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Balancing Priorities as Integrative Healthcare Providers

Relationships, priorities, and a life worth living when serving as a physician

Essay by Adam Perlman, MD, MPH, Director of the Leadership Program in Integrative Healthcare at Duke University.

adam-pictureRelationships are a key component to success — and sometimes failure — not only on the job but also in one’s life. Whether it’s our relationships with our spouse, parents, siblings or our children; or our relationships at work with colleagues, those who report to us, or those to whom we may report; or simply our relationships with friends, having good relationships is what makes life worth living. It’s through our relationships that we are supported and that we can support others, and it’s through our relationships that we expand beyond ourselves and live in a larger world.

There are very few scenarios in which our success or failure can be defined without the input or contribution of other people. It takes a team to be successful in any organization of any size or dimension. Having a rich and healthy home life requires the involvement of all members of the family. And we all need good friends to enjoy a dinner party, a book club discussion, or a golf game.

But all too often, in the bustle of life, we fail to recognize the importance of the total web of connections in which we operate.

The Opportunity to Give

The word “relationship” refers to the way in which two or more concepts, objects, or people are connected. Concerning people, it refers to how we regard and behave toward each other.

Much has been written on what a good relationship looks like, but one of my favorites is: Both sides see the relationship as an opportunity to give.

This is a very important point. A good leader is naturally defined by his or her personal successes and accomplishments. But a great leader is equally defined by his or her ability to help others succeed.

My father has always been someone who, anytime that he needs something, will have people falling all over themselves to do it for him. Years ago, I asked him why. He said, “When you climb the ladder, you can do it two ways. You can step on heads or you can take people with you. I have always chosen to try and take people with me.”

The Rule of Reciprocation

While altruistic and certainly virtuous, the act of helping others is also, on a certain level, practical.

In his book, Influence: The Psychology of Persuasion, Robert Cialdini talks about reciprocation. The rule of reciprocation, which he explains is extremely pervasive in human cultures everywhere and for all time, “is that we should try to repay, in kind, what another person has given us.” This video describes the power of persuasion and how these 6 concepts could make a difference in your daily professional and personal life.

Cultural anthropologists Lionel Tiger and Robin Fox and others hypothesized that this “web of indebtedness” created by reciprocation made it possible for human society to evolve. They point out that it “allowed for division of labor, the exchange of diverse forms of goods, the exchange of different services (making it possible for experts to develop) and the creation of a cluster of interdependencies that bind individuals together into highly efficient units.”

Based on this ingrained rule of reciprocation, Cialdini suggests that one of the best ways to get something from others is to first do something for them.

This is not to suggest that we should do things for others because we want something in return, but when you think about it objectively, to the degree that we, in our role as leaders, need to accomplish tasks that are largely determined by others supporting what we are trying to do, their willingness to help can certainly be influenced if we have been in service to them all along.

Being in Service

Being in service means that you act in way that helps another but without an expectation of reciprocation. One way of being in service to our employees or our organization is to understand their needs and priorities and then help them to achieve those things.

Obviously for any organization, the financial bottom line is always a priority, but most us in integrative healthcare will never be seen as a huge financial engine. Certainly, we need to pay attention to the bottom line, but we should look elsewhere to create value. For instance, there will always be other priorities for the organization as set by the C Suite and Board. Perhaps it’s improving the work culture or ensuring that customers have the best experience possible or minimizing human error — , but rarely is simply profit the sole priority.

If we know what these other priorities are, then we can strategize how to help. That’s why it is critical to be in relationship with those people who are making these types of decisions or with those who are at least in the meetings in which such decisions are discussed. We may not be on the attendee list but that doesn’t mean we can’t learn what is needed and wanted and have our perspectives represented. If we have a good relationship with our boss and if we have communicated to him or her about our capabilities as they relate to those other priorities, then he or she can relay how our units or areas or expertise can directly support the larger organization, and in that regard, ultimately create value.

People also have their own personal desires and goals within the roles they play in the organization, such as wanting to take on more responsibility or be more independent in some of the things that they do. The more we understand the priorities and goals of the people who report to us, the easier it will be to positively impact them.

Balancing Priorities

Of course, each of us, as leaders and as people, also has our own priorities and goals. Knowing how to match the organization’s priorities with our own is an art.

If we are able to focus on those areas for which we have a great passion (and hopefully knowledge and skills) that also relate to areas where the larger organization is focused, then we can be very successful.

For example, if healthy nutrition is one of our priorities and we are in an organization where healthy nutrition is not a priority and isn’t going to be one under the current leadership, then after trying very hard with no success we might find ourselves thinking that we are not in the right organization. That’s one approach.

Another approach is to sit back and take a broader look at all the things that integrative health principles could bring to the health system. Good nutrition is only one of them. What about employee burnout? What about stress management in general? What about employee retention or the patient experience? Are there ways that we can relate improving nutrition to the prioritized goals of the organization? Should we focus on other principles of integrative health first, show impact, create value, strengthen relationships, and then revisit improving nutrition?

So we should scan our environment and say, “Given what I know, based on the relationships that I have and my understanding of the priorities of individuals at various levels and those of the overall organization, where do I have the best opportunity to make an impact and bring value?”

When we look at what we want to be doing on any given day in any given week in any given year, we want to make sure we have a mixed portfolio. We shouldn’t abandon those things we are passionate about just because someone higher up doesn’t think they are a priority, but rather we should make sure it’s not all that we are focused on. We also need to be also zeroing on those things on to which we can be in service through our relationships, contributions and our passion, our knowledge and our skills, as this and which will and ultimately bring value to the greater organization.

If we do these things, at work and at home, we will create a life worth living.

Adam Perlman, MD, MPH, is an Associate Professor of Medicine and works within the Duke University Health System as Executive Director of Duke Integrative Medicine and Associate Vice President for Health and Wellness. In addition, he is the Director of the Leadership Program in Integrative Healthcare at Duke.

Click here to download excerpts of Cialdini’s principles of persuasion and interview with Tom Polanski, from EBrand Media.

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