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Positive Power

  • Iris Wagman Borowsky
    Correspondence
    Address correspondence to Iris Wagman Borowsky, MD, PhD, Division of General Pediatrics and Adolescent Health, Department of Pediatrics, University of Minnesota, 717 Delaware St SE, Suite 353, Minneapolis, MN 55414
    Affiliations
    Division of General Pediatrics and Adolescent Health, Department of Pediatrics, University of Minnesota, Minneapolis, Minn
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Published:October 14, 2019DOI:https://doi.org/10.1016/j.acap.2019.10.002
      I'll start with a confession. I went for a run this morning instead of going to Pediatric Grand Rounds.
      I wanted to go to Grand Rounds. I was genuinely looking forward to free coffee and continental breakfast with a bona fide source of protein, prepeeled hard-boiled eggs. Almost equal in draw power, the topic was important, the speaker sounded interesting, and I was excited to see my department colleagues.
      I quite enjoy the comfortable vibe of our auditorium—a modern playful space that manages to be both spacious and cozy—on Wednesday mornings. Despite my best efforts, I typically take my seat a hair late and a tad flustered. Once situated, sipping my coffee, and more or less catching on to what's happening at the front of the room, I look around and spot the regulars. Like family at the dinner table, they are seated in their places: Department Chair, fourth row, first seat to the left of the aisle; division colleague, third row, second seat to the right of the aisle. Turning around, I do a quick survey of the back half of the auditorium, scoping out any medical students, residents, or fellows I know and greeting them with a nod and a smile.
      But this Wednesday morning, 7:30 to 8:30 a.m. was my sole window for a run. And running is my self-care, my emotional health care. So I took it. And it was glorious.
      Earbuds in and playlist entitled “Songz 4 Mom” rolling, I let my mind wander and reflected. I won't pretend I learned actual facts on my run like I might have had I attended Grand Rounds. But I learned.
      I learned if you listen carefully to song lyrics, oftentimes (but not always) they are brilliant.
      Lizzo is brilliant.
      “It ain't my fault that I'm out here makin' news; I'm the pudding in the proof; Gotta blame it on my juice,” she crooned in my ears, firing me up with “Juice,” her empowering, feel-good song.
      If I wasn't actually doing a fist-pump while running (I think I was), I was boldly and unapologetically fist-pumping in my mind.
      “I be drippin' so much sauce,” she sang. “If I'm shinin', everybody gonna shine.”
      Her words flooded me with feelings of self-confidence, self-love, and self-care. This is why I am all in with Lizzo. Her positive energy is infectious and inspiring. Her Minnesota roots solidify our connection.
      I lost count of how many times I hit repeat. As my mind continued to wander, my thoughts drifted to organizational leadership strategies like appreciative inquiry. Lizzo, I reflected, would love this approach as much as I do. Appreciative inquiry is like Lizzo. It flips negative energy into positive power. It brings into focus what is good and right. It is uplifting.
      I replay in my head a meeting in which appreciative leadership came to my rescue.
      We gathered in one of the rare conference rooms with windows, though any light from the sun was dulled by the tiresome task at hand. As my division colleagues arrived for the faculty meeting I called, there were the friendly exchanges as well as beleaguered sighs that divulged some of the busyness of their lives. The solid walnut table and deluxe black conference room chairs—more chairs than we needed—contributed to the formal mood. More formal than I wanted.
      Our charge was to provide feedback on a new, formalized faculty development plan created by department leadership. I was not involved in developing the plan, but as division director, I was tasked with gathering input on it from my division. While appreciated by all as a show of commitment and investment in faculty and our career development, the plan contained requirements, like lengthy quarterly meetings, a surefire repellant to already overextended faculty.
      My email meeting invitation was overly animated, “This is going to be fun! Anything goes – come ready to tear the plan to pieces, advocate for what you love about it, offer alternative, creative, and/or crazy ideas for meeting your development needs and desires, or all of the above,” I wrote.
      Tear the plan to pieces was my quick read of the room. Stressed, sweating a little, I decided to give something a try.
      A decade earlier, I spent a year engaging with a cohort of women in the Executive Leadership in Academic Medicine (ELAM) program, a leadership training program aimed at expanding the national pool of qualified women candidates for leadership in Academic Health Centers. On the first day of ELAM (MALE spelled backwards, likely an unintended feature of the acronym), we turned to our neighbor and shared responses to the following 2 scenarios: 1) Tell about an exceptional moment in your career, a time when you accomplished more than you ever thought you could. What was the situation? What were you and others doing? What were you feeling in that moment? 2) If you went to the moon and came back in 10 years, and your entire organization embodied that exceptional moment in your career, what would the organization look like? What behaviors would you see?
      Among this group of accomplished women, deans and chairs abounding, I was objectively low in the pecking order. But introducing yourself as your best self in your proudest moment is inspired. Everyone is appreciated. Everyone is a superstar.
