain – it seems to be a mantra of many.  Many professionals continue to be ignorant when it comes to understanding the impact of stress – both distress and eustress – upon their lives [ASIDE: In the 1950s Hans Selye described two types of stress: Distress = ‘bad’ stress and Eustress = good stress; both types of stress impact our lives]. 

Now we know (or do we?) that when people do not know ahead of time about the emotional demands of their work, their expectations as they engage their profession will be decidedly out of line with reality.  The professional often experiences a clash between his/her ideals and the reality of the emotional toll that is a consequence of serving others.  This clash opens a pathway to burning out.  A major sign of burning out is emotional exhaustion.  AND (remember there is always an ‘AND’) other common experiences include (but are not limited to): frustration (frustration = not getting what one wants or getting things one does not want), experiencing being disillusioned, becoming angry (at self, at ‘superiors,’ at colleagues and at those served) and, if deeply distressed the person will become rage-full. 

The seeds of burn out lie dormant within a number of conflicts: the ideal vs the real; values conflicts; needs conflicts; philosophical conflicts; mission conflicts (for example, a common mission conflict in not-for-profit organizations is the conflict between the ‘mission for money’ and the ‘mission for serving’). 

Burn out requires a certain type of host.  The ‘service’ disciplines/professions attract deeply idealistic folks and these folks, research continues to show, are more susceptible to walk the path of burning out (AN ASIDE: I have learned, via experience, that professionals who are considered to be ‘cynics’ are ‘wounded idealists’ – a topic for another time).

Sadly, even today, the lack of prior information about the sources of emotional distress and hence the risk of burning out continue to be striking omissions of graduate and post-graduate experiences.  I am not sure why this continues to be.  I do have some reasons to consider.  Here are a few of them.

Burnout continues to be considered to be antithetical to professional ideals.  The professional is not supposed to be emotionally depleted by the work or feel negatively about those they serve (including team members and peers).  They are supposed to be energized and nurtured by the work (and, of course, they are ‘AND’ they are also depleted).  In addition, it appears as if knowledge about emotional distress and negative feelings about those served are not viewed as being critical for good performance.  We are learning more about this as we learn more about the big gaps in the preparation to become a police officer – these gaps continue to also be ‘big gaps’ when it comes to other professional development.

Then, there seems to be a belief that IF candidates were educated as to the risks for burning out fewer folks would enter the field.  This belief leads to misrepresenting the risks – or deliberately ignoring them.  My sense is that if a profession were clear as to the risks for burnout AND if they developed experiences that would more effectively prepare the person to cope with the distresses that the number of candidates who would choose not to enter the profession would not be significant and the positive pay-off would be enhanced. 

Not only should education about burnout become integrated in all aspects of professional development the ‘faculty’ must openly practice and demonstrate behaviors that are ‘health-wellness’ enhancing and ‘burnout’ minimizing (think: Living a ‘balanced’ life AND openly sharing how they nurture the five dimensions that impact health/wellness and if depleted lead to burnout – Gentle Reader you might remember that I call these our P.I.E.S.S.).

It is crucial to not only stress but to create an environment, climate and culture that supports safety and openness – that is, a person (student or faculty member) is able to ask for help, seek feedback and receive feedback. 

‘Be Prepared’ might be a good mantra.  What might this entail?  Check back next time and we will explore this a bit. 

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Research continues to confirm that burnout can be dealt with more effectively in its formative stages that when it is full-blown.  During its formative stages the symptoms are less severe; the effects and side-effects are minor rather than major; the person is still healthy enough to take preventative measures.  Early detection is, thus, crucial when it comes to prevention (think: Covid-19 Testing). 

Once you are burned-out it is easier to acknowledge that you are, indeed, burned-out.  On the other hand, it is quite possible that another person might well spot the early signs of burnout before you do.  Why might this be so?  Most of us have a focus that looks outward and hence we pay less attention to what is occurring within.  The old adage, it begins in here – not out there, is true.  Because we tend to be focused ‘out there’ we miss or flatly deny or dismiss that we are becoming dis-eased.  We also deny or dismiss that our dis-ease will negatively impact others so we do not take the steps to protect them from our dis-ease (again, think: Covid-19).

One of the most effective early-warning systems for identifying burnout lies not in the person but in others.  There is a wide range of folks who may be able to help the person recognize the signs of burning-out and then help the person become response-able rather than reactive (think: close friends, colleagues, supervisors, etc.).  In addition, the person is also a potential early-warning person for another. 

