Coaching Openness
Embracing being incomplete
“Half of what we’re going to teach you is wrong – we know and accept that. The problem is, we don’t know which half”.
What a thing to hear from your undergraduate dean as you start a vocational degree in healthcare!
The thing is, they were totally correct. Some ten years later, this same idea manifested on Twitter within #FOAMed (Free Online Access Medical Education) discussions around the concept of “dogma-lysis”: the breaking down of long-held, incorrect “medical knowledge”. The reason it was being discussed on Twitter was because letting go of “old” (wrong) ideas can be really hard. The truth of some folk struggling to let go was getting those “early adopters” of the new knowledge and practice all excited. Is it really possible that there is a gap between knowledge and adoption of the application of the knowledge? In saving lives?
Mind the gap
Looking at an example from the eighteenth century, the concept of “knowledge translation” can be explored by looking at the gap between the discovery that citrus fruits prevent/cure scurvy (by the Scot Dr James Lind – the Spanish had been nailing it for a couple of centuries already at this point). Scurvy was no small deal – up to half a crew would be expected to die resulting from it on long voyages. So, adoption would have been almost instantaneous?
So, how long between the “discovery” by Dr Lind in 1753, and universal implementation by The Admiralty (the authority over The Royal Navy)?
A year?
Ten?
How about 42!
Ouch – Houston, we have a problem! But surely not these days?
Knowledge translation, and what it means to us now
The 42 year gap in this example is known as the “knowledge translation” gap – the time it takes for a piece of knowledge to be universally accepted into practice. In healthcare, by 2019 it was estimated to be around 15 years. In 2020, it shortened to hours or days as the entire system rallied behind one simple and clear message – save lives from Covid. Current estimates have it back around 15 years again.
Indeed, if you hear anyone tell you a radial pulse is equal to 90mm systolic blood pressure, send them to the paper from the year 2000 that disproves this (reference below)! An inside joke for my friends at DMA there.
Looking at the knowledge translation period is a way of quantifying the presence (or absence) of a learning culture. Learning cultures are aspirational – the growth of individuals, teams and organisations results. The opposite is a blame culture – underpinned by a lack of trust, authoritarian leadership and risk avoidance. Simon Sinek labels the behaviour in a blame culture as “lying, cheating and faking”. He’s not wrong (of course).
Just a problem in healthcare?
A recent LinkedIn post brought my attention to a culture that receives huge attention internationally – the English Premier League. With weekly salaries equal to some folks’ annual ones, and organisational budgets bigger than some countries, these are big money enterprises. So you’d expect learning cultures to be deeply embedded as surely every stone has been turned in the interest of ensuring high performance?
The post described how a football team that has been one of the most successful in the world, is burning through its managers at a rate of more than once every two years, with consistently low performance (when compared to their recent glory years). It goes on to suggest that these previously very successful managers all failed at the football club perhaps not due to them not being up to the task, but a deeper organisation issue – a toxic blame culture.
Coaching Antidotes to Toxicity
The antidote to toxicity is an environment of trust where people feel psychologically safe to call out errors, to try new things, and to take managed risks.
From where comes trust?
Consistency.
Just being predictable. Not even perfect – just predictable.
Nobody is perfect, so being predictably imperfect is totally fine. This predictability comes from a deeper knowledge of each other.
Which is a measure of time, and at least one person taking the risk to be vulnerable and share.
To share being “incomplete”.
There we have it – the courage that sits at the heart of leading a culture from toxicity to growth; from blame to learning; from terrible to great.
Vulnerability, Courage and Openness
Once the example is set of it being ok to be incomplete (imperfect), similar sharing by others requires less and less courage. The need for courage shifts to one where simply openness is necessary. This is openness rather than courage because of an anticipation of acceptance. All, creating deeper mutual understanding cascading from an example of courageous vulnerability.
Understanding leads to predictability.
Predictability leads to trust.
Trust leads to the safe space needed for the stretching out of comfort zones necessary to stimulate growth.
Growth cultures grow from someone having the courage to be vulnerable. Consistently, this will take more than just a single occurrence. Change can be sticky.
So how to coach openness?
Openness is that key step – the first person must be courageous, and the second only needs to be open.
Here, the coach can set an example. Be the pebble dropped in the pond to initiate the waves of the movement.
Sharing appropriately, deepening mutual understanding, and then holding the responses safely.
This is coaching – being of service.
In this way, the coach enables and empowers the leader to be the change they want to see. Gandhi was right.
Reference to disprove that peskily inconvenient truth about radio pulses:
Deakin CD, Low JL. (2000). Accuracy of the advanced trauma life support guidelines for predicting systolic blood pressure using carotid, femoral, and radial pulses: observational study. BMJ. 2000 Sep 16;321(7262):673-4. doi: 10.1136/bmj.321.7262.673. PMID: 10987771; PMCID: PMC27481.