      Since ELAM, I had replicated this introduction technique many times to launch diverse groups—high school students in a summer health careers program, medical students in small group break-out sessions, and faculty in career development workshops. From ELAM, I knew appreciative leadership as a different way to approach organizational change, an alternative to the usual tactic of problem solving. Necessary at times, problem solving focuses on what is wrong and how to fix it. The perspective is one of deficit, defensiveness, and shame. Appreciative inquiry turns this dynamic on its head by highlighting instead what is working and how to have more of it. The resulting experience is one of strength, capability, and hopefulness.
      • Butani L
      • Plant J
      Building connections with role models using an appreciative inquiry approach.
      • Suchman AL
      • Williamson PR
      • Litzelman DK
      • et al.
      Toward an informal curriculum that teaches professionalism: transforming the social environment of a medical school.
      • Whitney D
      • Cooperrider DL
      The appreciative inquiry summit: an emerging methodology for whole system positive change.
      I knew strength-based leadership in theory. I had never actually used the practice to make real-life change.
      Standing in front of my division colleagues in that overly formal conference room, I saw an opportunity to use this positive approach to change our frame. Glancing down at the draft faculty development plan that department leadership had distributed to us, I quickly jotted a few key phrases on the white board from the stated overall goals: academic success; faculty engagement, satisfaction, and collaboration; effectiveness in mentoring, research, and education; leadership skills.
      “When you think about your career, what has been most important to you in achieving these goals?” I asked.
      There was silence as my colleagues looked at the words on the board. It was good silence, the silence of a rare pause, of taking a deep breath, of reflecting on years of experience.
      “Invitation by a senior faculty mentor to participate in a project that had legs from the ground up,” someone said.
      “Participating on a well-functioning, productive team in an environment supportive of team-based work,” said another.
      A treasured mentor to many of us spoke up. “Focused training through an outstanding workshop early in my career on the cross-cutting skill of giving and receiving feedback.”
      “Participating in a year-long leadership program together with people who became a cohort of support,” said another.
      “Colleagueship – developing relationships with peers who are supportive and will go to bat for you because they know you do outstanding work,” offered another.
      “Fantastic!” I exclaimed, gesturing at the board and waving my hands as I am prone to do when excited or even just talking. “This is what the best looks like. It's what we want this faculty development plan to be. Now, how do we get there from here?”
      More silence and then a laugh. “Wow, I see what you just did,” said my colleague. “I came here ready to talk about what's wrong with this plan, and now I'm thinking about this in a completely different way.”
      It worked. I won't claim we came up with mind-blowing ideas, but we did make some terrific suggestions. Appreciative inquiry invited us to think a little differently; it changed the conversation. Most importantly, this powerful collaborative approach was community building. We shared stories with each other of what the best looks like. We remembered what was good and why we do the work we do.
      Breathless as I ran up the hill to get home, with Lizzo's positivity on repeat in my ears, I vowed to support my department and attend Grand Rounds for the rest of the month. I thought about how I use appreciative inquiry, or something akin to it, every day, like when I first ask my school-aged patients what they are really good at in school—what they love—so when we then talk about what is hard, their strengths are top of mind.
      I thought about what it could look like to use an appreciative inquiry approach intentionally for current and future challenges.
      In mentoring fellows and faculty who struggle to write. Ask about a time when a writing project went well. What were the ingredients of that successful writing experience?
      In advising medical students whose experience leaves them feeling that they don't belong in a specialty because they don't see anyone there who looks like them. Ask what works in this system to truly promote inclusion and do more of it.
      • Bumpus N
      Moving toward inclusion.
      ,
      • Nivet M
      A diversity 3.0 update: are we moving the needle enough?.
      And with the students, share the positive power of Lizzo.
      Because our work in medicine should uplift us, emboldening us to feel like the most superstar versions of ourselves and know that we belong.

      References

        • Butani L
        • Plant J
        Building connections with role models using an appreciative inquiry approach.
        Acad Pediatr. 2016; 16: 411-412
        • Suchman AL
        • Williamson PR
        • Litzelman DK
        • et al.
        Toward an informal curriculum that teaches professionalism: transforming the social environment of a medical school.
        J Gen Intern Med. 2004; 19: 501-504
        • Whitney D
        • Cooperrider DL
        The appreciative inquiry summit: an emerging methodology for whole system positive change.
        J Organ Dev Netw. 2000; 32: 13-26
        • Bumpus N
        Moving toward inclusion.
        Science. 2015; https://doi.org/10.1126/science.caredit.a1500273
        • Nivet M
        A diversity 3.0 update: are we moving the needle enough?.
        Acad Med. 2015; 90: 1591-1593