Immunity to change: Building a healthy paradigm in the health care workplace

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What is good medicine?

As a leading primary care provider, our office uses that question every day to guide our decision making. And for many years I thought focusing on providing “good medicine” was the essential question. I’ve now realized that to get to that mission of top-notch patient care, our secret sauce is the empowerment and continuous development of each of our employees, including myself. Healthcare is, at its root, the empowerment of patients to make good decisions around their health. A healthcare team that uses a specific, intentional process to develop themselves is even more empowered to make that happen for each patient. Health care for patients starts with the health of the team.

Build Trust, Chose an Improvement Goal, and Develop New Insights

Our method starts with getting to know one another, human to human, in small groups, no matter our role. We build trust slowly and organically, as an aspect of getting to know one another as people. Then, we identify individual goals for personal or professional change — put simply, we choose a goal or a skill that we want to improve. As a leader I participate in this development work as well.

We work on our goals in small groups, slowly identifying the hidden commitments that can get in the way of our own goals. We enable one another to notice that sometimes, in our desire to achieve one good outcome, we unknowingly prevent ourselves from developing in the way that we want to develop. Our format helps us name those hidden commitments to reveal the ways in which we are getting in our own way. With practice, the experience of working through this is so life-giving that our professional satisfaction at work increases. In this way, work becomes energizing. Our intention in working on ourselves this way is to find a better way to live and work.

While we didn’t adopt this specifically to address burnout, it does help the experience of work become more meaningful; by encouraging us to grow continually, this process prevents burnout before burnout occurs.

It takes dedicated time, a reliable structure, and personal attentiveness to create groups where people feel safe enough to honestly explore their limiting beliefs. In turn, the benefit is creation of a culture that provides the space for each person to grow beyond where they thought they could go. The structure helps eradicate a culture of blame, and fosters the ability to assume positive intent from peer to peer. Building this foundation for each other allows us to be more attentive to our patients.

Everyone has unconscious limitations. The key is to identify them. This is where Immunity to Change becomes a valuable tool for growth.

Immunity to Change

The structure we use is a well-developed process built on 30 years of research by Harvard organizational psychologists called Immunity to Change (ITC).^[1] ITC is a personal development structure that helps people learn to see their environment with increasing levels of cognitive complexity. It helps them find a “hidden commitment” with an underlying root cause that competes with and conflicts with an intended change. Hidden commitments become "so entrenched that they become unconscious." and these types of competing commitments can cause people to fail to achieve their best intentions. Organizations that engage in this kind of work become wildly more effective at every level of professional training. It works across levels of education, experience, and lifestyle. Its scalability makes it flexible for any size group.^[2]

I have benefitted personally from doing this work. Several years ago, our practice used to have ineffective monthly staff meetings. Almost everyone in the room was silent. The manager would take us through announcements and the same one or two people would speak. It drove me crazy that no one participated. How could we improve and work on problems if most people didn’t talk? I wanted to speak at every turn, but I (mostly) held my tongue trying not to stifle other people’s participation. My first instinct was frustration and impatience with all those people who were not talking. This situation needed to change.

A few years later, when I took on a leadership role, to my dismay, the same pattern persisted.

While trying to learn to improve this dynamic I came across the Immunity to Change (ITC) model, also known as the Deliberately Developmental Organization (DDO) model.^[3] Worldwide, hundreds of successful organizations employ the ITC method to empower their people. It increases professional and personal satisfaction, improves communication, increases retention and attracts new employees. Through becoming a Deliberately Developmental Organization, a medical office helps to create a safe place to work, fosters a culture of trust, and provides a structure in which each individual builds insights that help transcend limiting beliefs. The structure helps us get out of our own way.

[1]Kegan, R., & Lahey, L. L. (2009). Immunity to change. Harvard Business Review Press.

[2] Lahey, L. L. et. al., (2016). An Everyone Culture: Becoming a Deliberately Developmental Organization. Harvard Business Review Press.

[3] Kegan, R., & Lahey, L. L. (2016). An everyone culture: Becoming a Deliberately Developmental Organization. Harvard Business Review Press.