In helping the other, one helps one’s self.  For example, by becoming aware of the other’s behavior one can learn to become more aware of one’s own behavior.  In addition, demonstrating concern for the other’s well-being helps develop tap roots of trust, safety and support and thus helps ensure that the other will care for you. 

‘Early Warning Systems’ not only depend upon people’s ability to discern the early warning signs of burn-out (or, for example, Covid-19) the ‘Systems’ must provide a climate and environment rooted in trust and safety so that people feel safe enough to speak up (and be listened to).  Mutual safety, trust and respect are crucial tap roots that must have strong, deep roots if they are going to support folks speaking up. 

Organizations can help by developing a series of scenarios including responses to each of them – a ‘scenario handbook’ if you will (our current administration was provided a ‘Pandemic Handbook’ and discarded it prior to the Covid-19 outbreak).  Scenarios provide ‘symptoms’ to note and if all have access to them then no one person has to accept the burden of discerning and alerting everybody else to the fact that something is amiss (someone or someones are burning around the edges and are moving toward burning out).  In-time discernment also requires the organization to embrace a ‘prevention’ posture rather than a ‘reactive’ posture.  This involves discerning the elements of a Climate, Environment, Culture and Sub-Cultures that could, and/or do, contribute to burning out.  Again, early detection and intervention is crucial (think: testing, wearing masks, shutting stuff down – when it came to responding to the ‘signals’ of Covid-19). 

We will continue next time and I leave us with a common, after-the-fact question: ‘How come nobody told me/us that it was going to be like this?’

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For decades now I have been helping professionals nurture ‘wellness’ and minimize or avoid ‘burn-out.’  About a year ago I began to help a health care system develop a ‘Wellness Initiative.’  A few days ago as I was making some notes I stopped.  I looked.  I re-read what I had written.  What I was writing about was indeed ‘Wellness Enhancement and Burn-Out Avoidance’ AND (remember, Gentle Reader, there is always an ‘AND’) I was also writing about Covid-19.  Yup. True.

I have decided to share some of what I have been writing about ‘Wellness-Burnout’ and I invite you, Gentle Reader, to then substitute the concept/reality of Covid-19 as you read and consider what I have to offer.  Perhaps you, like me, will also be stunned by the similarities.  Then again you might not.  Let us continue with a definition.

Similarity = an aspect or feature resembling another

If, as the old saying goes, ‘an ounce of prevention is worth a pound of cure,’ then one of the most effective ways of enhancing wellness and minimizing burnout is to prevent it from happening or, at minimum to limit its enhancement.  To put it simply: take action before it appears or as it is appearing.  Instead of enduring and suffering through the costs, while trying to recover, it makes more sense to seek to eliminate, if not prevent burnout.  If one waits then the costs might become too high and the outcomes too harmful. 

In our Culture ‘prevention’ is often preached – it is, sadly, rarely practiced.  In our Culture we are prone to avoid making extra efforts until we are immersed – if not whelmed-over – by the dis-ease.  For example, rather than the insurance companies paying for preventative procedures they will only pay once the dis-ease has been diagnosed (and, as we know, with some dis-eases once the diagnosis has been confirmed it is too late).  We have developed ways of dealing with the dis-ease after it has manifested itself.  We are not very good at prevention or at intervening when the first signs of the dis-ease manifests itself.   

The inevitable consequence of waiting until the dis-ease has developed deep roots is that we end up engaging in remediation rather than prevention.  This pattern is also a Cultural pattern.  A good example of this is our belief that we can ‘roll’ something out and then fix it later.  Sadly, we are good at this – except for the times when we are not and then the price we pay is staggering.  The dis-ease is not only debilitating it is fatal to many.  Because we are not committed to ‘Wellness Programs’ – we are committed to dis-ease interventions – we have not developed effective preventative programs, or minimizing interventions, nor have we developed ways of evaluating preventative programs. 

A major key to prevention is early action.  The risk of burnout is less likely to become a full-fledged dis-ease when we engage in early prevention or, at minimum, early response.  As a Culture, we pride ourselves on our ability to react and we minimize our ability to be response-able (we are reactive rather than proactive). 

Early intervention diminishes the high costs of reacting to the dis-ease once it has embedded itself – once it has ‘taken over.’  So, what does this mean?  We will continue next time…

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